All studies since the 1970's have consistently reported that the surgical wound infection rates increase when hair is removed from the body. The highest rates are from razor shaving, which causes small nicks in the skin that cannot be readily seen. Clippers, designed not to give as close a shave, may damage the skin but to a much lesser degree. The lowest infection rates come from using depilatories (e.g. Neet), or no hair removal. However, depilatories may cause rashes and other problems. The infection rate is inversely related to the cost, from razors being the cheapest to depilatories being the most expensive. No pre-operative hair removal is the least expensive of all the options.
So why do pre-op shaves? There are usually three reasons given which include:
1. Better visibility and access to the surgical site.
2. Patient comfort (removing tape from hairy areas may be painful).
3. Microorganisms living on the hair may cause infections.
Despite the evidence, pre-operative hair removal is still considered necessary by most surgeons. Given this practice, the safest way to deliver this patient care deserves further scrutiny. Studies have shown that the closer to O.R. time the shave/clipping was done, the lower the infection rate. In response to this finding, some surgeons have shaved their patients in the O.R. suite. This practice is considered unhygienic, as the hair and drying skin cells plus attached bacteria may be aerosolized around the room, contaminating sterile tables. A new Hospital policy restricts shaving/clippings in the O.R. For the same reason, no shaves/clippings will be allowed in the new O.R. holding room. Therefore, the only place for pre-op hair removal is on the nursing units as close to the time of surgery as possible. Pre-op hair removal should be avoided the evening before surgery!
A review of the economics of hair removal revealed our Hospital has been using a disposable blade clipper, at a cost of $3.75 per blade. The handles, originally supplied free of charge, have had a poor performance record. As a consequence, a Total Quality Management project, initiated by the Infection Control Unit and the Shave Team, and also involving O.R. Managers, many Nursing Unit Managers and staff nurses, and the V.I.T. Med-Surg Products Committee, was developed and executed using an in-house trial and sampling of two reusable clippers. In the formal seven week study, 187 male patients were clipped, involving a total of 850 sites. Different cleaning procedures were trialed for user acceptability and patient safety. The clippers trialed proved to be good quality products, with no breakdowns and no loss in blade sharpness. The disadvantage to a reusable clipper is that it may be susceptible to theft.
The potential savings for the Hospital will be at least $35,000 annually, with the initial purchase price of clippers being costed over a ten year period. In the next few months when the clippers are introduced, a cleaning and maintenance policy will be provided and inservices on the care of the clipper will be available on request.
References:
Alexander, J.W.; Fischer, J.E.; Boyajian, M.; Palmquist, J.;Morris, M.J. The Influence of Hair-Removal Methods on Wound Infections. Arch Surg 1983; 118:347-52.
Hallstrom, R.; Beck, S.L. Implementation of the AORN Skin Shaving Standard - Evaluation of a planned change. AORN Journal 1993; 58:498-506
Hamiliton, H.W.; Hamilton, K.R.; Lone, F.J. Preoperative Hair Removal. The Canadian Journal of Surgery 1977;20:269-275.
Seropian, R., Reynolds. B.M. Wound Infections After Preoperative Depilatory Versus Razor Preparation. The American Journal of Surgery 1971;121:251-254.
Winston, K.R. Hair and Neurosurgery. Neurosurgery 1992;31:320-329.
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