What a difference a degree makes

Healthcare Purchasing News, Dec, 2005 by Jeannie Akridge

Bringing renewed interest in patient temperature management protocols, numerous organizations are drawing attention to surgical site infections (SSIs)--just one of the costly complications associated with hypothermic surgical patients.

Leading the pack for a number of patient safety initiatives is the Institute for Healthcare Improvement (IHI) with its "100,000 Lives Campaign" which is recruiting hospitals nationwide in an effort to save lives through the implementation of protocols known to improve patient care. One of the six targeted interventions is to "Prevent Surgical Site Infections" and one of the four ways to achieve that is to maintain post-operative normothermia.

Arizant Healthcare (Eden Prairie, MN) recently launched its own "Prevent Hypothermia" campaign targeting a reduction in SSIs. Citing statistics that say that of the 97 million people undergoing surgery in the U.S. annually, 14 million will suffer from unintended hypothermia and nearly 750,000 will acquire an SSI, Arizant is attempting to educate healthcare providers on simple, cost-effective ways to prevent SSIs, of which 40 to 60 percent are avoidable. The "Prevent Hypothermia" campaign, available at www.PreventHypothermia.org, includes an educational "kit featuring a variety of warming measurement and tracking tools, implementation tips and an educational presentation.

Clinical evidence cited by the IHI and others includes a study that evaluated patients undergoing colorectal surgery and proved that there was nearly three times greater chance of an infection with hypothermic patients: an 8 percent infection rate in normothermic patients versus a 19 percent infection rate in hypothermic patients. (1) Normothermia is defined as 36 to 38 degrees Celsius; even one degree less than 36 degrees C constitutes a hypothermic patient. And that one degree can make all the difference in patient outcomes and costs.

In a recent study that looked specifically at difficult-to-manage Off-Pump Cardiac Artery Bypass (OPCAB) patients, researchers found that patients who were just 1 degree C below normothermia upon entering the ICU had nearly twice the chest tube drainage output; required two additional units of blood; almost five hours longer to extubation; a little more than half a day longer in the intensive care; and stayed almost a full day longer in the hospital. (2)

In order to reduce the incidence of such complications, an effective temperature management protocol will involve the use of several different warming products and techniques tailored to meet the unique needs of specific groups of patients. Available options include forced air or convective warming systems; circulating-water conductive systems; fluid warmers and temperature monitoring products.

The most common systems used to maintain normothermia in surgical patients are forced air warming systems, in which warm air is piped through a blanket placed over or tinder the surgical patient. It's cost-efficient and it's been proven clinically effective time and time again.

"More than 100 scientific papers have been written about the benefits of forced-air warming and maintaining normothermia. In fact, two clinical organizations, including the American Society of PeriAnesthesia Nursing and the American Society of Anesthesiologists, already have forced-air warming guidelines in place," said Troy Bergstrom, senior public relations specialist, Arizant Healthcare.

Complex cases call for high-tech systems

Indeed forced air warming is effective for the majority of surgeries. However, important to note: "It's definitely not one size fits all in managing patient temperatures," emphasized Tim Dye, general manager, medical device business, Kimberly-Clark Health Care (Roswell, GA). "I think we will see the market continuing to evolve towards differentiation in the products and greater understanding that [facilities] need to have different applications for different patient populations."

In particular, complex, lengthy and invasive procedures that require access to a large body surface area--such as cardiac surgery, thoracic surgery, organ transplantation, total hip re placement, even robotic surgery--carry a greater risk of hypothermia. These types of procedures are not particularly suited for the more traditional forced air warming products.

Case in point is the above mentioned study on OPCAB patients led by Y. Joseph Woo, M.D., assistant professor of surgery, director of the minimally invasive and robotic cardiac surgery program for the University of Pennsylvania. (2) The study compared the facility's standard warming practices for OPCAB surgeries, which included the use of a forced air warming system, to the Kimberly-Clark Patient Warming System, a conductive warming system that uses circulating water and unique warming pads with an adhesive hydro-gel layer for optimal heat transfer. The researchers found that the Kimberly-Clark Patient Warming System was able to maintain a 1 degree C higher temperature than standard practice, an average of 36.5 degrees C versus 35.6 degrees C for those warmed by standard practice