To the Editor

A recent article in the New England Journal of Medicine recommends chlorhexidine-alcohol as a surgical site preparation solution.¹ However, the use of an alcohol-based preparation solution represents a step backwards in terms of operating room fire safety because it increases the risk of combustion. Thus, important safety measures must be undertaken to prevent the occurrence of operating room fires when an alcohol-based preparation solution is used. Such fires have already been reported.^2,3 The alcohol-based preparation solution must be applied without pooling and allowed to completely dry before surgery begins. When the site of surgery is near an open source of oxygen such as a nasal cannula and an ignition source such as cautery is employed, extreme care must be used to prevent the occurrence of a fire.

Mitchel B. Sosis, MS, MD, PhD
Holy Redeemer Hospital and Medical Center
Meadowbrook, PA

References

1. Darouiche RO, Wall MJ jr, Itani KMF, et al. Chlorhexidine-alcohol versus povidone-iodine for surgical site antisepsis. N Engl J Med 2010;362:18-26.
2. Batra S, Gupta R. Alcohol based surgical prep solution and the risk of fire in the operating room: a case report. Patient Saf Surg 2008;2:1-3.
3. Weber SM, Hargunani CA, Wax MK. DuraPrep and the risk of fire during tracheostomy. Head Neck 2006;28:649-52.