Patient safety


and therefore the risk for thermal injury during surgery.7


These may present as an adverse


skin reaction such as blistering, redness or inflammation.8 Some antibiotics, chemotherapy agents or immunosuppressive medications can cause drug-induced photosensitivity.7


People with


autoimmune conditions such as lupus or dermatomyositis often experience heightened sensitivity to light exposure. Paediatric patients, with thinner and more delicate skin, can also be at increased risk.8 In addition, long duration surgical procedures,


closer distance between the lighthead and surgical field (less than one metre), and operations that involve sensitive anatomical areas, can all increase the risk of higher thermal exposure.


Collectively, these factors support the need


for greater awareness of the risks posed by operating theatre lighting. However, focusing solely on identifiable risk groups does not capture the full picture.


Thermal injury without known risk factors Published case reports have documented severe thermal injuries occurring in patients with no known photosensitising conditions, no relevant medication history and no device malfunction. One UK case described a deep, dermal burn sustained during a routine vascular procedure, despite normal theatre setup, standard lighting distances and a relatively short operative time.2


Investigations into the incident ruled out equipment fault, inappropriate use and patient- specific vulnerability. The injury pattern was consistent with focused thermal exposure from operating theatre lighting alone. This clearly demonstrates that using multiple light sources with overlapping beams can represent a risk when conditions allow irradiance to accumulate beyond safe thresholds.


Limitations of current guidelines From a patient safety perspective, these events represent latent system risks rather than individual error. This reinforces the importance


Fig.1 Overlapping surgical lights can create unintended thermal risks


of learning from harm and redesigning systems to make practice safe by default. Regulatory bodies and medical safety


organisations have recognised this risk and have issued warnings and guidelines to mitigate the potential for these injuries. Current existing guidance for managing thermal risk from surgical lighting typically relies on manual and behavioural controls. These include limiting the number of overlapping lightheads, manually reducing light intensity, or following warnings and recommendations outlined in manufacturers’ instructions for use. However, these measures can be difficult


to apply consistently in everyday clinical practice. Operating theatres are busy, intense environments, requiring constant cognitive focus and rapid decision-making. Research has shown that theatre lights are adjusted frequently, approximately every 7.5 minutes during procedures, requiring surgeons to pause their work to reposition or reconfigure them in 97% of cases. 4,9, Unlike many intra-operative hazards,


cumulative irradiance risk is not easily recognisable by the surgical team. There are no visible cues, audible alarms or tactile feedback when safe thresholds are exceeded.3


The risk


can accumulate silently, even for experienced and highly attentive teams. Asking healthcare professionals to continually monitor this is an additional task requiring concentration and can be a distraction. Evidence increasingly links such distractions to decreased overall safety performance in the operating theatre.10,11 As a result, while current recommendations


are well intentioned, they may not be the most appropriate or realistic strategy to control risk during complex surgical care.


Impact on the surgical team The risk of over-illumination may have implications beyond patient safety. Surgeons and theatre staff are repeatedly exposed to high-intensity lighting. Research into operating theatre ergonomics has highlighted a link between prolonged exposure to intense illumination and visual fatigue, headaches and reduced visual acuity.4 In one meta-analysis, it was found that over


25% of surgeons reported eye strain as an occupational health hazard.12 Over time, sustained exposure may contribute


Fig.2 Automated systems maintain cumulative irradiance within safe limits


to photochemical retinal stress, with potential effects on sleep quality and performance.4 Although the impact may be subtle, it does reinforce the need to effectively control surgical illumination, not only to ensure clear visualisation of the operative field, but also for the wellbeing of healthcare professionals.


July 2026 I www.clinicalservicesjournal.com 23


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