Surgical Fires

FDA Seeks to Reduce Risk of Surgical Fires, Patient Injuries Surgical instruments and numerous medical devices are a chief ignition source for fires in the operating room. These instruments and devices also play an important role in the prevention of these fires, according to a recent safety communication published by the FDA. To reduce the risk of these fires harming patients, in late May the agency released a new set of recommendations that you need to share with your staff and co-workers.¹ According to the FDA report, “Although surgical fires are preventable, the FDA continues to receive reports about these events. Surgical fires can result in patient burns and other serious injuries, disfigurement, and death. Deaths are less common and are typically associated with fires occurring in a patient's airway.” As of 2015, an estimated 550 to 650 surgical fires occur in the United States per year.² These fires can begin to burn when all three elements of what the agency calls the “fire triangle” are present: high concentrations of oxygen (e.g., oxygen gas, nitrous oxide), an ignition source (e.g., laparoscopic cautery instruments, lasers, electrosurgical units, fiber-optic illumination systems), and a fuel source (e.g., surgical drapes, alcohol-based skin preparation agents, the patient’s hair). Most surgical fires occur in oxygen-enriched environments, when the concentration of oxygen exceeds 30 percent. “When supplemental oxygen is delivered to a patient in an operating room, an oxygen-enriched environment can be created. An open oxygen delivery system, such as nasal cannula or mask, presents a greater risk of fire than a closed delivery system, such as a laryngeal mask or endotracheal tube,” the FDA wrote in the safety communication. “In an oxygen-enriched environment, materials that may not normally burn in room air can ignite and burn.” The FDA also recommended in their safety communication that surgical team members be trained in surgical fire risk factors, as well as how to manage fires when they do occur and how to use carbon dioxide fire extinguishers near or on patients. Training should also include fire and evacuation drills.³ Specific recommendations from the agency include:

• Conducting a fire risk assessment at the beginning of each surgical procedure.
• Ensuring communication between the anesthesia professional delivering medical gases, the surgeon controlling the ignition source, and the operating room staff applying skin preparation agents and drapes.
• Evaluating if supplemental oxygen is needed for the patient, and if so, using a closed oxygen system when appropriate.
• When performing surgery on the head, neck, or upper chest, considering alternatives to an ignition source if high concentrations of supplemental oxygen are being delivered.
• If using an ignition source, allowing time for the oxygen concentration in the room to decrease.
• Inspecting all instruments for evidence of insulation failure.
• Keeping tips of cautery instruments clean.
• Storing instruments properly when not in use, away from the patient or surgical drapes.
• Allowing adequate drying time for alcohol-based antiseptics and not allowing them to pool.
• Being aware of products that may trap oxygen, such as surgical drapes, towels, sponges, and gauze.
• Planning and practicing how to manage surgical fires.⁴

In addition to being a potential source for a surgical fire, laparoscopic cautery instruments are a major cause of patient burns due to compromised/failed insulation on the shaft of the instrument. The Association of periOperative Registered Nurses (AORN) states that when reprocessing insulated laparoscopic instruments “Technology should be used to conduct stray current leakage tests at the end of each decontamination cycle.”⁵ The best way for you and your staff to help reduce the risk of patient burns/harm caused by  laparoscopic cautery instruments is to follow AORN’s recommendation and test your instruments for stray current leakage at the end of every cleaning process. Your patients are counting on you to keep them safe from harm! 1. Recommendations to Reduce Surgical Fires and Related Patient Injury: FDA Safety Communication, May 29, 2018 2. FDA’s website www.fda.gov 3. Recommendations to Reduce Surgical Fires and Related Patient Injury: FDA Safety Communication, May 29, 2018 4. Op. Cite. 5. AORN’s website https://www.aorn.org