Alcohol-Based Skin Preps Can Fuel Surgical fFres Interview with:
Edward L Jones, MD MS

Assistant Professor
Department of Surgery, Denver VA Medical Center and
University of Colorado, Denver, CO What is the background for this study? What are the main findings?

Response: Operating room fires continue to be an underreported source of sometimes catastrophic injuries to our patients and we could find no recent data evaluating common surgical skin antiseptics as a potential fuel for these flames. Manufacturers continue to recommend waiting at least 3 minutes for “drying” of an alcohol-based prep prior to a surgical start but cite no searchable studies to support this timeframe. We were curious if these alcohol-based preps were flammable and what impact a 3 minute delay had on their flammability. Thus we decided to study them in rigorous fashion. What should readers take away from your report?

Response: Alcohol-based skin preps can fuel surgical fires, even after waiting a full 3 minutes prior to starting surgery with an energy device. Pooling of the prep in skin creases or the umbilicus creates an even more risky situation where we were able to ignite a fire in almost 40% of cases. No alcohol-free skin preps fueled fires. In short, we recommend the avoidance of alcohol-based skin preps in order to reduce the incidence of OR fires. What recommendations do you have for future research as a result of this study?

Response: One of the main reasons for the use of an alcohol-based skin prep is a presumed decreased risk of infection. This has not been clearly demonstrated in randomized fashion across the 4 major skin preps: plain chlorhexidine, chlorhexidine with alcohol, plain iodine and iodine with alcohol. The performance of a rigorous trial comparing these skin preps would likely demonstrate equivalent or minimally significant differences in surgical site infection rates. This would affirm that the avoidance of alcohol-based preps, in order to reduce surgical fires, would result in overall patient benefit with minimal increase in infection risk. 

No Disclosures Thank you for your contribution to the community.


Operating Room Fires and Surgical Skin Preparation

Presented at the Western Surgical Association 124th Scientific Session, Coronado, CA, November 2016.

Edward L. Jones, MD, MS , Douglas M. Overbey, MD, Brandon C. Chapman, MD, Teresa S. Jones, MD, MS, Sarah A. Hilton, MD, John T. Moore, MD, FACS, Thomas N. Robinson, MD, MS, FACS


Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on February 14, 2017 by Marie Benz MD FAAD