Patient Warming Helps Prevent Infections

Warming patients before, during and after surgeries delivers two primary benefits. The most obvious is the comfort. Warmth can do wonders to soothe a shivering, nervous patient. But the second benefit, patient safety, often doesn’t get the credit it deserves. Warming patients throughout their perioperative episodes maintains normothermia, which can prevent surgical site infections (SSIs) by promoting better healing of their surgical wounds. 

Mimi DesBiens, BSN, RN, administrator and director of nursing at Premier Outpatient Surgery Center in Colton, Calif., says her facility began actively warming patients in the mid-2010s. “We did warm patients before that, but mainly with warmed blankets,” she says. Then a director of nursing from Loma Linda University arrived at her facility, and brought the active warming with her.

The practice took hold, and now active warming is a core tenet of patient safety at Premier. In fact, the primary reason patients are warmed is to prevent SSIs. “It’s an evidence-based practice for infection control,” says Ms. DesBiens. “If you keep the patient warm enough, you have good blood flow to the incision site, and it helps with healing.” Another impact of warming has been quicker recoveries with reduced postoperative usage of narcotics. “We don’t want that risk of hypothermia,” she says. “Before we started using warming devices, some patients came into the PACU shivering, and we had to use quite a bit of narcotic medications,” she says.

Ms. DesBiens’ facility has criteria that triggers the implementation of its active warming protocols. “For the most part, active warming is always going to be used when the patient’s body is exposed and under general anesthesia using inhalational agents for procedures that last longer than 30 minutes,” she says. The practice is regularly deployed with longer cases involving MAC sedation as well — but not for shorter procedures. “If it’s a quick 30-minute carpal tunnel case under MAC sedation, we’ll give them warm blankets,” she says.

The exception to this is age. If an 80-year-old patient who is cold to begin with comes into pre-op, there’s a very good chance active warming will take place, says Ms. DesBiens. “We do a lot of nursing assessment when it comes to warming, and if the anesthesia provider requests it, we do it,” she adds.

Barb Draves, CASC, administrator at The Surgery Center of Southwest General in Middleburg Heights, Ohio, describes a two-pronged rationale for warming patients. Nurses regularly provide warm blankets to patients on request, which puts patients more at ease. With active warming, however, there are no firm protocols in place; rather, the devices are usually employed based on the preferences of certain surgeons and anesthesiologists.

For Ms. Draves, it’s all about the comfort. “There’s nothing better than a warm blanket; everybody loves one,” she says. Ms. Draves knows this firsthand. “Having been a surgery patient myself, there is something comforting about being kept warm, so we always ask, ‘Would you like a warm blanket?’” she says. The hardest thing, says Ms. Draves, is teaching nurses to pick up the blankets already on the patient when applying another one, because the tendency is to stack them. “It’s easy for nurses to put a warm blanket on top, but you need to put it closest to their body,” she says.

Active warming devices are most frequently used at The Surgery Center of Southwest General to prevent hypothermia and its clinical complications, as well as for patient comfort in conjunction with cosmetic, orthopedic and podiatry procedures, and for all cases lasting two hours or more. Patients receiving general anesthesia or those with certain ASA statuses and preexisting medical conditions are warmed as a matter of course.

While Ms. Draves’ facility doesn’t have hard data on the connection between patient warming and SSI rates, the practice clearly isn’t harming its constant and diligent efforts to prevent infections. “I’m not sure we even have looked at putting those two things together, but we have very few post-op infections,” she says. “We had a 0.08% infection rate last year in 5,861 cases.”

Use of patient warming doesn’t move the economic needle at the facility, according to Ms. Draves. “Everything costs money, but blankets are cheap and with the warming cabinet, you’re just using electricity and paying for laundry,” she says. Patients are going to need a blanket one way or the other and, if they’re going have one, it may as well be a warm blanket considering the benefits, adds Ms. Draves. “The most important factors are patient safety, patient comfort and positive outcomes,” she says. “What can you do within your facility to ensure those things occur? Patient warming is part of those efforts.”

Ms. DesBiens also appreciates the patient comfort component. “Patients feel like royalty when we wrap them up,” she says. “It’s that extra added comfort measure that helps ease them through the surgical journey. I think it’s so cute when the patient giggles and says, ‘Wow! This is great! Can I take this home with me?’”