Infection control hazards of intraoperative forced air warming

Baker, Nicky; King, D.; Smith, E.G.

doi:10.1053/jhin.2002.1226

Cited by 22 publications

(22 citation statements)

References 7 publications

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“…31 Therefore, SSI may result from the implant being contaminated by a few organisms, 32 or in some orthopedic cases even a single Staphylococcus aureus bacterium may be sufficient. 33 Although the present study did not evaluate the link between FAW and SSI rates, the findings in this study and those of others 21–23 suggest that bacteria colonize the internal air path surfaces of the majority of FAW blowers. The findings also suggest that a significant percentage of FAW blowers are emitting particulates, which were shown to originate inside the blowers.…”

Section: Discussioncontrasting

confidence: 56%

“…19 Most FAW devices contain a “0.2 µm rated” intake filter 20 to prevent the devices from becoming internally contaminated and to lessen the mobilization of airborne contamination in the operating room. However, several studies have reported colonization 21–23 on the internal surfaces of the warm-air blower devices and one study was able to repeatedly culture microbes from the blower's airstream; 21 this study recommended the placement of a distal hose end filter to lessen FAW microbial emissions.…”

Section: Introductionmentioning

confidence: 87%

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Forced-air warming: a source of airborne contamination in the operating room?

2009

Orthop Rev

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Forced-air-warming (FAW) is an effective and widely used means for maintaining surgical normothermia, but FAW also has the potential to generate and mobilize airborne contamination in the operating room.We measured the emission of viable and non-viable forms of airborne contamination from an arbitrary selection of FAW blowers (n=25) in the operating room. A laser particle counter measured particulate concentrations of the air near the intake filter and in the distal hose airstream. Filtration efficiency was calculated as the reduction in particulate concentration in the distal hose airstream relative to that of the intake. Microbial colonization of the FAW blower's internal hose surfaces was assessed by culturing the microorganisms recovered through swabbing (n=17) and rinsing (n=9) techniques.Particle counting revealed that 24% of FAW blowers were emitting significant levels of internally generated airborne contamination in the 0.5 to 5.0 µm size range, evidenced by a steep decrease in FAW blower filtration efficiency for particles 0.5 to 5.0 µm in size. The particle size-range-specific reduction in efficiency could not be explained by the filtration properties of the intake filter. Instead, the reduction was found to be caused by size-range-specific particle generation within the FAW blowers. Microorganisms were detected on the internal air path surfaces of 94% of FAW blowers.The design of FAW blowers was found to be questionable for preventing the build-up of internal contamination and the emission of airborne contamination into the operating room. Although we did not evaluate the link between FAW and surgical site infection rates, a significant percentage of FAW blowers with positive microbial cultures were emitting internally generated airborne contamination within the size range of free floating bacteria and fungi (<4 µm) that could, conceivably, settle onto the surgical site.

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Section: Discussioncontrasting

confidence: 56%

Section: Introductionmentioning

confidence: 87%

Forced-air warming: a source of airborne contamination in the operating room?

2009

Orthop Rev

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“…Unlike forced-air warming, there is no consumable associated with use of the heating pad, so the latter is cheaper in long-term use. For forced-air warming, the hose, the warming units and even the brand new commercial blankets have been shown to be potential sources of nosocomial infection [3][4][5]. The heating pad warming system, which comprises a control unit, an electric cable and a heating pad, has no hidden space for bacterial colonisation and is theoretically easier to clean.…”

mentioning

confidence: 99%

A randomised controlled trial of the electric heating pad vs forced‐air warming for preventing hypothermia during laparotomy

Leung¹,

Lai²,

Wu³

2007

Anaesthesia

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SummaryA randomised controlled trial was conducted to compare the efficacy of upper body forced-air warming (Bair Hugger TM , Augustine Medical model 500 ⁄ OR, Prairie, MN) with that of an electric heating pad (Operatherm 202, KanMed, Bromma, Sweden) for maintenance of intraoperative body temperature in 60 patients undergoing laparotomy under general anaesthesia. The nasopharyngeal temperature was recorded throughout the operative period. The mean (SD) final temperatures were 36.2 (0.4)°C with forced-air warming and 35.5 (1.0)°C with electric heating pad (p < 0.01). Upper body forced-air warming is more effective than the heating pad for maintenance of body temperature during laparotomy.

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“…However, although inexpensive, cost remains a concern because the air blanket cannot be reused. Moreover, the hose and the warming unit are potential sites for bacterial colonization, probably due to the difficulty in cleaning these parts [24]. The circulating-water mattress has no hose or hidden spaces, and is easier to clean and disinfect than the forced-air warming system.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the efficacy of a forced-air warming system and circulating-water mattress on core temperature and post-anesthesia shivering in elderly patients undergoing total knee arthroplasty under spinal anesthesia

Kim

Lee

et al. 2014

Korean J Anesthesiol

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BackgroundIn the present study, we compared changes in body temperature and the occurrence of shivering in elderly patients undergoing total knee arthroplasty under spinal anesthesia during warming with either a forced-air warming system or a circulating-water mattress.MethodsForty-six patients were randomly assigned to either the forced-air warming system (N = 23) or circulating-water mattress (N = 23) group. Core temperature was recorded using measurements at the tympanic membrane and rectum. In addition, the incidence and intensity of post-anesthesia shivering and verbal analogue score for thermal comfort were simultaneously assessed.ResultsCore temperature outcomes did not differ between the groups. The incidence (13.0 vs 43.5%, P < 0.05) and intensity (20/2/1/0/0 vs 13/5/3/2/0, P < 0.05) of post-anesthesia shivering was significantly lower in the forced-air system group than in the circulating-water mattress group.ConclusionsThe circulating-water mattress was as effective as the forced-air warming system for maintaining body temperature. However, the forced-air warming system was superior to the circulating-water mattress in reducing the incidence of post-anesthesia shivering.

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Infection control hazards of intraoperative forced air warming

Cited by 22 publications

References 7 publications

Forced-air warming: a source of airborne contamination in the operating room?

Forced-air warming: a source of airborne contamination in the operating room?

A randomised controlled trial of the electric heating pad vs forced‐air warming for preventing hypothermia during laparotomy

Comparison of the efficacy of a forced-air warming system and circulating-water mattress on core temperature and post-anesthesia shivering in elderly patients undergoing total knee arthroplasty under spinal anesthesia

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