Which Patient Warming Option Limits SSI Risks?

Forced-air patient warming systems do not disturb laminar airflow in the OR, according to an Anesthesia and Analgesia study. Research published in this month's British Journal of Bone and Joint Surgery, however, contradicts those findings.

In the Anesthesia and Analgesia article, Dutch researchers tested the impact of forced-air upper-body and underbody blankets on laminar flow - which dispenses highly filtered air over the sterile field to reduce airborne bacteria - by assessing particle counts above the surgical site during abdominal surgery. Particle concentration was reduced in both cases compared to measurements taken in other areas of the OR, and the blankets caused no statistically significant difference in particle counts, regardless of which setting (off, ambient or high) was used on the forced-air warming units.

The study, which was sponsored by 3M, manufacturer of the blankets used in the research, notes that neither the forced-air warming blanket or blower generated upward air that interfered with the normal uni-directional stream of the laminar airflow system, and "activation of forced-air warming does not reduce operating room air quality, even during laminar flow ventilation."

In the JBJS study, British researchers compared the infection rates of hip replacement patients who were warmed with forced-air systems or air-free conductive fabric. One of this study's authors disclosed a previous financial relationship with the manufacturer of the conductive fabric product.

The air-free systems cut implant infection rates by nearly 75%, according to the study's authors, who say forced-air units disrupted proper operating room ventilation and "resulted in the development of hot-air convection currents between the surgeon's body and the operating table, that transported (contaminated) floor-level air upwards and into the surgical site."

Air-free warming is therefore recommended over forced-air warming for orthopedic procedures, the authors conclude.

Daniel Cook

Health Insurance Premiums Rising Across the Board

A recent analysis of federal data finds premiums for employer-sponsored health insurance rising faster than incomes in every U.S. state.

Across all states, total premiums now amount to a sizable proportion of typical incomes. In 2003, 13 states had annual premiums that made up less than 14% of the median income. In 2010, there were none. And 62% of Americans now live in a state in which health insurance premiums equal 20% or more of median earnings for adults younger than 65 years.

Study co-author Cathy Schoen, MS, of the Commonwealth Fund, cited an earlier study from the health policy research group that predicted federal healthcare reform could help to curb future premium increases through measures that encourage providers to give less expensive care, subject insurers to greater scrutiny and foster more competition.

That report found that the net effect would be to slow annual premium increases by 1%, a more optimistic assessment than those of the Congressional Budget Office and other government sources. The most recent report considered the effect of a decrease of 1% per year, and found that it could amount to substantial savings over the long haul. Families could see a savings of $2,161 in annual premium costs by 2020, for example.

This latest report finds the District of Columbia with the highest annual total premiums, including both the employer's and worker's share. In 2010, they averaged $5,644 for a single policy and $15,206 for a family version - a rise of 51% and 41%, respectively, since 2003.

Costs were still significant even in states with some of the lowest average rates, such as Alabama, where a single policy averaged $4,571 in total premiums, and a family version reached $12,409.

"Although employees typically don't see the total cost of their insurance, the sharp increase, in effect, means lower wages and salaries as employers make the trade-off between increasing wages and offering insurance," says Ms. Schoen.

Mark McGraw

2011 Showcase Stocking Stuffer Contest On Now

Outpatient Surgery Magazine subscribers who participate in our 2011 Showcase Stocking Stuffer Contest can learn about new surgical products while entering themselves for a chance to win great prizes, including an Apple iPad 2, a Microsoft Xbox 360 4GB with Kinect, an Amazon Kindle Fire and other merchandise.

It's easy, fun and educational. Just point your browser to our contest website to get started. You'll need your subscriber number (which is located on your mailing label) and a copy of the November 2011 Product Showcase, which was enclosed with November's issue of Outpatient Surgery. But hurry: The deadline for contest entries is Friday, Dec. 2.

Stephen Archibald

InstaPoll: Who's Hiding Out in Your Break Room?

OK, fess up. Who spends the most time in the lounge, drinking coffee and reading the newspaper? Is it your surgeons, anesthesia providers, nurses or techs? Vote in this week's InstaPoll.

Nearly 3 out of 4 (72%) of the 52 folks who took last week's poll say they're "very likely" or "somewhat likely" to purchase a new piece of capital equipment in the next 6 months. The results:

  • Very likely: 60%

  • Somewhat likely: 12%

  • Might or might not: 12%

  • Somewhat unlikely: 6%

  • Very unlikely: 10%

    Dan O'Connor

  • News & Notes
  • AORN targets DVT Last March, AORN updated its recommended practices for preventing deep vein thrombosis, the preventable complication it says kills 60,000 to 100,000 patients each year. The update will be included in the organization's 2012 Perioperative Standards and Recommended Practices. For guidance on how to implement the planned recommendation, check out this article in November's AORN Journal.

  • Site marking for spine surgery Researchers have proposed a technique to prevent wrong-level surgery when operating on the spine. They compared a group of patients who underwent percutaneous implantation of fiducial screws followed by minimally invasive or open thoracic spine surgery with a group in whom localization of specific vertebrae was made using fluoroscopy and a series of percutaneous needles to aid in counting vertebral levels. While neither group saw wrong-site surgery, researchers reported a shorter fluoroscopic localization time with the screw. The added costs of the pre-operative implantation procedure were offset by a shortened operative time.

  • Age linked to breast surgery complications Women aged 50 years and older see more complications following breast reduction surgery, including higher post-op infection rates and wound healing delays, according to a study published in the December issue of the journal Plastic and Reconstructive Surgery. Researchers at the Johns Hopkins Medical Institutions in Baltimore speculate the observed increase results from age-related hormone level changes.

  • Tip of the weekWhen it comes to pre-op antiseptic skin prepping, every little bit helps. Orthopedic surgeon William A. Neucomb, MD, enlists his foot and ankle patients in the effort by asking them to spray their operative foot with a store-bought aerosol deodorant containing triclosan on the morning of surgery to keep bacteria counts low. "There's really no downside to the precaution," says Dr. Neucomb.