Wednesday, November 16, 2011

Why Is The Operating Room So Damn Cold?

One of the most common questions asked by patients is, "Why is the operating room so cold?" It is freezing cold to me even though I'm wearing a few layers of clothing along with a scrub jacket. After a while my fingertips almost turn blue. Sometimes I shiver so much that my abs hurt. Occasionally the circulating nurse and I will get heated blankets from the blanket warmer to drape over ourselves to lessen the misery. Now consider the fate of the poor patient who is lying on a cold operating table, supine, wearing a paper thin hospital gown or nothing at all. It's no wonder they complain about the temperature in the operating room.

There are a few stock answers to give to patients when they ask about the frigid conditions in the O.R. One is that the patient is wearing virtually nothing, so she will feel colder. Another is that the cold temperature helps keep bacterial count down, the way a refrigerator helps keep food from spoiling. This helps prevent contamination and wound infections. Then of course there is the real reason why the O.R. is so cold--the surgeons like it that way.

Sure we tell the patients that we wouldn't want the surgeons dripping sweat into the wound, would we? But is it really necessary to turn the temperature down that much? There are all sorts of studies that show a cold patient has increased risks of poor wound healing, and higher rates of complications. A cold shivering patient in the PACU can potentially have worsened respiratory effort and increased cardiac workload, leading to a more complicated  recovery period.

Does a hot sweaty surgeon really work less efficiently than a comfortable surgeon to the detriment of the patient? No. And the proof is in the cases where the O.R. is deliberately kept hot. Pediatric surgeries, burn cases, and trauma are all procedures where the operating room is kept warm to prevent severe hypothermia in patients who cannot tolerate it. I have never seen a surgeon complain that they just cannot operate properly if they are dripping in sweat after one of those cases. Plus there are no studies to prove that a warm operating room leads to more wound infections from bacterial contamination. So why can't a surgeon work in at least a temperate setting during routine cases?

We spend thousands of dollars on equipment to help keep patients warm. Bair hugger warming blankets are a must in every room. Hotline tubing to heat up IV fluids prior to flowing into a patient are also stocked in every O.R. All these expensive devises can be minimized if we simply turn up the thermostat a few degrees. But then the delicate surgeons will have a hissy fit and demand that it be turned to the lowest setting possible, patient safety be damned. So the thermostat gets set down to 55F, expensive warming equipment is charged to the patient's insurance company, and the anesthesiologist daydreams about how nice it would be to sit in a warm hot tub on the beach in Turks and Caicos.


10 comments:

  1. I read your piece with great amusement. I am a paediatric anaesthesiologist in Malaysia but today I'm doing a list with 'big babies'.As i write this, i am relaxing with a cup of coffee because all the elective lists have been cancelled for the day. The air-conditioning broke down and OT temperature is 23C.The surgeons are throwing a hissy-fit. I've read so many articles on how increased OT temperatures do not affect the wound infection rate but try convincing them! Back to my coffee,then..

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  2. Look for a heater with control settings, which will allow you to control the level of heat produced. Some heaters also have timers or automatic shut-off features, which can prevent fires or malfunctions if the heater is left on for a long time.

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  3. We know exactly where all the HVAC controls are in the rooms. It's that the thermostats keep getting turned down to frigid every time somebody tries to warm up the room.

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  4. Quite an offensive and inflammatory piece. One could respond by slamming anaesthetists or at least the intelligence of this poster. Alternatively one might ask what he or she has against surgeons, who are supposed to be collaborative colleagues.

    The best approach is to simply deal with apparent ignorance. The benefits of heating patients appears to be currently well accepted, but there is now also evidence emerging that does suggest that both a surgeon's cognitive performance and technical performance may be impaired in hot ORs.

    It is a valid question worth exploring, but sadly unnecessary to post revealing comments about one prejudices and jealousy.

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  5. Offensive and inflammatory? Anonymous, you have a pretty thin skin if you think this piece is inflammatory. Yes surgeons and anesthesiologists are collaborative colleagues but when it comes to adjusting the thermostat the surgeon always seem to get the final word. I'm not asking for the room to be turned into a sauna but is 68F really too much to ask?

    You think I'm "jealous" of the surgeon's wish for an ice cold operating room? That's a laugh. As a member of the operating team, I'm simply looking out for the patient's well being by keeping him as warm as possible to minimize any cold related complications like those listed in the post.

    As far as cognitive impairment in an overheated surgeon, well I'm sure pediatric and burn surgeons will be glad to hear that they have been operating with addled brains.

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  6. I'm a patient who just had surgery yesterday in a freezing OR. They put a warming blanket on me but a nurse told me I still was shaking near the end of the 30 min procedure. I can't see how keeping the room at 65-68F can be too hot for a surgeon to think or that it would make them sweat.

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  7. Absolutely agree with ZMD on this one. The best case I can list here is a liver transplant. This case lasts from 8-12 hrs and the room is always kept between 70-75 without a single complaint from the surgeons. As an anesthesia resident, and as ZMD stated, we're not asking for 70-75 degree rooms every day, but 68 would be quite an improvement over the 58 I see quite often.

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  8. Low temperatures and low humidity are needed in order to prevent microbial growth. The category of bacteria which inflict the most disease upon humans- the mesophiles- require a temperature between 50-125° F, but grow exponentially at a high rate between 77-98.6°F. The lower the temperature, the slower the rate of growth for the bacteria.
    As covered up as surgeons are when they conduct their work, they do overheat at higher temperatures, and I wouldn't want them dripping beads of sweat off their forehead onto my body in a higher temperature room where their bacteria would then be free and comfortable to grow on my body and possibly on my wound.
    Many bacteria that cause serious infections of wounds such as Staphylococcus aureus are found living on the skin where they are not harmful, but once they enter the wound they cause serious complications, and I would bet that many doctors are unknowing carriers of species like this, considering their daily exposure to sick patients.
    So if you ask me, I'd be more worried about my health and take a little cold air and make sure to exercise and have a healthy diet after surgery to speed up recovery naturally instead of asking for comfortable conditions for a short period of time that may only lead to my demise :)

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  9. O M G
    I am a surgery intern and I completely agree man. It's so freaking cold in there. One of my attendings is known for keeping the thermostat at a higher temperature (=normal) and the scrub nurses won't stop complaining about it.
    Seriously, like someone needs to put these mofos in line re: the suffering of the scores of people that goes on for the ONE person (not the patient, mind you, but the attending surgeon that decrees it so, generally).
    Although its sad that sometimes when the attending wants the temp up, the scrubs start complaining.
    Whoever these thyrotoxicosis peeps are that are making the rest of us suffer frostbite need to seriously slap on the deodorant and suck it up.

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  10. According to my ATI nursing exam, low temperatures and low humidity reduce the risk of fire related to volatile compounds that may be used by the anesthesiologist.

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