title: Operating room fire prevention: creating an electrosurgical unit fire safety device.
abstract: OBJECTIVE
  To reduce the incidence of surgical fires.
  
  
  BACKGROUND
  Operating room fires represent a potentially life-threatening hazard and are triggered by the electrosurgical unit (ESU) pencil. Carbon dioxide is a fire suppressant and is a routinely used medical gas. We hypothesize that a shroud of protective carbon dioxide covering the tip of the ESU pencil displaces oxygen, thereby preventing fire ignition.
  
  
  METHODS
  Using 3-dimensional modeling techniques, a polymer sleeve was created and attached to an ESU pencil. This sleeve was connected to a carbon dioxide source and directed the gas through multiple precisely angled ports, generating a cone of fire-suppressive carbon dioxide surrounding the active pencil tip. This device was evaluated in a flammability test chamber containing 21%, 50%, and 100% oxygen with sustained ESU activation. The sleeve was tested with and without carbon dioxide (control) until a fuel was ignited or 30 seconds elapsed. Time to ignition was measured by high-speed videography.
  
  
  RESULTS
  Fires were ignited with each control trial (15/15 trials). The control group median ± SD ignition time in 21% oxygen was 3.0 ± 2.4 seconds, in 50% oxygen was 0.1 ± 1.8 seconds, and in 100% oxygen was 0.03 ± 0.1 seconds. No fire was observed when the fire safety device was used in all concentrations of oxygen (0/15 trials; P < 0.0001). The exact 95% confidence interval for absolute risk reduction of fire ignition was 76% to 100%.
  
  
  CONCLUSIONS
  A sleeve creating a cone of protective carbon dioxide gas enshrouding the sparks from an ESU pencil effectively prevents fire in a high-flammability model. Clinical application of this device may reduce the incidence of operating room fires.
authors.affiliation: From the Department of Anesthesiology, Texas A&M University Health Science Center College of Medicine, Scott & White Hospital, Temple, TX.
authors.forename: William C
authors.initials: WC
authors.lastname: Culp
authors.forename: Bradly A
authors.initials: BA
authors.lastname: Kimbrough
authors.forename: Sarah
authors.initials: S
authors.lastname: Luna
authors.forename: Aris J
authors.initials: AJ
authors.lastname: Maguddayao
mesh_terms: D002245:Carbon Dioxide; D004598:Electrosurgery / Q000295:instrumentation*; D004867:Equipment Design; D004869:Equipment Safety; D005390:Fires / Q000517:prevention & control*; D006801:Humans; D009873:Operating Rooms; D011482:Protective Devices
chemical_list: D002245:Carbon Dioxide