National Institute for Health and Clinical Excellence (NICE)
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Mattress to prevent patients developing hypothermia during surgery backed by NICE guidance

NICE, the healthcare guidance body, has today (Wednesday 31 August) published its final guidance supporting the use of the Inditherm patient warming mattress to prevent inadvertent hypothermia during surgery.

The Inditherm mattress is designed to be used for patients having surgery involving an anaesthetic who may be at risk of inadvertent hypothermia, a common and preventable complication of surgery. Possible consequences of inadvertent hypothermia include increased blood loss, increased heart problems, increased risk of wound infection, longer recovery times and longer hospital stay.

The clinical evidence considered by the independent Medical Technologies Advisory Committee (MTAC) suggests that for maintaining patient core body temperature above 36°C, the effectiveness of the Inditherm patient warming mattress is similar to that of forced air warming (a technique which continues to be recommended in NICE clinical guideline 65). In particular, MTAC looks at whether a device offers benefits to the patient and NHS at a lower cost compared with similar products, or increased benefits for equal cost. The estimated average NHS cost saving for the Inditherm mattress is in the region of £9800 per theatre each year.

The evidence also suggests that the Inditherm mattress may have practical advantages for patients and the NHS. Some benefits include that it is re-usable and is cleaned in the same way as the normal operating table mattress, as well as having low energy consumption and warming only the patient without unintentionally also warming the surgical team.

Professor Carole Longson, Director of the NICE Centre for Health Technology Evaluation, said: "We are very pleased to publish guidance today advising that the Inditherm patient warming mattress should be considered for use in patients at risk of inadvertent hypothermia. The evidence examined indicates that as well as benefiting patients by reducing a range of serious complications associated with inadvertent hypothermia, it also benefits the NHS by saving money.

"It's important to note that this medical technology guidance does not supersede the recommendations on pre- or peri-operative warming in NICE Clinical Guideline 65. It also does not update the guideline with respect to the recommendation about forced air warming as a cost-effective use of resources. However, it does suggest that when considering new investment in warming devices, consideration should be given to whether use of Inditherm would be beneficial with respect to local circumstances."

Notes to Editors

About the guidance

1. The guidance on the use of Inditherm patient warming mattress to prevent inadvertent hypothermia during surgery is available on the NICE website at from 31 August.

2. NICE medical technology guidance helps enable new medical technologies, or innovative modifications to existing ones, to be used more quickly and consistently in the NHS across England.

3. The cost models used indicated that the estimated average cost saving, assuming that all eligible patients are warmed with Inditherm, and compared with forced air warming, is £9800 per theatre each year. This is based on an annual cost of £1300 for an Inditherm patient warming system comprising one full-length and one half-length mattress, two blankets and three controllers, and including maintenance costs. This includes the maintenance cost and likely costs of repairs. The cost saving is based on the average annual cost of £1300 for the Inditherm patient warming system and an average annual cost of forced air warming of £11,100. It is estimated that there are around 2700 theatres in England not currently using any type of warming mattresses, of which there is a reasonable expectation that an estimated 40% might be expected to purchase the Inditherm mattress.

4. The Inditherm mattress is manufactured by Inditherm plc.

5. NICE published a clinical guideline in 2008 on perioperative hypothermia: This guideline recommends that if a patient's temperature is below 36.0°C they should be warmed using a technique called 'forced air warming‘ where hot air is blown in to a specially designed blanket. At the time of publication, the guideline noted within the research recommendation section that there was emerging evidence to suggest that electric heating mattresses, electric heating pads and heated water garments may be as effective as forced air warming; however, the evidence at that point was insufficient for use of these devices to be recommended. It is important to note that this medical technology guidance does not supersede the clinical guideline but addresses the case for adoption of the Inditherm patient warming mattress as an alternative to forced air warming.

About the Medical Technologies Evaluation Programme

6. Established by NICE in 2009, the focus of this new area of work is specifically on the evaluation of innovative medical technologies, including devices and diagnostics. The types of products which might be included are medical devices that deliver treatment such as those implanted during surgical procedures, technologies that give greater independence to patients, and diagnostic devices or tests used to detect or monitor medical conditions. The independent Medical Technology Advisory Committee has two core remits: selecting medical technologies for evaluation by NICE guidance programmes and also developing medical technologies guidance itself. The guidance applies to the NHS in England, and is not mandatory.

More information is available at .

About NICE

7. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.

8. NICE produces guidance in three areas of health:

  • public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
  • health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
  • clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

9. NICE produces standards for patient care:

  • quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
  • Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients

10. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.


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