Patient warming to maintain perioperative normothermia reduces temperature-related complications, improves postoperative results, and shortens patient stays.1,2,3 Forced-air warming (FAW) devices introduce bacteria into environments, increasing contamination and surgical-site infection (SSI) risks. Studies point to a surface-component contamination and tissue-air risk connection.4,5,6 Research sought new FAW-bacteria correlation data to better understand FAW-use risks and improve infection-control protocols that mitigate or diminish healthcare-associated infection (HAI) risk. Objectives address AORN Guidelines to prevent and reduce the incidence of SSIs, HAIs, and other adverse events related to surgical patients. Surface and air samples were collected from 35 FAW devices used in varying procedures (e.g., gensurg, total joint, hernia, etc.) in operating rooms (ORs) at associated hospitals. Surface samples were from the internal hose, and proximal and distal hose ends. Samples were bagged, plated, and incubated under sterile procedures. Of 320 samples, 24.4% had higher-than-maximum-acceptable colony-forming unit (CFU) pathogen levels and 42.5% had higher-than-minimum-acceptable CFU pathogen levels, including 37.2% of equipment samples and 5.3% of air samples. Due to the high volume found of Staph epidermidis and volumes of Staph aureus, Staph pyogenes, Corynebacterium spp. and Propionibacterium spp., OR theater air-quality monitoring and HEPA-filter and FAW-unit maintenance may not adequately prevent microorganism communication and transmission. Data identified a correlation of positive airborne samples for instances with high-pathogen contamination in warmer-temperature components. No correlation was found by surgery type. FAW device-component contamination may be a heightened risk in the OR. Cross-contamination remains a risk. A reduction in surface and airborne CFUs may positively reduce SSI and HAI risk. Clinical intervention studies have proven beneficial outcomes.7 Nursing and infection-prevention practitioners would benefit from further consideration. Ongoing vigilance and collaboration is a must. 1 Kurz A et al. Study of wound infections and temperature group: perioperative normothermia to reduce incidence of surgical-wound infection and shorten hospitalization. NEJM. 1996; 334:1209-15. 2 Madrid E et al. Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults. Cochrane Library. 2016. 3 Broessner G et al. Complications of hypothermia: infections. Critical Care. 2012; 16(S2):A19. 4 Legg AJ and Hamer AJ. Forced-air patient warming blankets disrupt unidirectional airflow. Bone Joint J. 2013 Mar; 95-B (3):407-10. 5 McGovern PD et al. Forced-air warming and ultra-clean ventilation do not mix: an investigation of theatre ventilation, patient warming and joint replacement infection in orthopaedics. J Bone Joint Surg Br. 2011 Nov; 93(11):1537-44. 6 Albrecht M et al. Forced-air warming: a source of airborne contamination in the operating room? Orthop Rev (Pavia). 2009 Oct 10; 1(2):e28. 7 Darouiche RO, et al. Infect Control Hosp Epidemiol. 2016;doi:10.1017/ice.2016.240.
Disclosure(s): Victor Lange - Encompass Group - Consultant/Speakers' Bureau