Infection prevention in surgery… what does it have to do with hypothermia?
When we talk about infection control in the surgical environment, most professionals instinctively think of sterile instruments, surgical handwashing, and antibiotic prophylaxis. While these are undeniably vital, a less obvious—but equally critical—component is often overlooked: maintaining normothermia in the perioperative period (before, during and after surgery).
Emerging evidence and clinical guidelines now point to perioperative hypothermia as a significant, modifiable risk factor for surgical site infections (SSIs). Preventing hypothermia is no longer just about patient comfort; it’s a frontline defence in infection control. We explore how hypothermia can impact strategies for infection prevention in surgery.
Why hypothermia occurs
During surgery, general anaesthesia impairs the body’s ability to regulate temperature, while the cold ambient temperatures in operating rooms further increase the risk. Perioperative hypothermia can occur in short or minor surgical procedures, as well as lengthier operations, which see the majority of focus when it comes to hypothermia prevention.
The pre- and post-operative periods are equally important (in fact, studies show that pre-warming patients can significantly decrease surgical site infection rates), but these bookends of the patient pathway are often overlooked when it comes to hypothermia prevention and infection prevention. It’s important to note that whilst patients may present as warm on the ward, often heat is lost when the patient is in transit from the ward to theatre, often in nothing more than a flimsy patient gown.
Why hypothermia matters
But what’s most concerning is how hypothermia impairs the body’s natural defences:
- Vasoconstriction reduces oxygen delivery to the surgical wound, slowing healing and weakening the immune response.
- Leukocyte function is impaired at lower temperatures, reducing the body’s ability to fight off contaminants.
- Wound healing slows, giving bacteria more opportunity to multiply.
- Increased blood loss and coagulation issues further complicate recovery.
All these factors contribute to a higher risk of postoperative infections, particularly SSIs, which are among the most common—and most costly—hospital-acquired infections.
The cost of inaction
Surgical site infections affect an estimated 0.5-3% of surgical patients (NIH), depending on the procedure and setting. While that may sound modest, the impact is anything but:
- Each SSI can add thousands in extended hospital stays, reoperations, and antibiotic treatment. This article in the International Wound Journal shows an example of this real-world cost: “A mean SSI‐associated length of stay of 9.72 days resulted in an additional cost of £3776 per patient (including a mean antibiotic cost of £532).”
- Patients with SSIs are up to 60% more likely to require ICU admission.
- They’re also at double the risk of readmission within 30 days.
From both a patient and economic standpoint, the case for prevention couldn’t be clearer.
Global guidelines agree: Warm your patients
Leading health authorities now explicitly recommend maintaining normothermia as a standard component of surgical care:
- NICE Guidelines (CG65): Advise warming preoperatively on the ward or in the emergency department if the patient’s temperature is below 36.0°C [2016] and at least 30 minutes before the induction of anaesthesia where the patient’s temperature is 36.0°C or above.
- NICE Guidelines (CG65): Advise active warming for patients undergoing anaesthesia lasting longer than 30 minutes.
- WHO Global Guidelines for the Prevention of Surgical Site Infections: Include temperature management as a key preventive measure.
- CDC Recommendations: Support perioperative thermal management as part of infection prevention bundles.
Yet despite these guidelines, hypothermia still occurs in a significant percentage of surgical patients—often due to gaps in practice or limitations in current warming methods.
It’s time to reframe thermal care as infection prevention
Perioperative hypothermia is far from harmless—it has been shown to increase surgical site infections by up to 20%, impair wound healing, and triple the risk of cardiac complications.
Even a mild drop in core body temperature can reduce immune defences and impair platelet function, directly increasing postoperative morbidity. The downstream effects are significant: patients experiencing hypothermia may remain in recovery 40% longer, face extended hospital stays by 2–3 days on average, and generate thousands in added healthcare costs per case.
Importantly, this is one of the most preventable surgical complications. Proactive, consistent thermal management—through evidence-based practices and innovative solutions can not only improve patient comfort and outcomes, but also serve as a powerful, cost-effective tool in any hospital’s infection prevention strategy.
THERMARMOUR: Simple patient warming to help with infection control
As a non-active, easy-to-deploy and effective passive warming solution, THERMARMOUR provides consistent thermal support throughout the perioperative journey:
- Easy to store and ready to use straight from the pack on the ward, in theatre or in Recovery.
- No external power or setup – effective passive warming on the ward and in transit, where forced air warming is difficult to deploy.
- It can be used in conjunction with heat mattresses where required for longer operations.
- Designed with infection prevention in mind—single-use, non-invasive, and disposable.
THERMARMOUR fits seamlessly into existing protocols while helping hospitals meet both infection control and patient warming guidelines, as well as considering budget constraints. Infection prevention in surgery is everyone’s responsibility.
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Categories: Medical
