Study highlights surgical slush sterility, heart health risks

Editor's Note

Researchers studying the exposure of sterile surgical slush to open air urge the adoption of closed-system technology to alleviate risks to sterility and surgical outcomes, according to a May 19 article in OR today.

The article focuses on a time and motion study led by perioperative nursing leaders across three health systems, who tracked the use of open-basin slush units in 47 cases between December 2024 and March 2025. The researchers found that slush remained exposed to ambient OR air for an average of 169 minutes before use, with another 113 minutes between final use and case completion. Some outliers exceeded 300 minutes of exposure, and two cases reported drape leaks that raised additional contamination concerns.

As detailed in the article, surgical slush—a semi-frozen saline or lactated Ringer’s solution—is used to cool and protect myocardial tissue during open-heart procedures. The cooling effect lowers metabolic demand, prolongs safe ischemic times, and reduces intraoperative bleeding. However, the open-basin delivery method raises sterility issues, especially in light of the Association of periOperative Registered Nurses’ (AORN) 2025 Guidelines for Sterile Technique, which emphasize minimizing the exposure of sterile items to the OR environment.

The study’s authors advocate transitioning to closed-system slush technology, which limits ambient exposure, better regulates temperature, and supports sterile technique. They also recommend further research, including more detailed time tracking and procedural benchmarking.