Not only is every state affected, but every hospital, and every department in the hospital – certainly not just those performing bariatric surgery.

"The issues and challenges faced by bariatric patients are the same for obese patients that are in the hospital for non-bariatric treatment," said Michael Klein, vice president, sales for bariatric products distributor, TSK Products (Eatontown, NJ). "Therefore these issues are translated throughout the entire hospital. No department is exempt from the challenges of treating obese patients."

According to industry research firm Frost & Sullivan, "Over the past three years, the bariatric market has expanded almost as quickly as waistlines…Many manufacturers entered the bariatric market by increasing their standard weight capacity of equipment to 350 pounds, but now that is not nearly enough. We are seeing that capacity rise to 700-pounds and even 1,000-pounds."²

Frost & Sullivan estimates market revenues for the U.S. specialty bed and support surface market for bariatric will compound at an annual growth rate of 17.3 percent, reaching $522.2 million by 2012, up from $170.7 million in 2005. "Bariatric manual wheelchairs are the largest segment of the wheelchair market; revenues were $38.4 million in 2005 and are anticipated to reach over $100 million in 2012. There are more than a dozen participants in each of these segments, with the number of participants rapidly growing as more manufacturers are entering this profitable market."

Glenn Barras, president of healthcare seating company Sittris (Toronto, Ontario), observed that facilities are responding to the increasing obesity rates by specifying anywhere from 10 to 20 percent of their seating needs at a bariatric size. "We’ve also been told that in some emergency rooms the percentage that they’re looking at is higher because often bariatric people will have other problems too – heart problems, diabetes, and so on. So for cardiac units, it could be up to 50 percent of their seating," said Barras.

No doubt, last year’s expanded Medicare coverage for bariatric surgery – with the provision that it be performed in an ASBS/Surgical Review Corporation (SRC) Center of Excellence or American College of Surgeons (ACS) Level One Center of Excellence – will help fuel even further growth.

"Each year more than 200,000 bariatric surgeries are completed, far exceeding any other surgery performed," confirmed the Frost & Sullivan report. "Estimates predict this surgery will exceed 30 percent growth rate during the next few years."

"The expanded Medicare coverage, and the resultant financial incentive, has sparked a renewed interest by many hospitals to look into obtaining a Bariatric Center of Excellence from ASBS or ACS," said Klein.

Sandy Wise, R.N., MBA, senior director for group purchasing organization Novation LLC, noted that the qualifications for becoming a Center of Excellence are very strict. "So in order to achieve that designation, that really means something," she said. (For criteria, and a list of required bariatric equipment, visit www.asbs. org or www.facs.org).

"Not only are we seeing more facilities trying to get Center of Excellence accreditation, we’re also seeing them creating dedicated bariatric wings," added Mike Doust, president, Stretchair Corp. (Largo, FL).

"Clearly the market is growing and based on estimates of the growing obesity problem in the U.S. we expect that it will continue to grow," said Dave Jacobs, president, Medline DME division (Mundelein, IL). "In addition, we as a society are becoming more sensitive to the needs of people with weight issues. Our customers want to be sensitive to them and provide products that will afford their patients safety, comfort and dignity."

So how does your facility begin to prepare for the many challenges of accommodating obese and even morbidly obese patients?

Wise suggested, "The best way to think about it truly is to look at the entire continuum of care, from how that patient accesses the hospital, to every area of the hospital that patient goes through, to getting that patient home. As well as looking at that patient from head-to-toe and what are the unique needs of an obese patient whether or not they’re coming in for a planned surgical procedure.

"And of course, I think you can’t highlight this enough, the facilities who have patients coming in for planned obesity procedures, they’re going to have everything ready, it’s the obese patient that presents with an emergency and who may then end up having to have surgery that we need to make sure their needs are met, and that’s both for quality of care, safety for the healthcare worker, safety for the patient, but also for the dignity of the patient," she added.

Stretchair motorized MC675

Novation’s comprehensive portfolio of over 1,000 bariatric products and equipment includes everything from longer trach tubes, IV catheters, longer needles, larger oxygen masks, to a full line of transport and patient handling equipment. Wise notes that in recent years the focus has begun to shift from facilities hurrying to equip their facilities with the "essential" items, such as bariatric beds, to a more comprehensive, total-care approach.

"The first couple of years you saw facilities identifying the larger items, the durable medical equipment, wheelchairs, stretchers, the beds, and I think now they’re able to focus on – What about the patient ID bands? What about the slippers? What about the anti-embolism stockings? What about the patient gowns? – some of the more basic things, " said Wise. New to the Novation portfolio are red-colored slippers available in bariatric sizes that designate a patient may be at a higher risk of falling.

TSK‘s Klein advises facilities to consider patients’ acuity levels when planning bariatric product and equipment purchases. "While patients that have bariatric surgery are generally in the hospital for only two to three days, morbidly obese patients with a variety of co-morbidities can be in the hospital for days or weeks," said Klein.

"A more comprehensive product offering is needed for patients with longer hospital stays. An example: many large, morbidly obese patients that are in the hospital for several days or weeks have special toileting needs, especially if they are not ambulatory. Our unique bariatric bedpan is a simple, yet highly effective solution for this patient’s hygiene and personal comfort needs," added Klein.

Facilities should also consider visiting family members when equipping for bariatric patients. "Many bariatric or morbidly obese patients have family members that are also very large in size and weight. Hospital waiting room areas, common areas, coffee shops and particularly patient rooms must have furniture and other assistive devices available for those family members as well," said Klein.

As a full-line distributor of bariatric equipment and products, TSK Products provides a complete offering of bariatric products from patient lifts and lateral transfer systems, stretchers, furniture, treatment recliners, scales, exam tables, to blood pressure cuffs, commodes, bedpans and socks.

TSK also offers a comprehensive facility assessment of the pathways taken by both bariatric and obese patients. "The assessment involves much than just looking for proper equipment," explained Klein. "We analyze patient flow, treatment areas, room sizes, staffing issues, storage space issues, availability and access to equipment, accom-modations for family members, etc."

Klein notes that common issues for hospitals when dealing with bariatric or obese patients include: Transporting and transferring patients – either by stretcher, lift, wheelchair or air mattress; providing appropriate sized room and lobby furniture; and having adequate size beds, commodes and personal hygiene items.

Among new products recently added to TSK’s bariatric product offerings is the ScopeMD pre-and post-operative treatment recliner with clinical features and comfort for bariatric/obese patients weighing up to 650 lbs. The ScopeMD HD1030 Bariatric recliner features swing-out arms which helps caregivers transfer patients in and out of the recliner. If the patient is ambulatory, having both arms swing away means now two caregivers, one on each side of the patient, can help them to their feet.

The ScopeMD also features true Trendelenburg positioning capabilities and 4" locking 1,000-lb. casters mounted on a solid steel base, rather than on the arm frame, for durability. The chair can be thoroughly cleaned along the sides and power-washed under and in the mechanism. Another popular new item from TSK is the Toilet Jack, a simple, yet effective means of increasing the weight capacity of a wall mounted toilet from 350 lbs. to 1,000 lbs.

Medline manufactures a full range of bariatric DME products including wheelchairs, walking aids and bath safety (walkers, canes, crutches, commodes, etc.), respiratory equipment, patient apparel (e.g. gowns), blood pressure cuffs, disposable surgical drapes and instrumentation, and furniture.

In addition to expanding its bariatric product offerings in all areas, Medline recently added a bariatric wheelchair line that accommodates patients who require a wheelchair with up to a 28" seat width and 700-lb. weight capacity. Medline also just introduced a bariatric transport chair that weighs less than a lightweight wheelchair, but has a 22" seat width and 400-lb. weight capacity. This month, the company will begin offering standard crutches with a 300-lb. weight capacity.

"Standard crutches typically have a 250-lb. weight capacity, but we’re seeing hospitals with an increasing number of patients weighing 250-300 lbs. If the facilities don’t want to spend the extra money on crutches with a capacity of 500 lbs. this provides a great alternative that’s cheaper and lighter," said Jacobs.

"This year we introduced a bariatric readiness assessment," added Jacobs. It takes best practices from hospitals across the country to identify the areas of a hospital with which bariatric patients may interact/come into contact with and provides information on how a facility could consider accommodating those patients. It covers standard equipment like wheelchairs, commodes and crutches. However, it also covers areas like doorway widths required to accommodate this equipment, weight capacities of standard toilets and sinks, and areas like furniture in waiting rooms."

According to the Surgical Review Corporation, for hospitals to qualify for Center of Excellence accreditation, "the applicant maintains a full line of equipment and instruments for the care of bariatric surgical patients including furniture, wheel chairs, operating room tables, beds, radiologic capabilities, surgical instruments and other facilities suitable for morbidly obese patients.

In addition, "patient movement/transfer systems for morbidly obese patients must be in place throughout the institution wherever the morbidly obese receive care. Ambulances serving the institution should also be equipped to manage these large patients with appropriate stretchers, straps, and transfer devices. Finally, and perhaps most important, the staff must be trained to use the equipment and be capable of moving these large individuals without injury either to the patients or the staff."

No matter if a facility provides bariatric surgery, obese and morbidly obese patients are bound to present to its emergency room and operating rooms.

"Hospitals realize they need to factor in the accommodation of severely obese patients as part of their surgical table purchase decisions," said Ward Sanders, product manager, STERIS Corp. (Mentor, OH).

"Suppliers and manufacturers have responded to the need for tables that hold higher capacity weight, the O.R. tables will now hold 1,200 pounds," said Wise. "As facilities purchase new equipment, pretty much the standard O.R. table now has a higher weight capacity."

"The other thing that’s really important that the manufacturers are now responding to is the need for O.R. tables to be able to be lowered very low," said Wise. "When you’re operating on a morbidly obese patient, the incision site is often very high because their abdomen is so large, so they need the ability for the O.R. table to be lowered very low, so that the caregivers, the surgeons, the scrub nurses, etc. are able to ergonomically reach the patient."

STERIS’ Cmax surgical table can support, raise and lower patients as heavy as 1,100 pounds. Patients as heavy as 600 lbs. can be fully positioned into various surgical postures, and can also be moved along the longitudinal slide of the table top. Steris’ Amsco 3085 SP general surgical table can accommodate patients as heavy as 1,000 lbs. in a normal orientation and 500 lbs. in reverse orientation. Complementing the tables are a complete line of table accessories including table- width extensions that expand from 20" to 28", and split-leg sections – all designed to help make bariatric surgery easier and safer for surgeons and patients, as well as improve outcomes and efficiencies. Modular designs and an abundance of accessories means existing tables can be easily upgraded with bariatric capabilities.

Bariatric restraints available with the STERIS tables help assure secure positioning of the heaviest patients, while bariatric power-lift stirrups utilize gas-spring assistive technology to help users easily lift the legs of patients weighing up to 800 lbs. into lithotomy postures.

STERIS surgical table pressure management systems are designed to support obese patient weight. Its TLT Tri-Layer Technology Pads incorporate three layers of foam to help evenly distribute patient weight and minimize the possibility of patients’ bottoming out on the hard table surface. Aqua-Gel pressure management system fits all STERIS surgical tables and offers a combination of contour and material technology to suspend and/or relieve vulnerable bony prominences helping to avoid pressure ulcers.

The Hercules 6700B table from Skytron (Grand Rapids, MI) provides 1,200-lb. lift and 1,000-lb. articulation capacity to safely handle even the heaviest of patients. Hercules also has 210º top rotation and removable back and leg sections that can be replaced with carbon fiber sections for obstruction-free imaging, and can be lowered to 23". Skytron’s UltraSlide 3600B has 1,000-lb. lift and 800-lb. articulate capacity with 23" top slide and full-body imaging.

Stryker Medical (Kalamazoo, MI) has a 500-lb. weight capacity mobile surgery platform that was designed for ambulatory surgery centers. The Trio Mobile Surgery Platform contributes to a "no-lift" environment because it enables patients to remain on the same surface from pre-op to recovery.

Stryker also offers a line of general purpose stretchers with a 700-lb. weight capacity. The M-Series SM204 stretcher includes a "big wheel" design that reduces the start-up force by 50% and turning force by 60% for improved mobility and injury prevention for staff members transporting bariatric patients. Stryker’s Zoom Motorized (SM304) stretcher virtually eliminates pushing efforts; requiring the same amount of force to transport an empty stretcher without a patient as it does to transport a 700-lb. patient.

A lift-assist backrest feature on the Stryker stretchers employs the patient’s weight to help them sit up, reducing the risk of injury to the care-giver; a drop seat section cradles the patient and helps prevent them from sliding towards the foot of the stretcher. Glideaway siderails provide a zero-transfer gap when transferring patients.

TRUMPF’s TITAN is a mobile, modular, split-leg, fully articulating surgical table with an unrestricted 1,000-lb. weight capacity. "Unrestricted" means that the table maintains its advertised weight capacity even when patients are positioned at extreme angles such as 40º reverse Trendelenburg.

At the AORN congress this year, TRUMPF (Charleston, SC) is introducing the latest version of its mobile MARS surgical table with an increased weight capacity of 790 lbs. As with the TITAN, the MARS maintains stability at full capacity and at extreme positioning angles. TRUMPF’s ORBIT PT (Patient Transfer) system offers "one nurse, one button, "no-lift" patient transfer for patients up to 400 lbs.

For maximum flexibility look for tables that offer full-body imaging capabilities. This will also help to reduce patient transfers. TRUMPF’s TITAN and MARS tables provide unrestricted imaging with head-to-toe X-Ray channels and easy C-arm access. They can be lowered 24" off the ground to provide easy access to a bariatric patient’s stomach, while 40º reverse Trendelenburg positioning can be used to sink excess body tissue away from the surgical site and improve access. In addition, 25º lateral tilt provides precise access to the surgical site, and can be used to counterbalance girth on larger patients.

Dual-articulating headrests on the TRUMPF tables can be positioned up and down for neck and throat access. This headrest position compensates for the large back and neck of the obese patients. During anesthesia the headrest can be articulated to position the neck and head so as to free the anesthesiologist’s hands for two-handed intubation instead of having one hand occupied to manipulate the patient’s head. Two-part simple leg plates allow for independent positioning to increase surgical site access.

Maquet Alphamaxx from Getinge USA (Rochester, NY) has a 1,000-lb. weight capacity with a low table height of 23". The Alphamaquet system table has an 800-lb. capacity with removable table top that can be used to transport the patient to and from the O.R. The Maquet Alphastar Plus has a 1,000-lb. weight capacity with a low height of 27". Standard 3-inch padding has been shown to reduce pressure ulcers as well as skin shearing, which is a major concern for bariatric patients. The pads have two layers of foam – a soft, memory-type foam and a harder foam at the bottom – to prevent the obese patient from "bottoming out" on the table top. The Maquet tables also feature dual-articulating split legs.

TSK Products also offers a line of transfer and transport equipment that can be used in the surgical care environment. The Breez Powered Electric Wheelchair from TSK is a walk-behind transport chair designed to accommodate patients up to 750 lbs. With a storage space for personal belongings, IV pole and optional oxygen bottle holder, the Breez is ideal for admitting and discharging patients. It has dual fingertip controls and on-board battery charger.

Motorized products such as the Breez are especially helpful when negotiating difficult surfaces including carpeted floors, inclines and uneven floor conditions such as elevators where manual wheelchairs can be difficult to push.

The AirMatt Lateral Patient Transfer System available through TSK allows the caregiver to laterally transfer a patient without any lifting, greatly reducing back injuries. With no weight-limit, the AirMatt is an air mattress with hundreds of tiny holes in the bottom. In just five seconds, the air supply fills the mattress, lifts the patient, then as air escapes from the bottom holes, the caregiver simply slides the mattress and patient to the new surface. AirMatt can stay under the patient during imaging and surgery further eliminating patient transfers.

ARJO (Roselle, IL) has a range of sling lifts, slings and sliding sheets for positioning that are designed to accommodate bariatric patients, the ARJO Tenor mobile sling lift for patients up to 704 lbs., and the ARJO MaxiSky 1000 which allows a single caregiver to transfer patients up to 1,000 lbs. under handset control without stress, strain or manual lifting.

Amy McCaw, marketing and communications manager, ARJO, explains that "sling lifts are designed to assist clients with less mobility. They also give more flexibility where maneuvering a client is required. A ceiling lift system is specifically designed to facilitate safe and dignified transfer of non-ambulatory bariatric clients."

ARJO’s Resident Gallery, available at www. arjo.com, classifies five patient types based on their degree of mobility and appropriate patient handling equipment. ARJO offers four types of slings based on different bariatric body shapes.

Liko Inc.‘s Viking lift weighing approximately 95 lbs. can easily handle lifting/repositioning/ambulation assistance tasks for persons weighing up to 660 lbs. Viking bariatric models can lift patients directly from the floor and are easy to operate. Liko’s overhead ceiling-mounted systems, the Likorall family, offer flexible operating, and easy X-Y positioning via traverse-type mounting rails.

In addition to being used for transferring patients throughout the hospital and in surgical suites, Liko’s lifts are also used to hold limbs in stable position during surgery.

"Over and above fundamental equipment requirements such as lifting capacities, user support and specific operational issues, by far the most important issue is the availability of bariatric-designed slings," said Jan DuBose, RN, director of clinical education, LIKO Inc (Franklin, MA). "These are slings designed specifically to accommodate the unique body characteristics and different centers of gravity of distinctive bariatric body types. O.R. directors also need to understand that the availability of the appropriate selection of bariatric slings can affect surgical outcomes by enabling precise movement and positioning of patients."

Stretchair Corporation’s patient handling equipment – which provides nearly infinite positioning from stretcher, to wheelchair, to bed – also contributes to a "no-lift" environment. "The less you have to move a patient from bed to stretcher to wheelchair, that eliminates heavy lifting, and the versatility of our products can eliminate each of those," said Stretchair’s Doust. Over the past thirty years, the company has been evolving its flagship Stretchair from its original 250-lb. model to accommodate heavier and heavier patients, while accounting for the safety of caregivers as well.

A complete redesign of its basic models several years ago led to, in addition to increased weight capacity and widths, several new features designed to aid both patient and caregiver. For one, a seat-assist function was added. "One of the significant issues for a large individual is not only sitting down in a chair, but also getting up from the chair," said Doust. "They need effective ways to assist them in getting up, and as they are rising from the chair, to always feel safe. For the patient that’s one of the biggest fears, is not feeling safe in what is happening with them."

The new Stretchair models also feature convenient swing legs and perhaps most importantly: motorization. About a year ago, Stretchair introduced its Crosstown 1,200-lb. capacity motorized transport complete with a riding platform for caregivers. While the Crosstown unit has been quite successful and is especially popular in hospitals that are specifically designed to accommodate bariatric patients, Doust said that the company had repeated requests for a smaller unit with similar design features. The company responded by developing the MC675M, a 675-lb. capacity motorized transport chair that’s designed to fit through standard size doorways, and provides easy maneuverability.

"Unfortunately most of the facilities today still have standard-size doors. They have not evolved yet and made the change-over," said Doust. "The average patient weight has increased so drastically; whereas before a facility might be limited on where they would need a 675-lb. capacity transport chair, they’re now finding that they need it anywhere and everywhere," he added.

The MC675M Stretchair can be utilized as a gurney, wheelchair, standing/lifting aid, short term bed and for performing minor procedures and exams. Essentially, a patient could be placed in the Stretchair and never transferred to another piece of equipment until they are released. While not technically a "clinical" chair, the Stretchair provides the added advantage of helping to aid mobility for post-surgery patients. "It does lend itself towards aiding in rehab," said Doust.

In addition to specially-designed surgical tables and stretchers, you’ll also need special surgical instruments in order to perform bariatric surgery, or surgery on obese patients.

"Candidates for bariatric surgery pose a number of unique challenges during laparoscopic surgery because of fundamental differences in the anatomy of obese patients, beginning with added difficulties that can arise in airway management, as well as added risks and greater technical difficulties that can be encountered during endoscope surgery and when closing," said William Schnorr, marketing manager, bariatrics, Karl Storz Endoscopy-America (Culver City, CA).

"Bariatric and morbidly obese patients present a higher risk of complication and pose difficulties and challenges in terms of access, tissue thickness and instrument manipulation. Tissues may be more difficult to manipulate because of the added torque placed on instruments. For example, during colorectal procedures, abdominal wall thickness can make access using conventional instruments difficult or impossible, even if port placement is altered," he added.

Consequently, "instruments and scopes must have sufficient length to overcome challenges of tissue thickness and differences in the anatomies of obese patients. Additionally, instruments and scopes must incorporate ergonomic designs to facilitate handling and manipulation during procedures, as well as sufficient durability to resist breakage or failure," said Schnorr.

Karl Storz’ extended-length laparoscopes with advanced optics help maximize visualization for improved outcomes. Precision Clickline instruments include a selection of extended-length instruments and tips for procedures involving large patients. A wide selection of jaw patterns enables gastric bypass and banding procedures.

"The challenges that surgeons face in everyday surgery is amplified when dealing with bariatric patients, which makes the need for enhanced imaging, ergonomic design and strong hand instruments even more important," said Julio Monroy, assistant product manager, surgical for Olympus Surgical America (Orangeburg, NY).

Olympus offers long versions of its HD EndoEYE High-Definition video laparoscopes, the ergonomic line of HiQ+ Hand Instruments and a reusable line of Ultrasonic Hand Instruments. Olympus has also enhanced the use of the EVIS EXERA II universal imaging platform which allows surgeons to switch between a laparoscope and a gastroscope with the same system to confirm the anastamosis and perform a leak check after bariatric surgery.

Bariatric surgical instrumentation available through Cardinal Health (Dublin, OH) includes the V. Mueller and Snowden Pencer lines of reusable and take-apart laparoscopic instruments. Diamond-Flex instrumen-
tation provides broad atraumatic organ retraction and graspers that allow surgeons to reach around corners.

Snowden Pencer brand Switch-Blade reposable laparoscopic scissors are a money-saving alternative to disposable scissors that feature a reusable handle and a variety of single-use disposable tip styles.

"Because of the complexity of the operation, patient size and number of ports utilized, surgeons often find both themselves and their instruments in a compromised position," said Sean Looney, senior marketing manager, V. Mueller surgical instrumentation.

"Whereas traditional ring-handled laparoscopic instruments force the surgeon to interface their hands with the handle in a prescribed way, Diamond-Touch and Diamond-Drive instruments offer access to key handle functions regardless of the surgeon’s orientation to the instrument."

Looney notes that quality is especially important for bariatric instruments because of their longer length and the fact that "they tend to take a real beating given the inherent challenges associated with the surgery."

Spectrum Surgical Instruments Corporation (Stow, OH) provides a full line of longer-length bariatric instruments with lengths up to 18" including Tungsten Carbide needle holders, scissors, suction tubes and more for improved reach in bariatric patients. The instruments are made from fine German stainless steel and are backed by a lifetime guarantee.

Obviously furniture and equipment designed to hold extremely large patients needs to withstand extreme force and pressure. So how do you know if your bariatric chair will stand the ultimate test?

"One of the most common, and arguably most dangerous problems with current bariatric seating options is the lack of sufficient testing," said Benjaman Hubbard, sales manager, Carstone Seating (Somerset, KY)."There are no standardized methods for testing which opens up the door for false claims of quality. Some manufacturers claim that their products live up to BIFMA (Business and Institutional Furniture Manufacturer’s Association) standards, which are intended for office furniture that is used by average sized individuals, therefore insufficient for bariatric use."

So what Carstone, Sittris and some other companies have done is to look at creating their own set of standards, with testing done by independent laboratories, that more accurately account for the real-life requirements of bariatric furniture and equipment.

For example, Sittris performs dynamic load weight tests on its welded tubular steel-framed Sittris BA bariatric chair, by not just setting a 750-lb. weight on the chair, but dropping it from a 6" height, before making the claim that the chair can safely hold a 350 to 600 lb. patient. "Because realistically someone could drop the last couple of inches when they’re sitting down," said Barras.

Arms of bariatric chairs also need special attention when testing for strength. "They need to be strong and they need to handle not just vertical pressure but also horizontal pressure," he said. Sittris’ structural durability cyclic test, involves placing 750 lbs. on top of the chair, and using 350 lb. force to shake the chair for over 100,000 times. "That’s designed to try and simulate use over a number of years of people getting into it and putting pressure on the sides," said Barras.

Carstone’s bariatric chairs have passed a complete battery of tests including intense static load tests of 6,000 lbs., as well as numerous other cyclic and static tests, both on the seat of the product as well as "side-load" tests to the legs to account for patients shifting from side-to-side in the chair, explained Hubbard.

Being strong is just the beginning of what makes a good bariatric chair. Before spinning off Sittris as a new healthcare seating company, parent company Keilhauser conducted four years of research in the unique seating needs of bariatric individuals. "Most conventional bariatric products are simply wider and stronger versions of regular seats. Simply making seats wider does not fully address the issues of bariatrics," said Barras.

Attending various gastric bypass self-help groups and meeting with pre-and post-operative patients and bariatric specialists, Sittris researchers, led by designer Helen Kerr of Kerr and Co., found that "bariatric patients have very specific seating needs."

Among those special seating needs are seats that are not too steep, and arms positioned to enable bariatric patients to lift themselves from the chair regardless of their body shape, explained Barras. The Sittris BA also has a sculpted lumbar area of the chair designed to accommodate excess skin, allowing patients to sit more comfortably and promote airflow.

The soap-and-water cleansable Sittris BA also provides infection control benefits with its Microcare fabric, an advanced technical textile that has nano-sized silver particles incorporated into it providing bactericidal capabilities. Because the nano silver particles are actually incorporated into the fabric itself, no amount of washing or wear-and-tear will wear it off. "It will always be active, it will always be killing bugs," said Barras.

Carstone’s steel-framed bariatric chairs can complement any décor, are available in fully upholstered models, stackable conference room chairs, patient transport options and several styles of more traditional waiting room furniture to accommodate patients from 600 to 1,000 lbs. The chairs feature extra-thick high-density foam cushioning. Crypton fabric is available for moisture-repellency.

Frame construction should be paramount when considering a chair for bariatric purposes, Hubbard advised. "The frame is the ‘backbone’ of the chair and its principle source of strength. Frame construction encompasses both the frame’s material and its design. Though they are often specified in healthcare facilities, wood framed chairs are generally not capable of handling the stresses associated with repeated bariatric use."

Klein advises that buyers look for specific construction details such as smooth, continuous welds on steel tubing, proper weight loading and size of casters, structural reinforcements on furniture, adequate seat widths and depths, battery life and ease of storage.

Westin Nielsen seating available through TSK is available in six different product lines including bariatric chairs, hip chairs, rockers, stackable conference chairs and benches. The chairs have passed 600-lb.drop tests and 1,200-lbs. static load tests.

"The risk of injury to patients and caregivers if bariatric patients do not have the proper equipment is significant," stressed Medline’s Jacobs. "Hospitals should be confident that they have the right equipment in the right places and that this equipment has been thoroughly tested by the manufacturer and that the manufacturer has extensive processes in place to ensure consistent quality. Not having the proper equipment also compromises patient dignity. It is very, very disturbing to patients if they cannot fit in equipment provided or they break it because of their weight."

Novation’s Wise stressed the importance of sensitivity training in caring for obese patients. "It’s not just for the caregivers. Everybody in the hospital, from the people who are in the admitting office, to the volunteers that man the desk, should have sensitivity training so they know the proper things to say to patients and their family members and the things not to say."

References:

1. Centers for Disease Control and Prevention, Overweight and Obesity: Obesity Trends: U.S. Obesity Trends 1985–2005, http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/index.htm

2. Frost & Sullivan, U.S. Specialty Bed and Support Surface Market for Bariatric, 2006.