Wednesday, November 16, 2011
Why Is The Operating Room So Damn Cold?
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.