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Is Your Hospital Seeking to Reduce Infection Risk? Eliminate Forced-Air Warming in the OR

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By Kristy Warren
Director, Clinical Resources
Encompass Group, LLC

Forced-air warming (FAW) is a commonly used method to maintain patient normothermia in the operating room (OR) to minimize associated surgical complications. However, questions about the safety of forced air in the OR continue to emerge. In the past 20 years, numerous studies have looked at the use of FAW devices in surgical suites and their potential for increasing contamination and surgical-site infection (SSI) risks. Research has pointed to both surface-component contamination and tissue-air risk connection.


Now, strategic regulatory compliance expert and healthcare epidemiologist Victor R. Lange, JD, MSPH, MS, BS, BA, ICP, CRC, CRA, has demonstrated through retrospective research that FAW may indeed lead to a higher environmental bacterial load and therefore greater infection risk — even when the FAW units are properly managed. 

As part of their overall safety planning process, hospitals and health systems should seriously consider the implications of Lange’s findings. And perhaps it’s time for patients to know more about the risks beyond the surgical procedures they undergo and how medical facilities could better mitigate post-surgical infections starting in the operating room.

Lange’s Research Connected the Dots

A 2018 study showed that forced-air warming contamination occurs more than anticipated in the surgical environment. It demonstrated that 42.5 percent of the 320 samples collected revealed higher than minimum accepted pathogen levels. That research identified Staphylococcus epidermidis as the primary bacterium. Other pathogens included Staphylococcus aureus, Staphylococcus pyogenes, Micrococcus spp., Corynebacterium spp., and Propionibacterium.

Lange’s findings, published in this month’s Annals of Medicine and Surgery, retroactively correlated the samples collected in the 2018 analysis with evidence of any associated SSIs. His research revealed significant instances of resulting surgical site infections:

  • 3.4 percent of OB/GYN cases
  • 5.6 percent of colon cases
  • 1.4 percent of GI cases
  • 5.3 percent of amputation cases.

Lange noted in his study that SSIs continue to cause substantial morbidity, prolonged hospitalization, and death, pointing out that three-fourths of SSI-associated deaths are directly attributable to SSI’s. Surgical site infections are also extremely costly to hospitals each year in terms of additional inpatient days (nearly one million) and expenses (3.3 billion dollars). Lange concluded, “FAW device-component contamination is a real risk in the OR. Cross-contamination of the environment is a risk factor.” 

Hospitals Must Examine All Risks, Including FAW

According to an article in Patient Safety in Surgery, “Quality improvement efforts aimed to enhance patient safety should include the implementation of healthcare equipment with the least known or suspected risk.” In the case of surgical suite equipment, this means hospitals still using forced-air warming should evaluate alternate options for maintaining perioperative patient normothermia. There are additional steps these healthcare facilities can take:

  • Continue to track and trend data and patient outcomes with surgical site infections, performing root cause analysis to identify contributing factors
  • Periodically sample or culture the forced-air warming units, including the hose distal, proximal and internal.
  • Create a plan to assess the air filtration system, guided by patient volume or usage rather than by date if possible.
  • Evaluate the movement of air potentially disrupting the laminar airflow.

Surgical Patients Should Question Providers

Consumers have the right to inquire about the process surrounding any procedure, both outside and inside the OR environment. Which professionals will be present? What instruments will be used? What anesthesia will be administered? What steps will be taken to keep the patient and the surgical team safe? Yes, it’s ideal for a patient to maintain normal body temperature before, during and after surgery. But should normothermia be attained at the risk of an SSI? 

Suppose forced-air warming is a facility’s only method to keep patients warm during surgical procedures. In that case, patients may want to ask about their post-surgical odds of infection or the possibility of having the surgery at another hospital not using FAW. If these inquiries proliferate, surgeons and healthcare providers may be driven to consider air-free warming methods to protect their quality and safety ratings — and reputations.

Safety Must Come First

Lange’s study found that hospitals using forced-air warming could not adequately prevent microorganism transmission and cross-contamination, despite OR air-quality monitoring and HEPA-filter or FAW-unit maintenance. Given this latest evidence, it’s time for healthcare facilities to evaluate new technology to remove the possibility of cross-contamination: one that does not disrupt air, does not emit excess heat, that’s disposable and supports maintaining normothermia before, during and after surgery. They owe it to their patients and their staff!

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