Patient Perioperative Warming

Measure with very different weighting

What makes perioperative warming an SSI preventing aspect

"... the maintenance of normothermia has a significant benefit in reducing the risk of SSI when compared to non-warming standard care.”1

In this context, the WHO also mentions relevant benefits of warming strategies, such as a possible decrease in myocardial events, blood loss and transfusion requirements.1

In addition, it is reported that studies have shown a correlation between unplanned perioperative hypothermia and impaired wound healing, adverse cardiac events, altered drug metabolism and coagulopathies.1

Guidelines

GuidelineRecommendationCategory (if mentioned)
CDC2“Maintain perioperative normothermia.”Category IA; strong recommendation; high to moderate-quality evidence
“... To optimize tissue oxygen delivery, maintain perioperative normothermia and adequate volume replacement.”Category IA; strong recommendation; moderate-quality evidence
WHO1“The panel suggests the use of warming devices in the operating room and during the surgical procedure for patient body warming with the purpose of reducing SSI.”Conditional recommendation; moderate quality of evidence
NICE3,4“Maintain patient temperature in line with NICE's guideline on hypothermia: prevention and management in adults having surgery.”3-
“The patient's temperature should be measured and documented before induction of anaesthesia and then every 30 minutes until the end of surgery.”4-
“Standard critical incident reporting should be considered for any patient arriving at the theatre suite with a temperature below 36.0°C.4-
“Induction of anaesthesia should not begin unless the patient's temperature is 36.0°C or above (unless there is a need to expedite surgery because of clinical urgency, for example bleeding or critical limb ischaemia).”4-

“In the theatre suite:

  • the ambient temperature should be at least 21°C while the patient is exposed
  • once active warming is established, the ambient temperature may be reduced to allow better working conditions
  • using equipment to cool the surgical team should also be considered.”4
-
“The patient should be adequately covered throughout the intraoperative phase to conserve heat, and exposed only during surgical preparation.”4-
“Intravenous fluids (500 ml or more) and blood products should be warmed to 37°C using a fluid warming device.4-

“Warm patients intraoperatively from induction of anaesthesia, using a forced-air warming device, if they are:

  • having anaesthesia for more than 30 minutes or
  • having anaesthesia for less than 30 minutes and are at higher risk of inadvertent perioperative hypothermia.

Consider a resistive heating mattress or resistive heating blanket if a forced-air warming device is unsuitable.”4

-
“The temperature setting on forced-air warming devices should be set at maximum and then adjusted to maintain a patient temperature of at least 36.5°C.”4-
“All irrigation fluids used intraoperatively should be warmed in a thermostatically controlled cabinet to a temperature of 38°C to 40°C.4-
KRINKO5With the exception of therapeutically or protectively desired hypothermia, accidental hypothermia should be avoided, especially in colorectal surgery.-

HARTMANN:

Denise Leistenschneider, Senior Clinical Consultant
“Patient perioperative warming not only has a feel-good aspect, but obviously also contributes to SSI prevention.”

Some recommended instruction

Temperature

  • Keep patient’s temperature in the range of normothermia and avoid hypothermia2–5

  • Do not induce anaesthesia before patient’s temperature is 36.0°C or above.4

Control

  • Measure and document patient’s temperature before and during (every 30 minutes) anaesthesia/surgery.4

Warm fluids

  • Warm intravenous fluids (500 ml or more) and blood products to 37°C.4

  • Warm perioperative used irrigation fluids to 38°C–40°C.4

Warming devices

  • Use warming devices for patient body warming.4

Aspects influencing patient’s core temperature6

Patient-centred and external factors, e.g.

  • drugs

  • comorbidities

  • trauma

  • environmental temperature

  • type of anaesthesia

  • extent and duration of surgery

Relevance of patient’s core temperature6

Perioperative hypothermia has negative effects on, e.g.

  • coagulation

  • blood loss

  • transfusion requirements

  • metabolization of drugs

  • discharge from the post-anaesthesia care unit

  • surgical site infections

  1. WHO (2016) Global guidelines for the prevention of surgical site infection. World Health Organization 2016.
  2. Berríos-Torres SI, et al. (2017) Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg; 152(8): 784–791.
  3. NICE (2020) Surgical site infections: prevention and treatment. NICE guidelines. Published: 11 April 2019. Last updated:19 August 2020. www.nice.org.uk/guidance/ng125.
  4. NICE (2016) Hypothermia: prevention and management in adults having surgery. NICE guideline. Published: 23 April 2008. Last updated: 14 December 2016. https://www.nice.org.uk/guidance/cg65/resources/hypothermia-prevention-and-management-in-adults-having-surgery-pdf-975569636293.
  5. KRINKO (2018) Prävention postoperativer Wundinfektionen. Empfehlungen der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Bundesgesundheitsbl 61: 448–473.
  6. Rauch S, et al. (2021) Perioperative Hypothermia – A Narrative Review. Int J Environ Res Public Health 18: 8749.

In focus

Multidrug resistant teaser
Multidrug-resistant organisms

Multidrug-resistant organisms (MDRO) are on the rise worldwide. Due to the limited treatment options for MDRO infections, hygiene management plays a key role in their prevention. Learn all about hygiene measures and effectiveness of disinfectants.

Learn more…

Publications teaser
Publications
Scientists around the world work daily to identify and assess infection risks. This scientific debate is an indispensable prerequisite for increasing the safety of patients and medical staff.

Here you will find a selection of recent studies and publications...
Expert advise
Expert Advice
We are happy to answer your questions about our products, application and compatibility. Our advice covers all topics related to disinfection, hygiene and infection control.

Learn more…

Related & interesting

Risk prevention
Risk prevention

Reduced preparation time in wards and operating theatres means fewer mistakes and more treatment and surgeries.

Learn more here...

Patient underlayer

How to support the change-over process between patients treated in sequential interventions?

Look here for an answer…

Preventia
PREVENTIA® Surgical Irrigation

Surgical irrigation is a crucial measure in preventing SSI. Discover our new fluid to take your common practice to the next level.

Find out more…

PAUL HARTMANN AG processes the personal information provided exclusively for the purpose of customer care. For this purpose we might share your personal information within the responsible employee in the relevant country within the HARTMANN Group. The personal information is not stored, transferred or used for any other purpose. The personal information is not transferred to any third parties outside the HARTMANN Group.