Most Infection Control Professionals are not Aware of Contaminated Water in the OR

Waterbath-based blood/fluid warmers contain stagnant, warm water, which has long been known as a source of gram-negative bacilli in the operating room, according to William A. Rutala, PhD, MPH. Endocarditis, bacteremia and peritonitis with Pseudomonas or Acinetobacter have been traced to contaminated 37-degree C water baths. Sitting just inches from the sterile field in the OR, these waterbaths may leak and transmit pathogens to patients.

A recently released survey of Association for Professionals in Infection Control and Epidemiology, Inc. (APIC) members indicates that almost 35 percent are unaware of whether waterbath-based blood/fluid warmers are in their facility's operating rooms and almost 40 percent do not believe that these devices are used. Yet, according to industry-reported marketshare statistics, conventional waterbath-based blood/fluid warmers are used in 80 percent of operating rooms where fluids are warmed.

These discoveries become a concern when we note that most infection-control professionals are aware of the dangers of water in the OR. In fact, more than 80 percent of the respondents stated their awareness of waterbaths as reservoirs for nosocomial pathogens. Additionally, almost 70 percent viewed waterbaths as a source of contamination. Further, more than 20 percent see waterbaths as a source of bacterial growth and contamination that they would not allow in the OR if they were aware of another, clinically acceptable alternative.

Where is the disconnect?

Apparently, infection-control professionals are not being made aware of waterbath technology used in the OR. Were they aware, they would be concerned. Respondents to the survey believed that it is highly likely that water leaks out of waterbath unit and could come into contact with clinician's hands or with the patient (at the IV site or intravenously). From this exposure, there is a high likelihood that infection can arise.

Susan Burns, BSMT, CIC, Infection Control, Henry Ford Hospital & Medical Center, has reported a possible link between surgical infections and a water-bath fluid warmer. During a two-week period, four patients developed a bloodstream infection within two-10 days of neurosurgical procedures.

"I was investigating a series of bloodstream infections that occurred following neurosurgical procedures. As part of the investigation, I cultured the water from the Hotline/Level 1 fluid warmers used to administer IV fluids during these procedures. Microbiology cultures of the water were found to have high levels of bacterial contamination (less than 100,000 colonies of multiple gram negative organisms). I further observed that each time the disposable IV connector was connected or disconnected to the warming unit, the open ports on the side of the unit allowed the water to spray out and potentially contaminate the clinician's hands and /or the OR environment."

Almost 20 percent of APIC members surveyed are unsure if there have been infections in their hospitals related to waterbath-based blood/fluid warmers in the OR. However, 20 percent respond that contamination in their waterbath-based blood/fluid warmers in their facilities was found at a level of more than 100,000 CFUs/mL. In addition, more than 65 percent do not know who is responsible for maintaining and decontaminating the warmers in their ORs.

It is clear that the problem is not being addressed. The survey indicated that less than two percent of hospitals culture their waterbath-based blood/fluid warmers. Almost 70 percent responded that their hospital did not have a policy of regular maintenance and decontamination of the waterbath-based blood/fluid warmers or were unsure of their facility's policies in this area.

What will be the result of this information?

According to the survey, given the opportunity, almost 40 percent of respondents would eliminate waterbath-based blood/fluid warmers in the OR. (Only 8.5 percent said they would not.)

The technology is available to make this change. One of the latest alternatives to waterbath-based blood/fluid warmers are blood/fluid warmers that use dry-heat technology. For example, the fastest-growing fluid warmer in the market today, Augustine Medical's Ranger system, features SmartHeat technology that warms fluids without the use of bacteria-prone waterbaths. It delivers both high-and low-flow rates for instant switching from routine to trauma situations.

How do other healthcare professionals view waterbath-based blood/fluid warmers? Separate surveys show that members of the American Association of Nurse Anesthetists (AANA) and the American Society of Anesthesia (ASA) also are unaware of how often their facility's waterbath-based blood/fluid warmers are decontaminated. Less than five percent of each group believed that their hospital cultures waterbaths and both groups rated water in the OR as an

overall concern.

For reference list or a review of up-to-date information on safe water, visit icanPREVENT at (go to Infection Control/Facilities Management/Safe Water) or visit

Augustine Medical, Inc.

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