NATIONAL—New studies appear to have pinpointed a commonly used medical warming blanket as the true cause of many post-surgery Periprosthetic Joint Infections (“PJIs”).
The Bair Hugger
This warming blanket, known as the “Bair Hugger,” is a Forced-Air Warming blanket that has been used for more than two decades to warm patients during lengthy surgeries. While the warming blanket is marketed to minimize the risk of hypothermia for patients during surgery, research suggests that it is also capable of depositing harmful bacteria into the patients’ surgical wound. Specifically, the literature shows that forced-air/convective heat transfer systems (like the Bair Hugger blankets) tend to disrupt ventilation systems which provide unidirectional airflow to the sterile field, and thus impede their ability to clear contaminants from the surgical site, spreading airborne particles and pathogens into the wound.
How Does it Work?
The Bair Hugger operates like a hair dryer—it takes ambient air from the operating room, heats it to approximately 117 degrees Fahrenheit and then blows the hot air through a hose into an inflatable Polypropylene “blanket” that lies on top of, or sometimes underneath, the patient. Once there, the air blows out of the blanket through strategically placed holes and onto the skin of the patient, warming them convectively. This technology is generically referred to as “forced-air warming” and is used in virtually every type of surgery in the U.S. lasting longer than 60 minutes.
Research published over the past few years shows that there’s a substantial increased risk of infection in patients undergoing hip or knee implant surgery using Forced-Air Warming blankets such as the Bair Hugger. The most dramatic research in recent years was conducted by McGovern et al and directly linked Bair Hugger blankets to a 3.8 times increase in deep joint infections. Five peer-review studies have further established that the 1000+ watts of rising heat produced by Bair Hugger blowers lift contamination from the floor of the operating room and deposit it in the sterile surgical field. The more contamination, of course, the more likely an infection is to occur.
The manufacturer of this device, a multinational conglomerate corporation, boasts a better than 90 percent+ market share of warming blanket devices used during surgeries. While the most popular competitor, the “Hot Dog” warming blanket, utilizes newer technology, it still only makes up less than 10 percent of the warming blanket device market share. What does this mean for hip or knee implant surgery patients? Well, it means that it is highly likely that any patient who received a new joint within the past five years received Bair Hugger’s forced-air warming technology.
With 12,000-20,000 PJIs occurring each year, PJIs are relatively common in the U.S. and develop in approximately 1-2 percent of primary hip and knee replacement patients. Treatment of PJIs most often times requires at least two additional surgeries and, thus, are very expensive, often costing over $100,000 to treat, assuming no amputation. Further, these infections are extraordinarily painful and permanently disabling; some 12 percent of PJI survivors rate their eventual quality of life as “worse than death.”2
Troy Rafferty, Ben Gordon & Daniel Nigh, Bair Hugger Warming Blankets: A Little-Known Medical Device that Causes Catastrophic Infection Injuries During Hip and Knee Implant Surgeries, 586 J. FLA. JUSTICE ASS’N 28, 28-30 (Sept.—Oct. 2015).
Cahill JL et al., Quality of Life After Infection in Total Joint Replacement, 16(1) J. ORTHOPAEDIC SURG. 58, 58-65 (2008).
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