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Blanket Warming:
Comfort and Safety
W
armed blankets are often
used in the surgery depart-
ment to increase the warmth
and comfort of patients waiting for sur-
gery. Patients at a 270-bed hospital in
the Columbus, Ohio, area frequently
complained, however, that the blankets
did not keep them warm enough.
The facility policy followed ECRI
recommendations to “limit warming
cabinet temperatures to no higher than
110° F (43° C).”1(p9) The warming cabi-
nets used in this facility have an oper-
ating temperature of 90° F (32° C) to
160° F (71° C), and compliance with
keeping the warmers at the 110° F
(43° C) limit was low. Safety depart-
ment audits also revealed that blankets
sometimes were being warmed to higher
temperatures in autoclaves and micro-
waves to satisfy patient complaints.
Irrigation fluids are also warmed in
the cabinets, and the irrigation fluid
manufacturer recommends that the flu-
ids be stored at a temperature lower than
150° F (66° C). The hospital’s safety
committee requested that the surgery
department recommend a policy to
address the warmth of the blankets as
well as the warmth of fluids in the
warming cabinet. As clinical coordina-
tor of the surgery department, I initiat-
ed a project to address patients’ needs
and safety and staff members’ con-
cerns. The purpose of this project was to
determine whether cotton-polyester
blend hospital blankets warmed in
blanket warming cabinets at various
temperatures are safe for patient use.
METHODS
I stocked two dual-compartment
blanket warming cabinets with identi-
cal cotton-polyester blend hospital
© AORN, Inc, 2009
PAUL J. BUJDOSO, RN
blankets at normal blanket loads for
five hours prior to the test. The first
warmer was set at 110° F (43° C), and the
second warmer was set at 150° F (66° C).
I placed a third stock of unwarmed
blankets in a patient room for five
hours at 70° F (21° C). I checked the
temperature of each stock of blankets
hourly before conducting the test.
The blanket warmer temperatures were
measured with the blanket warmers’
internal thermometer and an infrared
thermometer. I loaded the blankets into
the warmers per the manufacturer’s
recommendation. The manufacturer
states, “Blankets can generally be felt
by hand by a qualified nurse for patient
safe temperatures,”2(p4) but offers no other
guidance for temperature settings.
The same room was used for all of the
tests. The room is a private patient room
with overhead lighting. All warmed
ABSTRACT
A project was undertaken to establish the safety of hospi-
tal blankets warmed at different temperatures in a warm-
ing cabinet. Three volunteers were covered with unheated
blankets, blankets warmed to 110º F (43º C), and blankets
warmed to 150º F (66º C).
Evaluators asked the participants to rate their perceived
warmth and perceived comfort on a scale of zero to 10
before the blanket was placed and at one, three, and five
minutes after blanket exposure.
Blanket temperatures decreased to approximately 80º F
(27º C) within five minutes regardless of the initial tem-
perature. No participants perceived overheating or burn-
ing at any temperature. Perceived warmth and comfort
increased with the initial temperature of the blanket.
Key words: temperature guidelines, blanket warmers, skin tem-
perature, patient warmth, patient comfort. AORN J 89 (April
2009) 717-722. © AORN, Inc, 2009.
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APRIL 2009, VOL 89, NO 4 Bujdoso

blankets (ie, either to 110° F 80° F (27° C)

[43° C] or 150° F [66° C]) were
78° F (26° C)
brought into the room from the
blanket warmer approximately 76° F (24° C)
35 feet from the room. Room- Volunteer 1

Temperature
74° F (23° C)
temperature blankets (70° F Volunteer 2
[21° C]) were brought from an 72° F (22° C)
Volunteer 3
adjoining room. 70° F (21° C)
The measuring instrument
for skin temperature, warm- 68° F (20° C)
ing cabinet temperature, and 66° F (19° C)
blanket temperature was a initial 1 minute 3 minutes 5 minutes
handheld infrared thermome- Time
ter with an accuracy within
1% or 2° F (1.1° C). Three Figure 1 • Temperatures of the room-temperature (ie, 70° F [21° C]) blankets at
female health care workers initial placement and at one, three, and five minutes.
between the ages of 25 and 55
years and with varying body 120° F (49° C)
types volunteered to take part
in the project. Measurements 100° F (38° C)
included the temperatures of
80° F (27° C)
the blankets, the skin temper- Volunteer 1
Temperature

atures of the participants’ ab- 60° F (16° C) Volunteer 2

domens and lower legs, and
40° F (4° C) Volunteer 3
the perceived warmth and
comfort of the test partici-
20° F (-7° C)
pants. Each of the participants
wore identical scrub clothing 0° F (-18° C)
and lay on a patient bed. For initial 1 minute 3 minutes 5 minutes
each test, the blanket was Time
placed directly on the bare
skin of the participant’s Figure 2 • Temperatures of the blankets warmed to 110° F (43° C) at initial
abdomen and lower legs. placement and at one, three, and five minutes.
Evaluators who were not
aware of the temperature of 160° F (71° C)
the blanket being used asked
140° F (60° C)
the volunteers about their per-
ceived warmth and perceived 120° F (49° C)
comfort before the test and at 100° F (38° C) Volunteer 1
Temperature

one minute, three minutes, 80° F (27° C) Volunteer 2

and five minutes after expo-
60° F (16° C) Volunteer 3
sure to the blankets. Blankets
were either folded or unfold- 40° F (4° C)
ed, and a blanket of each tem- 20° F (-7° C)
perature setting was placed on 0° F (-18° C)
each participant in both a fold- initial 1 minute 3 minutes 5 minutes
ed and unfolded fashion at Time
least one time. I selected the
blankets in a random pattern Figure 3 • Temperatures of the blankets warmed to 150° F (66° C) at initial
to keep the evaluators and placement and at one, three, and five minutes.

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Bujdoso APRIL 2009, VOL 89, NO 4

participants from knowing

10
which temperature blanket
was being tested. Before the 8
experiment, at one minute, at

Warmth rating
three minutes, and at five min- 6 Volunteer 1
utes, the evaluator asked, “On Volunteer 2
a scale of zero to 10, how warm 4
do you feel? On a scale of Volunteer 3

zero to 10, how comfortable 2

do you feel?”
0
initial 1 minute 3 minutes 5 minutes
RESULTS
All the blankets approached Time
a normalized (ie, room) tem-
perature within the five- Figure 4 • Participants’ perceived warmth before placement of the room tempera-
minute test. The unwarmed ture (ie, 70° F [21° C]) blanket and at one, three, and five minutes after
blankets averaged 75° F (24° C) blanket exposure.
within the five-minute test, the
110° F (43° C) blankets aver- 10
aged 82° F (28° C) within five
minutes, and the 150° F (66° C) 8
blankets averaged 83° F (28° C)
Warmth rating

6 Volunteer 1
within five minutes (Figures
1-3). The normalized tempera- Volunteer 2
ture was assumed to be a result 4
Volunteer 3
of the ambient room tempera-
ture and radiant body heat 2
from the test participants.
PERCEIVED WARMTH. Perceived 0
initial 1 minute 3 minutes 5 minutes
warmth on a scale of zero to
10 decreased with use of the Time
room temperature blanket, Figure 5 • Participants’ perceived warmth before placement of the blanket warmed
from an average of 6 at one to 110° F (43° C) and at one, three, and five minutes after blanket exposure.
minute after blanket exposure
to an average of 5.6 five min-
utes after blanket exposure 10
(Figure 4). With the blanket
warmed to 110° F (43° C), the 8
average perceived warmth
Warmth rating

Volunteer 1
remained constant through- 6
out the experiment (Figure 5). Volunteer 2

With the blanket warmed to 4

Volunteer 3
150° F (66° C), the perceived
warmth one minute after 2
blanket placement averaged
0
7.3 and decreased to 6.3 at initial 1 minute 3 minutes 5 minutes
five minutes (Figure 6).
Time
PERCEIVED OVERALL COMFORT.
Perceived overall comfort Figure 6 • Participants’ perceived warmth before placement of the blanket warmed
measured the self-reported to 150° F (66° C) and at one, three, and five minutes after blanket exposure.

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APRIL 2009, VOL 89, NO 4 Bujdoso

well-being of the volunteer on

10
the patient bed. The tempera-
ture of the room was identical
8
for all volunteers. The per-
Comfort rating

Volunteer 1 ceived comfort reported with

6
the 70° F (21° C) blanket de-
Volunteer 2
4
creased from an average of 5
Volunteer 3 at one minute after blanket
2 exposure to an average of 4.3
at five minutes after blanket
0 exposure (Figure 7). The over-
initial 1 minute 3 minutes 5 minutes all perceived comfort when
Time the volunteers were covered
with a 110° F (43° C) blanket
Figure 7 • Participants’ perceived comfort before placement of the room tempera- improved from an average of
ture (ie, 70° F [21° C]) blanket and at one, three, and five minutes after 6.3 at one minute after blan-
blanket exposure. ket exposure to an average of
6.6 at five minutes after blan-
10 ket exposure (Figure 8). The
perceived comfort when the
8 volunteers were covered with
a 150° F (66° C) blanket at one
Comfort rating

Volunteer 1
6 minute after exposure was
Volunteer 2 9.3 and decreased to 7.6 at
4
Volunteer 3
five minutes after exposure
(Figure 9).
2 SKIN TEMPERATURE. Skin tem-
perature was measured on the
0 abdomen and lower legs of
initial 1 minute 3 minutes 5 minutes
volunteers before placement
Time of the blankets and at three
Figure 8 • Participants’ perceived comfort before placement of the blanket warmed
minutes after placement of
to 110° F (43° C) and at one, three, and five minutes after blanket exposure.
the blankets. With the 70° F
(21° C) blankets, the average
warming on the abdomen
10 measured 0.3° F (0.17° C), and
the average warming on the
8 lower legs measured 0.6° F
(.34° C). With the 110° F (43° C)
Comfort rating

Volunteer 1
6 blankets, the average warm-
Volunteer 2 ing on the abdomen meas-
4 ured 2° F (1.1° C), and the
Volunteer 3
average warming on the
2 lower legs measured 1.6° F
(0.9° C). With the 150° F (66° C)
0
initial 1 minute 3 minutes 5 minutes blankets, the average warm-
Time
ing on the abdomen meas-
ured 4.3° F (2.4° C), and the
Figure 9 • Participants’ perceived comfort before placement of the blanket warmed average warming on the
to 150° F (66° C) and at one, three, and five minutes after blanket exposure. lower legs measured 2° F

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Bujdoso APRIL 2009, VOL 89, NO 4

(1.1° C). No skin temperature changes greater
than 10° F (5.6° C) were measured throughout
the experiment. No participants perceived
overheating or burning at any temperature,
including when they were exposed to a folded
blanket at 150º F (66º C).
DISCUSSION
The ECRI recommendation is based in part
on a study conducted in 1947 by Henriques
and Moritz,3 which determined that skin tem-
perature must reach 117º F (47º C) to 119º F
(48º C) to achieve cellular damage. In this proj-
ect, none of the participants’ skin temperatures
rose higher than 94º F (34º C), and there was
no more than a 10º F (5.6º C) change with a
folded blanket on bare skin.
The rapid normalizing of
blanket temperatures in all of
the instances demonstrates the 180° F (82° C)
unlikely event of patient injury 160° F (71° C)
from blanket temperature. 140° F (60° C)
Hospital laundering involves 120° F (49° C)
Temperature
blankets may pose an unforeseen risk, but the
blankets themselves pose no measurable risk.
In another test, I removed folded infant
blankets from a warming cabinet and meas-
ured the temperature every 15 seconds for a
total of 90 seconds. The temperatures of the
infant blankets cooled from 138° F (59° C) to
119° F (48° C) within 15 seconds, to 111° F
(44° C) within 30 seconds, and to 98° F (37° C)
within 90 seconds (Figure 11).
Additional data were obtained from pa-
tients in the emergency department and labor
and delivery department. Patients in these
departments completed a questionnaire con-
cerning their perceived comfort and warmth,
and the data obtained from these question-
naires correlated with the data obtained from

dryers that use higher temper- 100° F (38° C)

atures than can be attained in 80° F (27° C)
blanket warming cabinets.
60° F (16° C)
Housekeeping personnel han-
40° F (4° C)
dle the blankets from the dryer
without significant risk of ther- 20° F (-7° C)
mal burns from the blankets 0° F (-18° C)
initial 30 60 90 120
alone.
In a separate experiment, I Time in seconds
measured the dissipation of
Figure 10 • Temperatures of blankets in a hospital dryer at 30-second intervals.
heat from blankets in a hospi-
tal dryer. The dryer was
opened near the end of the 160° F (71° C)
drying cycle and blankets were
140° F (60° C)
left in the dryer with the door
opened. The blanket tempera- 120° F (49° C)
ture was measured using the 100° F (38° C)
Temperature

infrared thermometer in the 80° F (27° C)

middle of a load with radiant
60° F (16° C)
heat from other blankets and
the dryer itself. The tempera- 40° F (4° C)
ture of the blankets in the 20° F (-7° C)
dryer decreased from 153° F 0° F (-18° C)
(67° C) to 109° F (43° C) within initial 15 30 45 60 75 90
30 seconds (Figure 10). Other Time in seconds
factors such as metal snaps
and safety pins attached to the Figure 11 • Temperatures of warmed infant blankets at 15-second intervals.

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APRIL 2009, VOL 89, NO 4
the surgery department tests.
Because the irrigation fluids also placed in
the warming cabinets must be kept at less than
150° F (66° C), facility leaders elected to change
the policy to set all warming cabinets at 145° F
(63° C). This change was expected to increase
compliance with the warming cabinet policy
and decrease the number of patient complaints.
I followed up after three months with an
audit of compliance and a patient satisfaction
questionnaire. No unanticipated outcomes were
noted, and no corrective action needed to be
taken. Compliance with the blanket warming
temperatures remained at 100% six months after
the policy change, and the safety committee has
reported no blankets found in autoclaves or
microwaves since the implementation of the
new policy.
Patient comfort, warmth, and safety were
demonstrated in each test. Further studies
with additional test participants and a greater
variation of blanket temperatures should be
conducted to provide additional data.
Editor’s note: AORN recommends that blanket
warming temperatures not exceed 110° F (43° C)
(Recommended practices for a safe environment of
Weight Loss May Reduce Urinary Incontinence in Some Women
A clinical trial funded by the National Institutes of
Health (NIH) showed that weight loss may
reduce urinary incontinence in women who are
overweight or obese, according to a January 28,
2009, news release from the NIH. The clinical trial
(ie, the Program to Reduce Incontinence by Diet
and Exercise [PRIDE]) was held in Birmingham,
Alabama, and Providence, Rhode Island, and includ-
ed 338 obese and overweight women who leaked
urine at least 10 times per week.
Women in the trial were randomly assigned to
either a group that participated in an intensive six-
month weight loss program consisting of diet, exer-
cise, and behavior modification or a group that
received information about diet and exercise but no
training to assist in changing their habits. Results
of the trial indicated that women in the weight-loss
program lost an average of 8% of their body weight
722 • AORN JOURNAL
Bujdoso
care. In: Perioperative Standards and Recommended
Practices. Denver, CO: AORN, Inc; 2009:415-437.)
REFERENCES
1. Steris Amsco Warming Cabinet Operator Manual
P129361-177. Mentor, OH: Steris Corp; 2006:4.
2. ECRI Institute upholds recommendations on
warming cabinets. Risk Management Reporter. 2007;
26(2):9-10.
3. Moritz AR, Henriques FC Jr. Studies of thermal
injury II. The relative importance of time and sur-
face temperature in the causation of cutaneous
burns. Am J Pathol. 1947;23(5):695-720.
RESOURCES
Hazard report: limiting temperature settings on
blanket and solution warming cabinets can prevent
patient burns. Health Devices. 2005;34(5):168-171.
Mathias JM. Technology in surgery: are your
OR’s warming cabinets too hot? OR Manager.
2005;21(10):1-2.
Moon JK. Warmed blankets are safe. February
2006. Enthermics Medical Systems. http://www
.enthermics.com/learn/pdfs/skin%20warming.pdf.
Accessed February 16, 2009.
Paul J. Bujdoso, RN, is the clinical coordi-
nator, surgical services, at Licking Memori-
al Hospital, Newark, OH.
(ie, approximately 17 lbs) and reduced their urinary
incontinence episodes by nearly one-half (47%).
Women in the information-only group lost an aver-
age of 1.6% of their body weight (ie, approximately
3 lbs) and had 28% fewer incontinence episodes.
Among the women in the weight-loss group, 41%
achieved a clinically relevant reduction of at least
70% of total incontinence episodes, compared to
only 22% of women in the information-only group.
More than 13 million women in the United
States are affected by urinary incontinence. The
PRIDE trial provides evidence supporting weight loss
as a treatment for incontinence.
Weight loss in overweight and obese women reduces uri-
nary incontinence [news release]. Bethesda, MD: US
Department of Health and Human Services; January 28,
2009.