Surgical fires and alcohol‐based skin preparations

Tooher, Rebecca; Maddern, Guy J.; Simpson, John F.

doi:10.1111/j.1445-1433.2004.02997.x

Cited by 44 publications

(27 citation statements)

References 11 publications

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“…They concern alcoholic solutions of iodophore [24][25][26][27][28] as well as chlorhexidine [27,[29][30][31]. Fires are not the only cause of burns in the operating room.…”

Section: Discussionmentioning

confidence: 99%

Operating room fire: Should we mistrust alcoholic antiseptics?

Bonnet

Devienne

Broucker

et al. 2015

Annales de Chirurgie Plastique Esthétique

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“…They concern alcoholic solutions of iodophore [24][25][26][27][28] as well as chlorhexidine [27,[29][30][31]. Fires are not the only cause of burns in the operating room.…”

Section: Discussionmentioning

confidence: 99%

Operating room fire: Should we mistrust alcoholic antiseptics?

Bonnet

Devienne

Broucker

et al. 2015

Annales de Chirurgie Plastique Esthétique

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“…Following the inclusion criteria and a review of the references, a total of six articles were included in the present systematic review (5,(8)(9)(10)(11)(12). The literature review demonstrated that surgical fires caused by the electrocautery unit are rare in the operating room.…”

Section: Resultsmentioning

confidence: 99%

Third-degree burns caused by ignition of chlorhexidine: a case report and systematic review of the literature

Bengezi

2014

CAN J PLAST SURG

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S urgical fires in the operating room are rare, but can have devastating consequences for the patient and the surgeon. The published literature indicates an incidence of approximately 20 to 200 each year in United States (1). Although the majority of surgical fires cause morbidity, mortality can occur (2). For surgeons, it is a source of litigation and, in a recent review, 100% of incidences have resulted in lawsuits (3); therefore, prevention is important.The surgical fire triangle is a useful paradigm to understand the three elements necessary to initiate a fire ( Figure 1). The three elements are an oxidizer (supplemental oxygen), a fuel and an ignition source. In the operating room, all three are in ample supply (4). The fuel is most often the alcohol-based preparation solution used to disinfect the patient (5). The most common source of ignition is the electrocautery unit, which is used in 85% of surgeries and responsible for initiating 70% of surgical fires. In experimental studies, electrocautery units have been shown to easily ignite all alcohol-based preparation solutions even if the solutions contain as little as 20% alcohol (5).Chlorhexidine provides broad-spectrum bacteriostatic and bacteriocidal activity (6). It has a rapid onset and appears to be more resistant to contamination than many other antiseptic agents, making it the agent of choice for surgical scrub in several studies (7). Although chlorhexidine is less flammable than many other alcohol-based antiseptic agents, surgical fires may still occur. There are very few case reports of burns caused by the ignition of chlorhexidine by an electrocautery unit. We present a case report and a systematic review with best-practice recommendations. CASE PRESENTATIONA 77-year-old man presented to his urologist with worsening obstructive voiding symptoms due to a malfunctioning indwelling artificial urethral sphincter and urethral stricture secondary to radiation. His medical history included type 2 diabetes mellitus, hypertension, hiatus hernia and hyperlipidemia. Previous surgeries included fundoplication, radical prostatectomy for stage T3 prostate cancer and insertion of the artificial sphincter. The urologist elected removal of his artificial sphincter to improve his voiding symptoms.Under general anesthetic, the patient was prepped with chlorhexidine (2% chlorhexidine gluconate in 70% isopropyl alcohol) and draped in the supine position. The bulb, reservoir and pump were removed through a suprapubic incision. The incision was closed and the patient was again prepped with chlorhexidine and draped in the lithotomy position. An incision was made in the perineum overlying the sphincter cuff; however, when the electrocautery unit was activated, the drapes -wet with chlorhexidine -were ignited. It was quickly extinguished with sterile saline. At this point, the procedure was immediately aborted, the incision was closed and plastic surgery was consulted to assess the burns, while the patient was under general anesthetic.Assessment by the plastic surgeon rev...

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“…Attention to these details demands increasing the required solution drying time. [8] Operating room fires are uncommon, but have the potential to complicate surgical procedures disastrously. The risk of surgical fires can be minimized by avoiding situations in which all three conditions for a fire are present and by educating and training operating room personnel in fire hazards.…”

Section: Discussionmentioning

confidence: 99%

A patient who was burned in the operative field: a case report

Chung¹,

Lee²,

Kim³

et al. 2012

Ulus Travma Acil Cerrahi Derg

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Ameliyat alanı yangınları oldukça nadirdir. Yine de, bir felaket, hemen hemen her türlü cerrahiyi güçleştirebilir. Ameliyat alanı yangınlarının çoğunluğu, oksijenden zengin bir ortamda alkol bazlı cerrahiye hazırlama solüsyonları-nın, elektrikli cerrahi ekipmanın veya kolay tutuşan kumaş-ların kullanılmasından kaynaklanmaktadır. Biz, over kisti ve uterin miyomları nedeniyle jinekolojik cerrahi geçirir-ken alev yanığına maruz kalan hastayı sunuyoruz.Anahtar Sözcükler: Alev; alev yanığı; ameliyathane; alkol bazlı cerrahi hazırlık solüsyonları; elektrikli cerrahi ekipman.Operating room fires occur very rarely. Nevertheless, a disaster can complicate almost any kind of surgery. The majority of operating room fires result from the use of alcohol-based surgical preparation solutions, electro-surgical equipment, or flammable drapes in an oxygen-rich environment. We report a patient with an ovarian cyst and uterine myomas who suffered a flame burn while undergoing gynecological surgery.

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Surgical fires and alcohol‐based skin preparations

Cited by 44 publications

References 11 publications

Operating room fire: Should we mistrust alcoholic antiseptics?

Operating room fire: Should we mistrust alcoholic antiseptics?

Third-degree burns caused by ignition of chlorhexidine: a case report and systematic review of the literature

A patient who was burned in the operative field: a case report

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