After spending 25 years shivering in operating room I created a novel product OPERATIONHEATJAC that acts as a personal radiator. Originally designed with OR staff in mind, patient benefits have now become apparent.
Recent headlines suggest my garment may be more than just a convenience…it may be life-saving.
You may be aware of the over 3000 lawsuits against the 3M Bair Hugger. The suits are largely based on a study showing a 74% reduction in Surgical Site Infections (SSIs) after hip and knee arthroplasty when a forced air warming system isn’t used. Lawyers argue the Bair Hugger increases SSIs by lifting floor contaminants, or that the flow of wasted heat interfered with laminar flow and directed bacteria into the surgical field. However, several simulations have failed to show this occurs. Interestingly, the authors of this study explicitly disclaim any ability to attribute changes in infection rates to forced-air warming, stating “[t]his study does not establish a causal link for the association.” In addition, the study has many flaws. One such flaw is that the study did not control for important confounding variables that influence SSIs. In fact, there was a change in prophylactic antibiotic administration to the patients during the two study periods, and this is known to be a most important factor for preventing these SSIs.
A well-designed study was published in the Journal of Clinical Anesthesia in February 2017, entitled: Airborne bacterial contamination during orthopedic surgery: A randomized controlled pilot trial. This study measured bacterial counts in six locations in the operating room, with a group of 80 different patients. The study found that “it was not possible to detect any higher bacterial counts on any plate in the forced-air warming group (the Bair Hugger system) versus the resistive warming [non-forced air warming] group (the HotDog blanket).”
I believe the Bair Hugger does indeed cause SSIs, but only indirectly; the direct cause is an age-old unspoken OR ritual. To stay warm, shivering staff remove the Bair Hugger hose and put it under their scrubs. I hear about this all the time, particularly at society and association meetings. Unfortunately, the result can shower the surgical site with contaminated skin cells.
I seriously doubt that any anesthesia providers or perioperative nurses were using the Bair Hugger hose for themselves during important studies.
Twelve thousand Surgical Site Infections occur every year. They cause immense pain and suffering, further surgery, amputations, permanent disability, and rarely death.
Preventing that has given me a new sense of urgency. I’m now working with manufacturers, hospitals, and the media to spread the word about this common ritual, the likely danger it poses, and my simple inexpensive solution.
If you work in an OR I ask that you talk to your colleagues and administrators about this issue. I also ask that you realize this device is no longer for you, it’s for your patients. Perhaps most importantly whether or not you use this device, please end the unspoken ritual and leave the Bair Hugger hose where it belongs.