Infection control hazards associated with the use of forced-air warming in operating theatres

Journal of Hospital Infection

Volumn 88, Issue 3, 2014, Pages 132-140

  Wood, A M ^a   Moss, C ^a   Keenan, A ^b   Reed, M R ^a   Leaper, D J ^c  

^a NORTHUMBRIA HEALTHCARE NHS FOUNDATION TRUST   (United Kingdom)

^b ROYAL INFIRMARY OF EDINBURGH   (United Kingdom)

^c UNIVERSITY OF HUDDERSFIELD   (United Kingdom)

Author keywords

Forced air warming; Perioperative hypothermia; Surgical site infection

Indexed keywords

AIR; AIR CONDITIONING; ARTICLE; CONTAMINATION; FORCED AIR WARMING; HUMAN; HYPOTHERMIA; INFECTION CONTROL; INFECTION RATE; INFECTION RISK; OPERATING ROOM; SURGEON; SURGICAL INFECTION; ULTRACLEAN VENTILATION; WARMING; HEATING; MICROCLIMATE; PROCEDURES; RISK FACTOR; SURGICAL WOUND INFECTION;

ENVIRONMENT, CONTROLLED; HEATING; HUMANS; HYPOTHERMIA; INFECTION CONTROL; OPERATING ROOMS; RISK FACTORS; SURGICAL WOUND INFECTION; VENTILATION;

EID: 84927511746     PISSN: 01956701     EISSN: 15322939     Source Type: Journal    
DOI: 10.1016/j.jhin.2014.07.010     Document Type: Review

References (70)

1. Frank S.M., Fleisher L.A., Breslow M.J., et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA 1997, 14:1127-1134.
2. Bush H.L., Hydo L.J., Fischer, et al. Hypothermia during elective abdominal aortic aneurysm repair: the high price of avoidable morbidity. JVasc Surg 1995, 3:392-402.
3. Brown-Mahoney C., Odom J. Maintaining intraoperative normothermia: a meta-analysis of outcomes with costs. Am Assoc Nurse Anesth J 1999, 67:155-163.
4. Kurz A., Sessler D.I., Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. NEngl J Med 1996, 334:1209-1215.
5. Melling A.C., Ali B., Scott E.M., Leaper D.J. Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomised controlled trial. Lancet 2001, 358:876-880.
6. Charnley J., Eftekhar N. Post-operative infection in total prosthetic replacement arthroplasty of the hip-joint. With special reference to the bacterial content of the air of the operating room. Br J Surg 1969, 56:641-649.
7. Lidwell O.M., Lowbury E.J., Whyte W., et al. Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomised study. BMJ (Clin Res Ed) 1982, 3285:10-14.
8. Lidwell O.M. Clean air at operation and subsequent sepsis in the joint. Clin Orthop Related Res 1986, 211:91-102.
9. Gristina A.G., Naylor P., Myrvik Q. Infections from biomaterials and implants: a race for the surface. Med Prog Technol 1989, 14:205-224.
10. Subbiahdoss G., Kuijer R., Grijpma D.W., Van der Mei H.C., Busscher H.J. Microbial biofilm growth vs. tissue integration: "the race for the surface" experimentally studied. Acta Biomater 2009, 5:1399-1404.
11. Department of Health Heating and ventilation systems. Heath Technical Memorandum 03-01: specialised ventilation for healthcare premises November 2007, DH, London.
12. Mangram A.J., Horan T.C., Pearson M.L., Silver L.C., Jarvis W.R. Guideline for prevention of surgical site infection, 1999. The Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1999, 27:97-134.
13. McGovern P.D., Albrecht M., Belani K.G., 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. JBone Joint Surg (Br) 2011, 93:1537-1544.
14. Nelson J.P., Glassburn A.R., Talbott R.D., McElhinney J.P. The effect of previous surgery, operating room environment, and preventive antibiotics on post-operative infection following total hip arthroplasty. Clin Orthop Relat Res 1980, 147:167-169.
15. Friberg B.E., Burman L.G., Friberg S. Zoned exponential, vertical and horizontal ultra-clean laminar airflows. No differences in bacteriological efficiency. Acta Orthop Scand 1998, 69:169-172.
16. Ahl T., Dalen N., Jorbeck H., Hoborn J. Air contamination during hip and knee arthroplasties. Horizontal laminar flow randomized vs. conventional ventilation. Acta Orthop Scand 1995, 66:17-20.
17. Hubble M.J., Weale A.E., Perez J.V., Bowker K.E., MacGowan A.P., Bannister G.C. Clothing in laminar-flow operating theatres. JHosp Infect 1996, 32:1-7.
18. National Institute of Cinical Health and Excellence. Clinical Guideline 65 Inadvertent perioperative hypothermia. The management of inadvertent perioperative hypothermia in adults 2008, NICE, London.
19. Humphreys H. Infection control and the design of a new operating theatre suite. JHosp Infect 1993, 23:61-70.
20. Bennett J., Ramachandra V., Webster J., Carli F. Prevention of hypothermia during hip surgery: effect of passive compared with active skin surface warming. Br J Anaesth 1994, 73:180-183.
21. Hubble M.J. Clothing in laminar flow operating theatres. JHosp Infect 1996, 32:1-7.
22. Welch T.C. AANA journal course. Update for nurse anesthetists. A common sense approach to hypothermia. Am Assoc Nurse Anesth J 2002, 70:227-231.
23. Shanks C.A. Humidification and loss of body heat during anaesthesia. II: Effects in surgical patients. Br J Anaesth 1974, 46:863-866.
24. Scott E.M., Leaper D.J., Clark M., Kelly P.J. Effects of warming therapy on pressure ulcers - a randomized trial. AORN J 2001, 73:921-933.
25. Casati A., Fanelli G., Ricci A., et al. Shortening the discharging time after total hip replacement under combined spinal/epidural anesthesia by actively warming the patient during surgery. Minerva Anesthesiol 1999, 65:507-514.
26. Moola S., Lockwood C. The effectiveness of strategies for the management and/or prevention of hypothermia within the adult perioperative environment: systematic review. JBI Libr Systematic Rev 2010, 8:752-792.
27. Valeri R.C., Feingold H., Cassidy G., et al. Hypothermia-induced reversible platelet dysfunction. Ann Surg 1987, 205:175-181.
28. Morrison R.C. Hypothermia in the elderly. Int Anesthesiol Clin 1988, 26:124-133.
29. Reed R.L., Johnson T.D., Hudson J.D., Fischer R.P. The disparity between hypothermic coagulopathy and clotting studies. JTrauma 1992, 33:465-470.
30. Widman J., Hammarqvist F., Sellden E. Amino acid infusion induces thermogenesis and reduces blood loss during hip arthroplasty under spinal anesthesia. Anesth Analg 2002, 95:1757-1762.
31. Heier T., Caldwell J.E., Sessler D.I., Miller R.D. Mild intraoperative hypothermia increases duration of action and spontaneous recovery of vecuronium blockade during nitrous oxide-isoflurane anesthesia in humans. Anesthesiology 1991, 74:815-819.
32. Freysz M., Timour Q., Mazze R.I., et al. Potentiation by mild hypothermia of ventricular conduction disturbances and re-entrant arrhythmias induced by bupivacaine in dogs. Anesthesiology 1989, 70:799-804.
33. Sessler D.I. Complications and treatment of mild hypothermia. Anesthesiology 2001, 95:531-543.
34. Jönsson K., Hunt T.K., Mathes S.J. Oxygen as an isolated variable influences resistance to infection. Ann Surg 1988, 208:783-787.
35. Klebanoff S.J. Oxygen metabolism and the toxic properties of phagocytes. Ann Intern Med 1980, 93:480-489.
36. Prockop D.J., Kivirikko K.I., Tuderman L., Guzman N.A. The biosynthesis of collagen and its disorders. NEngl J Med 1979, 301:13-23.
37. Sheffield C.W., Sessler D.I., Hunt T.K. Mild hypothermia during isoflurane anesthesia decreases resistance to E.coli dermal infection in guinea pigs. Acta Anaesthesiol Scan 1994, 38:201-205.
38. Berard F., Gandon J. Postoperative wound infections: the influence of ultraviolet irradiation of the operating room and of various other factors. Ann Surg 1964, 160(Suppl. 1):1-192.
39. Centers for Disease Control and Prevention/National Healthcare Safety Network. Protocol clarifications; July 2013.
40. Giesbrecht G.G., Ducharme M.B., McGuire J.P. Comparison of forced-air patient warming systems for perioperative use. Anesthesiology 1994, 80:671-679.
41. Moretti B., Larocca A.M., Napoli C., et al. Active warming systems to maintain perioperative normothermia in hip replacement surgery: a therapeutic aid or a vector of infection?. JHosp Infect 2009, 73:58-63.
42. Sigg D.C., Houlton A.J., Iaizzo P.A. The potential for increased risk of infection due to the reuse of convective air-warming/cooling coverlets. Acta Anaesthesiol Scand 1999, 43:173-176.
43. Brandt S., Oguz R., Huttner H., et al. Resistive-polymer versus forced-air warming: comparable efficacy in orthopedic patients. Anesth Analg 2010, 110:834-838.
44. Sessler D.I., Schroeder M. Heat loss in humans covered with cotton hospital blankets. Anesth Analg 1993, 73:1046-1054.
45. Sessler D.I., McGuire J., Sessler A.M. Perioperative thermal insulation. Anesthesiology 1991, 74:875-879.
46. Matsuzaki Y., Matsukawa T., Ohki K., et al. Warming by resistive heating maintains perioperative normothermia as well as forced air heating. Br J Anaesth 2003, 90:689-691.
47. Sessler D.I. Temperature monitoring and perioperative thermoregulation. Anesthesiology 2008, 109:318-338.
48. Negishi C., Hasegawa K., Mukai S., et al. Resistive-heating and forced-air warming are comparably effective. Anesth Analg 2003, 96:1683-1687.
49. Kimberger O., Held C., Stadelmann K., et al. Resistive polymer versus forced-air warming: comparable heat transfer and core rewarming rates in volunteers. Anesth Analg 2008, 107:1621-1626.
50. Hynson J.M., Sessler D.I. Intraoperative warming therapies: a comparison of three devices. JClin Anaesth 1992, 4:194-199.
51. Giuffre M., Heidenreich T., Pruitt L. Rewarming cardiac surgery patients: radiant heat versus forced warm air. Nursing Res 1994, 43:144-146.
52. National Institute for Health and Care Excellence. Guidelines, MTG7 Inditherm patient warming mattress for the prevention of inadvertent hypothermia August 2011, NICE, London.
53. Albrecht M., Gauthier R., Leaper D. Forced-air warming: a source of airborne contamination in the operating room?. Orthop Rev 2009, 1:e28.
54. Bayazit Y., Sparrow E.M. Energy efficiency comparison of forced air warming. Energy 2010, 35:1211-1215.
55. Chow T.T., Yang X.Y. Ventilation performance in the operating theatre. JHosp Infect 2004, 56:85-92.
56. Darsai K.B., Albrecht M., Harper M. Effect of forced air warming on the performance of operating theatre laminar flow ventilation. Anesthesia 2012, 67:244-249.
57. Belani K.G., Albrecht M., McGovern P.D., Reed M., Nachtsheim C. Patient warming excess heat: the effects on orthopedic operating room ventilation performance. Anesth Analg 2013, 117:406-411.
58. Legg A.J., Hamer A.J. Forced-air patient warming blankets disrupt unidirectional airflow. Bone Joint J 2013, 95-B:407-410.
59. Legg A.J., Cannon T., Hamer A.J. Do forced air patient-warming devices disrupt unidirectional downward airflow?. JBone Joint Surg (Br) 2012, 94:254-256.
60. Sessler D.I., Olmsted R.N., Kuelpmann R. Forced air warming does not worsen air quality in laminar flow operating rooms. Anaesth Analg 2011, 113:1416-1421.
61. Albrecht M., Gauthier R.L., Belani K., Litchy M., Leaper D. Forced-air warming blowers: an evaluation of filtration adequacy and airborne contamination emissions in the operating room. Am J Infect Control 2011, 39:321-328.
62. Reed M., Kimberger O., McGovern P.D., Albrecht M.C. Forced-air warming design: evaluation of intake filtration, internal microbial build-up and airborne-contamination emissions. Am Assoc Nurse Anesth J 2013, 81:275-280.
63. Bernards A.T., Harinck H.I., Dijkshoorn L., Van Der Reijden T.J., Van Den Broek P.J. Persistent Acinetobacter baumannii? Look inside your medical equipment. Infect Control Hosp Epidemiol 2004, 25:1002-1004.
64. Baker N., King D., Smith E.G. Infection control hazards of intraoperative forced air warming. JHosp Infect 2002, 51:153-154.
65. Avidan M.S., Jones N., Ing R., Khoosal M., Lundgren C., Morrell D.F. Convection warmers - not just hot air. Anaesthesia 1997, 52:1073-1076.
66. Tumia N., Ashcroft G.P. Convection warmers - a possible source of contamination in laminar flow theatre?. JHosp Infect 2002, 52:171-174.
67. Huang J.K., Shah E.F., Cinodkumar N., Hegarty M.A., Greatorex R.A. The Bair Hugger patient warming system in prolonged vascular surgery: an infection risk?. Crit Care 2003, 7:R13-R16.
68. Sharp R.J., Chesworth T., Fern E.D. Do warming blankets increase bacterial counts in the operating field in a laminar-flow theatre?. JBone Joint Surg Br 2002, 84:486-488.
69. Zink R.S., Iazzo P.A. Convection warming therapy does not increase the risk of wound contamination in the operating room. Anesth Analg 1993, 76:50-53.
70. Kellam M., Dieckmann L.S., Austin P.N. Forced-air warming devices and the risk of surgical site infections. AORN J 2013, 98:353-366.