Patient safety
Managing thermal risk in the operating theatre
Erk-Owe Hartz warns that modern operating theatre lighting can generate enough thermal energy to cause tissue damage at the surgical site. In addition, over-illumination may have other implications beyond patient safety.
Modern operating theatres depend on high quality surgical lighting to support precision, enable clear visualisation of the operative field, and keep patients safe. Over the past few decades, the wide adoption of light-emitting diodes (LEDs) in the operating theatre has brought clear advantages including heat reduction, reduced energy consumption, increased durability and compact design. This has resulted in them being perceived as a safe alternative compared to halogen bulbs.1 However, there is now evidence to suggest that there are less widely recognised risks associated with LED surgical lighting.2
Despite
being cooler, modern operating theatre lighting can still generate enough thermal energy to cause tissue damage at the surgical site. This is not linked to equipment failure, or misuse. It is more likely due to the common clinical practice of overlapping multiple high intensity lights.3 As the technology evolves, it is essential to
recognise the importance of understanding how today’s operating theatre lighting systems behave in real-world clinical environments, and how we can enhance safety without adding additional burden to already complex workflows.
Over-illumination in routine practice Operating theatre teams often use multiple, overlapping lights to achieve clarity, help minimise shadowing from blocking objects, enhance the view of tissue structure, and improve overall visibility of the surgical site.3 This includes the use of surgical lighting systems (SLS), lighted retractors, headlights, and operating microscopes.4 While surgical LED lights are cooler than halogen bulbs, they still emit energy. This
is measured as irradiance (W/m²) at the illuminated surface. International standards limit the maximum irradiance of a single surgical light to 700 W/m² to reduce the risk of thermal injury.5
modern light heads are designed to remain within this threshold. However, when multiple light sources are used, their beams can overlap, meaning that irradiance levels become cumulative. The Emergency Care Research Institute’s (ECRI) recent report3
shows that when two light
source beams converge at high intensity, their combined irradiance can significantly exceed the recommended safety limits. This can raise temperatures to levels capable of causing burns within relatively short exposure times. In one ECRI investigation, focusing two lightheads at maximum intensity produced a total irradiance of approximately 1,200 W/m2 within a simulated surgical field and raised
Despite being cooler, modern operating theatre lighting can still generate enough thermal energy to cause tissue damage at the surgical site.
22
www.clinicalservicesjournal.com I July 2026
temperatures to 47º
C (117º
F), heat capable of When used independently,
causing burns in less than 30 minutes. The addition of a third overlapping light further increased both irradiance and temperature, amplifying the risk of thermal injury. Crucially, this risk has been identified through
reports of actual thermal skin injuries linked to surgical lighting, triggering regulatory review and manufacturer investigation. A Field Safety Notice issued in 2024 explicitly recognises overlapping high-intensity light fields as a contributory mechanism of patient harm, even when devices are used in accordance with current instructions for use.6
Importantly, this illustrates how adverse
events can arise from guideline-compliant use, highlighting how the very practices intended to improve visibility, and surgical safety can, under certain circumstances, introduce an unintended source of harm.3
When is the risk increased? The risk of thermal injury is not consistent across all patients or surgical procedures. There are some specific factors that can increase susceptibility when exposed to high levels of radiant energy. Some medical treatments and conditions can increase skin UV photosensitivity
Viacheslav Yakobchuk -
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