Table overhang; hypothermia; separating sponges, skin lacerations when scrubbing; wound classification; forced air warming - Clinical Issues

AORN Journal,  July, 2003  by Carol Peterson

• E-mail
• Print
• Link

* Class III/Contaminated--Open, fresh, accidental wounds. In addition, procedures in which there are major breaks in sterile technique (eg, open cardiac massage), gross spillage from the gastrointestinal tract, or incisions in which acute, nonpurulent inflammation is encountered are included in this category.

* Class IV/Dirty-infected--Old traumatic wounds with retained devitalized tissue and those that involve existing clinical infection or perforated viscera. This definition suggests that the organisms causing postoperative infection were present in the surgical field before surgery. (13)

Question: We use forced air warming blankets intraoperatively on our patients. We ran out of blankets for the unit, and the anesthesia care provider suggested using the hose between two sheets to keep the patient warm. I refused to do this and borrowed the appropriate blankets from a neighboring facility. This decayed the start of the procedure by 20 minutes, and I was chastised for creating the delay. Was I wrong not to let them use the forced air hose between two ordinary sheets?

Answer: You did the right thing by not putting the hose between two sheets, Using the hose to blow warm air directly between two sheets on top of a patient without the designated warming blanket is very dangerous and not recommended. This inappropriate use of a forced air warming system often is called hosing. (15) The air temperature at the end of the hose is elevated, so using the hose without the warming blanket places patients at risk for thermal injuries. Placing the hose between two ordinary sheets does not provide adequate thermal protection. Extended exposure to concentrated heated air that is flowing freely under the sheets increases the risk of injury. (15) The risk of injury from the warming hose is greater for pediatric patients and patients with vascular compromise.

Misuse of forced air warming systems also creates an increased risk of infection for patients. Air blowing freely from the hose increases air currents and the amount of airborne particulate matter. These airborne particles are composed of dust, lint, skin squames, and respiratory droplets that may contain microbacteria. (14) Increased air currents can carry these contaminated particles to the sterile field. Strains of bacteria traced to outbreaks of surgical site infections have been recovered from the air in ORs. (14)

When used appropriately according to manufacturer's instructions, forced air warming systems provide an effective method of maintaining patients' temperatures. Forced air warming systems are intended for use with specifically designed, sealed blankets. The manufacturer's instructions should be followed exactly.

NOTES

(1.) D Fogg, "Infection prevention and control," in Alexander's Care of the Patient in Surgery, 12th ed, J C Rothrock, ed (St Louis: Mosby, Inc, 2003) 132.

(2.) "Recommended practice for maintaining a sterile field," in Standards, Recommended Practices, and Guidelines (Denver: AORN, Inc, 2003) 352.