Operating room fire: Should we mistrust alcoholic antiseptics?

What have we learned from the surveys of the AEC, AECP and the Observatory of Infection in Surgery? Compliance with postoperative infection prevention measures and comparison with the AEC recommendations

Before planning improvement strategies, it is crucial to know the degree of implementation of preventative measures for postoperative infection. The aggregated results of 3 surveys carried out by the Observatory of Infection in Surgery to members of 11 associations of surgeons and perioperative nurses are presented. The questions were aimed to determine the knowledge of the scientific evidence, personal beliefs and the actual use of the main measures. Of 2295 respondents, 45.1% did not receive feedback on the infection rate of their unit. Insufficient knowledge of some of the main prevention recommendations and some disturbing rates of use were observed. The preferred strategies to improve compliance with preventive guidelines and their degree of implementation were investigated. A gap between scientific evidence and clinical practice in the prevention of infection in different surgical specialties was confirmed.

Review, analysis, and education of antiseptic related ocular injury in the surgical settings

Preoperative skin antiseptic preparation is the gold standard for prevention of surgical infection. However, improper use of antiseptics may lead to severe ocular damage. Currently, the most common surgical antiseptics can be divided into aqueous-based and alcohol-based disinfectants, with chlorhexidine and iodine/iodophors being the two major components. Chlorhexidine has a persistent antimicrobial effect and is resistant to neutralization by blood or organic products in surgical wounds. Nevertheless, due to its toxicity to the ears, meninges, and eyes, application of chlorhexidine should be prohibited in these surgical fields. Iodine/iodophor is better tolerated by the ocular surface and is the recommended antiseptic for ophthalmic or head and neck surgeries close to the periocular area. Alcohol is less pricey and has a rapid antiseptic effect, though its desiccating effect and flammability restrict the use in mucosal or laser surgeries. The single or combined use of these antiseptics may inadvertently induce severe ocular damage, especially during time-consuming head and neck surgeries with prone, hyperextension, or lateral tilt positions, or surgeries under general anesthesia. Apart from the choice of antiseptics, appropriate selection and attachment of bio-occlusive dressings are key to avoiding antiseptic-related ocular injuries. In this review, we provided a comprehensive summary of the characteristics of antiseptics used in surgical settings and the possible mechanisms and outcomes of antiseptic-related ocular injuries. The prevention, diagnosis, and acute management of these complications were also discussed.

Intraoperative Fire Risk: Evaluating the 3-Minute Wait After Chlorhexidine-Alcohol Antiseptic Scrub

OBJECTIVE

We sought to determine the flammability of the skin at different time intervals after chlorhexidine-alcohol antiseptic scrub application, to provide evidence for hospital protocols recommending a 3-minute drying time.

METHODS

Swine feet, which contain the skin, subcutaneous tissue, muscle, and bone, were used for an experimental cohort. The skin was prepped with chlorhexidine-alcohol solution. Attempted ignition with an open flame was then performed in the presence of visible pooling, as well as at time points 0, 30, 60, and 90 seconds after application, in addition to when the skin appeared visibly dry. Six samples were used for each time point tested.

RESULTS

At time 0 seconds and with gross pooling, ignition was achieved with all samples tested. However, at 30 seconds, only 2 of 6 samples were ignited (which appeared wet). No samples after 60 or 90 seconds were flammable. Samples appeared dry after an average of 40.5 seconds and were not able to ignite.

CONCLUSIONS

Although our findings do support that a chlorhexidine-alcohol antiseptic scrub is a potentially flammable surgical prep solution, we found little support for a 3-minute time cutoff. More importantly, the presence of pooling and persistently wet appearing prep is a more important fire risk than the time elapsed after prep application. Caution should be used when working with any flammable solution, and efforts to minimize chemical burns and combustion should be sought based on evidence.