Alcohol-based preps are believed to cause only 4% of OR fires, but researchers had little trouble getting these prepping agents to ignite in an alarming study published online in the Journal of the American College of Surgeons.
Surgical fires occurred in 10% (6 of 60) of electrosurgical test cases — even when researchers let the skin preps dry for 3 minutes and didn't let them pool.
Researchers tested skin preps with and without alcohol, and applied them with and without pooling. Alcohol-based skin preps used in the study included 70% isopropyl alcohol (IPA) with 2% chlorhexidine gluconate, 74% IPA with 0.7% iodine povacrylex and plain 70% IPA.
Following manufacturer guidelines for drying time, the researchers used clipped, porcine skin and activated an electrosurgical pencil for 2 seconds on a 30-watts coagulation setting with room-air (21%) oxygen levels. When the same alcohol-based preps were allowed to pool, the frequency of fires rose from 10% to 27%.
Additionally, when no drying time was allowed, alcohol-based preps ignited 22% of the time with no pooling, and in 38% of cases with pooling.
Non-alcohol based preps did not result in any fires.
It's estimated that there are between 550 and 650 surgical fires a year.