For intra‑operative wound care, should I use sterile saline‑soaked sponges or dry sponges?

Intra-Operative Wound Care: Sponge Selection

Direct Recommendation

Use saline-moistened sponges when working near ignition sources (electrocautery, laser) in the operating room, particularly in proximity to the airway or in oxygen-enriched atmospheres. 1

Evidence-Based Algorithm for OR Sponge Selection

High-Risk Scenarios (ALWAYS Use Wet Sponges)

When ANY of the following conditions are present, sponges MUST be moistened:

• Electrocautery or laser use in proximity to sponges 1
• Surgery in or near the airway 1
• Oxygen-enriched atmosphere (supplemental O₂ or high FiO₂) 1
• Head, neck, or face procedures with supplemental oxygen 1

The American Society of Anesthesiologists strongly agrees that sponges should be moistened when used near an ignition source, particularly when used in or near the airway, based on observational comparative studies demonstrating that flammability of sponges is significantly reduced when wet rather than dry or partially dry. 1

Standard-Risk Scenarios (Dry Sponges Acceptable)

Dry sponges may be used when ALL of the following are true:

• No electrocautery or laser in use 1
• No supplemental oxygen or oxygen-enriched atmosphere 1
• Surgery remote from airway 1
• No flammable prep solutions present 1

Critical Safety Considerations

Fire risk is the primary concern: Case reports consistently identify dry sponges and gauze as common fuel sources in operating room fires, which occur when an ignition source (electrocautery/laser) contacts fuel in an oxygen-enriched atmosphere. 1

The fire triangle requires three elements:

• Ignition source (electrocautery, laser)
• Oxidizer (oxygen, nitrous oxide)
• Fuel (dry sponges, drapes, tracheal tubes)

Removing any one element prevents fire. 1

Practical Implementation

For procedures involving electrocautery or laser:

• Moisten all sponges with sterile saline before placement 1
• Keep sponges moist throughout the procedure 1
• Configure surgical drapes to prevent oxygen accumulation 1
• Announce intent before activating ignition sources 1

Moisture maintenance is critical: Partially dry sponges retain significant flammability, so sponges must remain adequately moistened throughout the procedure. 1

Common Pitfalls to Avoid

Do not allow sponges to dry out during lengthy procedures - partially dry sponges are still highly flammable and lose their protective effect. 1

Do not assume room air eliminates fire risk - even without supplemental oxygen, electrocautery can ignite dry materials, though risk is substantially lower. 1

Do not forget to notify the surgical team - the anesthesiologist should announce whenever an oxidizer-enriched atmosphere is present or increases, allowing the surgeon to take appropriate precautions with sponge moisture. 1

Additional Wound Care Context

While the primary OR concern is fire safety, saline-moistened sponges also provide superior wound healing properties compared to dry environments in post-operative settings, with faster epithelialization and better quality tissue regeneration. 2 However, this wound healing benefit is secondary to the critical fire prevention indication in the intra-operative setting. 1

The ASA Task Force on Operating Room Fires provides the highest-quality guideline evidence specifically addressing this question, making moistened sponges the clear recommendation for high-risk scenarios. 1