when a low blue flame ignited on her face. Ms. Holden's nose and left
eye are so badly disfigured that she can no longer wear her eyeglass-
es, says her daughter.
The lawsuit seems to implicate her alcohol-based skin prep as the
cause of the fire, but that's far from certain. The language in the com-
plaint is confusing, in several instances seemingly mistaking "antiseptic"
for "anesthetic" when describing the cause of the flash burns. "A local
liquid anesthetic was applied to plaintiff's left face and as [the sur-
geon] attempted to use an electrocautery unit, plaintiff's face, head
and neck caught fire," reads the suit.
Regardless of the cause of Ms. Holden's fire, you must still exercise
care when applying flammable prepping agents. Here are a few ques-
tions to test your prepping knowledge.
J A N U A R Y 2 0 1 7 • O U T PA T I E N TS U R G E R Y. N E T • 3 9
Alcohol-based skin preps cause only 4% of all OR fires. Was
the prep likely to blame in Ms. Holden's case?
a. yes b. no c. maybe
Answer: c
It's possible, but not likely, that an alcohol-based prep was the fuel
that ignited the fire. The physical evidence suggests this was a classic
case of an oxygen-enriched fire (oxygen-enriched atmospheres are
reportedly involved in about 75% of surgical fires). Check out the inci-
sion site above Ms. Holden's left eye. The burn marks don't extend to
that area, indicating the prep did not ignite. Also notice that Ms.
Holden's hair and ear were not burned, which could have happened if
the prep had ignited — or if the surgical team let excess prepping
solution drip off her face. The suit says Ms. Holden received supple-
mental oxygen through a mask rather than a nasal cannula during the
procedure. That suggests the surgeon's electrocautery device ignited
