Learning Objective #1: Describe the documented knowledge base related to the etiology and sequelae of inadvertent perioperative hypothermia

Learning Objective #2: Discuss the strengths and limitations of the evidence-base supporting interventions for effective management or prevention of inadvertent perioperative hypothermia

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Introduction of clinical problem: Participation in the National Surgical Infection Prevention Project (SIPP), a large metropolitan hospital led investigators to question the direct correlation between inadvertent perioperative hypothermia (IPH) and post-operative wound infection (PWI), with a focus on IPH for the adult population. The clinical question: Three areas of interest were explored. 1. What frequency and etiology exists of IPH? 2. What complications or sequelae are associated with IPH? 3. What effective strategies can manage or prevent IPH? Search for evidence included a review of nursing and medical literature from computerized databases of CINAHL, OVID, DOCLINE, and EBSCO. The search for literature was limited to studies that were methodologically sound. An "ancestry approach," tracing previous generations of work from references in more recent publications, found additional citations. Published guidelines from the Association of Perioperative Registered Nurses and the Association of Post Anesthesia Nurses were reviewed. Strong consensus among colleagues through various forums was discovered. Recommendation for best clinical practice based on the evidence. IPH was found to be a frequent, iatrogenic complication of surgery. The etiology includes physiological factors of decreased thermoregulatory response and neuromuscular blocking induced by anesthesia, aging and decreased body mass and environmental factors such as room temperature, intravenous fluids and skin surface exposure. Potential sequelae includes cardiac arrhythmias; pulmonary left shift in oxyhemoglobin saturation curve; prolonged bleeding and clotting times; reduced immunity predisposing to PWI; increased postoperative recovery time; increased hospital length of stay; detrimental patient psychological effects and increased costs. Studies support hypothermia management through airway heating and humidification, warmed intravenous fluids, cutaneous warming and ambient room temperature greater than 24 degrees C. Many predisposing factors interrelate with post operative wound infections. With over 675,000 PWI occurring annually (2-3% incidence rate), additional research is needed to directly implicate IPH in post operative infection.