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What’s New in the Patient Safety World

November 2022

Forced-air Warming and Surgical Site Infections



We’ve done many columns on how opening OR doors affects airflow and can potentially lead to surgical site infections (SSI’s). But how about an internal disturbance in air flow? Forced-air warming is commonly utilized in many surgical procedures. Hypothermia is a known risk factor for SSI’s in several types of surgical procedure, so we use forced-air warming to maintain normothermia. A recent study, however, has raised a potential unintended consequence of use of forced-air warming (FAW) devices.


Lange (Lange 2021) noted a study conducted in 2018 revealed that FAW contamination occurs more than expected in the surgical environment. The study demonstrated that 42.5 percent of the 320 samples collected were higher than the minimum accepted pathogen levels. His subsequent retrospective review of surgical cases suggested that the risk for SSI’s is present when FAW is used.


He discussed the findings in an interview with Anesthesiology News (Kronemyer 2022). In that it was noted that “Raising awareness that FAW systems lead to increased risk for contamination should encourage surgical departments to review their disinfection protocols and to identify alternative devices for patient warming, such as blankets, fluid-warming devices and conductive-fiber warming blankets.”


The numbers in the Lange study were small and this was not a randomized controlled trial, so we consider the this to be a pilot finding. And a systematic review in 2018 (Ackermann 2018) found no robust evidence to support that FAW can increase SSI’s.


Nevertheless, we agree that increased surveillance for SSI’s when FAW is used makes sense and attention should be given to disinfection protocols for such devise.


Of course, the other significant unintended consequence of forced-air warming is the potential for burns (Augustine 2002, Chung 2012, Mehta 2013). We also discussed such thermal injuries in several of our prior columns on iatrogenic burns, including our Patient Safety Tips of the Week for December 23, 2014 “Iatrogenic Burns in the News Again” and May 3, 2022 “Iatrogenic Burns Again”. Proper use of the devices is essential.



Our prior columns on iatrogenic burns:






Lange VR. Forced air contamination risk in the OR. Ann Med Surg (Lond). 2021 Nov 6; 73: 102976



Kronemyer B. Forced-Air Warming Systems Linked to Increased Risk For Surgical Site Infections. Anesthesiology News 2022; September 22, 2022


Ackermann W, Fan Q, Parekh AJ, et al. Forced-Air Warming and Resistive Heating Devices. Updated Perspectives on Safety and Surgical Site Infections. Frontiers in Surgery 2018;



Augustine S. Misuse of Forced-Air Warming Devices Causes Burns. APSF Newsletter 2002; 17(1):



Chung K, Lee S, Oh SC, Choi J, Cho HS. Thermal burn injury associated with a forced-air warming device. Korean J Anesthesiol 2012; 62(4): 391-392



Mehta SP. Burn Injuries From Warming Devices in the Operating Room. ASA Newsletter 2013; 77(2): 16-17






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