Studies show that forced-air warming (FAW) reduces soft-tissue surgical infections. How can FAW be linked to increased deep-joint infections?
The paradox is easy to explain: BIOFILM. A bacterium that lands on a prosthetic implant can secrete a coating of biofilm that protects it from both antibodies and antibiotics. Bacteria in soft-tissue cannot form effective biofilm coatings.
In contrast, without biofilm protection, the germs in soft-tissue are susceptible to antibiotics and to an immune system activated by heat. As a result, the creation of soft-tissue surgical infections require large inoculums of more than 100,000 germs (Elek & Cohen, 1957).
This also explains why soft-tissue surgical infections may not be increased by contaminated FAW air, while blowing even one germ into the surgical site during implant surgery can have significant negative concequences.