Forced air warmers and infection

[Planktonmd]

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Has anyone stopped using forced air warming because of concerns about increased surgical site infections particularly in total joints?
It seems that the whole idea is based on fake science but this does not mean lawyers won't jump on it.

 

[Psai]

Sounds about as stupid as bouffant hats being necessary to decrease infections. Hypothermia increases infection rate.

I thought it was the guy who invented the bare hugger who was spreading these rumors so people would buy his new patient heating idea instead

 

[dchz]

Totally agree with Psai that it's stupid. The usual MO is that you don't turn it on while the patient isn't draped... just in case.

However, i'm still trying to convince myself that mod hypothermia really causes coagulopathy.... (and for that matter i'm not sure it really causes more infection either), it's tough to say what the real optimal move is...

At this point in my search for the truth, i would not pick a battle on the fact that no one wants a bair hugger. That way they can blame the people not going through the sterile core. I'm ok with it as long as they give anes the credit of infection prevention.

 

[bigdan]

Plank -

We switched away from forced air warmers in the ortho rooms. Much to my professional satisfaction, I spend very little time in those rooms, so I don't know exactly when we switched, but at least several months ago we began using these "stick on" pads that don't work very well (at least in the manner we use them).

ArcticGel Pads

The surgeons want one on the one on the back and one on the chest, or something like that.

What are you guys doing, Plank?

 

[Planktonmd]

Plank -

We switched away from forced air warmers in the ortho rooms. Much to my professional satisfaction, I spend very little time in those rooms, so I don't know exactly when we switched, but at least several months ago we began using these "stick on" pads that don't work very well (at least in the manner we use them).

ArcticGel Pads

The surgeons want one on the one on the back and one on the chest, or something like that.

What are you guys doing, Plank?

We are looking at the available non forced air options to make the surgeons happy but so far they all seem inferior and cumbersome.
The FDA still supports forced air and states that there is no evidence connecting it to infection.

 

[psychbender]

At my old hospital, the Ortho joint guys heard about it, got scared of legal action (one even said it's BS, and admitted it was too appease lawyers), and insisted that the hospital buy the hotdog system that the creator of the bair hugger is now selling. We used those in all total joint rooms. They're cumbersome and don't seem to work as well, but the surgeons were happy.

Sent from my SM-G930V using SDN mobile

 

[DM27]

We had the same issue where there was one little fright and the surgeons got scared so now for patient warming we've moved away from forced air.

We use the hot dog warmer too for ortho and it's garbage.

 

[Southpaw]

For those that’ve moved away from forced air systems, I encourage you to track infections before and after assuming nothing else in your system changed. Since infections are rare this shouldn’t be difficult to do with some assistance. This is the type of quality measure tracking we should care about.

 

[jwk]

There is no "science" indicating that forced air warming increases infection rates in any kind of surgery. There is a significant body of knowledge regarding the increased risks of SSI with hypothermia.

 

[AdmiralChz]

A lot of these "studies" are pushed/promoted by a big competitor to the Bair Hugger - I think it's called the Hot Dog or something. In residency I was inundated with their e-mails, and their reps were always giving presentations to the ortho guys about it and how Bair Huggers were the devil or something.

Their website even has a page dedicated to ongoing litigation about the Bair Hugger. Nice.

Bair Hugger® Litigation Update - HotDog Patient Warming

I have yet to see this in clinical practice, but I haven't worked in all that many hospitals. Anyone seen this product around?

 

[pgg]

I like the forced air warmers because it's easy to stuff the hose in my scrubs to keep me warm. I don't ever take sick days so that's good enough evidence for me that they don't cause infection.

 

[DocVapor]

I like the forced air warmers because it's easy to stuff the hose in my scrubs to keep me warm. I don't ever take sick days so that's good enough evidence for me that they don't cause infection.

There's gotta be a joke about big, hot tubes blowing stuff into pants in this post somewhere.

 

[urge]

I might be the only one who buys Bair Huggers can increase infections. It just makes sense to me. That thing is blowing air via tubings that have never been cleaned since they were bought and as someone has pointed out, many anesthesiologists use the same dirty hose to warm their privates too. In case you were not aware the blanket is made so air leaches out of the blanket and I can imagine into the surgical field specially with those underbody blankets.

The moment I heard of literature supporting increased infections years ago I realized the Bair Huggers were on the way out.

 

[narcotics999]

I might be the only one who buys Bair Huggers can increase infections. It just makes sense to me. That thing is blowing air via tubings that have never been cleaned since they were bought and as someone has pointed out, many anesthesiologists use the same dirty hose to warm their privates too. In case you were not aware the blanket is made so air leaches out of the blanket and I can imagine into the surgical field specially with those underbody blankets.

The moment I heard of literature supporting increased infections years ago I realized the Bair Huggers were on the way out.

Doesn’t toasting the privates increase sterility?

 

[epidural man]

It seems easy enough to make a forced air solution that contains a filter - put the question to rest.

Forced hot air works very well so hard to replace that.

 

[deleted162650]

Doesn’t toasting the privates increase sterility?

You say that like it's a bad thing

(says the father of 3)

Sometimes my wife talks about #4, and I consider straddling the C-arm and yelling "Go Live!"

 

[Psai]

I'm always looking for a good hot dog warmer in the or

 

[abolt18]

We had the same issue where there was one little fright and the surgeons got scared so now for patient warming we've moved away from forced air.

We use the hot dog warmer too for ortho and it's garbage.

I see what you did there.

 

[narcusprince]

I know we will never get the surgeons to turn up the temperature in the ORs. But maybe we can get them to increase the temperature in the toilet bowls because the water is sooo cold.......

 

[coffeebythelake]

I might be the only one who buys Bair Huggers can increase infections. It just makes sense to me. That thing is blowing air via tubings that have never been cleaned since they were bought and as someone has pointed out, many anesthesiologists use the same dirty hose to warm their privates too. In case you were not aware the blanket is made so air leaches out of the blanket and I can imagine into the surgical field specially with those underbody blankets.

The moment I heard of literature supporting increased infections years ago I realized the Bair Huggers were on the way out.

This doesn't consider the air circulation patterns in the OR. While I agree there is a hypothetical concern for infection from hair hugger, I think the evidence doesn't support this.

 

[Onefellswoop87]

I might be the only one who buys Bair Huggers can increase infections. It just makes sense to me. That thing is blowing air via tubings that have never been cleaned since they were bought and as someone has pointed out, many anesthesiologists use the same dirty hose to warm their privates too. In case you were not aware the blanket is made so air leaches out of the blanket and I can imagine into the surgical field specially with those underbody blankets.

The moment I heard of literature supporting increased infections years ago I realized the Bair Huggers were on the way out.

Then by that argument, shouldn't hospitals, or buildings in general, have more infections as the buildings age? Can't imagine the HVAC ducts every get cleaned except for a dust particulate filter change every couple of months. Outside of the rare Legionella, which I think is unrelated to building's/HVAC's age, I think its a non-issue.

I'm skeptical that a bair hugger under the drapes that blows air away from surgical site has any impact on infections.

 

[shepardsun]

Semi-random tangent with respect to forced air warmers- I was reading a colleague's note on a chronic pain patient with a fentanyl patch and they stated they would remove the patch pre-operatively as to avoid the chance of rapid increases in serum levels secondary to forced air warming. Is this a thing or a consideration you take into account with this or other dermal medications?

 

[deleted87051]

Semi-random tangent with respect to forced air warmers- I was reading a colleague's note on a chronic pain patient with a fentanyl patch and they stated they would remove the patch pre-operatively as to avoid the chance of rapid increases in serum levels secondary to forced air warming. Is this a thing or a consideration you take into account with this or other dermal medications?

No because if they are on a fentanyl patch, they are opioid tolerant and it’s not gonna make any difference.

 

[rakotomazoto]

We use the hot dog conductive warmer for ortho/total joints. The chest/arm pads only seems to help during really long cases, but there is a pad we place on the bed underneath the patient and turn on prior, so at least the bed is warm when patients lay down.

 

[urge]

Then by that argument, shouldn't hospitals, or buildings in general, have more infections as the buildings age? Can't imagine the HVAC ducts every get cleaned except for a dust particulate filter change every couple of months. Outside of the rare Legionella, which I think is unrelated to building's/HVAC's age, I think its a non-issue.

I'm skeptical that a bair hugger under the drapes that blows air away from surgical site has any impact on infections.

Don't know in which dumps you have worked but they get cleaned routinely where I'm at.

 

[Onefellswoop87]

Don't know in which dumps you have worked but they get cleaned routinely where I'm at.

I’m impressed if they can be regularly cleaned to the same state when they were installed. You must have gremlins and oompa-loompas crawling through your hospitals HVAC
But thanks for helping to prove my point. Cause if I work in a dump, and I know our surgical infections aren’t through the roof, I doubt the Bair Hugger makes any difference. Or if they clean the HVAC and I don’t recognize it, which is likely the case, and surgical site infections as far as I know haven’t appreciably gone up since the bair hugger, it’s also not likely the air under the drapes being blow away from the surgical site that makes any difference.