Journal of Hospital Infection: Forced-air Warming An Infection-Control “Hazard” in Ortho Surgery

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.
MINNEAPOLIS - Nov. 12, 2014 - PRLog -- “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

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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