ACE 21B Sample Question

What is the MINIMUM drying time recommended for alcohol-based skin preparation according to the manufacturers?

A. 1 minute X

B. 3 minutes ✔

C. 5 minutes X

Read the discussion below.

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Discussion

Operating room fires are estimated to occur more than 600 times a year, sometimes resulting in the death of the patient. There was an increase in the proportion of surgical liability claims due to operating room fires from less than 1% in 1980 to 5% during the 2000–2009 period. This increase mirrors the increased number of fires related to surgical devices as reported to the US Food and Drug Administration.

To address this risk, many institutions have incorporated a fire-risk assessment as a part of the preprocedural time-out. This assessment generally incorporates a discussion or identification of procedural risk factors and elements of the fire triad (Figure 1): the presence of oxidizers, ignition sources, and fuel sources.

Figure 1. The fire triad. © 2023 American Society of Anesthesiologists.

Anesthesiologists should be aware of a variety of potential fuel sources in the operating room (Table 1). Alcohol-based skin preparations have been implicated as a fuel in operating room fires in a number of case reports. Manufacturers of alcohol-based skin preparations recommend a minimum drying time of 3 minutes and as much as 1 hour (for hair-covered skin) to allow complete drying of the alcohol component (generally isopropyl alcohol). This reduces the risk of ignition upon exposure to a heat source. Although non-alcohol-based skin preparations (primarily containing iodine) may seem like an attractive alternative, most guidelines, including those from the Centers for Disease Control and Prevention, recommend alcohol-based skin preparations to reduce surgical site infections compared to non-alcohol-based skin preparations.

Table 1. Common fuel sources in operating room fires. Of note, nearly all materials, even those marked “nonflammable,” become flammable when the oxygen content is elevated. Used with permission, from Jones TS, Black IH, Robinson TN, Jones EL. Operating room fires. Anesthesiology. 2019;130(3):492-501. doi:10.1097/ALN.0000000000002598

REFERENCES

1. Jones TS, Black IH, Robinson TN, Jones EL. Operating room fires. Anesthesiology. 2019;130(3):492-501. doi:10.1097/ALN.0000000000002598
2. Ehrenwerth J, Eisenkraft JB, Berry JM, eds. Anesthesia Equipment: Principles and Applications. 3rd ed. Elsevier; 2021:526-555.

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