Duke weighs in: Keep using forced-air warming devices

The Duke Infection Control Outreach Network has notified hospitals that it recommends they keep using forced-air warming devices (such as the 3M™ Bair Hugger™ warming system) during surgeries.

You can read DICON’s review here.

In the strongly worded missive, DICON said the warming devices are “the only devices proven to decrease the risk of developing a post-operative infection.’’ It noted that forced-air warming (FAW) devices have a 20-year track record of safety in more than 200 million patients.

DICON issued its memo as a result of the misinformation campaign being waged by Augustine Medical, maker of the HotDog warming blanket. The HotDog uses a different technology, called resistive polymer warming (RPW.)

DICON noted that a few investigators “have speculated that use of FAW devices disrupts laminar flow thus potentially increasing the risk of contamination of the operative site. Most studies that reached these conclusions were funded by’’ Augustine Medical. Augustine’s most-cited study is McGovern, which DICON found to “have significant limitations.’’ McGovern, by the way, is one of the key studies cited by plaintiff attorneys in their lawsuits against Bair Hugger devices. The study even admits that it “does not establish a causal basis’’ for risks of surgical site infections and forced-air warming devices like the Bair Hugger system.

DICON summed it up succinctly:

Our take:
The body of evidence describing the link between FAW and increased operative site infections is weak. To the best of our knowledge, no adequately powered, properly controlled, statistically significant, reproducible study has been published that demonstrates an increased risk of SSI due to the use of FAW warming devices. We do not believe that experimental studies using machines that emit bubbles in mock surgical procedures is a proven or standardized method to assess the risk of operative site contamination. Finally, we believe it is important and notable that no studies performed by independent investigators have been published that confirm the findings of the study by McGovern et al. Until such data are published, we believe that it is reasonable and appropriate to continue the use of FAW warming devices in patients. Indeed, our data and that collected by the NHSN suggest that approximately 99% of patients undergoing joint replacement procedures do not develop a SSI despite the fact that FAW warming devices continue to be widely and appropriately used.


  • We continue to believe that it is reasonable and appropriate to use FAW warming devices to maintain normothermia as these devices are the only devices proven to decrease the risk of developing a post-operative infection.
  • FAW warming devices have a >20-year track record of safety in >200 million surgical patients.
  • FAW devices should be regularly undergo maintenance as outlined by manufacturer’s guidelines, see attached table for recommendations.