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warming should continue or resume in recovery until a normothermic tem-
perature is documented.
5. Can forced-air warming be blamed for SSIs?
Importantly, this has been proposed as a concern only for patients undergoing
total joint replacements. The evidence that I've reviewed shows there is little
risk of infection if forced-air warming units are used according to the manufac-
turers' directions and proper cleaning methods are employed
(osmag.net/Qv5NBj). In addition, ECRI Institute, an independent healthcare
device research firm in Plymouth Meeting, Pa., conducted a review of existing
studies and says there is insufficient evidence to suggest forced-air warming
causes SSIs. However, others have called for not using any device in the operat-
ing room that blows air.
Three observational studies have addressed the issue: 2 showed forced-air
warming did not increase risk of SSIs and 1 study did suggest a link. The study
that implicated forced-air warming was conducted over a number of years and
showed an increased risk in orthopedic patients. There were, however, a num-
ber of problems with how the study was conducted. The researchers did not
identify several key factors: patients' physical status; whether patients had been
incontinent post-op, which can increase infection risk in total hip patients; and
incidence of blood transfusions. The antibiotic regimen employed by the surgi-
cal teams also changed over the study period. Should you disregard an effica-
cious warming method based on the results of a study with questionable
methodology? I'm not so sure.
There are other indirect methods that have been used to assess a possible link
between SSIs and forced-air warming. One way is to look at bacteria counts on
surfaces of forced-air warming units and in a unit's air path. Researchers who
have cultured surfaces and air paths have found evidence of bacteria, but a
causal link between the bacteria and SSIs has not been made. Another method
involves looking at bacteria counts in and around the surgical wound. Five stud-
