title: Operating Room Fires and Surgical Skin Preparation.
abstract: BACKGROUND
  Operating room fires are "never events" that remain an under-reported source of devastating complications. One common set-up that promotes fires is the use of surgical skin preparations combined with electrosurgery and oxygen. Limited data exist examining the incidence of fires and surgical skin preparations.
  
  
  METHODS
  A standardized, ex vivo model was created with a 15 × 15 cm section of clipped porcine skin. An electrosurgical "Bovie" pencil was activated for 2 seconds on 30 Watts coagulation mode in 21% oxygen (room air), both immediately and 3 minutes after skin preparation application. Skin preparations with and without alcohol were tested, and were applied with and without pooling. Alcohol-based skin preparations included 70% isopropyl alcohol (IPA) with 2% chlorhexidine gluconate, 74% IPA with 0.7% iodine povacrylex, and plain 70% IPA.
  
  
  RESULTS
  No fires occurred with nonalcohol-based preparations (p < 0.001 vs alcohol-based preparations). Alcohol-based preparations caused flash flames at 0 minutes in 22% (13 of 60) and at 3 minutes in 10% (6 of 60) of tests. When examining pooling of alcohol-based preparations, fires occurred in 38% (23 of 60) at 0 minutes and 27% (16 of 60) at 3 minutes.
  
  
  CONCLUSIONS
  Alcohol-based skin preparations fuel operating room fires in common clinical scenarios. Following manufacturer guidelines and allowing 3 minutes for drying, surgical fires were still created in 1 in 10 cases without pooling and more than one-quarter of cases with pooling. Surgeons can decrease the risk of an operating room fire by using nonalcohol-based skin preparations or avoiding pooling of the preparation solution.
authors.affiliation: Department of Surgery, Denver VA Medical Center and the University of Colorado, Denver, CO.
authors.forename: Edward L
authors.initials: EL
authors.lastname: Jones
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Overbey
authors.forename: Brandon C
authors.initials: BC
authors.lastname: Chapman
authors.forename: Teresa S
authors.initials: TS
authors.lastname: Jones
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Hilton
authors.forename: John T
authors.initials: JT
authors.lastname: Moore
authors.forename: Thomas N
authors.initials: TN
authors.lastname: Robinson
mesh_terms: D019840:2-Propanol / Q000008:administration & dosage*; D000279:Administration, Cutaneous; D000818:Animals; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D004598:Electrosurgery; D005390:Fires; D066298:In Vitro Techniques; D009873:Operating Rooms; D010100:Oxygen; D011206:Povidone-Iodine / Q000008:administration & dosage*; D011300:Preoperative Care / Q000009:adverse effects*; D012997:Solvents / Q000008:administration & dosage*; D013530:Surgical Wound Infection / Q000517:prevention & control; D013552:Swine
chemical_list: D000891:Anti-Infective Agents, Local; D012997:Solvents; D011206:Povidone-Iodine; C010882:chlorhexidine gluconate; D019840:2-Propanol; D002710:Chlorhexidine; D010100:Oxygen