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Keep Calm. Stay Warm. A Quality Improvement Initiative to prevent Surgical Site Infection (SSI) through Perioperative Temperature Management

by Nur-in Mohammad

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Background

A surgical site infection (SSI) is an infection that occurs after surgery in the part of the body where the surgery took place. SSIs are the 3rd leading cause of hospital acquired infections. It affects both the patient and organisation. The impacts to the patient include, but not limited to, prolonged hospital stay, negative effect on quality of life due to losing of job while in the hospital or being treated, morbidity and mortality. Treatment of SSIs are also a huge financial burden to the organisation amounting to approximately £10,000 per patient. This cost includes extended length of hospital stay, antibiotics, and further surgeries.

One of the key elements to reduce SSI rate is to prevent patient form developing Inadvertent Perioperative Hypothermia (IPH). Patients with low core body temperature of less than 36 C are at risk or SSI and also cardiovascular diseases. Hypothermia can cause the blood vessels to constrict, reduce blood circulation and tissue perfusion, thus affecting effective wound healing.

Aim

To increase compliance to Inadvertent Perioperative Hypothermia (IPH) NICE Guidelines in Chedworth and Kemerton Day Surgery Units by 30 % within 6 months.

Method

Three PDSA Cycles used which include:

  1. Initiating IPH Risk Assessment for all patients undergoing elective surgery in CGH General Theatres
  2. Implemented interventions guidelines for pre-warming patients according to their risk, as per NICE Guidelines
  3. Staff education on importance of warming and ASA Grading and documentation

Results

Process Measure: Compliance to IPH NICE Guidelines increased from 12.5% to 58% in 3 months

Outcome Measure: Incidence of IPH reduced from 33% to 14% in 3 months.

Next Steps

  1. IPH Risk assessment will be part of the Pre-operative Checklist
  2. Education pack for all staff.
  3. Include importance of warming in patient’s letters/leaflets.
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