The Food and Drug Administration on May 29 issued a set of recommendations to medical professionals and health care facility staff to reduce the occurrence of surgical fires on or near a patient.
Surgical fires most often occur when there is an oxygen-enriched environment (a concentration of greater than 30%). In addition to an oxygen source, the other two necessary elements of the “fire triangle” are an ignition source and a fuel source.
The recommendations discuss the safe use of devices or items that may serve as a source of any one of those three elements.
Oxygen: Evaluate if supplemental oxygen is needed. If it is, titrate to the minimum concentration needed for adequate saturation. Closed oxygen delivery systems (such as a laryngeal mask or endotracheal tube) are safer than open oxygen delivery systems (such as a nasal cannula or mask). If you must use an open system, take additional precautions to exclude oxygen and flammable/combustible gases from the operative field, such as draping techniques that avoid accumulation of oxygen.
Ignition sources: Consider alternatives to using an ignition source for surgery of the head, neck, and upper chest if high concentrations of supplemental oxygen are being delivered. Check for insulation failure before use, and keep devices clean of char and tissue. When not in use, place the devices safely away from the patient and drapes. Devices are safer to use if you can allow time for the oxygen concentration in the room to decrease.
Fuel sources: Ensure dry conditions prior to draping, avoiding pooling of alcohol-based antiseptics during skin preparation. Use the appropriate-sized applicator for the surgical site. Be aware of products that may serve as a fuel source, such as oxygen-trapping gauze, plastic laryngeal masks, and aware of potential patient sources such as hair or gastrointestinal gases.
Training should include how to manage fires that do occur – stop the ignition source, then extinguish the fire – and evacuation procedures.
Read the full recommendations.