Understanding Hypothermia

PICOT Questions and Surgical Site Infection Studies indicate that 2% -5% of patients undergoing surgical procedures suffer from surgical site infections (SSIs). These infections result in significant patient morbidity and in some cases mortality, which both are costly to the healthcare systems. According to WHO, SSIs are the second most common cause of healthcare-associated infections among hospitalized patients, only outdone by medication errors. As such, many hospital readmission cases stem from surgical site infections as also noted by Meyer (2017). Furthermore, Surgical Site Infection (SSI) occurs in 9 % of laparoscopic colorectal surgery. This infection results in both preoperative or postoperative hypothermia. This research causes examination of the relationship between nursing characteristics and patient outcomes in preoperative surgery.

Understanding Hypothermia

In the nursing field, the study of hypothermia is vital to understanding the severity of SSIs. Hypothermia is described as a temperature below 36°C and has been associated with an increased risk of SSI (Leaper & Ousey, 2015). This temperature is common during and after major surgical procedures especially those lasting more than 2 hours. The human body comprises of a central section encompassing the main organs where the temperature is compactly regulated, and a marginal section where the temperature fluctuates widely. During surgical operation process, heat loss from the body is compensated by reducing blood flow through the skin, and through inducing muscular activity (shivering) including an increase in the basal metabolic rate; this result in increased heat production. Normally the periphery (marginal) compartment is typically 2ºC to 4ºC cooler than the central (core) compartment (Quintini, Martins, Shah, Killackey, Reed, & Guarrera, 2018). The Problem Given the heavy burden SSIs impact on patients and families based on high morbidities and mortalities there is a need to analyze the efficacy of some variables regarding the perioperative nursing workforce. There is a need to know if nursing characteristics, such as certification status and educational attainment, impact surgical site infection rates? The Significance of the Problem As a nurse, the responsibility of preventing SSIs is comprehensive and spans the continuum of care. As such, we perform an important role in executing or promoting the implementation of evidence-based practices that work towards the prevention of SSIs. For instance, based on the problem, we can provide counseling and education during the initial preoperative processes as well as aid the aesthetic team in carrying out their roles of ensuring patients have balanced normothermia.

Consequently, studying the problem is significant considering we get to know the effective interventions to administer in case patients develop SSI or what do when the environment in the hospital has high severity to the risk of developing an SSI. I. What is the relationship between adverse patient outcomes such as SSIs and the characteristics of the nursing workforce? This question seeks to identify the role of the nursing workforce towards adverse outcomes eecially SSIs. TheF question is vital because most of the causes of SSIs result from unmonitored surgical operations. Hence, with this question, we will get to understand how the patient and the nursing workforce is connected during surgical operations. II. Do certified perioperative nursing workforce record better outcomes during surgery? This question seeks to identify if the premise of a link between improved patient outcomes and certification of the perioperative nursing workforce is correlating. This is an attempt to understand how much certification is required for the nurses to ensure reduced SSI in patients. III. Does the level of experience in perioperative nurses determine better outcomes regarding the prevention of SSIs? This question seeks to unravel if limited to work experience, level of nursing education, workload, and limited training on infection prevention mechanisms, do impact the capability of perioperative nurses in ensuring prevention of SSIs and related diseases. IV. Other than properly timed antibiotics, skin antisepsis, hygiene, and other measures, why is the use of warm blankets emphasized as a measure as important to reducing SSI rates? This question seeks to highlight the significance of some SSI intervention measures with more emphasis on the use of blankets during the perioperative procedures.

V. What are the existing guidance guidelines for perioperative nurses to enable detection, and surveillance of SSIs? This question seeks to examine some of the laid out guidelines that work towards detection, surveillance as well as some of the key interventions advocated to help reduce the severity of SSI infections. PICOT Question In surgical operations, should systemic body warming be an essential requirement for the prevention of SSI? P- Peri-operative patients in the Cardiovascular operating room I-Peri-operative temperature management using a warming blanket C- Patients receive no treatment to prevent hypothermia (standard procedure) O- Patients with warming blankets will not succumb to SSI-attributable mortality T- The study will take place for one year Based on the PICOT, some of the following recommendations are necessary for intraoperative warming Assessment: first, there should be an identification of a patient’s risk factors for unplanned perioperative hypothermia. Second, there should be frequent monitoring of intraoperative temperature in all cases. Third, there should be an assessment for signs and symptoms of hypothermia to determine a patient’s thermal comfort level. Finally, the assessment data should be documented and risk factors communicated to all members of the anaesthesia/surgical team. Interventions: All patients involved in cardiovascular operation should not be exposed to lower ambient environmental temperatures, also passive warming measures should be initiated.