M A Y 2 0 1 7 O U T P A T I E N TS U R G E R Y. N E T 2 7
ies have involved placing agar
plates around patients in the OR
during cases when forced-air
warming was used, but none of the
results showed a definitive
increase in bacteria load on the
plates after surgery.
Researchers have also looked at
forced-air warming's impact on lami-
nar airflow patterns in the OR during joint replacement procedures. If laminar flow
is used, airflow around the surgical table should shoot straight down from the ceil-
ing to the floor without bouncing back toward the wound. Some research has sug-
gested forced-air warming interrupts the ideal laminar airflow, but a definitive link
to SSI risk has not yet been shown in rigorous studies. The other issue is that cur-
rent research assessing forced-air warming's impact on laminar airflow has been
conducted in simulated settings without people moving around the OR table and
without a door to an outside hallway opening and closing. Those aren't realistic
methods for assessing unwanted airflow, so I'm not convinced the studies repre-
sent real-life conditions. Effective testing needs to be done in a live operating room
setting, but that would be difficult to accomplish.
Some researchers have suggested the use of alternative warming methods dur-
ing joint replacement procedures until more robust and definitive studies are con-
ducted to assess the safety of forced-air warming, but have stopped short of con-
demning the latter method. It's not unreasonable to follow that advice, but you
must carefully consider the evidence suggesting forced-air warmers cause SSIs.
Ultimately, it's up to you to stay current on the evidence independent
researchers publish in peer-reviewed journals and keep an open mind about
findings that touch on the safety and efficacy of patient warming.
OSM
Dr. Austin (paustin@txwes.edu)
is a professor at Texas Wesleyan
University in Fort Worth, Texas.
• UNDER COVER Forced-air warming coverlets are disposable, light-
weight and easy to apply.