Take Precautions With Flammable Meds

Fires involving flammable meds are rare but dangerous.

These fires are most likely to occur when patients are receiving oxygen and there’s a heat source, such as cautery or a laser.

For example, about 100 surgical fires are reported each year in the US...with the potential for serious patient harm or death.

Be familiar with meds that are flammable. Many are topicals...such as alcohol skin preps, flexible collodion skin adhesive, and ethyl chloride numbing spray.

In some cases, pharmacies are moving away from stocking meds that’ve been involved in fires. For example, petrolatum-based eye lubricants may be replaced with potentially safer options.

If you need to find out if a med is flammable, check the package labeling closely. It may not be obvious...such as when there’s just a small flame icon.

Or access the med’s safety data sheet (SDS)...which should be available online or as a hard copy in your pharmacy.

Keep in mind, solutions that are at least 24% alcohol (malathion for lice, etc) are considered flammable.

Store flammable meds correctly in the pharmacy. Regulatory agencies may require that certain flammable products be kept in specially designed cabinets...in all locations.

And don’t be surprised if pharmacy policies only allow pharmacists to access certain flammable products from storage areas.

Properly label flammable meds when dispensing them. Attach a “flammable” auxiliary label to med containers as appropriate...especially if the warning on the package isn’t clear.

Anticipate seeing flammable meds on your “do not tube list”...to reduce spill hazards.

Check pharmacy policies for proper disposal and other handling concerns...to ensure you follow applicable laws and regulations.

For example, nurses may need to return used aerosol inhalers to the pharmacy for disposal...rather than disposing of them on patient care units...due to ignitability classification under RCRA.

Get our resource, Med Disposal in the Hospital, to learn more.

Key References

  • Grauer JS, Kana LA, Alzouhayli SJ, et al. Surgical Fire in the United States: 2000-2020. Surgery. 2023 Feb;173(2):357-364.
  • ASHP. ASHP Technical Assistance Bulletin on Hospital Drug Distribution and Control. https://www.ashp.org/-/media/assets/policy-guidelines/docs/technical-assistance-bulletins/technical-assistance-bulletins-hospital-drug-distribution-control.ashx (Accessed November 16, 2023).
  • ISMP. Surgical Fires Caused by Skin Preps and Ointments: Rare but Dangerous and Preventable. March 8, 2018. https://www.ismp.org/resources/surgical-fires-caused-skin-preps-and-ointments-rare-dangerous-and-preventable (Accessed November 16, 2023).
  • A 10-Step Blueprint for Managing Pharmaceutical Waste in US Healthcare Facilities. 2022 Edition. https://hercenter.org/10_step_blueprint_guide_final_9-22.pdf  (Accessed November 16, 2023).
Hospital Pharmacy Technician's Letter. December 2023, No. 391216

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