ABSTRACT
Operating room fires, though rare, can involve substantial morbidity and mortality. Surgical fires require an ignition source, oxidizer, and fuel. Ignition sources generally include lasers and electrocautery, oxidizer are usually oxygen, nitrous oxide, and ambient air, whereas fuels are classically surgical drapes, materials, and prepping agents. We experienced a patient who, during skin incision, sustained burns resulting from a fire in the operating room. Shortly after application of disinfectants and placement of the surgical drapes, the surgeon used the electrosurgical unit on the incision. In this case, the use of an alcohol-based disinfectant was the major contributing factor to the surgical fire. To avoid recurrence, if alcohol is used for skin prepping, it should be allowed to dry completely before draping.