Skin antiseptics and the risk of operating theatre fires

Background: Following press reports of patients catching fire or receiving chemical burns in the operating theatre, a review was conducted on the flammability of skin antiseptics. The purpose of the paper was to clarify confusion regarding povidine-iodine ( Betadine), which had been reported as being flammable, and also to determine the use of alcohol-based solutions in the Hunter Area Health Service. A risk assessment was conducted and risk reduction strategies outlined. Methods: Risk assessment was made following a literature review and an audit of 10 operating theatres in the Hunter Area Health Service. Results: Risk for operating room fires from alcohol-based skin antiseptics was confirmed. Antiseptics in aqueous solutions only smoulder. The Hunter Health survey indicated that although alcohol-based solutions were not used in operating theatres, they were used in anaesthetic bays for insertion of epidural and central line catheters. Strategies to reduce the risk of fire include discontinuation of use of alcohol-based skin antiseptics in operating theatres; using fire retardant surgical drapes; installing over-current protection devices on electrical equipment; minimizing flammable conditions by avoiding nitrous oxide and using the lowest required concentration of inspired oxygen; use of non-flammable cuffed endotracheal tubes; education and training of operating theatre personnel in fire hazards. Conclusions: Operating theatre fires continue to be a major risk for patient safety. In order to reduce this risk, the strategies outlined here should be followed.