Assessment of intraoperative temperature management at the University Teaching Hospital of Kigali: A quality improvement project

Background: Due to the inhibition of thermoregulation by anesthetics, hypothermia occurs in 50% of patients undergoing general and neuraxial anesthesia without active warming. High-quality research has shown the negative effects of intraoperative hypothermia including increased rates of surgical site infections, increased hospital length of stay, increased cardiac morbidity and increased rate of transfusion. The University Teaching Hospital of Kigali commonly known as CHUK is the largest public referral hospital in Rwanda. The International Standards for Safe Anesthesia were not being met regarding intraoperative temperature management at CHUK. However, due to high ambient temperature in the operating room, it was unknown if this was a significant problem and worth investment, in a health system, with limited resources.
Methods: After institutional review board approval, a two-stage descriptive cross-sectional quality improvement project was performed. The first stage was to assess current management of intra-operative temperature, determine if there was a significant rate of hypothermia and establish risk factors for developing intra-operative hypothermia in this clinical setting. The second stage was to determine if locally available warming techniques, an underbody warming blanket, significantly reduced the incidence of intra-operative hypothermia.
Results: The primary result of the study was a 58% incidence of hypothermia with current standard practice. This was reduced to 6% with the use of an underbody water blanket. Temperature was measure intraoperatively in only 6% of cases and never documented. Adult patients and patients undergoing neuraxial anesthesia were more likely to experience hypothermia.
Conclusions: Intraoperative hypothermia is common at CHUK despite high ambient operating room temperature. Monitoring and documentation of temperature is not occurring on a regular basis. The use of underbody water body, though not the gold standard for intraoperative warming, was effective in this study and a realistic solution in an environment with limited resources.