Evidence in Practice: Help in Healing

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Non-contact thermometers can signal the danger of infection

Life is full of questions. They range from the procedural — “Do I have time to see one more patient?”– to the obtuse — “Does this goniometer make me look smarter?” as well as to serious queries that inspire discoveries — “ Does my patient’s incision look infected?”

The last of these questions is a scary proposition, especially when consequences can range from a simple superficial infection to sequelae resulting in sepsis and amputation.

Dire Impact of Infections

Going forward, the old adage “an ounce of prevention is worth a pound of cure” is where the profession of occupational therapy can truly shine. Early detection of infection is clearly the best defense for healthcare providers when resistant superbugs such as MRSA and necrotizing fasciitis surreptitiously lurk everywhere from schools to hospitals to the local shopping mall.

Attempting to eradicate an infection is no slam dunk either. Tiers of antibiotics are becoming obsolete at an alarming rate, and once tried and true treatments such as whirlpool are on the Choose Wisely™ do not choose list.

Also, consider the potentially dire impact an infection can have on the patient and our healthcare system. It can cause disruption of occupation and roles in life, loss of income, and hospital readmissions, as well as contribute to less-than-optimal functional outcomes.

Readmissions due to infection can place a financial burden on not only the patient but our healthcare system up into the billions of dollars. This has prompted Medicare to assess penalties to hospitals for readmissions due to hospital-acquired infections in accordance with the Affordable Care Act, which mandates that healthcare must be high-quality and evidence-based.1

Using Objective Data

When it comes to infections, healthcare providers look for the five cardinal signs — increased pain, swelling, redness, warmth and pus, but most of these can be subjective. The only exceptions are the presence of pus and elevated temperature.

Often faced with a dearth of objective measures by which to assess our patients, our occupational therapy team collaborated to find an evidence-based measure to gauge temperature. We started with a basic review of the literature and found a simple, cost-effective answer.

Other healthcare professionals had already started to identify possible infections by taking a surface reading of the patient’s temperature with a non-contact infrared thermometer. Having a research-ready Level 2 OT student, the next logical step was to implement a project-based learning experience for the entire OT and hand therapy department.

Our department started with a comprehensive review of the literature and a hypothesis prior to implementation of the device in our clinic. Our clinical question was “Can OTs use objective data to identify infections?”

The simple answer is yes. A non-contact thermometer can provide a practical, safe and cost-efficient way to use evidence to support our hypothesis. The research not only supports the use of these tools, but provides occupational therapists and healthcare providers a concrete, objective number: 32. An increase in temperature of approximately 32 degrees Fahrenheit, as compared to the contralateral limb, provides a high correlation with a suspected infection.

Use in Practice

We have made it part of our standard operating procedure to take temperature readings of all open wounds and surgical sites at evaluation, at each treatment while the wound is open/during the cellular phase of healing, at reassessment, and finally at discharge.

Taking comparative readings allows us to see trends in the data, and prompts us to inform the referring physician if we see the above-noted temperature difference as well as any rapid temperature increase combined with other cardinal signs of infection. Additionally, the benefit of avoiding touching a potentially infected wound with the tool speaks for itself.

While a non-contact infrared thermometer may seem like a superfluous tool in a therapist’s arsenal, its benefits are exceptionally deep for the patient. At this time, healthcare is focused on patient-centered care in which the patient is an active member of the treatment team. Occupational therapists can support this process by empowering patients with the data that the non-contact infrared thermometer can provide.

The tool can give peace-of-mind by monitoring the condition of the wound or surgical site. A patient who is able to go into their physician’s office with concrete data may feel more involved in clinical decisions than someone who arrives with nothing more than a hunch.

Early detection of infection supports patients in engaging in occupations and returning to their roles and routines in a timely manner. It also may prevent readmission and admission as well as emergency department visits. A physician can provide the vital treatment on an outpatient basis to halt an infection in its tracks, if notified quickly enough, thereby putting the patient back on course to rehabilitation and recovery.

Every day counts as we work to return our patients to their normal quality of life, and the non-contact infrared thermometer could limit the number of days needed to identify an infection as well as limit downtime for a patient.

Money Matters

The benefits of this technology are far-reaching, and fortunately the investment of time and money to utilize a non-contact thermometer is relatively small. A recent study indicates that you don’t need to spend a lot of money to purchase a reliable tool.

Reliability is equivocal whether you spend a lot or a little, with prices ranging from $9.99 into the thousands. Low-cost thermometers may not include all the bells and whistles a high-cost thermometer might carry; however, the reliability between the two remains consistent.

Recommendations for proper use of the tool are few, but include holding it 1.5 to 6 inches away from the target for just a few seconds to produce a reading. The beam of light should produce the temporary image of a focused red circle at the site. The only contraindication we found is to avoid pointing the infrared beam at the patient’s eyes.

The use of evidence is hardly a new concept in occupational therapy. In fact, it has become the zeitgeist of what drives us forward as a community. With so many ways to gather knowledge, data mine and search for answers, we must keep our strategies valid, reliable, and patient-centric with a focus on function.

Non-contact thermometers give front-line practitioners another tool in their armamentarium to do just that, keeping us compliant with best practice guidelines. And yes, that goniometer does make you look smarter.

References

1. Roberts PS, Robinson MR. (2014). Health policy perspectives: Occupational therapy’s role in preventing acute readmissions. Am J Occup Ther. 2014;68(3):254-259.

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About Author

Amy Roux, OTR/L, CHT

Amy Roux is rehabilitation supervisor at PT Plus Whitney Field UMASS Health Alliance, Leominster, Mass.

Sabrina Bolly OTR/L

Sabrina Bolly, OTR/L, specializes in hand therapy at PT Plus Whitney Field UMASS Health Alliance Hospital.

Tom Savini, OTS

Thomas Savini graduated from Worcester State University in December 2016.

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