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availability of oxygen in peripheral wound tissues. Hypothermia is associated
with a higher risk of SSIs because it causes tissue hypoxia and vasoconstriction,
and compromises the body's normal immune function, which includes attacking
infections through the bloodstream. Vasoconstriction occurs when the core
body temperature decreases, which is a protective mechanism to divert blood to
the center of the body and help maintain the normal body temperature. The
reduction of nutrient and oxygen supply to wounds will increase the frequency
of surgical wound infection.
"Hypothermia can contribute to wound infections both by directly impairing
immune function and by triggering thermoregulatory vasoconstriction, which in
turn decreases wound oxygen delivery," says Daniel I. Sessler, MD, professor
and chair of the department of outcomes research at the Cleveland Clinic in
Ohio.
The promising news is that prevention is easy. Active patient warming is a sure
cure for SSIs. Study after study has shown that preventing hypothermia before,
during and after surgery by using evidence-based practices prevents post-opera-
tive hypothermia and the resultant wound infections.
Mild hypothermia matters
A 1- to 3-degree drop in core body temperature is relatively common in surgical
procedures, but even mild hypothermia can have deleterious consequences,
says Victoria M. Steelman, PhD, RN, CNOR, FAAN, assistant professor of nurs-
ing at the University of Iowa. Research has shown that mild hypothermia:
• triples the risk of surgical site infection in patients undergoing colon surgery;
• quadruples the risk of morbid cardiac events;
• increases blood loss;
• increases the duration of action of anesthesia and neuromuscular blocking
agents; and
• extends post-anesthesia recovery by an average of 90 minutes.
If you do nothing to thwart hypothermia, chances are that most patients under-
P A T I E N T W A R M I N G
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