Challenges in Preventing Electrical, Thermal, and Radiation Injuries

  • Mark E. Bruley


Energy—its use in various forms during surgery has tremendously advanced our practice of surgery since the 1920s with the introduction of the first electrosurgical units by William Bovie, MD. Each type of energy—electricity, heat, and radiation (including intense MRI magnetic fields)—presents variable risks of injury to patients if the risks are not recognized and care not taken to prevent harm. Intraoperative injuries that are suspected of being caused by a medical device/implement and its related energy may not be related to a technology. In many cases, the injury may be an abnormal or idiosyncratic physiologic response to otherwise normal conditions of device use and performance. Alternatively, the injury may be due to pressure necrosis, tissue chemical sensitivity, an adverse drug reaction, or a disease process that happens to develop in the area where a device was applied. Such alternative etiologies, beyond those from energy emitting technologies, are briefly discussed. This chapter addresses the etiology of intraoperative skin and tissue injuries from medical technologies that are the source of electrical, thermal, and radiation energy. A format for investigating such injuries is presented along with guidance on their prevention. The hazards of surgical fire on the patient are also addressed.


Burns Electrosurgery Electrical Thermal Radiation Injury Investigation Medical devices Patient safety Human factors 


  1. 1.
    Carter PL. The life and legacy of William T. Bovie. Am J Surg. 2013;205:488–91.PubMedCrossRefGoogle Scholar
  2. 2.
    Cushing H, Bovie W. Electrosurgery as an aid to the removal of intracranial tumors. Surg Gynecol Obstet. 1928;47:751–84.Google Scholar
  3. 3.
    Berwick DM. Disseminating innovations in health care. J Am Med Assoc. 2003;289:1969–75.CrossRefGoogle Scholar
  4. 4.
    Bruley ME. Surgical fires: perioperative communication is essential to prevent this rare but devastating complication. Qual Saf Health Care. 2004;13(6):467–71.Google Scholar
  5. 5.
    Lypson ML, Stephens S, Colletti L. Preventing surgical fires: who needs to be educated? Jt Comm J Qual Patient Saf. 2005;31(9):522–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Watanabe Y, Kurashima Y, Madani A, et al. Surgeons have knowledge gaps in the safe use of energy devices: a multicenter cross-sectional study. Surg Endosc. 2015. Available from: Cited 2 June 2015 [Epub ahead of print].
  7. 7.
    Cantin JE. Proper positioning eliminates patient injury. Today’s OR Nurse. 1989;11(4):18–21.Google Scholar
  8. 8.
    Medtronic [Internet]. Minneapolis: indications, safety, and warnings: NIM 3.0 nerve monitors. 2015. Available from: Cited 15 Dec 2015.
  9. 9.
    Association of periOperative Registered Nurses. Recommended practices for electrosurgery. AORN J. 2005;81(3):616–8, 621–6, 629–32.Google Scholar
  10. 10.
    Stoelting RK, Feldman JM, Cowles CE, Bruley ME. Surgical fire injuries continue to occur—prevention may require more cautious use of oxygen. APSF Newsl. 2012;26:41–3. Available from: Cited 14 Sep 2015.
  11. 11.
    Vickers MD. Fire and explosion hazards in operating theatres. Br J Anaesth. 1978;50(7):659–64.PubMedCrossRefGoogle Scholar
  12. 12.
    Phippen ML. OR nurse’s guide to preventing pressure sores. AORN J. 1982;36(2):205–12.PubMedCrossRefGoogle Scholar
  13. 13.
    Institute ECRI. Electrosurgical safety: conducting a safety audit. Health Devices. 2005;34(12):414–20.Google Scholar
  14. 14.
    Institute ECRI. Fires during surgery of the head and neck area [update]. Health Devices. 1980;9(3):82.Google Scholar
  15. 15.
    Koenig TR, Wolff D, Mettler FA, et al. Skin injuries from fluoroscopically guided procedures: part 1, characteristics of radiation injury. AJR Am J Roentgenol. 2001;177(1):3–11.PubMedCrossRefGoogle Scholar
  16. 16.
    Tucker RD, Platz CE, Landas SK. Histologic characteristics of electrosurgical injuries. J Am Assoc Gynecol Laparosc. 1997;4(2):201–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Barach P, Cantor M. Adverse event disclosure: benefits and drawbacks for patients and clinicians. In: Clarke S, Oakley J, editors. The ethics of auditing and reporting surgeon performance. Cambridge: Cambridge University Press; 2007. p. 76–91. ISBN 9780521687782.CrossRefGoogle Scholar
  18. 18.
    Cassin B, Barach P. Making sense of root cause analysis investigations of surgery-related adverse events. Surg Clin North Am. 2012;92(1):101–15. doi: 10.1016/j.suc.2011.12.008.
  19. 19.
    Tulikangas PK, Smith T, Falcone T, Boparai N, Walters MD. Gross and histologic characteristics of laparoscopic injuries with four different energy sources. Fertil Steril. 2001;75(4):806–10.PubMedCrossRefGoogle Scholar
  20. 20.
    Valentine J. Avoidance of radiation injuries from medical interventional procedures. Ann ICRP. 2000;30(2):7–67.CrossRefGoogle Scholar
  21. 21.
    Okun MR, Edelstein LM, Fisher BK. Gross and microscopic pathology of the skin. Canton, MA: Dermatopathology Foundation Press; 1988.Google Scholar
  22. 22.
    Moritz AR, Henriques FC. Studies of thermal injury, II: the relative importance of time and surface temperature in the causation of cutaneous burns. Am J Pathol. 1947;23:695–720.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Moritz AR. Studies of thermal injury, III: the pathology and pathogenesis of cutaneous burns and experimental study. Am J Pathol. 1947;23(6):915–41.PubMedPubMedCentralGoogle Scholar
  24. 24.
    ECRI Institute. Skin injury in the OR and elsewhere [hazard report]. Health Devices. 1980;9(12):312–8.Google Scholar
  25. 25.
    Barach P, Cantor M. Adverse event disclosure: benefits and drawbacks for patients and clinicians. In: Clarke S, Oakley J, editors. The ethics of auditing and reporting surgeon performance. Cambridge: Cambridge Press; 2007. p. 76–91. ISBN-13: 9780521687782.Google Scholar
  26. 26.
    Cantor M, Barach P, Derse A, Maklan C, Woody G, Fox E. Disclosing adverse events to patients. Jt Comm J Qual Patient Saf. 2005;31:5–12.Google Scholar
  27. 27.
    Cassin B, Barach P. Balancing clinical team perceptions of the workplace: applying ‘work domain analysis’ to pediatric cardiac care. Prog Pediatr Cardiol. doi: 10.1016/j.ppedcard.2011.12.005.
  28. 28.
    Jensen PF, Barach P. The role of human factors in the intensive care unit. Qual Saf Health Care. 2003;12(2):147–8.Google Scholar
  29. 29.
    Bruley ME. Accident and forensic investigation. In: van Gruting CWD, editor. Medical devices: international perspectives on health and safety. Amsterdam: Elsevier; 1994.Google Scholar
  30. 30.
    Becker CM, Malhotra IV, Hedley-Whyte J. The distribution of radiofrequency current and burns. Anesthesiology. 1973;38(2):106–21.PubMedCrossRefGoogle Scholar
  31. 31.
    ECRI Institute. Update: ESU return electrode contact quality monitors [risk analysis]. Health Devices. 1989;18(12):433–6.Google Scholar
  32. 32.
    ECRI Institute. Electrosurgical units [evaluation]. Health Devices. 1987;16(9–10):323–34.Google Scholar
  33. 33.
    ECRI Institute. ESU burns from poor electrode site preparation [hazard]. Health Devices. 1987;16(1):35–6.Google Scholar
  34. 34.
    ECRI Institute. Electrosurgery and laparoscopy [hazard report]. Health Devices. 1973;2(8–9):222–5.Google Scholar
  35. 35.
    Geddes LA. Handbook of electrical hazards and accidents. Boca Raton, FL: CRC Press; 1995.Google Scholar
  36. 36.
    Knickerbocker GG, Skreenock JJ. Electrosurgical equipment. In: Cook AM, Webster J, editors. Therapeutic electrosurgery. Englewood Cliffs, NJ: Prentice-Hall; 1981.Google Scholar
  37. 37.
    Knickerbocker GG. ESU safety: purchasing, preventive maintenance, incident investigation. Med Instrum. 1980;14:257.PubMedGoogle Scholar
  38. 38.
    Neufeld GR, Foster KR. Electrical impedance properties of the body and the problem of alternate-site burns during electrosurgery. Med Instrum. 1985;19(2):83–7.PubMedGoogle Scholar
  39. 39.
    Skreenock JJ. Electrosurgical quality assurance: the view from the OR table. Med Instrum. 1980;14:261.PubMedGoogle Scholar
  40. 40.
    ECRI Institute. Risk of electrosurgical burns at needle electrode sites [hazard report]. Health Devices. 1994;23(8–9):373–4.Google Scholar
  41. 41.
    Parker EO. Electrosurgical burn at the site of an esophageal temperature probe. Anesthesiology. 1984;61:93–5.PubMedCrossRefGoogle Scholar
  42. 42.
    ECRI Institute. ESU burns from poor dispersive electrode site preparation [hazard update]. Health Devices. 1993;22(8–9):422–3.Google Scholar
  43. 43.
    ECRI Institute. Alternate-site burns from improperly seated or damaged electrosurgical pencil active electrodes. Health Devices. 2012;41(10):334.Google Scholar
  44. 44.
    ECRI Institute. Electrosurgical safety: Managing burn risks during laparoscopic and high-current procedures. Health Devices. 2005;34(8):257–72.Google Scholar
  45. 45.
    ECRI Institute. Higher currents, greater risks: preventing patient burns at the return-electrode site during high-current electrosurgical procedures. Health Devices. 2005;34(8):273–9.Google Scholar
  46. 46.
    ECRI Institute. Return-electrode-site burns associated with Rita Medical Systems Model 1500 and 1500X radio-frequency generators [hazard report]. Health Devices. 2005;34(8):280–2.Google Scholar
  47. 47.
    ECRI Institute. Skin burns resulting from the use of conductive distention/irrigation media during electrosurgery with a rollerablation electrode [hazard report]. Health Devices. 2005;34(8):283–4.Google Scholar
  48. 48.
    ECRI Institute. Olsen 950 foot-controlled disposable electrosurgical electrodes [hazard report]. Health Devices. 1986;15(1):22–3.Google Scholar
  49. 49.
    ECRI Institute. Cameron-Miller Model 26–1104 suction coagulation electrode handle [hazard report]. Health Devices. 1983;12(6):152.Google Scholar
  50. 50.
    ECRI Institute. American V. Mueller coagulation forceps [hazard report]. Health Devices 1981;10(10):256.Google Scholar
  51. 51.
    ECRI Institute. Misconnection of bipolar electrosurgical electrodes [hazard]. Health Devices. 1995;24(1):34–5.Google Scholar
  52. 52.
    Fuchshuber PR, Robinson TN, Feldman LS, et al. The SAGES FUSE program: bridging a patient safety gap. Bull Am Coll Surg [Internet]. 2014. Available from: Cited 14 Oct 2015.
  53. 53.
    Leeming MN, Ray C, Howland WS. Low voltage direct current burns. J Am Med Assoc. 1970;214:1681.CrossRefGoogle Scholar
  54. 54.
    Cooper JB, DeCesare R, D’Ambra MN. An engineering critical incident: Direct current burn from a neuromuscular stimulator. Anesthesiology. 1990;73(1):168–72.PubMedCrossRefGoogle Scholar
  55. 55.
    ECRI Institute. H0271. Xavant STIMPOD NMS450 Nerve stimulators with software versions V9.40 and earlier: may cause superficial skin lesions [ECRI exclusive hazard report]. Plymouth Meeting, PA: ECRI Institute; 2015. 1p. (Health Devices Alerts).Google Scholar
  56. 56.
    Grossi EA, Parish MA, Kralik MR, et al. Direct-current injury from external pacemaker results in tissue electrolysis [case report]. Ann Thorac Surg. 1993;56(1):156–7.PubMedCrossRefGoogle Scholar
  57. 57.
    Lippman M, Fields WA. Burns of the skin caused by a peripheral-nerve stimulator. Anesthesiology. 1974;40(1):82–4.CrossRefGoogle Scholar
  58. 58.
    Orpin JA. Unexpected burns under skin electrodes. Can Med Assoc J. 1982;127:1106.PubMedPubMedCentralGoogle Scholar
  59. 59.
    ECRI Institute. Exposed connections in pulse oximeter sensors can cause electrochemical burns [hazard report]. Health Devices. 2001;30(12):456–7.Google Scholar
  60. 60.
    ECRI Institute. The risks of laparoscopic electrosurgery [clinical perspective]. Health Devices. 1995;24(1):4.Google Scholar
  61. 61.
    ECRI Institute. Electrosurgical burns and laparoscopy. Health Devices. 1980;9(8):206–7.Google Scholar
  62. 62.
    Morgan DA, McGiffin PB, Weedon DDeV. Surgical research: an experimental study of iatrogenically induced operating theatre burns. Aust N Z J Surg. 1985;55:55–60.Google Scholar
  63. 63.
    Moss CE, Ellis RJ, Parr WH, et al. Biological effects of infrared radiation. Cincinnati (OH): U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Institute for Occupational Safety and Health, Division of Biomedical and Behavioral Science, 1982; DHHS (NIOSH) Publication No. 82–109.Google Scholar
  64. 64.
    Stoll AM, Greene LC. Relationship between paid and tissue damage due to thermal radiation. J Appl Physiol. 1959;14:373–82.PubMedGoogle Scholar
  65. 65.
    Xu F, Wang PF, Lin M, Lu TJ, Ng EYK. Quantification and the underlying mechanism of skin thermal damage: a review. J Mech Med Biol. 2010;10(3):373–400.CrossRefGoogle Scholar
  66. 66.
    ECRI Institute. Hypo/hyperthermia machines [evaluation]. Health Devices. 1988;17(11):320–33.Google Scholar
  67. 67.
    Keatinge WR, Cannon P. Freezing-point of human skin. Lancet. 1960;1:11–4.PubMedCrossRefGoogle Scholar
  68. 68.
    ECRI Institute. Misusing forced-air hyperthermia units can burn patients [hazard report]. Health Devices. 1999;28(5–6):229–30.Google Scholar
  69. 69.
    ECRI Institute. Augustine Medical Bair Hugger patient warming systems [hazard report]. Health Devices. 1990;19(10):373.Google Scholar
  70. 70.
    Truell K et al. Third-degree burns due to intraoperative use of a Bair Hugger warming device. Ann Thorac Surg. 2000;69:1933–4.PubMedCrossRefGoogle Scholar
  71. 71.
    ECRI Institute. Scleral and corneal burns during phacoemulsification [hazard update]. Health Devices. 1996;25(11):426–31.Google Scholar
  72. 72.
    Bashein G, Syrovy G. Burns associated with pulse oximetry during magnetic resonance imaging [letter]. Anesthesiology. 1991;75(2):382–3.PubMedCrossRefGoogle Scholar
  73. 73.
    Institute ECRI. Thermal injuries and patient monitoring during MRI studies [hazard report]. Health Devices. 1991;20(9):362–3.Google Scholar
  74. 74.
    Hardy II PT, Well KM. A review of thermal MR injuries. Radiol Technol. 2010;81(6):606–9.PubMedGoogle Scholar
  75. 75.
    ECRI Institute. New clinical guide to surgical fire prevention [guidance article]. Health Devices. 2009;38(10):314–32.Google Scholar
  76. 76.
    ECRI Institute. Reducing the risk of burns from surgical light sources [hazard report]. Health Devices. 2009;38(9):304–5.Google Scholar
  77. 77.
    ECRI Institute. Top 10 technology hazards: fiberoptic light-source burns. Health Devices. 2008;37(11):350.Google Scholar
  78. 78.
    ECRI Institute. Preventing burns and fires caused by high-powered light sources [hazard report]. Health Devices. 2005;34(9):325–6.Google Scholar
  79. 79.
    ECRI Institute. Patient burn caused by excessive illumination during surgical microscopy [hazard report]. Health Devices. 1994;23(8–9):372–3.Google Scholar
  80. 80.
    Willis MJ, Thomas E. The cold light source that was hot [letter]. Gastrointest Endosc. 1984;30:117–8.PubMedCrossRefGoogle Scholar
  81. 81.
    Rutala WA, Weber DJ, Chappell KJ. Patient injury from flash-sterilized instruments. Infect Control Hosp Epidemiol. 1999;20:458.PubMedCrossRefGoogle Scholar
  82. 82.
    Vilos GA, Vilos AG. Weighted speculum buttock burns during gynecologic surgery. Obstet Gynecol. 2003;101(5):1064–6.PubMedCrossRefGoogle Scholar
  83. 83.
    Koh THH, Coleman R. Oropharyngeal burn in a newborn baby: new complication of light-bulb laryngoscopes. Anesthesiology. 2000;92:277–9.PubMedCrossRefGoogle Scholar
  84. 84.
    Siegel LC, Garman KJ. Too hot to handle; a laryngoscope malfunction. Anesthesiology. 1990;72:1088–9.PubMedCrossRefGoogle Scholar
  85. 85.
    Fraser R. Radiant heat burns and operating theatre lamps: a study of the heat required to cause tissue necrosis. Med J Aust. 1967;1(24):1199–202.PubMedGoogle Scholar
  86. 86.
    ECRI Institute. Air-shields model SC78-2 infant radiant warmer servo controller [hazard report]. Health Devices. 1983;12(9–10):263–4.Google Scholar
  87. 87.
    ECRI Institute. High-speed surgical drills may overheat and cause burns. Health Devices. 2008;37(7):213–5.Google Scholar
  88. 88.
    FDA Public Health Notification: Patient burns from electric dental handpieces. Dec 12, 2007. Available from: Cited 2 Oct 2015.
  89. 89.
    ECRI Institute. Common flashlights can cause burns when used for transillumination [hazard report]. Health Devices. 2003;32(7):273–4.Google Scholar
  90. 90.
    McArtor RD, Saunders BS. Iatrogenic second-degree burn caused by a transilluminator. Pediatrics. 1979;63(3):422–4.PubMedGoogle Scholar
  91. 91.
    Cheney FW, Posner KL, Caplan RA, Gild WM. Burns from warming devices in anesthesia. A closed claims analysis. Anesthesiology. 1994;80(4):806–10.PubMedCrossRefGoogle Scholar
  92. 92.
    ECRI Institute. ECRI Institute revises its recommendations for temperature limits on blanket warmers [hazard update]. Health Devices. 2009;38(7):230–1.Google Scholar
  93. 93.
    ECRI Institute. Limiting the temperature of warming cabinets remains a good safety practice [hazard report update]. Health Devices. 2006;35(12):458–61.Google Scholar
  94. 94.
    ECRI Institute. Limiting temperature settings on blanket and solution warming cabinets can prevent patient burns. Health Devices. 2005;34(5):168–71.Google Scholar
  95. 95.
    Feldman KW, Morray JP, Schaller RT. Thermal injury caused by hot pack application in hypothermic children. Am J Emerg Med. 1985;3(1):38–41.PubMedCrossRefGoogle Scholar
  96. 96.
    Vlietstra RE, Wagner LK, Koenig T, et al. Radiation burns as a severe complication of fluoroscopically guided cardiological interventions. J Interv Cardiol. 2004;17(3):131–42.PubMedCrossRefGoogle Scholar
  97. 97.
    Wagner LK. Radiation injury is a potentially serious complication to fluoroscopically-guided complex interventions. Biomed Imaging Interv J. 2007;3(2):e22.PubMedPubMedCentralCrossRefGoogle Scholar
  98. 98.
    Barach P, Pretto E. Chemical and radiation injuries. In: Lobato EB, Gravenstein N, Kirby RR, editors. Complications in anesthesiology. Philadelphia: Lippincott, Williams & Wilkins; 2007. pp. 962–973.Google Scholar
  99. 99.
    Abdel-Rehim S, Bagirathan S, et al. Burns from ECG leads in an MRI scanner. Ann Burns Fire Disasters. 2014;27(4):215–18. Available from:–215.pdf. Cited 2 Oct 2015.
  100. 100.
    Davis PL, Crooks L, Arakawa M, et al. Potential hazards in NMR imaging: heating effects of changing magnetic fields and RF fields on small metallic implants. Am J Roentgenol. 1981;137:857–60.CrossRefGoogle Scholar
  101. 101.
    ECRI Institute. Top 10 technology hazards: MR imaging burns. Health Devices. 2007;36(11):347.Google Scholar
  102. 102.
    ECRI Institute. What’s new in MR safety: the latest on the safe use of equipment in the magnetic resonance environment. Health Devices. 2005;34(10):333–49.Google Scholar
  103. 103.
    ECRI Institute. The safe use of equipment in the magnetic resonance environment [guidance article]. Health Devices. 2001;30(12):421–44.Google Scholar
  104. 104.
    Kanal E, Barkovich AJ, Bell C, et al. Expert panel on MR safety. ACR guidance document on MR safe practices: 2013. J Magn Reson Imaging. 2013;37(3):501–30.PubMedCrossRefGoogle Scholar
  105. 105.
    Andrea M, VanCleave AM, Jones JE, McGlothlin JD, et al. The effect of intraoral suction on oxygen-enriched surgical environments: a mechanism for reducing the risk of surgical fires. Anesth Prog. 2014; 61(4):155–61. Available from: Cited 2 June 2015.
  106. 106.
    American College of Surgeons. Preventing surgical fires. Bull Am Coll Surg [Epub]. 2013. Available from: Cited 2 June 2015.
  107. 107.
    American Society of Anesthesiologists Task Force on Operating Room Fires. Practice advisory for the prevention and management of operating room fires: an updated report. Anesthesiology. 2013;118(2):271–90.CrossRefGoogle Scholar
  108. 108.
    Association of periOperative Registered Nurses. AORN guidance statement: fire prevention in the operating room. AORN J. 2005;81(5):1067–75.CrossRefGoogle Scholar
  109. 109.
    Clarke JR, Bruley ME. Surgical fires: trends associated with prevention efforts. PA Patient Saf Advisory. 2012;9(2):130–5. Available from:;9(4)/Pages/130.aspx. Cited 1 Nov 2015.
  110. 110.
    Council on Surgical and Perioperative Safety [Internet]. Chicago: preventing surgical fires: collaborating to reduce preventable harm. Available from: Cited 12 Oct 2015.
  111. 111.
    de Richemond AL, Bruley ME. Head and neck surgical fires, Chapter 37. In: Eisele DW, editor. Complications in head and neck surgery. St. Louis: Mosby; 1992. p. 492–508.Google Scholar
  112. 112.
    Dorsch JA, Dorsch SE. Hazards of anesthesia machines and breathing systems. In: Dorsch JA, Dorsch SE, editors. Understanding anesthesia equipment. 3rd ed. Baltimore: Lippincott Williams & Wilkins; 1994. p. 325–61.Google Scholar
  113. 113.
    ECRI Institute [Internet]. Plymouth meeting: surgical fire prevention. Available from: Cited 12 Oct 2015.
  114. 114.
    ECRI Institute. A clinician’s guide to surgical fires: how they occur, how to prevent them, how to put them out [guidance article]. Health Devices. 2003;32(1):5–24.Google Scholar
  115. 115.
    ECRI Institute. The patient is on fire!: A surgical fires primer [guidance article]. Health Devices. 1992;21(1):19–34.Google Scholar
  116. 116.
    ECRI Institute. Airway fires: reducing the risk during laser surgery [clinical perspective]. Health Devices. 1990;19(4):109–11.Google Scholar
  117. 117.
    ECRI Institute. OR fires caused by fiberoptic illumination systems [hazard report]. Health Devices. 1982;11(5):148–9.Google Scholar
  118. 118.
    ECRI Institute. Fires during surgery of the head and neck area [hazard report]. Health Devices. 1979;9(2):50–2.Google Scholar
  119. 119.
    Greco RJ, Gonzalez R, Johnson P, et al. Potential dangers of oxygen supplementation during facial surgery. Plast Reconstr Surg. 1995;95(6):978–84.PubMedCrossRefGoogle Scholar
  120. 120.
    Pennsylvania Patient Safety Authority. Airway fires during surgery. PA Patient Saf Advisory. 2007;4(1):1, 4–6. Available from: Cited 1 Nov 2015.
  121. 121.
    Pennsylvania Patient Safety Authority. Airway fires during surgery [poster]. PA Patient Saf Advisory. 2007;4(1):1, 4–6. Available from: Cited 1 Nov 2015.
  122. 122.
    Pennsylvania Patient Safety Authority. Risk of fire from alcohol-based solutions. PA Patient Saf Advisory 2005;2(2):1, 4–6. Available from: Cited 1 Nov 2015.
  123. 123.
    Roy S, Smith LP. Surgical fires in laser laryngeal surgery: Are we safe enough? Otolaryngol Head Neck Surg. 2015;152(1):67–72.PubMedCrossRefGoogle Scholar
  124. 124.
    Schroeck H, Healy DW. Airway laser procedures in children and the American Society of Anesthesiologists’ practice advisory: a survey among pediatric anesthesiologists. Int J Pediatr Otorhinolaryngol. 2014;78(12):2140–4.PubMedCrossRefGoogle Scholar
  125. 125.
    Seifert PC, Peterson E, Graham K. Crisis management of fire in the OR. AORN J. 2015;101(2):250–63.PubMedCrossRefGoogle Scholar
  126. 126.
    Sosis MB. Anesthesiologists must do a better job of preventing operating room fires. J Clin Anesth. 2006;18(2):81–2.PubMedCrossRefGoogle Scholar
  127. 127.
    The Joint Commission. Monitoring OR fires to improve patient safety. Bull Am Coll Surg. 2015. Available from: Cited 2 June 2015.
  128. 128.
    Watson DS. New recommendations for prevention of surgical fires. AORN J. 2010;91(4):463–9.PubMedCrossRefGoogle Scholar
  129. 129.
    Watson DS. Surgical fires: 100% preventable, still a problem. AORN J. 2009;90(4):589–93.PubMedCrossRefGoogle Scholar
  130. 130.
    ECRI Institute. Top 10 technology hazards: surgical fires. Health Devices. 2012;41(11):364–65. Available from: Cited 12 Oct 2015.
  131. 131.
    ECRI Institute. Top 10 technology hazards: surgical fires. Health Devices. 2011;40(11):369–70.Google Scholar
  132. 132.
    ECRI Institute. Top 10 technology hazards: surgical fires. Health Devices. 2010;39(11):396–7.Google Scholar
  133. 133.
    ECRI Institute. Top 10 technology hazards: surgical fires. Health Devices. 2009;38(11):367.Google Scholar
  134. 134.
    ECRI Institute. Top 10 technology hazards: surgical fires. Health Devices. 2008;37(11):347.Google Scholar
  135. 135.
    Association of periOperative Registered Nurses. Safe use of lasers in the operating room-what perioperative nurses should know. AORN J. 2004;79(1):171–88. Review.Google Scholar
  136. 136.
    ECRI Institute. Top 10 technology hazards: surgical fires. Health Devices. 2007;36(11):350–1.Google Scholar
  137. 137.
    Macdonald AG. A brief historical review of non-anaesthetic causes of fires and explosions in the operating room. Br J Anaesth. 1994;73(6):847–56.PubMedCrossRefGoogle Scholar
  138. 138.
    Anesthesia Patient Safety Foundation. Prevention and management of operating room fires [DVD and streaming video]. Indianapolis, IN: Anesthesia Patient Safety Foundation; 2010. Available from: Cited 14 Oct 2015.
  139. 139.
    Bruley ME. Head and neck surgical fires. In: Eisele DW, Smith RV, editors. Complications of head and neck surgery. 2nd ed. Philadelphia: Mosby; 2009. An imprint of Elsevier.Google Scholar
  140. 140.
    Bailey SL. Electrical injuries: considerations for the perioperative nurse. AORN J. 1989;49(3):773–87.PubMedCrossRefGoogle Scholar
  141. 141.
    ECRI Institute. Fires from oxygen use during head and neck surgery [hazard report]. Health Devices. 1995;24(4):155–7.Google Scholar
  142. 142.
    Batra S, Gupta R. Alcohol based surgical prep solution and the risk of fire in the operating room: a case report. Patient Saf Surg. 2008;2:10.PubMedPubMedCentralCrossRefGoogle Scholar
  143. 143.
    Department of Health and Human Services, Centers for Medicare & Medicaid Services: Center for Medicaid and State Operations/Survey and Certification Group. Use of alcohol-based skin preparations in anesthetizing locations (ref: S&C-07-11). January 12, 2007. Available from: Cited 14 Oct 2015.
  144. 144.
    ECRI Institute. Only you can prevent surgical fires [poster]. Health Devices. 2009;38(10):319. Available from: Cited 2 June 2015.
  145. 145.
    ECRI Institute. Emergency procedure: extinguishing airway fires [poster]. Health Devices. 2009;38(10):330. Available from: Cited 2 June 2015.
  146. 146.
    ECRI Institute. Surgical fire hazards of alcohol [talk to the specialist]. Health Devices. 1999;28(7):286.Google Scholar
  147. 147.
    Galvan C, Bacha EA, Mohr J, Barach P. A human factors approach to understanding patient safety during pediatric cardiac surgery. Prog Pediatr Cardiol. 2005;20(1):13–20.CrossRefGoogle Scholar
  148. 148.
    Mathias JM. Scoring fire risk for surgical patients. OR Manager. 2006;22(1):19–20.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.ECRI InstitutePlymouth MeetingUSA

Personalised recommendations