General Assembly, Prevention, Operating Room Environment: Proceedings of International Consensus on Orthopedic Infections

Reducing Implant Infection in Orthopaedics (RIIiO): Results of a pilot study comparing the influence of forced air and resistive fabric warming technologies on postoperative infections following orthopaedic implant surgery

“…LAF is currently used in more than 60% of hospitals in the UK [5] but it is costly, there are reservations about its effectiveness in preventing infection [6][7][8][9][10], and there is some suggestion that it may even cause harm [10 11]. Despite limited evidence, an International Consensus meeting on prosthetic joint infections concluded that LAF is no longer considered necessary [12]. It is not currently recommended by the World Health Organization (WHO) [13] for reducing the risk of infection during arthroplasty surgery and it is no longer advised by some in new build operating theatres [7].…”

“…In addition, disruption of LAF by FAW has been shown in studies with neutral-buoyancy detergent bubbles [27 34], high-fidelity predictive fluid flow simulations [35] and modelling of temperature gradients [36]. An International Consensus meeting discussed these issues but agreed there was no direct evidence to definitively link FAW with an increased risk of SSIs [12], similar to several reviews on this topic [37][38][39][40]. In the absence of a large-scale trial, therefore, this controversy is likely to remain unanswered.…”

Intraoperative and Postoperative Infection Prevention

“…Similarly, Wang et al [36] showed that the risk of infection increased by an odds ratio of 1.34 for 90-day SSI and 1.25 for 1-year PJI with each 20-minute increase in operative time. While prolonged operative time may be the result of a considerable and inescapable level of complexity of the surgery, the second ICM concluded that "coordinated efforts to reduce the operative time without technically compromising the procedure can provide additional benefits for infection prevention" [38].…”

“…These studies have led the WHO to a conditional recommendation that LAF should not be used to reduce the risk of SSI for patients undergoing TJA [46]. Experts at the second ICM also concluded that the orthopedic literature has not demonstrated that the use of LAF reduces SSI or PJI in orthopedic surgery, and at this time, "it is not necessary to perform a clean orthopedic surgery procedure, including elective joint replacement surgery, in an operating theater equipped with LAF systems" [38].…”

“…The means of achieving normothermia can include the use of intraoperative warming devices and the administration of prewarmed intravenous fluids [74]. However, it is important to note that recommendations are largely based on nonarthroplasty literature, and the most effective strategy to achieve perioperative normothermia remains unknown [38].…”