Skip to main content
SpringerLink
Log in

Carbon dioxide can eliminate operating room fires from alcohol-based surgical skin preps

  • 2019 SAGES Oral dynamic
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Introduction

Surgical fires are a rare event that still occur at a significant rate and can result in severe injury and death. Surgical fires are fueled by vapor from alcohol-based skin preparations in the presence of increased oxygen concentration and a spark from an energy device. Carbon dioxide (CO2) is used to extinguish electrical fires, and we sought to evaluate its effect on fire creation in the operating room. We hypothesize that CO2 delivered by the energy device will decrease the frequency of surgical fires fueled by alcohol-based skin preparations.

Methods

An ex vivo model with 15 × 15 cm section of clipped, porcine skin was used. A commercially available electrosurgical pencil with a smoke evacuation tip was connected to a laparoscopic CO2 insufflation system. The electrosurgical pencil was activated for 2 s at 30 watts coagulation mode immediately after application of alcohol-based surgical skin preparations: 70% isopropyl alcohol with 2% chlorhexidine gluconate (CHG-IPA) or 74% isopropyl alcohol with 0.7% iodine povacrylex (Iodine-IPA). CO2 was infused via the smoke evacuation pencil at flow rates from 0 to 8 L/min. The presence of a flame was determined visually and confirmed with a thermal camera (FLIR Systems, Boston, MA).

Results

Carbon dioxide eliminated fire formation at a flow rate of 1 L/min with CHG-IPA skin prep (0% vs. 60% with no CO2, p < 0.0001). Carbon dioxide reduced fire formation at 1 L/min (25% vs. 47% with no CO2, p = 0.1) with Iodine-IPA skin prep and fires were eliminated at 2 L/min of flow with Iodine-IPA skin prep (p < 0.0001).

Conclusion

Carbon dioxide can eliminate surgical fires caused by energy devices in the presence of alcohol-based skin preps. Future studies should determine the optimal technique and flow rate of carbon dioxide in these settings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Mehta SP, Bhananker SM, Posner KL, Domino KB (2013) Operating room fires: a closed claims analysis. Anesthesiology 118:1133–1139

    Article  Google Scholar 

  2. PPS Authority (2007) Three ‘never complications of surgery’ are hardly that. Patient Safety Advisory 4

  3. Food and Drug Administration. Consumer update: FDA and partners working to prevent surgical fires—Council on Surgical and Perioperative Safety (CSPS). Food and Drug Administration; October 5th. http://www.cspsteam.org/consumer-update-fda-and-partners-working-to-prevent-surgical-fires

  4. Apfelbaum JL, Caplan RA, Barker SJ, Connis RT, Cowles C, Ehrenwerth J, Nickinovich DG, Pritchard D, Roberson DW, Caplan RA, Barker SJ, Connis RT, Cowles C, de Richemond AL, Ehrenwerth J, Nickinovich DG, Pritchard D, Roberson DW, Wolf GL, American Society of Anesthesiologists Task Force on Operating Room F (2013) Practice advisory for the prevention and management of operating room fires: an updated report by the American Society of Anesthesiologists Task Force on Operating Room Fires. Anesthesiology 118:271–290

    Article  Google Scholar 

  5. PPS Authority. Fire safety video. https://www.apsf.org/resources/fire-safety/. Accessed 21 Dec 2018

  6. Institue ECRI (2009) New clinical guide to surgical fire prevention. Health Dev 38:314–332

    Google Scholar 

  7. Fuchshuber P (2016) Only teams can prevent or fires. SAGES 2016 Annual Meeting, Boston, MA

  8. Jones TS, Black IH, Robinson TN, Jones EL (2019) Operating room fires. Anesthesiology 130:492–501

    Article  Google Scholar 

  9. Overbey DM, Townsend NT, Chapman BC, Bennett DT, Foley LS, Rau AS, Yi JA, Jones EL, Stiegmann GV, Robinson TN (2015) Surgical energy-based device injuries and fatalities reported to the food and drug administration. J Am Coll Surg 221(197–205):e191

    Google Scholar 

  10. Jones EL, Overbey DM, Chapman BC, Jones TS, Hilton SA, Moore JT, Robinson TN (2017) Operating room fires and surgical skin preparation. J Am Coll Surg 225:160–165

    Article  Google Scholar 

  11. Eberhardie RE (1940) CO2 fire protection for the chemical industry. J Soc Chem Ind 59:541–543

    Article  Google Scholar 

  12. Ho AM, Wan S, Karmakar MK (2007) Flooding with carbon dioxide prevents airway fire induced by diathermy during open tracheostomy. J Trauma 63:228–231

    Article  Google Scholar 

  13. Culp WC Jr, Kimbrough BA, Luna S, Maguddayao AJ (2014) Operating room fire prevention: creating an electrosurgical unit fire safety device. Ann Surg 260:214–217

    Article  Google Scholar 

  14. National Center for Biotechnology Information. “Carbon Dioxide”. PubChem compound database. https://pubchem.ncbi.nlm.nih.gov/compound/280. Accessed 21 Jan 2019

  15. Kerr RA (1987) Lake Nyos was rigged for disaster. Science (New York, NY) 235:528–529

    Article  CAS  Google Scholar 

  16. Peacock AJ (1998) ABC of oxygen: oxygen at high altitude. BMJ 317:1063–1066

    Article  CAS  Google Scholar 

  17. Culp WC Jr, Kimbrough BA, Luna S (2013) Flammability of surgical drapes and materials in varying concentrations of oxygen. Anesthesiology 119:770–776

    Article  CAS  Google Scholar 

  18. Roy S, Smith LP (2011) What does it take to start an oropharyngeal fire? Oxygen requirements to start fires in the operating room. Int J Pediatr Otorhinolaryngol 75:227–230

    Article  Google Scholar 

  19. Davis LB, Saxen MA, Jones JE, McGlothlin JD, Yepes JF, Sanders BJ (2018) The Effects of different levels of ambient oxygen in an oxygen-enriched surgical environment and production of surgical fires. Anesth Prog 65:3–8

    Article  Google Scholar 

  20. Greco RJ, Gonzalez R, Johnson P, Scolieri M, Rekhopf PG, Heckler F (1995) Potential dangers of oxygen supplementation during facial surgery. Plast Reconstr Surg 95:978–984

    Article  CAS  Google Scholar 

  21. Barnes AM, Frantz RA (2000) Do oxygen-enriched atmospheres exist beneath surgical drapes and contribute to fire hazard potential in the operating room? AANA J 68:153–161

    CAS  Google Scholar 

  22. VanCleave AM, Jones JE, McGlothlin JD, Saxen MA, Sanders BJ, Vinson LA (2014) The effect of intraoral suction on oxygen-enriched surgical environments: a mechanism for reducing the risk of surgical fires. Anesth Prog 61:155–161

    Article  Google Scholar 

  23. DeHaan JD (1996) The dynamics of flash fires involving flammable hydrocarbon liquids. Am J Forensic Med Pathol 17:24–31

    Article  CAS  Google Scholar 

  24. Tooher R, Maddern GJ, Simpson J (2004) Surgical fires and alcohol-based skin preparations. ANZ J Surg 74:382–385

    Article  Google Scholar 

  25. Patel R, Chavda KD, Hukkeri S (2010) Surgical field fire and skin burns caused by alcohol-based skin preparation. J Emerg Trauma Shock 3:305

    Article  Google Scholar 

  26. Schultz L (2014) An analysis of surgical smoke plume components, capture, and evacuation. AORN J 99:289–298

    Article  Google Scholar 

  27. Katz JD (2017) Control of the Environment in the operating room. Anesth Analg 125:1214–1218

    Article  Google Scholar 

  28. Orhan-Sungur M, Komatsu R, Sherman A, Jones L, Walsh D, Sessler DI (2009) Effect of nasal cannula oxygen administration on oxygen concentration at facial and adjacent landmarks. Anaesthesia 64:521–526

    Article  CAS  Google Scholar 

  29. Coronado CJR, Carvalho JA, Andrade JC, Cortez EV, Carvalho FS, Santos JC, Mendiburu AZ (2012) Flammability limits: a review with emphasis on ethanol for aeronautical applications and description of the experimental procedure. J Hazard Mater 241–242:32–54

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University of Colorado, Aurora, CO, USA

    Jason M. Samuels & Heather Carmichael

  2. Rocky Mountain Regional Veterans Affairs Medical Center and the University of Colorado, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA

    Krzysztof J. Wikiel, Thomas N. Robinson, Carlton C. Barnett Jr., Teresa S. Jones & Edward L. Jones

Authors
  1. Jason M. Samuels
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Heather Carmichael
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Krzysztof J. Wikiel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thomas N. Robinson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carlton C. Barnett Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Teresa S. Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Edward L. Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Edward L. Jones.

Ethics declarations

Disclosures

Drs. Samuels, Carmichael, Wikiel, Robinson, Barnett, Jones, and Jones have no conflicts of interests or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (MP4 66106 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Samuels, J.M., Carmichael, H., Wikiel, K.J. et al. Carbon dioxide can eliminate operating room fires from alcohol-based surgical skin preps. Surg Endosc 34, 1863–1867 (2020). https://doi.org/10.1007/s00464-019-06939-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-019-06939-z

Keywords

Search

Navigation