In April 2011, Medline launched its foray into patient warming products with the PerfecTemp, an operating room table pad which allows for the monitoring of patient temperature at the point where skin meets the mattress. Frank Czajka is the president of Medline's Proxima division, a surgical-focused division overseeing much of the company's disposable protective surgical apparel, facial protection and ancillary surgical products traditionally used in the OR to provide further infection control options, including the company's warming products.
Mr. Czajka discusses the importance of patient warming and maintaining normothermia, the reasons why it is a challenge for organizations and how Medline hopes its focus on providing warming solutions will help overcome these obstacles.
Q: Why is maintaining patient normothermia critical for hospitals and surgery centers, both from a safety and compliance perspective?
Frank Czajka: Achieving normothermia really does several things that are hyper-important to patients and ultimately their outcomes. [By maintaining normothermia], there's a three times reduction in the risk of surgical site infection and a three times reduction in the risk of a cardiac events during or post-surgery, which is going to truly have an impact on mortality and morbidity rates. It also reduces bleeding and recovery time. Maintaining normothermia not only benefits the patient, but also provides a huge benefit to the hospital in terms of lower time in PACU and ultimately a shorter stay in the hospital, which allows that facility to turn over and take care of more patients.
The decision to warm has really been made on a case-by-case basis. Instead of having the ability to warm every patient, every time, the decision was made when the case was a certain length with a certain amount of [expected] blood loss. Not every patient [receives warming] therapy in that case.
Typically, we've seen that 60-65 percent of patients receive some sort of therapy. SCIP (CMS's Surgical Care Improvement Project) says we have to do better, we can take better care of our patients. Maintaining normothermia or core body temperatures shouldn't be a choice; it should be something we do for every patient, every time.
We expect SCIP-Inf-10 (SCIP measure 10 – Surgery Patients with Perioperative Temperature Management) to bring about a shift in patient warming, where hospitals will likely warm more like 80-85 percent of their patients, and eventually we see the trend as every patient who goes into a surgery should be warned.
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Q: Why does maintaining patient normothermia present a challenge for organizations?
FC: If you look at the systems that are in place and have been in place for 15-20 years, it can be a little bit cumbersome in the OR if they add a lot of extra equipment and the disposables [used for patient warming]. To perform an effective therapy, using traditional warming techniques take a lot of setup time and manpower away from the routine setup of the OR and [the equipment] can be a bit intrusive, limit access to the patient and cause some trouble in setting up the surgical case.
If the warming therapy [equipment] is in the way of the case or could potentially be, it ends of being removed or set aside. In that case, the patient isn't getting the therapy they need during the case. That's why innovative warming techniques … are needed and critical.
Q: Why else are organizations coming up short in their efforts to maintain normothermia?
FC: Patient access is what I would say is a main driver. Space takes a back seat to patient access. The most popular systems [for providing warming] — the forced-air systems — typically have a blanket that goes over body and has to be secured in place underneath the draping mechanism so the sterile drapes create the sterile field.
That takes 4-5 minutes of total time for the staff, and then air is blown through the blanket to provide warming therapy which can cause a dynamic surgical field, which you don't always want. If it's over the patient, it can impede access for the surgery, in which case you have to manipulate the warming therapy, you have to move it around, you have to choose another style. You add to the setup and disposal time by having to pick a second blanket for the lower body, if that's the case.
The tremendous amount of setup time lends to a higher expense, and all hospitals are feeling the budget crunch now. Setup time is not to be taken lightly. The OR minute is an extremely important benchmark in the hospital today. Conservatively an OR minute costs a hospital $61, so it's $61 a minute to set up a 4-5 minute warming option. The costs are staggering to the facility, but they've just become part of the scenery.
Q: How does the PerfecTemp table pad help to support improvement efforts?
FC: Our method is very simple: We eliminate access issues by warming the patient through the table pad.. You're putting a lot of surface area in contact with that mattress pad, you're going to apply a lot more area of warming and the access issues for the surgeon and surgical team aren't there. We're warming in a different way — it's a conductive warming.
PerfecTemp does a nice job of incorporating into the environment. It's a surgical table pad that would be there every day. You would literally have to push the on button in the morning, warm the pad up before the first case and you could provide warming therapy for every patient all day in every case. It takes the decision process away, it takes access issues away and it takes the pain of some of the antiquated systems away.
It's an incredibly high-end pressure reduction mattress as well. Pressure ulcers are at the forefront of SCIP and hospital care. Sixty-seven percent of pressure ulcers originate in the OR but then they're treated on the floor. Finding out where these pressure ulcers are beginning and then giving products that can alleviate some of that pressure should certainly be a welcomed addition.
That's a two for one. The foam layer on top of the PerfecTemp, where is where the patient would contact the mattress, is a viscoelastic foam. It's thermally conductive so it's incredible high density, allowing for that pressure reduction and ultimately better patient outcomes from a pressure ulcer standpoint.
Q: What other benefits does such a system offer?
FC: Another benefit is you're not adding to the scenery, you're not adding one or two blankets per procedure and disposing of packaging, and disposing of those blankets at the end of the case. In most of the studies [done], PerfecTemp helps hospitals to eliminate about 200 lbs. of disposable waste per OR suite by eliminating all disposable warming products. The life of the [PerfecTemp] is five years.
From an energy consumption perspective, the power the PerfecTemp generates would run a 120 watt light bulb. Traditional forced-air blowers run on more than 10 times that amount of electricity, or about 1,500 watts. It means literally several hundred dollars for the facility, which adds up, and the energy consumption is not to be taken lightly.
In the end, PerfecTemp takes away that decision to warm. That's something we talk about a lot. It just makes it part of every case. If you could warm 100 percent of your patients, why wouldn't you? There's no downside. There's certainly the cardio cases where you go on pump and you have to bring the patient's temperature down, but the perfusionist is there to do that. In those cases, you hit a simple standby button on the unit and it stops sending energy to the pad. As soon as you need to go back on warming, you hit that standby button again and go back to therapeutic warming.
Q: What other patient warming solutions has Medline developed?
FC: We really looked at [PerfecTemp] as the first of a family of warming products. Since the launch of PerfecTemp OR pad, we've launched a pre-op and post-op stretcher pad using the same therapy, the underbody warming with the extremely high-end pressure reduction foam that can go on the PACU and pre-op carts that transport the patient. It's not often thought about, but if you were to actively warm your patient therapeutically, not just giving them a toasty robe or blanket, the dip when they do go under anesthesia would be less severe because that patient will already be therapeutically warmed.
If they were on a pre-op stretcher that was providing therapeutic warming, then they're transferred to a warm table, their core and their patient temperature is going to maintain a [comfortable level] and they're going to see a less of a dip. In other systems, even if the patient is warmed prior to the case, they are still transferred to a cool OR suite with a cool table pad. Any warming that may have been achieved is lost in the 15-30 minutes that take place before forced air systems are turned on after prep and draping. It's really all about that continuum of warming, and PerfecTemp allows for that.
Learn more about PerfecTemp.
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