What makes perioperative warming an SSI preventing aspect
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Guidelines
Guideline | Recommendation | Category (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 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:
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 | - | |
KRINKO5 | With the exception of therapeutically or protectively desired hypothermia, accidental hypothermia should be avoided, especially in colorectal surgery. | - |
HARTMANN:
![](/-/media/country/website/topics/infection-prevention/hp/denise_leistenschneider_quote-1.png?h=135&iar=0&mw=320&w=144&rev=f812cfe4845440be8bc3c720610a3dc5&sc_lang=en&hash=75B5F27787BB0ED92CECDB9861950921)
“Patient perioperative warming not only has a feel-good aspect, but obviously also contributes to SSI prevention.”
Some recommended instruction
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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
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Control
Measure and document patient’s temperature before and during (every 30 minutes) anaesthesia/surgery.4
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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
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Warming devices
Use warming devices for patient body warming.4
Aspects influencing patient’s core temperature6
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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
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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
- WHO (2016) Global guidelines for the prevention of surgical site infection. World Health Organization 2016.
- 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.
- 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.
- 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.
- KRINKO (2018) Prävention postoperativer Wundinfektionen. Empfehlungen der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Bundesgesundheitsbl 61: 448–473.
- Rauch S, et al. (2021) Perioperative Hypothermia – A Narrative Review. Int J Environ Res Public Health 18: 8749.
In focus
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