Managing fire risk with emollients and other skin products

Fire risk from use of emollient creams

Emollients, including creams, ointments, lotions and gels, are widely used to manage chronic dry skin conditions. They are effective and important treatments and should continue to be used where clinically indicated.

However, emollient residue can increase the risk of severe and fatal burns when it contaminates clothing, bedding, or other fabrics and is exposed to a source of ignition.

Low-paraffin and paraffin-free emollients

Fire risk applies to all emollients, including paraffin-free emollients.

Some services suggest considering lower-paraffin or non-paraffin emollients, particularly for smokers or oxygen users. However, there is no evidence that lower-paraffin products are lower-risk. Non-paraffin oily components such as shea or cocoa butter, nut or mineral oil, beeswax, or lanolin, are also flammable. Water-based components may also evaporate, leaving flammable residue behind. 

All emollients should be considered a potential fire risk once transferred to fabrics. 

How emollients increase risk

Emollients do not ignite spontaneously and are not flammable directly on skin or in their containers. Fire risk only arises when emollient residue transfers from the skin onto fabrics and accumulates over time.

When emollient residue dries on fabrics:

• materials ignite more easily
• fire spreads more rapidly
• flames burn more intensely

A source of ignition is always required, such as smoking materials, naked flames or heat sources.

Fabric contamination

Commonly affected fabrics include:

• clothing
• bedding and towels
• dressings and bandages
• upholstered furniture

Regular washing at high temperatures reduces residue build-up but may not remove it completely. Risk can therefore increase over time if residue is not removed.

How healthcare equipment increases risk

Emollients are not contraindicated for patients using oxygen, but a careful risk assessment should be made. 

Oxygen does not cause emollients to self-ignite. However, fires ignite more easily and burn faster and hotter in oxygen enriched environments. They are also more difficult to extinguish. Patients using oxygen are at higher risk of a serious fire. Patients should be advised to not allow their oxygen equipment including their mask or nasal cannula to come into contact with any emollients. 

Airflow mattresses

Air mattresses increase fire risk because they are continually filled with air and can help a fire spread more quickly. If punctured by a heat source such as a cigarette or match, the escaping air can intensify flames and lead to rapid fire growth. Oxygen therapy and the presence of emollients on bedding can further increase how quickly a fire develops and the severity of harm.

Risk with non-emollient topical treatments  

Fire risk is primarily related to the volume of product applied over time and the potential for transfer to fabrics.

Risk is therefore lower for products that:

• are applied in small amounts
• are used on limited body areas
• are applied to body areas less likely to come into contact with clothing or bedding

Examples include topical corticosteroids, antifungals, eye or lip preparations used in small quantities. However, the same principles of fire safety apply if significant transfer to fabrics occurs.

Patients at increased risk

Fire risk may be increased in patients who:

• smoke or are exposed to smoking materials 
• have contact with other heat sources or naked flames such as electric heaters, gas fires, or gas hobs
• use medical oxygen
• have reduced mobility, cognitive impairment, drowsiness or confusion
• spend prolonged periods sitting or in bed
• require frequent or high-volume emollient application

Risk reduction advice

People should continue to use emollients as prescribed, and should not stop treatment due to fire risk alone.

People using emollients and their carers should be counselled regarding risk of fire and how to reduce it. Provide appropriate information material for future reference. Examples are given in the additional resources section below.

High risk individuals may require additional counselling and risk mitigation. For complex cases, consider contacting the local fire and rescue service for advice and support.

If a person’s risk of fire cannot be reduced by risk mitigation, refer to the prescriber to consider alternative appropriate treatments.

Reducing fabric contamination

The main fire risk relates to how easily emollient-contaminated fabrics such as clothing, bedding and soft furnishings ignite and burn. Reduce contamination by:

• changing and washing clothing and bedding regularly, preferably daily if emollients are used frequently
• washing at the highest temperature recommended for the fabric, recognising this may not fully remove residue
• using washable covers on furniture where possible

Minimising sources of ignition

Emollient-contaminated fabric will not catch fire unless exposed to a source of ignition such as heat or a naked flame. Reduce the risk by:

• keeping emollient-contaminated fabrics away from cookers, heaters and open fires
• avoiding drying emollient-contaminated fabrics near heat sources
• ensure furniture is washable or can be wiped down regularly to avoid becoming saturated with the build up of emollients
• avoiding smoking and naked flames when wearing cream or ointment contaminated clothing
• if stopping smoking is not possible, switching to vaping is likely to reduce risk; faulty lithium batteries can cause ignition, but this is rare
• if the person continues to smoke, consider the use of a fire-resistant smoking apron

Reducing emollient use

Treatment effectiveness is the key consideration. 

Ensure the patient is using their emollient correctly to maximise its effect, this may reduce the quantity required. Using a less effective emollient may lead to increased usage and greater contamination of clothing to fabrics. 

Additional considerations for care providers

The risk of fire varies for each patient who uses emollients or other skin products. Care should always be tailored to the individual. Standard organisational approaches should not replace personalised patient care. 

Organisations should regularly review local policies, clinical guidelines, and protocols to ensure: 

• roles and responsibilities are clearly defined for carrying out individual fire risk assessments for patients using emollients or other skin products 
• healthcare professionals have access to guidance to support individual risk assessments 
• there is clarity on when a documented fire risk assessment is needed for patients at high risk and how often it should be reviewed 
• roles and responsibilities are defined for providing patients with information about fire risks and the actions they can take to reduce those risks 

Organisations that care for vulnerable people may take extra precautions. This is especially important for those who may not understand fire risks or may not be able to take action to reduce them. As a result, these organisations may set a lower threshold for completing detailed, documented fire risk assessments. In these cases, local templates can help staff carry out and record assessments consistently. 

Examples of fire risk assessment templates are available on the NHS Futures MSO workspace. 

Practice example: assessing fire risk

Scenario
A 78-year-old care home resident uses a paraffin based emollient twice daily. The resident smokes, spends long periods in bed or seated, and has mild cognitive impairment.

Key risk factors

• frequent emollient use causing fabric contamination
• smoking providing ignition source
• prolonged contact with clothing and bedding
• reduced awareness and reaction time

Actions

Actions to include:

Note: Responsibility for each action may vary and be undertaken by different members of the multidisciplinary team depending on local processes and available service provision.

• complete and document a personal fire risk assessment, as per local policies and guidance
• if appropriate provide MHRA and National Fire Chiefs Council risk advice and guidance to the patient and care home staff
• advise no smoking or naked flames when wearing contaminated clothing or on contaminated furniture
• arrange smoking cessation support, including NRT or a switch to vaping
• consider the use of risk minimisation equipment such as a smoking apron if the resident wishes to carry on smoking
• increase frequency of clothing and bedding changes
• consider regular checks of bedding, clothing and soft furnishings between scheduled changes, to ensure contamination has not occurred
• ensure staff know how to monitor the resident appropriately, and escalate concerns if advice is not followed
• review with the prescriber where appropriate

Additional resources

Joint guidance from the MHRA and the National Fire Chiefs Council provides information for both healthcare professionals and patients, including safety leaflets to support risk awareness and mitigation.

The Care Quality Commission has issued a learning from safety incident report highlighting the risks associated with emollient use and fire safety in care settings.

Fire and Rescue Services, including London Fire Brigade provide practical advice. They provide person centred fire risk assessments to support local risk management and prevention activity.