H. Carmichael1, J. Samuels1, K. Wikiel1,2, T. N. Robinson1,2, C. Barnett1,2, T. Jones1,2, E. L. Jones1,2 1University of Colorado,Department Of Surgery,Aurora, CO, USA 2Denver Veterans Affairs Medical Center,Department Of Surgery,Aurora, CO, USA
Introduction:
Operating room fires are a “never event” that can cause life-threatening injuries. Oxygen, electrosurgical instruments (ignition source) and alcohol-based surgical skin preparations (fuel source), are present in nearly every surgical procedure and are the three necessary components of a fire. Surgical suction and/or surgical smoke evacuators have the potential to reduce the concentration of alcohol vapors at the site of electrosurgical device activation, thus reducing fire risk. Our aim was to compare the incidence of fires created by activating a monopolar instrument on ex vivo porcine skin prepped with alcohol-based surgical skin preparations, with and without smoke evacuation.
Methods:
A standardized, ex vivo model was created with a 15 x 15 cm section of clipped porcine skin. The monopolar electrosurgical device was activated at 30 Watts spray coagulation mode in 21% oxygen (room air) for 2 seconds immediately following skin preparation with two common alcohol based skin preparations, 70% isopropyl alcohol with 2% chlorhexidine gluconate (CHG-IPA) or 74% isopropyl alcohol with 0.7% iodine povacrylex (Iodine-IPA). Results with no suction device were compared to standard wall suction 5 cm from the tip of the active instrument, as well as two standard monopolar devices with built-in smoke evacuators (SE-1 and SE-2). The presence of a fire was determined by the agreement of 2 of 3 observers and was confirmed with a thermal camera.
Results:
No fires were created using non alcohol-based skin preparations. With no suction, fires were generated in 60% (18 of 30) and 47% (14 of 30) of tests for both alcohol-based skin preparations. Standard wall suction did not significantly reduce the incidence of fires with either preparation (43% vs. 60%, p=0.30 and 57% vs. 47%, p=0.61). Use of both the SE-1 and SE-2 devices resulted in a reduction in the number of fires for CHG-IPA (p=0.001 and p=0.004) but not for Iodine-IPA. Neither of the tested devices with built-in smoke evacuators eliminated the incidence of fires.
Conclusion:
Smoke evacuation devices reduce but do not eliminate the incidence of fires when used with chlorhexidine-alcohol surgical skin preparation. Smoke evacuation does not significantly reduce fires with Iodine-alcohol surgical skin preparation. Non alcohol-based preparations are the most effective way to prevent operating room fires.
