How does alcohol-based skin prep pose fire risk, and how can risk be mitigated?

• A. It is non-flammable and safe.
• B. It should be used with all ignition sources present.
• C. It dries instantly, reducing risk.
• D. It is flammable; ensure it dries completely and avoid ignition sources; consider alternatives if appropriate.

Answer: (D)

Alcohol-based skin prep is flammable because the alcohol solvent can vaporize and mix with air to form a fire-prone atmosphere. In the operating room, those vapors can ignite from any ignition source—such as electrocautery, lasers, hot instruments, or even static discharge—especially while the prep is still wet or not fully dried under drapes in an oxygen-rich environment. The safest approach is to ensure the prep dries completely before any incision or use of ignition sources, and to keep all potential ignition sources off and away until dryness is confirmed. If fire risk is a concern or drying time is problematic, use alternatives that do not contain alcohol, such as aqueous chlorhexidine or povidone-iodine formulations, in accordance with facility policy. Apply in thin, even layers and allow the recommended drying time, maintain proper ventilation, and avoid pooling of prep near drapes or the incision site.