Journal of Hospital Infection: Forced-Air Warming An Infection-Control "Hazard" in Implant Surgery

StopSurgicalInfections.org recently submitted a press release regarding a review article published by Journal of Hospital Infection.  The press release is as follows:

Surgical-infection experts have unambiguously concluded that forced-air warming “...does contaminate ultra-clean air ventilation….” in the operating room. Their advice: Use air-free warming during implant surgery.

PRLog - Nov. 12, 2014 - MINNEAPOLIS -- “Infection Control Hazards Associated with the Use of Forced-air Warming in Operating Theatres," appears in the scientific publication of the Healthcare Infection Society, Journal of Hospital Infection. The article, in press, can be found on-line at www.journalofhospitalinfection.com/article/S0195-6701%2814%2900245-X/abstract?showall=true=

The authors, including surgeon D.L. Leaper, chair of the committee that drafted the UK’s surgical-site infection guidelines, summarized the findings of 10 peer-reviewed, published studies regarding the infection risks of forced-air warming.  Their conclusions:

• No studies have shown that forced-air warming (“FAW”) reduces surgical infections—other than in colorectal surgery.
• In implant surgery, even minor contamination of the operative field can be catastrophic.
• FAW devices contaminate the operative field.

The published research reviewed includes one study showing a three-fold decrease in deep joint infections when air-free warming was used instead of FAW,¹ one showing a 217,000% increase in contamination over the wound site when Bair Hugger FAW was used,² and another showing that 96% of Bair Hugger FAW blowers emitted significant levels of contaminants.³  “This concern is reinforced,” the authors said, “by case reports in which Acinetobacter baumannii has been found in the dust filters of FAW systems after outbreaks of this resistant organism.”

Supporting their recommendation of the use of air-free warming, the authors also noted that such devices are noiseless, re-usable, can cover a large percentage of the patient’s body and may offer a cost advantage.  The authors dismissed water mattresses and water blankets, saying that they “are rarely used and have limited efficacy in the operative setting.”

The recommendation by surgeons in the Journal of Hospital Infection contradicts that which appeared in the April 2013 issue of Health Devices.  In that article, ECRI Institute reviewed the published research related to the risks of FAW and chose not to recommend that FAW be banned in all ultra-clean surgeries. Under the headline “FORCED-AIR WARMING MAY DISTURB AIR PATTERNS IN THE OPERATING ROOM,” however, ECRI did conclude that the use of FAW in orthopedic surgery was “particularly worrisome” and “especially concerning.”

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About StopSurgicalInfections.org:

StopSurgicalInfections.org exists for the purpose of communicating with healthcare providers, infection control specialists, insurers, risk managers, and other interested parties regarding the risk and consequences of surgical site infections. StopSurgicalInfections.org is underwritten by Augustine Temperature Management and other healthcare-related organizations.

About the Healthcare Infection Society:

According to their website, “the Healthcare Infection Society (HIS) is a charity (no.1158172) whose objectives are to advance knowledge of, foster scientific interest in and disseminate information about the prevention and control of hospital and other healthcare associated infections (HCAIs), to medical and allied professionals for the benefit of the public."

Citations To Studies Regarding The Safety Of Forced-Air Warming:

1. McGovern et al. Forced-air warming and ultra-clean ventilation do not mix. J Bone and Joint Surg-Br. 2011;93(11):1537-1544.
2.  Legg, A.J. and Hamer, A.J. Forced-air patient warming blankets disrupt unidirectional airflow. Bone and Joint Journal, March 2013 vol. 95-B no. 3 407-410.

3. Albrecht M, Leaper D et al. Forced-air warming blowers: An evaluation of filtration adequacy and airborne contamination emissions in the operating room. Am J Infect Control 2011;39:321-8.