Introduction:
Surgical fires are fire accidents that may occur during a surgical procedure. Three main components are required for a surgical fire to happen, known as the fire triangle. These components include a fuel source, an oxidizer, and an ignition source. A few surgical fires cannot be prevented, eventhough they should be considered a 'never event.' However, components of the fire triangles are often utilized and brought to proximity by surgeons, which increases the chances of surgical fires.
What Are Surgical Fires?
The definition of surgical fire is the one that occurs in, on, or around the patient undergoing a surgical procedure. There are three main components in the fire triangle that cause surgical fires. First, they are fuel sources - degreasers, prepping agents, drapes, sponges, towels, gowns, masks, ointments, benzoin, mattress, pillows, blankets, ECG electrodes, hoses, tissue, and GI glasses.
The second component is an oxidizer which includes air, room oxygen, and nitrous oxide. The third component is the ignition source including laser, electrocautery, light, defibrillator, and flexible endoscope. All these three components are placed close to the patient during surgery. The main risk is a high oxidizer level when the oxygen level increases than the atmospheric oxygen level.
This risk is more common in oral, head, neck, pharyngeal, and rectal surgeries. Because in this area, the high oxygen level is there, and there is a presence of methane gas. Oxidizer level can reduce the ignition level temperature of the fuels. Inhaled halogenated anesthetics are considered safe, non-flammable, and protective of endotracheal tube fire.
What Are the Issues of Concern in Surgical Fires?
Surgical fires are purely preventable. And the surgeons can easily prevent surgical fires. They can be prevented in two phases - preoperative and intraoperative. Preoperative prevention of surgical fire begins with education and gaining knowledge. Initially, monitoring and checking the equipment and devices for damage or dysfunction. Then understanding manufacturer guidelines for equipment is also important.
Maintenance of these devices on time, a proper understanding of surgical fire and fire triangle should be there, and a protocol for the management of surgical fire also be obtained. Thus it helps prevent surgical fire and addresses the issue of a surgical fire. Therefore, everyone in charge of the operation field should be educated about surgical fire and the precautions that should be taken against it.
Proper communication is a key factor in the prevention of surgical fires. Communication between anesthesiologists, surgeons, and the nursing team. This communication should proceed before the initialization of the procedure. Through communication, each team member can point out the risk factors, take preventive measures, and discuss the source of the oxidizer, fuel source, and ignition source.
Intraoperative prevention of surgical fires also requires education and knowledge of all members of the team operation field about the risk of surgical fire and how to prevent its risk and manage it. In the fire triangle, in the anesthesia, the oxidizer will reduce the ignition temperature and increase the risk of fire which is preventable. However, it is a simple system that can illuminate unnoticed and create various risks.
A few measures that can prevent the risk of surgical fires are the usage of the lowest oxygen to maintain oxygen saturation, the use of proper preparation of skin following manufacturer guidelines for proper dry time on alcohol-based skin preparation, and avoiding the preparation of fluid pooling. And proper usage of surgical devices like reducing the cautery current, reupholstering the cautery, etc.
Knowledge about the number of instruments that can generate current and heat by each team member in the operation field. For example, urologists use laser and light cords in endoscopic and laparoscopic cases. In addition, avoiding the cross-contact between each component of the fire triangle, like the oxidizer, ignition source, and fuel source, is mandatory in controlling and preventing surgical fires; thus, educating each surgical team member is needed.
What Are the Harmful Effects of Surgical Fires?
The importance of prevention of surgical fires is essential because it can cause patient harm, increase hospital costs, and increase adverse outcomes. In addition, the surgical fire that occurs in or on the patient causes significant harm to the patient, not only at the burn site but also substantial harm to the patient, so prevention is mandatory.
Surgical fire may cause irreversible damage to the tissues because fire harm occurs in tissue by denaturation and coagulation of protein. In this damage, there is an activation of inflammatory response and thus causes vasoconstriction, vasodilation, increased capillary permeability, and edema formation locally and distally.
These all are direct harm to the patient. There is also indirect long-term harm to the patient following surgical fires, like smoke inhalation. In a case reported like in hypospadias repair, the preparational fluid ignited under the drape, and it caused first and second-degree burns to the patient's perineum. Urologists do operations with irrigation and iodine solutions which often reduce the risk of surgical fires. The urologist also uses devices like a flexible endoscope which can cause sparking. Certain urologist surgeries, like abdominal surgery, do bowel resection, which causes bowel gas ignition.
What Are the Preventive Measures for Avoiding Surgical Fires?
An interprofessional team approach should be taken to prevent surgical fires. Maintaining good communication between various team members in the operation theater is mandatory to prevent surgical fire. In addition, surgical time-out is crucial for detailing all the surgical equipment and components of surgical fire, that is, ignition source, fuel source, and oxidizer within the procedure.
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The surgeon and all team members should know the mechanism of each piece of equipment and device used in the operation theater. In addition, awareness and knowledge about each device's risk factors are essential in preventing surgical fires.
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An anesthesiologist's role is crucial; he should ensure that a minimum level of needed oxygen is only given to the patient. Also, knowledge about anesthetics reduces the risk of surgical fire.
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The team of nurses should ensure proper surgical field preparation to prevent preparation fluid pooling.
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Operation theater technicians should be cautious about the proper usage of all the equipment in the surgery.
Conclusion
Surgical fires are preventable hazards during surgery that can cause serious adverse effects on patients. Proper guidelines and proper communication between each member of the team should be done to prevent surgical fires. The three main components of surgical fires should be closely monitored. Each member is responsible in their operation field to control surgical fire.
