Fire in the OR

Did you know that while you are in surgery, your perioperative nurse & team are assessing risks for fires? The team considers the fire risks related to the procedure before bringing patients into the Operating Room. A plan is established and put into action to prevent fires at any given time.

Statistics

According to the Association of periOperative Nurses (AORN), it is estimated that there are 50-100 surgical fires a year (2025). These fires are rare and preventable when the staff have received proper education regarding fire prevention, and practice strong communication skills. Imagine going for a standard removal of a lip lesion. The next thing you know, you are suffering from burns and facial disfigurement that will affect the rest of your life and require multiple surgeries to reconstruct your face. It's difficult to imagine and heartbreaking to experience. Unfortunately, it continues to occur.

Three Main Causes of Surgical Fire

The three main causes of fire include an ignition source, fuel source and oxidizer (American Association of Nurse Anesthesiology (2025). A common ignition source is the use of electrocautery machines, laser machines and fiberoptic light sources. Fuel sources include alcohol based prep or pooling of surgical prep. The oxidizer source is oxygen or nitrogen being used in the procedure. Surgeries that are above the xiphoid process also increase the risk for surgical fires. Consider a facial surgery, prepped with an alcohol base prep, electrocautery source and open oxgyen- this is undoubtably the perfect storm for a surgical fire. This should never occur in an OR. However, due to rushing or MD not wanting wait for a prep to dry, or even an inexperienced perioperative nurse who is unaware of the risks, situations like this can occur.

Prevention

-Communicate fire risks of the procedure prior to the patient entering the room. Consider what sources are being used for the procedure. AORN has developed a fire risk score to be used for each procedure. The risk of fire is determined based on the procedure and sources that are present during the procedure. A score of 1 is low risk. A score of 3 is high risk in which all three fire sources are present during a procedure.

-Identify the fire risk during the surgical "Time Out" before starting the procedure.

-MD communicates with anesthesia before using electrocautery (anesthesia can decrease oxygen administration and take extra measures to protect the airway).

-Keep electrocautery and light source secured and off when not in use.

-Do NOT use alcohol based prep above the xiphoid process! 

-Wait for the prep to dry completely before draping.

-Keep Saline on the back table. 

-Be prepared to act quickly!

Surgical fires are one of every surgical teams worst fears. Unfortunately, they are real & they happen. Educating the OR staff and communication among team members are essential in preventing surgical fires.

References:

American Association of Nurse Anesthesiology (2025). https://www.aana.com/practice/clinical-practice/clinical-practice-resources/surgical-fires/

Association of periOperative Registered Nurses (2025). https://www.aorn.org/article/3-risks-for-fire-in-the-or-interventions-you-need

Assessed and Endorsed by the MedReport Medical Review Board