Convection warmers—a possible source of contamination in laminar airflow operating theatres?

Tumia, Nezar; Ashcroft, G. W.

doi:10.1053/jhin.2002.1297

Cited by 49 publications

(37 citation statements)

References 5 publications

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“…1,2,7 The scientific community generally accepts that laminar flow of ultraclean air and the use of HEPA filters over a relatively large area creates a field of air intended to isolate the surgical area and team and that these factors help prevent the development of SSIs. 25,26 All of the interventions carried out in our study met these basic conditions to prevent SSIs.…”

Section: Environmental Biosafety Factorsmentioning

confidence: 99%

“…7 Another possible factor is the fact that the operative attire of the staff was limited to the operating room.…”

Section: Environmental Biosafety Factorsmentioning

confidence: 99%

“…4 These include more effective surgical sterilization procedures, laminar flow, high-efficiency particulate absorbing (HEPA) filters, ultraviolet radiation, air renewal, humidity control, differential temperature and air pressure, particle count, surface colony count and antibiotic prophylaxis. [5][6][7][8] However, other factors, such as decreased length of hospital stay, and more aggressive interventions performed on patients with worse clinical conditions, probably contribute to an increased incidence of SSIs.…”

mentioning

confidence: 99%

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Analyzing the risk factors influencing surgical site infections: the site of environmental factors

Martínez

Martín-Moreno

et al. 2017

CJS

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Background: Addressing surgical site infection (SSI) is accomplished, in part, through studies that attempt to clarify the nature of many essential factors in the control of SSI. We sought to examine the link between multiple risk factors, including environmental factors, and SSI for prevention management. Methods:We conducted a longitudinal prospective study to identify SSIs in all patients who underwent interventions in 2014 in 8 selected hospitals on the Mediterranean coast of Spain. Risk factors related to the operating theatre included level of fungi and bacterial contamination, temperature and humidity, air renewal and differential air pressure. Patient-related variables included age, sex, comorbidity, nutrition level and transfusion. Other factors were antibiotic prophylaxis, electric versus manual shaving, American Society of Anaesthesiologists physical status classification, type of intervention, duration of the intervention and preoperative stay.Results: Superficial SSI was most often associated with environmental factors, such as environmental contamination by fungi (from 2 colony-forming units) and bacteria as well as surface contamination. When there was no contamination in the operating room, no SSI was detected. Factors that determined deep and organ/space SSI were more often associated with patient characteristics (age, sex, transfusion, nasogastric feeding and nutrition, as measured by the level of albumin in the blood), type of intervention and preoperative stay. Antibiotic prophylaxis and shaving with electric razor were protective factors for both types of infection, whereas the duration of the intervention and the classification of the intervention as "dirty" were shared risk factors. Conclusion:Our results suggest the importance of environmental and surface contamination control to prevent SSI.Contexte : La lutte contre les infections du site opératoire (ISO) passe entre autres par des études visant à clarifier la nature de nombreux facteurs essentiels de contrôle. Nous avons donc cherché à examiner le lien entre divers facteurs de risque, notamment de nature environnementale, et les ISO, dans une optique de prévention.

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Section: Environmental Biosafety Factorsmentioning

confidence: 99%

“…7 Another possible factor is the fact that the operative attire of the staff was limited to the operating room.…”

Section: Environmental Biosafety Factorsmentioning

confidence: 99%

mentioning

confidence: 99%

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Analyzing the risk factors influencing surgical site infections: the site of environmental factors

Martínez

Martín-Moreno

et al. 2017

CJS

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“…Furthermore, two trials involving colorectal and clean-site surgery have also shown that the use of forced-air warming significantly reduces surgical site infection risk [6,74], although neither study stipulated whether or not laminar flow theatres were used. An interesting study sampling air in the operative field of laminar flow theatres showed small increases in colony-forming units when forced-air warmers were turned on, although the authors deemed these unlikely to have clinical significance [75]. In fact, the effectiveness of laminar flow at reducing infections has recently been called into question [76].…”

Section: Forced-air Warming Device Safetymentioning

confidence: 99%

Peri‐operative warming devices: performance and clinical application

2014

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SummarySince the adverse consequences of accidental peri-operative hypothermia have been recognised, there has been a rapid expansion in the development of new warming equipment designed to prevent it. This is a review of peri-operative warming devices and a critique of the evidence assessing their performance. Forced-air warming is a common and extensively tested warming modality that outperforms passive insulation and water mattresses, and is at least as effective as resistive heating. More recently developed devices include circulating water garments, which have shown promising results due to their ability to cover large surface areas, and negative pressure devices aimed at improving subcutaneous perfusion for warming. We also discuss the challenge of fluid warming, looking particularly at how devices' performance varies according to flow rate. Our ultimate aim is to provide a guide through the bewildering array of devices on the market so that clinicians can make informed and accurate choices for their particular hospital environment.

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“…Forced air warming, or water garments, as well as appropriate passive insulation and an increased ambient temperature of the operating room are recommended. With forced air warming devices, there has been some concern that the devices may increase the spread of bacteria in the operating room however; this does not seem to increase the incidence of surgical site infections [66][67][68]. The SCIP measurement also suggests warming intravenous (IV) fluids [1], though the use of warmed IV fluids as a sole intervention to treat or prevent hypothermia has been shown to be ineffective [20].…”

Section: Scip Measurement and Maintenance Of Normothermiamentioning

confidence: 99%

Perioperative temperature measurement and management: moving beyond the Surgical Care Improvement Project

Sappenfield¹,

Hong²,

Galvagno³

2013

J Anesthesiol Clin Sci

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Intraoperative management of patient body temperature is a standard of care for practicing anesthesiologists. Merely complying with the Surgical Care Improvement Project (SCIP) measurement is inadequate for optimizing perioperative outcomes. Clinicians should have a sound understanding of available temperature monitoring sites, deleterious effects of hypothermia, and indications for therapeutic hypothermia. This foundation will help physicians use indicated modalities to improve patient outcomes throughout the perioperative period. The purpose of this paper is to review appropriate intraoperative temperature monitoring, the importance of maintaining normothermia, and indications for intraoperative hypothermia.

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Convection warmers—a possible source of contamination in laminar airflow operating theatres?

Cited by 49 publications

References 5 publications

Analyzing the risk factors influencing surgical site infections: the site of environmental factors

Analyzing the risk factors influencing surgical site infections: the site of environmental factors

Peri‐operative warming devices: performance and clinical application

Perioperative temperature measurement and management: moving beyond the Surgical Care Improvement Project

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