Tag Archives: perioperative nursing

Jul 8, 2016

Ask for evidence when determining forced-air patient warming fact from fiction

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Since 1987, the 3M™ Bair Hugger™ patient warming system has maintained a commitment to excellence by focusing on three guiding principles:

  1. Educating clinicians on the benefits of maintaining normothermia and emerging trends/science in the field of temperature management.
  2. Improving our products to continuously reflect customer needs and remain an industry leader in technology advancement.
  3. Supporting key research to advance the science of normothermia maintenance.

These principles are as relevant—if not more so—in today’s healthcare environment, where patient outcomes and clinical value lead the decision-making process. Medical devices are no longer products you sell to doctors or nurses based on “features” alone; they are tools that must contribute to better outcomes while providing an economic benefit worthy of investment.

The patient warming industry is a microcosm of the larger healthcare environment. Competition is growing and new technologies are attempting to gain a foothold in a crowded market. It’s virtually impossible for clinicians to distinguish between fact and fiction as they are bombarded with clever sales tactics and products claiming equal performance at lower cost.

Clinical Evidence is Key

To truly separate clinically supported warming technologies from “me too” imitators, clinicians should demand the clinical evidence supporting a manufacturer’s claims of performance, safety and overall value.

3M’s commitment to the science of temperature management has never been more evident. Recently, the company announced the publication of a robust research compendium highlighting the safety and effectiveness of the Bair Hugger patient warming system. The compilation of over 200 study summaries includes more than 60 randomized controlled trials and covers a wide range of surgeries – including hip, knee, cardiac and abdominal procedures – and reinforces the sheer volume of extensive research supporting the clinical use of the Bair Hugger system.

The compendium features summaries of publications in which the Bair Hugger system was either the subject of (or used during) a clinical research study or investigation. Also included are review articles, case studies and letters to the editor, which introduce relevant information or real-world user experience with the Bair Hugger system.

The compendium was assembled utilizing multiple search engines and five databases, including Medline, Embase, Biosis, Elsevier Biobase and Chemical Abstracts. Many of the included studies measure the performance of the Bair Hugger system against competing technologies, ranging from convection warming to resistive polymer technologies.

To download a digital copy of the Bair Hugger System Research Compendium, Click here.

Download a copy of the 3M Bair Hugger patient warming system research compendium


May 19, 2016

The Prevention of Perioperative Hypothermia Toolkit

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The Prevention of Perioperative Hypothermia

Guest blogger: Victoria M. Steelman, PhD, RN, CNOR, FAAN Associate Professor, College of Nursing, The University of Iowa Disclosure: Victoria M. Steelman, PhD, RN, CNOR, FAAN has served as a consultant for 3M and VitaHEAT. This article is sponsored by 3M.

The Prevention of Perioperative Hypothermia Toolkit

I am sometimes asked, “Is perioperative hypothermia really a big deal?” The answer is “yes, it is.” Most patients undergoing surgery will become hypothermia unless we use effective interventions to prevent it.

Why is preventing perioperative hypothermia important?

It is important to prevent perioperative hypothermia because it is associated with negative patient outcomes. Perioperative hypothermia increases:

  • surgical site infection risk,1
  • morbid cardiac events,2
  • blood loss,3,4
  • length of stay in the recovery room,5 and
  • impairment of drug metabolism.5

All of this increases the cost of healthcare.

Why does hypothermia occur?

One common misconception is that perioperative hypothermia is caused by the operating room being cool, and if the room temperature is increased, hypothermia will not occur. This is a myth. Although the room temperature plays a role, anesthesia plays the primary role. General and regional anesthesia impair the normal thermoregulatory responses.6 Upon induction of anesthesia, heat is redistributed from the core to the peripheral tissues, which are much (2-4oC) cooler. This causes the core temperature to drop significantly during the first hour of anesthesia.7 Anesthesia also impairs the body’s ability to respond to cold. Normally, the body would respond to a drop in temperature of 0.4oC. An anesthetized patient does not respond until there is a 4oC drop in core temperature.So, the patient does not produce enough heat to overcome the initial hypothermia.

Will using cotton blankets prevent hypothermia?

Passive warming with blankets retains heat. But, because the anesthetized patient is unable to produce enough heat, retention of heat alone is inadequate. Applying heated cotton blankets is only slightly more effective, and the benefit only lasts 10 minutes.9 In a randomized clinical trial, applying heated cotton blankets failed to prevent hypothermia.10

Will heating insufflation gases for laparoscopy prevent hypothermia?

Another commonly used, ineffective way of preventing hypothermia is heating the carbon dioxide used for insufflation during laparoscopy. A meta-analysis of 16 randomized clinical trials found that heating CO2 gas had no effect on core temperature, and there was no evidence to support the use of heated CO2 gas, with our without humidification, for laparoscopic surgery.11

How can we prevent hypothermia?

Applying heat to actively warm the patient is required to prevent perioperative hypothermia. The most common method of active warming is forced air warming (FAW), which distributes warm air over the skin surface, heating peripheral tissues, and minimizing core-to-periphery temperature gradient. Intraoperative FAW is more effective in maintaining body temperature than cotton blankets,10,12  reflective blankets,12 or thermo-lite® insulation.12,13

What patients should receive active warming?

Patients undergoing surgery that will be at least 30 minutes long, with general or regional anesthesia (spinal, epidural) should be actively warmed.

When should we use active warming?

To be most effective, active warming should be initiated preoperatively for at least 30 minutes and also used intraoperatively. Actively warming the patient preoperatively minimizes heat lost during redistribution of heat from the core to periphery upon induction of anesthesia, and minimizes the incidence of hypothermia.14-16

Why are hospitals not using these evidence-based practices?

Unfortunately, active warming is not always used when needed and is often not used correctly. First, practitioners are not knowledgeable enough about perioperative hypothermia, and do not always consider it a priority. Secondly, they do not understand the importance of prewarming the patient, and often start active warming after induction of anesthesia. Third, there was a quality performance measure that has been retired that required active warming or normothermia. Practitioners were in compliance with the measure even if they used active warming incorrectly, starting it after induction of anesthesia, and the patient became hypothermic.17 Actual evaluation of patient outcomes and reducing the incidence of hypothermia were not emphasized, resulting in a “checklist mentality”. And, lastly, complacency is an incredibly strong force, and a concentrated effort is required to make a change in practice.

How can we get practitioners to use this evidence to prevent perioperative hypothermia?

We need to use a combination of strategies to engage busy professionals and integrate a change into their work processes. For that reason, a team at the University of Iowa developed the Prevention of Perioperative Hypothermia Toolkit©. Use of this toolkit has been tested for the past two years, and refined with lessons learned. The toolkit includes is a list of steps for planning the implementation of changes. The second component is a template for a risk assessment, a Healthcare Failure Mode and Effect Analysis (HFMEA), to identify potential issues that can arise during implementation. The next component is an educational program that can be modified with taped statements of support from key perioperative leaders in the setting. A list of data elements to use for modifying the electronic documentation system is included to allow for the generation of reports. And, there are spreadsheets that can be used as templates for audit and feedback.

The Prevention of Perioperative Hypothermia Toolkit© is available free of charge.

For more information, watch the 3M webinar Strategies for Infusing Evidence-based Practices for Prevention of Perioperative Hypothermia.

The Prevention of Perioperative Hypothermia (PPH) Toolkit was funded by the Agency for Healthcare Research and Quality, grant 3 IR18HS021422-01A1.

Dr. Steelman has been a perioperative nurse for over 25 years. As a perioperative advanced practice nurse at the University of Iowa Hospitals and Clinics, she focused on implementing evidence-based practice changes for 20 years. She is currently Associate Professor in the College of Nursing at the University of Iowa where she teaches graduate students evidence-based practice. Her program of research focuses on perioperative safety and quality. She has extensively published and presented about issues related safe patient care in the operating room, including five research studies focusing on prevention of retained surgical sponges. She is well recognized for her contributions and received AORN’s Outstanding Achievement awards for Research and Evidence-based Practice. In 2008, she received the AORN’s highest award, the Award for Excellence in recognition of her contributions to perioperative nursing. In 2007, she was inducted into the American Academy of Nursing in recognition of the national and global impact of her work. 


1. Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med. 1996;334:1209-1215.

2. Frank SM, Fleisher LA, Breslow MJ, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA. 1997;277:1127-1134.

3. Schmied H, Kurz A, Sessler DI, Kozek S, Reiter A. Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet. 1996;347:289-292.

4. Winkler M, Akca O, Birkenberg B, et al. Aggressive warming reduces blood loss during hip arthroplasty. Anesth Analg. 2000;91:978-984.

5. Lenhardt R, Marker E, Goll V, et al. Mild intraoperative hypothermia prolongs postanesthetic recovery. Anesthesiology. 1997;87:1318-1323.

6. Sessler DI. Temperature monitoring and perioperative thermoregulation. Anesthesiology. 2008;109:318-338.

7. Sessler DI. Perioperative heat balance. Anesthesiology. 2000;92:578-596.

8. Torossian A. Thermal management during anaesthesia and thermoregulation standards for the prevention of inadvertent perioperative hypothermia. Best Pract Res Clin Anaesthesiol. 2008;22:659-668.

9. Sessler DI, Schroeder M. Heat loss in humans covered with cotton hospital blankets. Anesth Analg. 1993;77:73-77.

10. Fossum S, Hays J, Henson MM. A comparison study on the effects of prewarming patients in the outpatient surgery setting. J Perianesth Nurs. 2001;16:187-194.

11. Birch DW, Manouchehri N, Shi X, Hadi G, Karmali S. Heated CO(2) with or without humidification for minimally invasive abdominal surgery. Cochrane Database Syst Rev. 2011;(1):CD007821.

12. Ng SF, Oo CS, Loh KH, Lim PY, Chan YH, Ong BC. A comparative study of three warming interventions to determine the most effective in maintaining perioperative normothermia. Anesth Analg. 2003;96:171-176.

13. Borms SF, Engelen SL, Himpe DG, Suy MR, Theunissen WJ. Bair hugger forced-air warming maintains normothermia more effectively than thermo-lite insulation. J Clin Anesth. 1994;6:303-307.

14. Andrzejowski J, Hoyle J, Eapen G, Turnbull D. Effect of prewarming on post-induction core temperature and the incidence of inadvertent perioperative hypothermia in patients undergoing general anaesthesia. Br J Anaesth. 2008;101:627-631.

15. Horn EP, Schroeder F, Gottschalk A, et al. Active warming during cesarean delivery. Anesth Analg. 2002;94:409-414.

16. Vanni SM, Braz JR, Modolo NS, Amorim RB, Rodrigues GR,Jr. Preoperative combined with intraoperative skin-surface warming avoids hypothermia caused by general anesthesia and surgery. J Clin Anesth. 2003;15:119-125.

17. Steelman, V. M., Perkhounkova, Y. S., & Lemke, J. H. The gap between compliance with the quality performance measure “Perioperative Temperature Management” and normothermia. J Healthc Qual. 2014 January 13. PMID: 24417607. doi: 10.1111/jhq.12063.

May 9, 2016

Patient Safety in Practice

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hospital assessment and patient safety

Reducing SSIs Through Meaningful Dialog

If you’re like us, you come across a lot of information relating to infection prevention. There are facts like;

Five out of every 100 patients admitted to a hospital will acquire an infection during their stay, according to the U.S. Centers for Disease Control and Prevention (CDC).¹ Surgical site infections (SSIs) are the most common form and account for 30 percent of healthcare acquired infections (HAIs) and the cost of an SSI, according to JAMA, ranges from $18,902 to $22,667.² Yes, a lot of people study it, report on it and write scholarly journal articles. While we share the same concerns, we prefer to take action and the 3M Healthcare Safety in Practice Program is a good place to start.

Through our Third-party Clinical Audit program for perioperative and sterile processing departments, we have been partnering with hospitals and health systems to help them reduce or eliminate the incidence of SSIs. We work together with healthcare compliance program leadership to achieve impressive results that leave a given unit with an “always ready” capability to respond to any inquiry, be it a healthcare committee, governance or reporting/review agency. We help you accomplish this using a member from our team of licensed and highly experienced RNs. Why do we bother? Because our mission at 3M Infection Prevention includes just that, preventing infection, and we believe that educating and sharing technical expertise is an even more powerful defense against SSIs.

We take time to get to know you and your process, with all its nuances, staff and unique characteristics. Our staff of RNs, some of whom have over 30 years’ experience in the OR and Level One Trauma care centers, take on the role of the learner and observe how your process works. We talk about your healthcare compliance concerns and in what areas you are seeing a spike in SSIs. Then we discuss your thoughts as to where you feel we can help. As you might expect coming from 3M, we went ahead and developed a comprehensive and logical analytical model. It’s not a healthcare audit, inspection or evaluation. It’s an informed observation from the ground up based on nine key areas. Our proprietary analytical process is based on the latest practice guidelines from professional organizations such as AAMI, AORN, and the CDC. So with a fresh pair of eyes, real-world experience and our proprietary analytical methods, we work with you to attain an “always ready” capability to respond to any infection prevention department’s inquiry, committee, governance or reporting/review agency

We observe your staff in action, on a peer-to-peer level. In the process, some surprising things happen. The staff comes to appreciate their leadership for the focus received and direct role they play in improving patient care. And, hospitals often learn how they can save considerable costs.

As you might understand, we are bound by confidentiality regarding those hospitals that we serve, but the results are too exciting not to share. Click on these links to access case studies from actual healthcare clients.

Solving a Mysterious Rise in Surgical Site Infections: A 3M Safety in Practice Third-Party Assessment Customer Experience

Continuous OR practice improvement at North Shore-LIJ Health System

After we complete our findings, we engage in conversation with you and corroborate our observations with your concerns. Most often we find that teams and facilities often have slowly drifted away from best practices or that certain mandates are issued that may save materials cost but increase the risk of SSIs. We formulate and recommend solutions for those and any other issues that need correction. Infection prevention takes many forms that don’t always arrive through the loading dock, sometimes it walks in through the main entrance, shakes your hand and says, “I’m here to help.” Our Third-party Clinical Audit for perioperative and sterile processing departments is a win-win program for everyone, especially for each patient who recovers from surgery with no complications.

1. http://health.usnews.com/health-news/news/articles/2013/09/03/hospital-acquired-infections-cost-10-billion-a-year-study

2. Eyal Zimlichman, MD, MSc; Daniel Henderson, MD, MPH; et al. “Health CareAssociated Infections: A Meta-analysis of Costs and Financial Impact on the US Health Care System.” JAMA. 2013

Mar 25, 2016

AORN Surgical Conference 2016 – Plan Ahead

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AORN Perioperative Conference and Expo 2016

Calling all perioperative nurses and healthcare workers! AORN Surgical Conference and Expo is upon us once again, April 2-6, 2016 in sunny Anaheim, CA. We’re looking forward to another great conference and expo with new technology, scientific data, as well as great education seminars and events.

AORN Surgical Conference and Expo 2016 – Events to See

Education Sessions – Over 65 to sort through! From ambulatory to clinical to evidence-based practice/research, there’s a little of something for everyone to continue your education track.

OR Executive Summit – This special summit is geared for the day-to-day periop leaders. Managers, directors, vice presidents, and even chief nursing officers should attend this event. There are a lot of changes that leaders are dealing with today, and this is a way to get some creative insight to make improvements. There is a separate registration for this and additional fees do apply. Don’t forget to check out the breakfast symposium presented by 3M Health Care on Monday (4/4/16) from 7:00-8:00 am: Embedding an Infection Prevention Nurse in the OR.

Leadership Development Summit – This summit isn’t restricted to current leaders or job titles. Anyone who aspires to be in a leadership role should check out this event. This event is a chance to network with other future perioperative leaders. This event also has a separate registration and fees. Check out the lunch symposium presented by 3M Health Care on Tuesday (4/5/16) from 12:15-1:15 pm:  The Relationship between the Sterile Processing Department and the Operating Room.

3M Health Care Booth – Come Say Hi and See What’s New

We’d love to see you! Stop by our booth, #913, and receive 100 Surf the Hall points for a chance to win a prize from AORN.

3M™ Skin and Nasal Antiseptic (Povidone-Iodine Solution 5% w/w [0.5% available iodine] USP) Patient Preoperative Skin Preparationhelps reduce bacteria in the nares in 1 hour.1 Download and read the summary of clinical evidence before the show, then stop by for more information and to try it for yourself!

Stop Unintended Perioperative Hypothermia Before it Begins. Actively warming surgery patients before anesthesia induction is called prewarming. Prewarming is an effective way to help prevent intraoperative hypothermia in many surgical cases. Both the 3M Bair Hugger system and the 3M Bair Paws system use convective warming to help maintain a patient’s body temperature, and also can make the patient surgical experience a bit more comfortable. This year at the 2016 AORN Expo, we will have patient warming experts on hand to help you see, and feel, the difference! Before you head to the expo, download a copy the prewarming sheet and get your questions answered by one of our experts.  Want to discover even more? Take a free continuing education course on the topic! We look forward to see you in Anaheim!

1. 3M Study-05-011100.

Feb 25, 2016

Nosocomial Infection: Reduce the Risk of a Surgical Site Infection

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Ways to help reduce the risk of a nosocomial infection during surgery

Prevention of nosocomial infections is critical. These infections are more commonly known as healthcare-associated infections (HAIs).

Healthcare facilities and operating rooms are fast moving places with many things to keep track of. But, there are four principles that can help reduce the risk of spreading a HAI during surgery to always keep top of mind:

  1. Diligent hand hygiene. Hand hygiene should be practiced by everyone in a healthcare facility. Patients, visitors, and healthcare professionals should understand and practice the World Health Organization (WHO) Five Moments for Hand Hygiene. The perioperative team uses more specific guidelines from the Association of perioperative Registered Nurses (AORN). The periop team should know and remind each other when to practice hand antisepsis.
  2. Reduce Bacteria on the Patient. Bacteria from the skin are the leading cause of surgical site infections. Microorganisms such as Staphylococcus aureus and Methicillin-resistant Staphylococcus aureus (MRSA) are serious threats that can cost a hospital as much as $60,000.1 The skin cannot be sterilized, but by using a surgical skin prep and an incise drape, a sterile operating field can be created. Evidence now suggests bacteria from the patient’s own nares can contribute to surgical site infections (SSIs). Clinical evidence demonstrates that using a nasal antiseptic helps reduce the risk of SSI when part of a comprehensive preoperative protocol.
  3. Maintain normothermia. Operating rooms are typically cold and patients are often exposed. Maintenance of normothermia is important to help reduce the risk of SSIs.2-5 Even a 1.6°C decrease in body temperature can produce inadvertent perioperative hypothermia.6-7 Forced-air warming is a technology that has been proven safe and effective for over 25 years. Maintaining normothermia is one of the easiest, least expensive, and most effective benefits you can offer to patients.
  4. Mitigate cross-contamination. In a clinical study, 77% of reusable ECG leadwires were found to be contaminated with antibiotic-resistant nosocomial pathogens even after being cleaned.8 This is one reason to use disposable leadwires. Disposable leadwires can also remain with the patient even while they are being transported.

Prevention and reduction of HAIs are a priority for the U.S. Department of Health and Human Services (HHS).

For more information on the HHS plan, visit the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination. There is no one way to stop HAIs, prevention relies on people. By practicing proper protocols and looking out for the patient, we can all work together to improve infection rates.

1 Anderson DJ, Kaye KS, Chen LF, et al. Clinical and financial outcomes due to methicillin resistant Staphylococcus aureus surgical site infection: a multi-center matched outcomes study. PLoS ONE. 2009; 4(12): doi: 10.1371/journal.pone.0008305
2Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med. 1996;334:1209-15.
3 Melling AC, Ali B, Scott EM, Leaper DJ. Effects of preoperative warming on the incidence of wound infection after clean surgery: A randomized controlled trial. Lancet. 2001;358:876-880.
4 Barie PS. Surgical site infections: epidemiology and prevention. Surg Infect. 2002;3:S9-S21.
5 Seamon, M.J., et. al. The effects of intraoperative hypothermia on surgical site infection: An analysis of 524 trauma laparotomies. Ann of Surg. 2012;255(4)
6 Sessler DI. Current concepts: mild perioperative hypothermia. N Engl J Med. 1997; 336:1730-1737.
7 Barie PS. Surgical site infections: Epidemiology and prevention. Surg Infect. 2002; 3: S-9 – S-21.
8 Jancin, Bruce. Antibiotic-resistant pathogens found on 77% of ECG lead wires. Cardiology News. 2004;2(3):14.