Forced-Air Warming and Surgical Site Infections: Our Review Finds Insufficient Evidence to Support Changes in Current Practice

Maintaining normothermia during surgery is an important measure in preventing surgical site infections (SSIs). Several technologies are available to accomplish this during surgery, including the popular method of forced-air warming (FAW). Recently, however, some member hospitals have asked us about FAW and whether it might actually contribute to SSIs. Specifically, their questions were focused on whether the use of FAW during surgery (including orthopedic implant surgery) leads to an increased rate of SSIs as compared to the use of other methods of patient warming and, if so, whether such concerns merited discontinuing the use of FAW during surgery. In response to these questions, ECRI Institute has conducted an assessment of the published literature to determine whether the evidence supports a decision not to use FAW.

Based on our assessment, we do not believe that the currently available evidence justifies discontinuing the use of FAW during surgery. This article explains our reason for this judgment.

Maintaining normothermia in surgery patients has been reported to significantly lower the risk of postoperative surgical wound infections (Kurz et al. 1996, Melling et al. 2001). Hypothermia triggers vasoconstriction, ultimately resulting in a reduction of the partial pressure of oxygen in tissue. This in turn impairs the body’s ability both to fight infection at the wound site and to promote wound healing. Maintenance of body temperature during and after surgery is recommended in practice guidelines by a variety of organizations, including the Centers for Disease Control and Prevention, Guideline for Prevention of Surgical Site Infection, 1999; the American Society of Anesthesiologists, Practice Guidelines for...