Evidence is Inconclusive that Forcedair Warming Devices Increase Surgical Site Contamination or Infection

  • Ashley Bonner, SRNA Texas Christian University, Fort Worth Texas
  • Mark Welliver, DNP, CRNA, ARNP Associate Professor of Professional Practice School of Nurse Anesthesia Harris College of Nursing and Health Sciences, Texas Christian University, Fort Worth, Texas.


The greatest degree of heat loss in surgery is during the first hour after induction of general anesthesia.  Intraoperative hypothermia poses great risks for the patients and their recovery.  The use of forced air warming devices has been well studied and shown to maintain patient normothermia. There is concern that forced air warming disrupts operating room airflow and contaminates the sterile field leading to surgical site infections. A literature search was performed using Embase, Web of Science, Clinical Key and Nursing at Ovid Joanna Briggs Institute (JBI).Five articles were found comparing the contamination risk of forced air warming with other warming technologies.  The synthesis review found insufficient evidence to suggest delayed or discontinued use of forced air warming.  The studies’ lack of data showing patient surgical site contamination and inability to conclude that the forced air warming devices actually caused surgical site infections due to intraoperative contamination do not support a change to clinical practice.  As the greatest amount of patient heat loss is during the first hour of anesthesia, the use of forced air warming devices at this time is supported as opposed to delaying use due to unsupported concerns of surgical site contamination.


1. Moola S, Lockwood C. Effectiveness of strategies for the management and/or prevention of hypothermia within the adult perioperative environment. Int J Evid Based Healthc. 2011;9(4):337-345.

2. Legg AJ, Cannon T, Hamer AJ. Do forced air patient-warming devices disrupt unidirectional downward airflow? J Bone Joint Surg Br, 2012;94(2):254-256.

3. Belani KG, Albrecht M, McGovern PD, Reed M, Nachtsheim C. Patient warming excess heat: the effects on orthopedic operating room ventilation performance. Anesth Analg. 2013;117(2):406-411.

4. McGovern PD, Albrecht M, G Belani K, et al. Forced air warming and ultra-clean ventilation do not mix: an investigation of theatre ventilation, patient warming and joint replacement infection in orthopaedics. J Bone Joint Surg Br. 2011;93(11):1537-1544.

5. Sessler DI, Olmsted RN, Kuelpmann R. Forced-air warming does not worsen air quality in laminar flow operating rooms. Anesth Analg. 2011;113(6):1416-1421.

6. Albrecht M, Gauthier R, Belani K, Litchy M, Leaper D. Forced air warming blowers: An evaluation of filtration adequacy and airborne contamination emissions in the operating room. Am J Infect Control. 2011; 39(4):321-328.

7. Reed M, Kimberger O, McGovern PD, Albrecht MC. Forced air warming design: evaluation of intake filtration, internal microbial buildup, and airborne-contamination emissions. AANA J. 2013;81(4):275-280.

8. Dasari KB, Albrecht M, Harper M. Effect of forced air warming on the performance of operating theatre laminar flow ventilation. Anaesthesia. 2012;67(3):244-249.

9. Huang JK, Shah EF, Vinodkumar N, Hegarty MA, Greatorex RA. The Bair Hugger patient warming system in prolonged vascular surgery: an infection risk? Crit Care (London, England). 2003;7(3):R13-R16.

10. Moretti B, Larocca AMV, Napoli C, et al. Active warming systems to maintain perioperative normothermia in hip replacement surgery: a therapeutic aid or a vector of infection? J Hosp Infect. 2009;73(1):58-63.

11. Avidan MS, Jones N, Ing R, Khoosal M, Lundgren C, Morell DF. Convection warmers-not just hot air. Anaesthesia. 1997;52 (11):1073-1076.

12. Mahoney CB, Odom J. Maintaining intraoperative normothermia: a meta-analysis of outcomes with costs. AANA J. 1996;67(2):155-163.

13. Melnyk M, Fineout-Overholt E. Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice. Philadelphia, PA: Lippincott, Williams, and Wilkins. 2005:10.
How to Cite
BONNER, SRNA, Ashley; WELLIVER, DNP, CRNA, ARNP, Mark. Evidence is Inconclusive that Forcedair Warming Devices Increase Surgical Site Contamination or Infection. Anesthesia eJournal, [S.l.], v. 2, n. 1, july 2014. ISSN 2333-2611. Available at: <http://www.anesthesiaejournal.com/index.php/aej/article/view/15>. Date accessed: 13 dec. 2018.


Forced air warming; intraoperative; contamination; infection; normothermia