The US Food and Drug Administration (FDA) says it continues to receive reports of surgical fires, which can result in burns, other serious injuries, disfigurement, and death. Such fires are mostly preventable.

In a safety communication issued May 29, the FDA recommends practices to reduce the risk for surgical fires, including safe use of medical devices and products commonly used during surgical procedures.

The agency notes that surgical fires can occur whenever the elements of the "fire triangle" are present: an oxidizer (eg, oxygen and nitrous oxide); an ignition source (eg, electrosurgical units [ESUs], electrocautery devices, lasers, and fiberoptic illumination systems); and a fuel source (eg, surgical drapes, alcohol-based skin preparation agents, and patient's tissue, hair, or skin).

Most surgical fires occur in oxygen-enriched environments (i.e., environments in which the concentration of oxygen exceeds 30%). Such environments can occur when supplemental oxygen is given to a patient in an operating room, the FDA says.

An open oxygen delivery system, such as a nasal cannula or mask, poses a greater risk for fire than a closed delivery system, such as a laryngeal mask or endotracheal tube. "In an oxygen-enriched environment, materials that may not normally burn in room air can ignite and burn," the FDA says.

To reduce the risk for surgical fires, the FDA said healthcare providers and hospital staff who perform surgical procedures should be educated on the factors that increase the risk for surgical fires, as well as how to manage fires. Such education should include periodic fire drills, instruction on how to use CO2 fire extinguishers, and evacuation procedures.

The FDA recommends that staff perform a fire risk assessment at the beginning of each surgical procedure and ensure communication between the anesthesiologist delivering medical gases, the surgeon controlling the ignition source, and the operating room staff who apply skin preparation agents and drapes.

Plan and Practice

To ensure the safe use of any devices that may serve as an ignition source, the FDA suggests the following:

1. Consider alternatives to use of an ignition source for surgery of the head, neck, and upper chest if high concentrations of supplemental oxygen (>30%) are being delivered.

2. If an ignition source must be used, be aware that it is safer to allow time for the oxygen concentration in the room to decrease before using such a source. It may take several minutes for the oxygen concentration to be reduced in the area, even after stopping the gas or lowering the concentration.

3. Inspect all instruments for evidence of insulation failure (e.g., device, wires, and connections) before use. Do not use if any defects are found.

4. In addition to serving as an ignition source, use of monopolar energy can directly result in unintended patient burns from capacitive coupling and intraoperative insulation failure.

5. When not in use, place ignition sources, such as ESUs, electrocautery devices, fiberoptic illumination light sources, and lasers, in a designated area away from the patient in a holster or a safety cover.

6. Be aware that other items that generate heat, such as drills and burrs, argon beam coagulators, and fiberoptic illuminators, can also serve as potential ignition sources.