FDA Issues Recommendations to Prevent Surgical Fires

A new alert issued by the Food and Drug Administration (FDA) last week provides recommendations for healthcare organizations on how to prevent surgical fires and protect patients. The alert is targeted at healthcare professionals involved in surgical procedures, including surgeons, surgical technicians, anesthesiologists, anesthesiologist assistants, certified registered nurse anesthetists, physician assistants, nurses, and staff responsible for patient safety and risk management.

The FDA says healthcare workers who perform surgical procedures should be trained in practices to reduce surgical fires, including learning about factors that increase the risk of surgical fires, how to manage fires, periodic fire drills, how to use carbon dioxide fire extinguishers on or near patients, and evacuation procedures.

The specific recommendations include:

• Conduct fire risk assessment before each surgical procedure. Be aware that the highest-risk procedures involve an ignition source, delivery of supplemental oxygen, and use of an ignition source near the oxygen (e.g., head, neck, or upper chest surgery).
• Encourage communication among surgical team members. Ensure that communication exists between the anesthesia professional delivering medical gases, the surgeon controlling the ignition source, and the operating room staff applying skin preparation agents and drapes.
• Safe use and administration of oxidizers. Evaluate if supplemental oxygen is needed for the patient. If supplemental oxygen is necessary, particularly for head/neck/upper chest surgery, titrate to the minimum concentration of oxygen needed to maintain adequate oxygen saturation for the patient. When appropriate and possible, used a closed oxygen delivery system.
• Safe use of any devices that may serve as an ignition source. Consider alternatives to using an ignition source for surgery of the head/neck/upper chest if high concentrations of supplement oxygen (more than 30%) are being delivered. Inspect all instruments for evidence of insulation failure (e.g., device, wires, and connections) prior to use. In addition to serving as an ignition source, monopolar energy use can directly result in unintended patient burns from capacitive coupling and intraoperative insulation failure. Tips of cautery instruments should be kept clean and free of char and tissue. When not in use, place ignition sources (e.g., electrosurgical units, electrocautery devices, fiber-optic illumination light sources, and lasers) in a designated area away from the patient and not directly on the patient or surgical drapes. Other items that generate heat (e.g., drills and burrs, argon beam coagulators, fiber-optic illuminators) can also serve as potential ignition sources.
• Safe use of surgical suite items that may serve as a fuel source. Allow adequate drying time and prevent alcohol-based antiseptics from pooling during skin preparation and assess for pooling or other moisture to ensure dry conditions prior to draping. Use the appropriate size applicator for the surgical site. Be aware of other items that may serve as a fuel source, such as products that may trap oxygen (e.g., surgical drapes, towels, sponges, gauze), products made of plastic (e.g., some endotracheal tubes, laryngeal masks, suction catheters), and patient-related sources (e.g., hair, gastrointestinal gases).
• Plan and practice how to manage a surgical fire. Stop the main source of ignition; turn off the flow of flammable gas and unplug electrical devices that may be involved. Extinguish the fire using fire blankets, water or saline, and a CO2 extinguisher if the fire persists. Remove all drapes and burning materials and assess for evidence of smoldering materials. For airway fires, disconnect the patient from the breathing circuit, and remove the tracheal tube. Review the fire scene and remove all possible sources of flammable materials.