Experts from four companies that provide temperature manage- ment products discuss the technology that allows clinicians to keep themselves and their patients safe and comfortable.
SP: What are some of the potential consequences
of overlooking patient temperature management?
Karen Moore, Marketing Director, Ecolab Healthcare: Maintaining core
body temperature is critical to improving outcomes for surgical patients.
Clinical research shows that even mild hypothermia leads to adverse effects
including increased blood loss, delayed wound healing, potential adverse
cardiac outcomes, lengthened recovery and hospital stays and increased
risk of surgical site infections. Inadvertent hypothermia jeopardizes patient
health and is costly to the facility. Actively managing the patient’s temperature throughout the perioperative continuum reduces risk to the patient
and unnecessary cost to the facility. It is important to recognize the opportunities before, during and after surgery to maintain patient normothermia.
Kelley Terrell, Senior Marketing Manager, Techstyles Nonwovens
at Encompass Group, LLC: Clinical evidence demonstrates that mild
hypothermia increases the incidence of serious adverse consequences
including surgical site infections and adverse cardiac events including
Brent Augustine, President, Augustine Temperature Management:
According to Mahoney in Economics of Patient Warming (Outpatient
Surgery Magazine 2005), each hypothermic patient could incur as
much as $2,500-7,000 in additional costs. Warming literally saves lives
and is one of the least expensive things a hospital can do to improve
SP: Generally speaking, do most facilities do an
adequate job of addressing patient temperature
management? Why or why not?
Terrell: Most facilities have implemented patient temperature management protocols for the intraoperative and postoperative environments.
However, the benefits of effective prewarming are still frequently overlooked and the impact remains significant. In a 2012 study, the data
reflected that despite more aggressive measures, over 32% of patients
arrive in the postoperative area hypothermic. We are beginning to consider the solution may be more complex than simply applying active
measures intraoperatively for longer duration procedures. The most
effective warming strategies focus on the patient's needs and maximizing skin surface coverage to prevent cutaneous heat loss. Shorter
duration procedures (typically 90 minutes or less) can typically be
effectively addressed by passive warming products such as reflective
warming gowns or blankets. However, patients undergoing longer
duration procedures benefit from combining active and passive warming measures. This combination provides maximum coverage as well
as a supplemental heat source.
Augustine: Even facilities that follow SCIP guidelines may not be
doing as well as they think. A recent study by Leijtens in the Journal
of Arthoplasty showed that forced-air warming failed 28% of the time,
a rate the physician authors called “disturbingly high.” Other studies
have corroborated the low success rate, and since many facilities still
use forced-air warming systems, the overall failure rate is high.
SP: What are some of the products out there that
are designed to deal with patient temperature
Augustine: Some technologies dating to the 1980s—like forced-air warming and circulating-water systems—are being challenged by less expensive,
environmentally friendly, reusable electric warming systems. Among
electric warming systems, for example, there are older-style carbon-fiber
heaters and the newer conductive-polymer blankets and mattresses.
Moore: Technologies available include methods to warm irrigation
fluid, warm IV fluids and warm the surface of the patient. Systems
that allow for active irrigation fluid warming within the sterile field are
replacing the use of cabinet warmers in many facilities.
Terrell: Forced air is one of the most common active warming measures used intraoperatively. The efficacy of these products is well documented. However, according to recent studies, they can take up to 30
minutes to have a measurable impact. This can present a challenge in
shorter duration procedures where there may not be time to rewarm
the patient before transport to PACU. Reflective warming technology
products combine the function of traditional linen with intrinsic warming and insulating properties. They use the body’s radiant heat as a
generator and minimize cutaneous heat loss. They are ultra-lightweight
and move with the patient throughout the perioperative journey to