The changes to practice that operating theatres would have to make, to reduce this preventable harm, are few, simple and low cost, according to KATE WOODHEAD RGN DMS. However, best practice is not being followed in many instances.
Surgical site infections are a significant burden for patients, causing pain, suffering and potential re-admission, as well as being the source of disgust and an interruption to almost all daily activities. In addition to the burden for patients, additional costs for the Trusts are high because of the extended length of stay in hospital. Among the many risk factors which have been subject to guidance and high impact interventions, there is cause to revisit the clinical guidance issued by NICE on Inadvertent Perioperative Hypothermia (IPH). IPH is entirely preventable – requiring a focus for admission units or surgical wards to collaborate with the operating theatre on methods of keeping patients warm. How hard can this be? The well recognised link between surgical site infection and perioperative hypothermia indicates that with a small amount of additional work, we can effectively reduce harm to patients and costs to healthcare institutions. However, anecdotally it would seem that this advice and best practice is not being followed in many instances. The clinical impact of not taking action to keep patients warm during surgery shown by numerous studies include a higher risk of cardiac mortality, a decreased ability for wound healing, slower drug metabolism, slower awakening in recovery and longer Post Anaesthesia Care Unit (PACU) stays as well as a greater likelihood of blood loss perioperatively.
Hypothermia
The definition of hypothermia is a core temperature of less than 36°C. This definition applies, regardless of the patient’s initial temperature. Inadvertent perioperative hypothermia is distinguished from therapeutic hypothermia, which is the deliberate induction of hypothermia. Inadvertent perioperative hypothermia is a recognised and common occurrence during surgery, with the adult surgical patient at risk of developing hypothermia at any stage of the perioperative pathway. When asked, many patients say that they are cold in hospital, so that unless action is taken prior to the patient’s journey to the operating department, many will be cold when they arrive for surgery. NICE Guidance issued in 20081 emphasises the need to ensure that patients are kept warm pre-operatively. Perioperatively, a multidisciplinary team effort is needed to ensure that the recommendations from NICE (and many others) are implemented, to prevent patients from becoming cold in the cool temperature of the ward, hospital corridors, operating theatres and the recovery unit. We must actively warm patients so that unplanned hypothermia does not occur.
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