Three Things That Should Never Meet

A surgical fire needs three elements at once — an oxidizer (an oxygen- or nitrous-enriched surgical field), a fuel (alcohol-based skin prep, drapes, hair), and an ignition source (an electrosurgery pencil, laser, or light source). In an oxygen-enriched field, a routine spark can ignite drapes or prep.

Surgical fires are a long-standing, largely preventable hazard tracked by ECRI and the FDA, which ran a Preventing Surgical Fires initiative under its Safe Use Initiative. Most involve electrosurgery as the ignition source in an oxygen-enriched field. (FDA Safe Use Initiative.)

1. Supplemental oxygen pools under the drapes near the surgical site, enriching the local atmosphere.
2. An alcohol-based skin prep is not given full time to dry, leaving flammable vapor.
3. The electrosurgery pencil or another ignition source is activated nearby.
4. The enriched field ignites the drapes or prep in an instant.
5. The fire is on the field before anyone registers what completed the triangle.

FDA estimated ~550–650 surgical fires per year in the US (2007-era); ECRI's later, prevention-improved estimate is roughly 90–100 per year. (FDA / ECRI)

Fire on the surgical field. Shown through the electrosurgery unit, the drapes, the oxygen line, and the empty OR — never the patient.