Fire Risks During In-Office Surgery - Hot Times in the OR

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Recently, the popular news program "60 Minutes" ignited the fears of the American public by demonstrating how easily fires can occur during routine surgery. Of the several hundred surgical fires that occur each year, more than a few result in serious harm to the sedated patient. Most are miraculously extinguished before patients and staff are harmed.

Because operating suites usually contain ignition sources, fuel sources and a high oxygen content, they are high-risk environments for fires. If your practice provides on-site surgical services, take the following measures to prevent these fires from occurring in the first place.

Keep ignition sources away from flammables.
Items such as electrosurgical units, lasers, certain drills, fiber optic devices, and electrocautery units can create sparks during a surgical procedure and also produce temperatures hot enough to start a fire. For example, the hot tip of an electrocautery unit laid on a garment or near prepping agents, instead of in its holster, can ignite those materials.

Keep fuel sources away from heat-producing surgical equipment.
Wet prepping agents, surgical drapes, and items in the patient's airway, such as a tracheal tube or sponge, can be flammable when near heat-producing surgical equipment. Avoid letting prepping agents pool near or under a patient, and allow sufficient drying time for prepping agents before beginning surgery.

Keep oxygen levels low and leaks to a minimum.
Oxygen enriched environments (over 21% oxygen in the air) are created by the supply of anesthesia or oxygen to a patient and are potential hazards. These gases act as oxidizers and encourage combustion at lower temperatures. Keep oxygen concentrations in the surgery suite as low as possible, and attempt to reduce the oxygen concentration when a heat-producing device is introduced. Also, be sure that oxygen that leaks around nasal cannula or mouthpieces is not allowed to accumulate under the patient drape, since if a spark reaches such a drape, a fire can quickly accelerate out of control.

What to do if a fire starts.
If a fire starts, immediately cut or tear off any burning material from the patient. Use a CO₂ extinguisher if tearing the material is ineffective. Water mist extinguishers, as opposed to traditional water extinguishers, are also options for OR surgical fires. Water mist canisters may decrease the risk of electrocution because the mist doesn't pool as easily as water spray. Also, be aware that some surgical draperies are liquid resistant, so water merely beads up on them when doused with an extinguisher.

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