Implementation of a quality improvement initiative for standardising essential newborn care in a teaching public hospital in rural central India.

OBJECTIVE: Our aim was to refine the essential newborn care practices by employing the multidisciplinary peer team-led quality improvement (QI) projects. DESIGN: In 2017, concerning the same, the department focused on early initiation of breast feeding, prevention of hypothermia within an hour of life and rational usage of antibiotics among babies admitted to neonatal intensive care unit (NICU). Baseline data reported the rate of initiation of breast feeding, hypothermia and antibiotic exposure rate as 35%, 78% and 75%, respectively. Root causes were analysed and a series of Plan-Do-Study-Act cycles were conducted to test the changes. The process of change was studied through run charts (whereas control charts were used for study purpose). RESULT: After the implementation of the QI projects, the rate of initiation of breast feeding was found to be improved from 35% to 90%, the incidence of hypothermia got reduced from 78% to 10% and the antibiotic exposure rate declined from 75% to 20%. Along with the improvement in indicators related to essential newborn care, down the stream we found a decrease in the percentage of culture-positive sepsis rate in the NICU. CONCLUSION: Peer team-led QI initiatives in a resource-limited setting proved beneficial in improving essential newborn care practices.

Introduction of a Warming Bundle to Reduce Hypothermia in Neonatal Surgical Patients.

INTRODUCTION: Hypothermia in the neonatal surgical population has been linked with significant morbidity and mortality. Our goal was to decrease intra and postoperative hypothermia. INTERVENTION: In November 2021, a radiant warmer and hat were included along with standard warming methods prior to the start of General Surgery procedures to minimize episodes of hypothermia. PRIMARY OUTCOME: Core body temperature was measured pre, intra and post-operatively. METHODS: Data were prospectively collected from electronic medical records from July 2021 to March 2023. A retrospective analysis was performed. Hypothermia was defined as a temperature <36.5C. Control charts were created to analyze the effect of interventions. RESULTS: A total of 277 procedures were identified; 226 abdominal procedures, 31 thoracic, 14 skin/soft tissue and 6 anorectal. The median post-natal age was 36.1 weeks (IQR: 33.2-39.2), with a pre-surgical weight of 2.3 kg (IQR: 1.6-3.0) and operative duration of 181 min (IQR: 125-214). Hat and warmer data were unavailable for 59 procedures, both hat and warmer were used for 51 % procedures, hat alone for 29 %, warmer alone for 10 % and neither for 10 % of procedures. Over time there was a significant increase in hat utilization while warmer usage was unchanged. There was a significant increase in the mean lowest intra-operative temperature and decrease in proportion of hypothermic patients intra-operatively and post-operatively. CONCLUSIONS: The inclusion of a radiant warmer and hat decreased the proportion of hypothermic patients during and after surgery. Further studies are necessary to analyze the impact on surgical outcomes. LEVEL OF EVIDENCE: III.

Comparison of the incidence of inadvertent perioperative hypothermia between general anesthesia and interscalene brachial plexus block in shoulder arthroscopy: A randomized prospective study.

INTRODUCTION: Inadvertent perioperative hypothermia (IPH), defined as core body temperature below 36°C, is associated with various complications. Shoulder arthroscopy is a risk factor of IPH. This study aimed to compare the incidence of IPH between general anesthesia (GA) and interscalene brachial plexus block (ISBPB) for shoulder arthroscopy. METHOD: Patients scheduled for shoulder arthroscopy were prospectively enrolled and randomly assigned to GA or ISBPB groups. The body temperature of the patients was measured from baseline to the end of anesthesia and in the post-anesthetic care unit to compare the incidence of IPH. RESULTS: Of the 114 patients initially identified, 80 were included in the study (GA = 40, ISBPB = 40). The incidence of IPH differed significantly between the groups, with GA at 52.5% and ISBPB at 30.0% (P = .04). Profound IPH (defined as < 35.0°C) occurred in 2 patients with GA. Upon arrival at the post-anesthesia care unit, the GA group exhibited a significantly lower mean body temperature (35.9 ±â€…0.6°C) than the ISBPB group (36.1 ±â€…0.2°C, P = .04). CONCLUSION: The incidence of IPH in the GA group was higher than that in the ISBPB group during shoulder arthroscopy, suggesting that ISBPB may be a preferable anesthetic technique for reducing risk of IPH in such procedures.

Effect of wet clothing removal on skin temperature in subjects exposed to cold and wrapped in a vapor barrier: a human, randomized, crossover field study.

BACKGROUND: Prehospital care for cold-stressed and hypothermic patients focuses on effective insulation and rewarming. When encountering patients wearing wet clothing, rescuers can either remove the wet clothing before isolating the patient or isolate the patient using a vapor barrier. Wet clothing removal increases skin exposure but avoids the need to heat the wet clothing during rewarming. Leaving wet clothing on will avoid skin exposure but is likely to increase heat loss during rewarming. This study aimed to evaluate the effect of wet clothing removal compared to containing the moisture using a vapor barrier on skin temperature in a prehospital setting. METHODS: This randomized crossover experimental field study was conducted in a snow cave in Hemsedal, Norway. After an initial cooling phase of 30 min while wearing wet clothes, the participants were subjected to one of two rewarming scenarios: (1) wet clothing removal and wrapping in a vapor barrier, insulating blankets, and windproof outer shell (dry group) or (2) wrapping in a vapor barrier, insulating blankets, and windproof outer shell (wet group). The mean skin temperature was the primary outcome whereas subjective scores for both thermal comfort and degree of shivering were secondary outcomes. Primary outcome data were analyzed using the analysis of covariance (ANCOVA). RESULTS: After an initial decrease in temperature during the exposure phase, the dry group had a higher mean skin temperature compared to the wet group after only 2 min. The skin-rewarming rate was highest in the initial rewarming stages for both groups, but increased in the dry group as compared to the wet group in the first 10 min. Return to baseline temperature occurred significantly faster in the dry group (mean 12.5 min [dry] vs. 28.1 min [wet]). No intergroup differences in the subjective thermal comfort or shivering were observed. CONCLUSION: Removal of wet clothing in combination with a vapor barrier increases skin rewarming rate compared to encasing the wet clothing in a vapor barrier, in mild cold and environments without wind. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT05996757, retrospectively registered 18/08/2023.

Effect of 10 Minutes of Prewarming and Prewarmed Intravenous Fluid Administration on the Core Temperature of Patients Undergoing Transurethral Surgery under General Anesthesia.

Background: Patients undergoing transurethral urologic procedures using bladder irrigation are at increased risk of perioperative hypothermia. Thirty minutes of prewarming prevents perioperative hypothermia. However, its routine application is impractical. We evaluated the effect of 10 minutes of prewarming combined with the intraoperative administration of warmed intravenous fluid on patients' core temperature. Methods: Fifty patients undergoing transurethral bladder or prostate resection under general anesthesia were included in this study and were randomly allocated to either the control group or the prewarming group. Patients in the prewarming group were warmed for 10 minutes before anesthesia induction with a forced-air warming device and received warmed intravenous fluid during operations. The patients in control group did not receive preoperative forced-air warming and were administered room-temperature fluid. Participants' core body temperature was measured on arrival at the preoperative holding area (T0), on entering the operating room, immediately after anesthesia induction, and in 10-minute intervals from then on until the end of the operation (Tend), on entering PACU, and in 10-minute intervals during the postanesthesia care unit stay. The groups' incidence of intraoperative hypothermia, change in core temperature (T0 - Tend), and postoperative thermal comfort were compared. Results: The incidence of hypothermia was 64% and 29% in the control group and prewarming group, respectively (P = 0.015). Change in core temperature was 0.93 ± 0.3 °C and 0.55 ± 0.4 °C in the control group and prewarming group, respectively (P = 0.0001). Thermal comfort was better in the prewarming group (P = 0.004). Conclusions: Ten minutes of prewarming combined with warmed intravenous fluid significantly decreased the incidence of intraoperative hypothermia and resulted in better thermal comfort in patients undergoing transurethral urologic surgery under general anesthesia.

Polyethylene bags before cord clamping in very preterm infants: a randomised controlled trial.

OBJECTIVE: Hypothermia on admission to the neonatal intensive care unit (NICU) is associated with an increased risk of death in preterm infants. There are currently no evidence-based recommendations for thermal care before cord clamping (CC). We wished to determine whether placing very preterm infants in a polyethylene bag (PB) before CC, compared with after CC, results in more infants with a temperature in the normal range on NICU admission. DESIGN: Randomised controlled trial. SETTING: Tertiary maternity hospital. PATIENTS: Inborn infants<32 weeks' gestational age (GA). INTERVENTIONS: Infants were randomly assigned to have a PB placed before or after CC. MAIN OUTCOME: Rectal temperature within the normal range (36.5°C-37.5°C) on NICU admission. RESULTS: Between July 2020 and September 2022, 198/220 (90%) eligible infants were enrolled in this study; 99 (44 (44%) girls) were randomly assigned to BEFORE and 99 (53 (54%) girls) to AFTER. Median (IQR) GA 29 (27-31) vs 29 (27-31) weeks, mean (SD) birth weight 1206 (429) vs 1138 (419) g, respectively. The proportion of infants who had normal temperature on NICU admission did not differ between the groups (BEFORE 54/99 (55%) vs AFTER 55/98 (56%), p 0.824). The proportion of infants with a temperature outside of the normal range was similar between the groups; hypothermia (BEFORE 34/99 (34%) vs AFTER 33/98 (34%), hyperthermia (BEFORE 10/99 (10%) vs AFTER 10/98 (10%)). CONCLUSIONS: Placing a PB before CC did not increase the proportion of preterm infants with normal temperature on NICU admission. A large proportion of preterm infants had abnormal temperature. Further studies on thermoregulation before CC are needed. TRIAL REGISTRATION NUMBER: NCT04463511.

Preventing hypothermia in pediatric neurosurgery in Africa-A randomized controlled non-inferiority trial of insulation versus active warming.

PURPOSE: The objective of this study was to compare the efficacy of a low-cost heat-preserving method in preventing intraoperative hypothermia with that of forced-air warming in a resource-limited setting. METHODS: In this randomized controlled non-inferiority trial, we recruited children younger than 12 years scheduled for cranial neurosurgery in a large East-African hospital. Patients were block-randomized by age to intraoperative warming measures using Hibler's method (intervention) or warm air (comparator). Hibler's group patients were circumferentially wrapped in transparent plastic sheeting (providing a vapor-trap) over a layer of cotton blankets, then laid on an insulating foam mattress. Warm air group patients were treated with forced-air convection via an underlying Snuggle Warm™ Pediatric Full Body mattress. Allocated warming measures were initiated in the operating theatre and discontinued upon anesthesia emergence. Perioperative temperatures were measured using noninvasive forehead probes (SpotOn™). The primary outcome was incidence of hypothermia (core temperature < 36.0° for longer than 5 min). Our null hypothesis was that Hibler's method is inferior in efficacy to the warm air method by a margin exceeding 20%. Among secondary outcomes were duration of hypothermia as proportion of surgical duration, incidence of postoperative shivering and rescue measure requirements. RESULTS: We analyzed data for 77 participants (Hibler's = 38; warm air = 39). There was no significant difference between the Hibler's and warm air arms of the study in the primary outcome of incidence of hypothermia (59.0% vs. 60.5% respectively; OR 1.07; 95% CI 0.43-2.65; p = .890). However, the risk difference (1.55%; 95% CI -0.20 to -0.24) exceeded the 0.2 margin and non-inferiority could not be declared. There was considerable need for rescue measures in both groups (71.1 0% vs. 69.2%; OR 1.09; 95% CI 0.41-2.90; p = .861). There was no statistically significant difference between groups for any prespecified secondary outcome. CONCLUSION: Although perioperative core temperatures were not significantly different, we could not declare an inexpensive heat-preserving method non-inferior to warm air convection in preventing intraoperative hypothermia in children undergoing anesthesia for cranial neurosurgery in a resource-limited setting. The extensive need for rescue measures may have masked important differences. TRIAL REGISTRATION: US National Institutes of Health Clinicaltrials.gov database (ID no. NCT02975817).

Effect of preoperative warming on intraoperative hypothermia and postoperative functional recovery in total hip arthroplasty: a randomized clinical trial.

BACKGROUND: Intraoperative hypothermia is associated with increased morbidity and impaired postoperative recovery. Direct anterior-approached total hip arthroplasty (ATHA) may lead to significant thermal loss. We aimed to assess whether preoperative warming had an impact on intraoperative hypothermia and postoperative functional recovery after ATHA. METHODS: In this prospective randomized controlled clinical trial 40 patients scheduled for ATHA were randomly divided into two groups of 20 patients each. Group W received, prior to the induction of general anesthesia, a 30 minutes 43 °C forced-air preoperative warming. Group C did not receive any preoperative warming. A blinded observer noted the core body temperature at the time of induction and at fixed time points, i.e. every five minutes during the first hour of surgery. The evolution of postoperative patient perceived thermal comfort (TC) and functional recovery (QoR-15) was assessed 24, 48 and 72 hours after surgery. Length of stay in the post-anesthesia care unit (PACU) was noted. RESULTS: The temperature drop was significantly faster and of higher amplitude in group C than in group W, during first hour of surgery (P<0.001). Evolution of QoR-15 and TC was significantly better in group W than in group C (P<0.001 for QoR-15 and P<0.001 for thermal comfort), with shorter length of stay (median [IQR]) in the PACU (minutes; 73 [61-79] for group C and 98 [83-129] for group W, P<0.001). CONCLUSIONS: In ATHA, pre-warming delays and reduces intraoperative heat loss, impacting patient comfort and postoperative functional recovery.

A Warm Air Blanket is Superior to a Heated Mattress in Preventing Perioperative Hypothermia in Orthopedic Arthroplasties, a Time-Series Analyses.

BACKGROUND: Hypothermia is a common perioperative problem that can lead to severe complications. We evaluated whether a heated mattress (HM) is superior to a warm air blanket (WA) in preventing perioperative hypothermia in patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). METHODS: A retrospective cohort study was performed in a teaching hospital and data were collected for all patients undergoing THA or TKA between January 1, 2015 and May 1, 2022. We used logistic and linear regressions to analyze hypothermia occurrence and important complications. Results were adjusted for confounders and time, and was present in all subgroups and after imputation of missing data. RESULTS: In total, 4,683 of 5,497 patients had information on type of heating. We found more perioperative hypothermia in patients treated with an HM compared to a WA for both THA (odds ratio-adjusted 1.42 [1.0 to 1.6] P = .06) and TKA (odds ratio-adjusted 2.10 [1.5 to 3.0] P < .01). There was no difference in postoperative infections between groups (all between 0.5% and 1.3%). Patients who had an HM significantly stayed longer in the postoperative ward (a mean difference of 4 [TKA] to 6 [THA] minutes, P < .01), but there was no difference in hospital stay. CONCLUSION: A WA is superior compared to an HM in preventing perioperative hypothermia, with no increased risk of complications. Patients who have an HM stayed longer at the postoperative ward, potentially because of higher hypothermia rates. Therefore, it is suggested to use a WA instead of an HM.

The Effect of Warmed Serum on Shivering and Recovery Period of Patients Under General and Spinal Anesthesia: A Randomized Clinical Trial.

PURPOSE: Postoperative hypothermia followed by shivering is a common phenomenon in patients undergoing surgery under anesthesia, and should be prevented and treated in postoperative patient care units. This study was conducted to investigate the effect of warmed serum injection on postoperative shivering and recovery period of patients operated under general and spinal anesthesia. DESIGN: In this clinical trial, patients to be operated on under general and spinal anesthesia were randomly assigned into two groups of test and control. In the test group, patients received warmed intravenous fluids and blood products. All patients were monitored to record vital signs, incidences of hypothermia and shivering, and recovery period. METHODS: The collected data were analyzed with repeated measures analysis of variance to detect significant differences between groups and significant changes within groups over time. FINDINGS: The incidence of nausea, vomiting, and shivering in the intervention and control groups was (4.7%, 42%), (2.8%, 16.8%), and (6.6%, 43%), respectively. Patients in the intervention group had higher body temperature than the control group (<0.001). Also, patients under spinal anesthesia had higher body temperature than patients under general anesthesia (<0.001). Blood pressure reduction was also significantly higher in the control group than in the intervention group. The patients who received warm intravenous serum, and especially those who had received spinal anesthesia spent less time in the recovery room (<0.001). CONCLUSIONS: The use of warmed intravenous serum increased the patients' core temperature, reduced their postoperative shivering, and shortened their recovery period. Considering the potential risks associated with hypothermia, using such methods for hypothermia prevention can be highly effective in preventing shivering and prolongation of the recovery period and other potential complications. Anesthesia specialists and technicians are therefore encouraged to use this method as a preventive measure.

Bundle para regulação da temperatura corporal de recém-nascidos maiores de 34 semanas: construção e validação / Bundle for regulating the body temperature of newborns over 34 weeks: Construction and validation / Paquete para regular la temperatura corporal de recién nacidos de más de 34 semanas: construcción y validación

Objetivo: Descrever o processo de construção e validação de um bundle para promoção da regulação da temperatura corporal de recém-nascidos maiores de 34 semanas. Métodos: Pesquisa metodológica executada em três etapas: revisão de escopo, construção da primeira versão do bundle e validação de conteúdo realizada por 15 experts, sendo nove enfermeiros e seis médicos, selecionados conforme critérios adaptados de referencial na área. O índice de validade de conteúdo acima de 0,80 foi considerado aceitável para a concordância entre os experts sobre cada cuidado. Foram necessárias duas rodadas de avaliação para a confecção da versão final. Resultados: O bundle foi estruturado em cuidados: na sala de parto, no transporte e no alojamento conjunto, com total de 15 itens, todos com concordância acima de 0,90 após a segunda rodada de avaliação. Conclusão: O bundle elaborado foi considerado válido quanto ao conteúdo e estabelece cuidados baseados em evidências científicas de maneira padronizada e segura para a equipe de assistência ao parto.

Objective: Describe the process of building and validating a bundle to promote body temperature regulation in newborns over 34 weeks of age. Methods: This methodological research was carried out in three stages: a scoping review, construction of the first version of the bundle, and content validation by 15 experts, nine nurses and six physicians, selected according to criteria adapted from references in the field. A content validity index above 0.80 was considered acceptable for the agreement among the experts on each type of care. Two rounds of evaluation were required to produce the final version. Results: The bundle was structured into care in the delivery room, during transportation, and in the rooming- in unit, with a total of 15 items, all with agreement above 0.90 after the second round of evaluation. Conclusion: The bundle developed was considered valid in terms of content and establishes care based on scientific evidence in a standardized and safe way for the childbirth care team.

Objetivo: Describir el proceso de creación y validación de un paquete para promover la regulación de la temperatura corporal en recién nacidos de más de 34 semanas de edad. Métodos: Investigación metodológica realizada en tres etapas: una revisión del alcance, la construcción de la primera versión del paquete y la validación del contenido llevada a cabo por 15 expertos, nueve enfermeras y seis médicos, seleccionados según criterios adaptados a partir de referencias en la materia. Se consideró aceptable un índice de validez de contenido superior a 0,80 para el acuerdo entre los expertos sobre cada tipo de atención. Fueron necesarias dos rondas de evaluación para elaborar la versión final. Resultados: El paquete se estructuró en cuidados: en la sala de partos, durante el transporte y en la unidad de alojamiento, con un total de 15 ítems, todos ellos con una concordancia superior a 0,90 tras la segunda ronda de evaluación. Conclusión: El paquete se consideró válido en cuanto a su contenido y establece una atención basada en pruebas científicas de forma estandarizada y segura para el equipo de atención al parto.

Effect of prewarmed crystalloid fluids and an in-line fluid warming device on fluid outflow temperatures at ambient temperatures of 21-22°C and 3.5°C.

Equine veterinarians frequently treat patients in non-climate-controlled (i.e., hospitalized) settings. In colder environments, intravenous (IV) fluid administration can contribute to patient hypothermia. The objective of this study was to evaluate three IV fluid warming mechanisms to determine their effect on fluid outflow temperatures at ambient temperatures of 21-22°C and 3.5°C. In this study, fluid outflow temperatures were measured using three warming mechanisms: (1) pre-warmed fluids at 42°C, (2) an in-line warming device placed 163 cm away from the Luer-lock fluid line adaptor (location 1) on the fluid line, and (3) an in-line warming device placed 88 cm away from the Luer-lock fluid line adaptor (location 2) on the fluid line. These warming mechanisms were compared to outflow temperatures measured using no warming mechanism at ambient temperatures of 21-22°C and 3.5°C with flow rates of ∼12 L/hour (gravity flow bolus) and 999 mL/hour. All outflow temperatures were measured with a thermistor. At ∼12L/hour, the use of pre-warmed fluids increased outflow temperatures at both ambient temperatures of 21-22°C and 3.5°C ambient temperatures and an in-line warming device placed at location 1 significantly increased outflow temperatures in 3.5°C ambient temperatures. At 999 mL/hour, use of pre-warmed fluids or an in-line warming device, placed at either location, increased outflow temperatures at ambient temperatures of 21°C or 3.5°C.

Knowledge and practice of nurses with respect to perioperative hypothermia prevention in the Northwest Amhara Regional State Referral Hospitals, Ethiopia: a cross-sectional study.

OBJECTIVES: It has been reported that maintaining a normal body temperature among surgical patients can reduce the length of hospitalisation by up to 40%, decrease the risk of surgical site infection by 64% and reduce mortality by fourfold. Nurses are primarily responsible for preventing the occurrence of hypothermia among surgical patients. This study assessed nurses' knowledge and practices with respect to perioperative hypothermia prevention in Northwest Ethiopia, and investigated the factors associated with good knowledge and practice. DESIGN: Cross-sectional study. SETTING: Northwest Amhara Regional State Referral Hospitals, Northwest Ethiopia, 25 March-20 May 2021. PARTICIPANTS: 413 nurses working in the perioperative units of five referral hospitals. OUTCOME MEASURES: Perioperative hypothermia prevention knowledge and practice among nurses. RESULTS: Nearly three-fifths (59.1%; 95% CI: 54.7% to 63.7%) of respondents had good knowledge and about half (50.4%; 95% CI: 45.5% to 55.0%) had good practice with respect to perioperative hypothermia prevention. Factors associated with nurses' knowledge of prevention of perioperative hypothermia included male sex (adjusted OR (AOR): 1.61, 95% CI: 1.02 to 2.53), having a bachelor's degree (AOR: 2.50, 95% CI: 1.25 to 5.00), having a master's degree (AOR: 4.39, 95% CI: 1.45 to 13.20) and training participation (AOR: 3.68, 95% CI: 2.14 to 6.33). Factors associated with nurses' practice of prevention of perioperative hypothermia included working in recovery (AOR: 2.87, 95% CI: 1.08 to 7.58) and intensive care units (AOR: 2.39, 95% CI: 1.09 to 5.22), training participation (AOR: 2.64, 95% CI: 1.53 to 4.57), being satisfied with their job (AOR: 2.15, 95% CI: 1.34 to 3.43) and having good knowledge (AOR: 2.64, 95% CI: 1.63 to 4.27). CONCLUSION: Nurses' knowledge and practice of the prevention of perioperative hypothermia were inadequate. Hospital managers need to design and strengthen training programmes and work to enhance job satisfaction.

Elaboración e implementación de un protocolo para la Hora Dorada de recién nacidos prematuros utilizando ciencia de la implementación / Elaboration and implementation of a protocol for the Golden Hour of premature newborns using an Implementation Science lens / Elaboração e implementação de protocolo para Hora Ouro do recém-nascido prematuro utilizando ciência da implementação

Objetivo: describir el proceso de diseño e implementación de un protocolo de atención para la primera hora de vida del recién nacido prematuro. Método: investigación participativa, que utilizó el marco de la ciencia de la implementación y los dominios del Consolidated Framework for Implementation Research. Estudio realizado en un hospital escuela del sureste de Brasil, con la participación del equipo multidisciplinario y de los gestores. El estudio se organizó en seis etapas, mediante del ciclo de mejora continua (Plan, Do, Check, Act): diagnóstico situacional; elaboración del protocolo; capacitaciones; implementación del protocolo; relevamiento de barreras y facilitadores; seguimiento y revisión del protocolo. Los datos fueron analizados mediante estadística descriptiva y análisis de contenido. Resultados: el primer protocolo de la Hora Dorada de la institución fue organizado por el equipo multidisciplinario a partir de un enfoque colectivo y dialógico. El protocolo priorizó la estabilidad cardiorrespiratoria, la prevención de hipotermia, hipoglucemia e infección. Después de cuatro meses de capacitación e implementación, el protocolo fue evaluado como una intervención de calidad, necesaria para el servicio, de bajo costo y de poca complejidad. La principal sugerencia de mejora fue realizar actividades educativas frecuentes. Conclusión: la implementación generó cambios e inició un proceso de mejora de la calidad de la atención neonatal, es necesario que la capacitación sea continua para lograr mayor adherencia y mejores resultados.

Objective: describe the process of designing and implementing a care protocol for the first hour of life of premature newborns. Method: a participatory research study using an implementation science framework, the Consolidated Framework for Implementation Research (CFIR) was employed to determine drivers and facilitators of implementation success of the Golden Hour protocol for newborns at a large university hospital in southeastern Brazil. A multi-professional team, including first line providers and managers participated in six stages of quality improvement: situational diagnosis; protocol elaboration; training protocol implementation; barrier and facilitator assessment; and protocol monitoring and review. Qualitative and monitoring data collected across these six stages were analyzed using descriptive statistics and content analysis. Results: the institution's Golden Hour protocol was organized by the multi-professional team based on a collective and dialogical approach. The protocol prioritized the infant's cardiopulmonary stability, as well as prevention of hypothermia, hypoglycemia and infection. After four months of implementation, the care team was evaluated the protocol as a good quality intervention, necessary for the service, low-cost and not very complex. One suggested improvement recommended was to carry out refresher training to address staff turnover. Conclusion: implementation of the Golden Hour protocol introduced an appropriate and feasible neonatal care quality improvement process, which requires periodic refresher training to ensure greater adherence and better neonatal results.

Objetivo: descrever o processo de elaboração e implementação de protocolo assistencial para a primeira hora de vida do recém-nascido prematuro. Método: pesquisa participativa, que utilizou referencial da ciência da implementação e os domínios do Consolidated Framework for Implementation Research. Estudo realizado em hospital universitário no sudeste do Brasil, com participação da equipe multiprofissional e gestores. O estudo foi organizado em seis etapas, por meio do ciclo de melhoria contínua (Plan, Do, Check, Act): diagnóstico situacional; elaboração do protocolo; treinamentos; implementação do protocolo; levantamento de barreiras e facilitadores; monitoramento e revisão do protocolo. Os dados foram analisados por estatística descritiva e análise de conteúdo. Resultados: o primeiro protocolo Hora Ouro da instituição foi organizado pela equipe multiprofissional a partir de uma abordagem coletiva e dialógica. O protocolo priorizou a estabilidade cardiorrespiratória, prevenção de hipotermia, de hipoglicemia e de infecção. Após treinamento e implementação por quatro meses, o protocolo foi avaliado como uma intervenção de qualidade, necessária ao serviço, de baixo custo e pouco complexa. A principal sugestão de melhoria foi realizar ações educativas frequentes. Conclusão: a implementação provocou mudanças e iniciou um processo de melhoria da qualidade da assistência neonatal, sendo necessária a manutenção dos treinamentos para maior adesão e melhores resultados.

Perioperative hypothermia prevention: development of simple principles and practice recommendations using a multidisciplinary consensus-based approach.

OBJECTIVES: To develop a consensus on evidence-based principles and recommendations for perioperative hypothermia prevention in the Australian context. DESIGN: This study was informed by CAN-IMPLEMENT using the ADAPTE process: (1) formation of a multidisciplinary development team; (2) systematic search process identifying existing guidance for perioperative hypothermia prevention; (3) appraisal using the AGREE II Rigor of Development domain; (4) extraction of recommendations from guidelines meeting a quality threshold using the AGREE-REX tool; (5) review of draft principles and recommendations by multidisciplinary clinicians nationally and (6) subsequent round of discussion, drafting, reflection and revision by the original panel member team. SETTING: Australian perioperative departments. PARTICIPANTS: Registered nurses, anaesthetists, surgeons and anaesthetic allied health practitioners. RESULTS: A total of 23 papers (12 guidelines, 6 evidence summaries, 3 standards, 1 best practice sheet and 1 evidence-based bundle) formed the evidence base. After evidence synthesis and development of draft recommendations, 219 perioperative clinicians provided feedback. Following refinement, three simple principles for perioperative hypothermia prevention were developed with supporting practice recommendations: (1) actively monitor core temperature for all patients at all times; (2) warm actively to keep body temperature above 36°C and patients comfortable and (3) minimise exposure to cold at all stages of perioperative care. CONCLUSION: This consensus process has generated principles and practice recommendations for hypothermia prevention that are ready for implementation with local adaptation. Further evaluation will be undertaken in a large-scale implementation trial across Australian hospitals.

The Effect of Using a Normothermia Checklist on Awakening Time From Anesthesia and Coagulation Disorder: A Randomized Controlled Trial.

BACKGROUND: Inadvertent perioperative hypothermia (IPH) is a common issue in surgical patients. To avoid this issue, the patient should be monitored continuously throughout the perioperative process. Evidence-based practices in line with relevant guidelines are necessary to maintain normothermia. PURPOSE: This study was developed to determine the effect of using a control list developed for preventing IPH on time of awakening from anesthesia and coagulation disorder in surgical patients. METHODS: In this randomized controlled study, nursing interventions were applied to patients in accordance with the normothermia checklist (NC) developed by the researchers to prevent IPH. RESULTS: In this study, 30 patients were respectively assigned to the experimental and control groups. Conducting nursing interventions in accordance with the control checklist was found to be effective in preventing IPH. Moreover, time of awakening from anesthesia was significantly shorter in the experimental group (3.77 ± 1.10 minutes) than the control group (11.03 ± 2.51 minutes; p < .05). Furthermore, tendency to bleed was higher in the control group than the experimental group, and a statistically significant between-group difference in coagulation disorders was found ( p < .05). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The results of this evidence-based study indicate that implementing nursing interventions in line with the developed NC is effective in preventing IPH. Preventing IPH, which increases the risk of numerous complications in surgical patients, is an important responsibility of nurses. Nurses may employ the NC proposed in this study to better secure the safety and minimize the risk of complications in surgical patients.

The effect of combining prewarming with intraoperative phenylephrine infusion on the prevention of hypothermia in patients undergoing urological surgery: a prospective, randomized, and controlled trial.

Background: Hypothermia is common in patients undergoing urological surgery; however, no single preventative modality is completely effective. This study evaluated the effects of combining prewarming with intraoperative phenylephrine infusion for the prevention of hypothermia in patients undergoing urological surgery. Methods: This prospective study enrolled 58 patients scheduled for urological surgery under general anesthesia. The patients were randomized into two groups (n = 29). Patients in the experimental (prewarming and phenylephrine infusion) group (PP group) received prewarming for 20 min and intraoperative phenylephrine infusion, whereas those in the control group (C group) received no active prewarming with only intermittent administration of vasoactive agents. The patient's sublingual temperatures before and after anesthesia and nasopharyngeal temperature during anesthesia were recorded as core temperatures. Results: The incidence of intraoperative hypothermia was higher in the C group than in the PP group (57.7% [15/26] vs. 23.1% [6/26], P = 0.01). The severity of intraoperative hypothermia was higher in the C group than in the PP group (P = 0.004). The nasopharyngeal temperature at the end of surgery was lower in the C group than in the PP group (35.8 ± 0.6°C vs. 36.3 ± 0.4°C, P = 0.002). The trend of core temperature decline during the first hour after anesthesia induction differed between the two groups (P = 0.003; its decline was more gradual in the PP group). Conclusions: The combination of prewarming for 20 min and intraoperative phenylephrine infusion reduced the incidence and severity of intraoperative hypothermia and modified the trend of decreasing core temperatures in patients undergoing urological surgery.

Effects of a forced-air warming system and warmed intravenous fluids on hemodynamic parameters, shivering, and time to awakening in elderly patients undergoing open cardiac surgery.

Background: As one of the most common postoperative complications, hypothermia is the main cause of numerous problems during treatment, especially in elderly patients with decreased cardiac reserves. Objectives: The aim of the present study was to compare the effects of forced-air warming system (FAWS), warmed intravenous fluids (WIVFs) and routine method on hemodynamic parameters, arterial blood gases (ABGs), shivering, and time to awakening in elderly patients undergoing open cardiac surgery (OCS). Methods: This clinical randomized controlled trial was conducted on 94 elderly patients who underwent OCS at Ayatollah Rouhani Hospital, Babol, Iran. They were divided into three groups, namely FAWS (n=31), WIVFs (n=31) and routine rewarming method (RRWM, with a blanket) (n=32). The data were then recorded in a checklist. Descriptive and inferential statistics were performed using SPSS 26 at a significance level of less than 0.05. Results: The findings demonstrated that the degree of hypothermia had a significant decreasing trend in the groups receiving FAWS and WIVFs (P=0.002). Additionally, increased respiratory rate (P=0.013), higher bicarbonate (HCO3-) levels on arrival up to 4 hours after surgery (P=0.045), reduced lactate level (P=0.005), normal base excess (BE) and accelerated time to awakening (P=0.004) were observed in patients receiving FAWS. There was no significant difference in the study groups regarding shivering. Conclusion: The results revealed that FAWS could mitigate the degree of hypothermia, increase body temperature and decrease the postoperative serum lactate levels. Moreover, BE as one of the most important parameters for ABGs, could remain at a normal level. Besides, the use of FAWS could lead to early awakening, and thus facilitate weaning and extubation of these patients.

Inadvertent hypothermia in patients undergoing brachytherapy under monitored anesthesia care: A prospective observational cohort study.

Brachytherapy, which is often performed under anesthesia, is one of the main treatment options for cervical cancer. It is unclear whether hypothermia and its associated negative outcomes are encountered during this procedure. This prospective observational cohort study aimed to investigate the prevalence and adverse effects of hypothermia during serial brachytherapies under deep sedation for cervical cancer. Female patients over the aged > of 18 years who underwent were taken to serial brachytherapy sessions under deep sedation on alternate dates at most twice a week for the treatment of cervical cancer were included. A total of 23 female were screened for initial and post-procedural hypothermia using infrared thermometers without contact to the skin at forehead between July and October 2022 at tertiary education and research hospital. Hypothermia was detected in 2 2 (8.7%) of the 23 patients and 5 5 (5.4%) of the 92 sessions. A negative correlation was found between the anesthesia time and post-procedural body temperature values (r = -0.385, P < .001). It was observed that there was a decrease in body temperature of at most -1.3 degrees and at least -0.1 degrees during the sessions. A decrease of ≥ 0.4°C was detected in any session in 16 (69.9%) of the 23 patients. A decrease of ≥ 0.4°C was detected in 34 (37%) of the 92 sessions. Involuntary hypothermia may occur during brachytherapy sessions performed under sedation. Institutions should encourage routine temperature monitoring and active warming to prevent hypothermia and adverse outcomes.

Hats Off for Full-Term Healthy Newborns: No Benefits for Thermoregulation.

BACKGROUND: Hyperthermia is a known risk for sudden unexpected infant death. The practice of hat placement at birth to prevent transient hypothermia may not be necessary and sets an early standard for clothing infants that may lead to hyperthermia postnatally. OBJECTIVE: To examine the elimination of hats on thermoregulation (eg, hypothermia, <97.6°F) in full-term newborns with no abnormalities within 24 hours of birth. METHODS: In 2018, an institution guideline discontinued the use of hats at birth. Subsequently, newborn body temperatures were respectively extracted from electronic health records and data were compared from 482 infants (>38 weeks' gestation and newborn birth weight >2500 g) prior to ( n = 257) and following ( n = 225) the practice change. Body temperatures prior to and after the practice change to eliminate hats use were compared. RESULTS: No statistically significant difference was observed: (1) in the proportion of infants experiencing hypothermia with or without hat use, respectively, 23.7% compared with 31.1% ( P = .09) and (2) in the odds of an infant experiencing hypothermia when adjusting for relevant covariates (odds ratio = 1.44; 95% confidence interval 0.89-2.32; P = .14). CONCLUSIONS: Our findings demonstrate that the use of hats on infants at birth had no measurable impact on newborn thermoregulation.