THE USE OF A SMOKE EVACUATION DEVICE REDUCES THE RISK OF SURGICAL PREP-ASSOCIATED FIRES.

Jason M Samuels, MD¹, Peter Einersen, MD¹, Krzysztof J Wikiel, MD², Heather Carmichael¹, Douglas M Overby¹, John T Moore², Carlton C Barnett², Thomas N Robinson, MD², Teresa S Jones², Edward L Jones, MD². ¹University Of Colorado Denver, ²Denver VA Medical Center

Introduction: The PURPOSE of our study was to evaluate the impact of smoke evacuation devices on operating room fires caused by surgical skin preps. Surgical fires are rare but preventable events that cause devastating injuries. Alcohol-based surgical skin prep serves as the fuel for a fire ignited by electrosurgical instruments. We HYPOTHESIZED that increasing air exchanges near the tip of the active electrode will reduce the concentration of alcohol thus reducing the incidence of surgical fires.

Methods: A standardized, ex vivo model was created with a 15 x 15 cm section of clipped, porcine skin. Surgical skin preparations tested: 70% isopropyl alcohol with 2% chlorhexidine gluconate (CHG-IPA) and 74% isopropyl alcohol with 0.7% iodine povacrylex (Iodine-IPA). Based upon previous studies, a high-risk situation was replicated with immediate energy activation in the presence of pooled alcohol-based prep. The site was draped to simulate a small surgical procedure with approximately 25 square cm exposed. (Figure 1) A standard and smoke evacuating electrosurgical pencil was activated for 3 seconds on 30W coagulation mode in the presence of 21% Oxygen. A standard wall suction was also tested with the tip held 5cm from the tip of the electrosurgical pencil. A chi-square test was used to compare differences between groups.

Results: Surgical fires were created in 80% (16/20) of the tests with the CHG-IPA and 95% (19/20; p=0.34) of the tests with Iodine-IPA. Continuous wall suction did not change the incidence of fire. The smoke evacuation electrosurgical pencil significantly decreased the incidence of fire when compared to the standard pencil and continuous wall suction for both preparations (Table 1). With CHG-IPA, the smoke evacuation electrosurgical pencil decreased the frequency of fire by 81% (Figure 2, p<0.001). Similarly, when using Iodine-IPA, the electrosurgical pencil with integrated smoke evacuation demonstrated a 73% decrease in fires (figure 2, p<0.001).

Conclusion: Alcohol-based skin preps fuel surgical fires. The use of a smoke evacuator electrosurgical pencil reduces the occurrence of surgical fires. Elimination of alcohol-based preps and the use of smoke evacuation devices decrease the risk of operating room fires.