QAPI 149 - Quality Initiative to Improve Intraoperative Normothermia to Reduce Hysterectomy Surgical Site Infections

Background: Risks for abdominal hysterectomy surgical site infections (SSIs) include prolonged surgical discomfort, increased morbidity, extended length of stay, and increased likelihood of readmissions. The hospital identified a significant increase in abdominal hysterectomy SSIs between October 2021 and September 2022.

Methods: A multidisciplinary team was formed to address abdominal hysterectomy SSIs. Based on a review of literature, the team recommended maintenance of intra-operative normothermia (greater than 36° Celsius) as a process measure to improve our SSI rate. In September 2022, the Women’s Center operating room (OR) nursing team piloted a normothermia protocol: ensuring patients were warmed to greater than 36° Celsius by use of a warming blanket/warming gown in Pre-operative holding; use of hot lines (warm intravenous infusions) by anesthesia; and communication between the anesthesia provider and surgical team about initial patient temperature, raising the OR room temperature if the patient was hypothermic. The surgical and anesthesia teams would also keep track of the patient’s temperature throughout the procedure. The OR nurse clinicians educated surgical staff and anesthesia providers about the goal of the protocol and its importance.

Results: At the start of the pilot, the cumulative rate of abdominal hysterectomy SSIs was 2.1 per 100 surgeries, between October 2021 and September 2022. Pre-intervention, normothermia was maintained in 45% of reviewed abdominal hysterectomy surgeries. Post-intervention, normothermia was maintained in 61% of reviewed abdominal hysterectomy surgeries from September 2022 to April 2023. The hysterectomy SSI rate decreased to 0.9 per 100 surgeries from January to March 2023 and to 0.0 per 100 surgeries from April to June 2023.

Conclusions: Since the implementation of the normothermia protocol, the abdominal hysterectomy rate has improved significantly over a 6-month period. Spread of the normothermia protocol to other surgical suites should be considered to determine if sustained reduction in SSIs can be maintained in other specialties.