ABSTRACT
Background: The high cost and perception of poor quality of a disposable single clipper blade used for pre-operative hair removal at The Toronto Hospital, General Division prompted us to look at reusable clipper blades as an alternative.
Purpose: The purpose of our analysis was to develop a survey form for a reusable product for clipping hair pre-operatively and to trial the reusable blade for user acceptability, patient safety, costs and cleansing protocols.
Methods: A clipper survey form was established to include: demographics, type/amount hair, ease of use, patient problems and clipper care using a Likert rating scale. One member of the hospital shave team was chosen to assist in both the design of the survey form and its implementation.
Results: Two types of reusable clipper were studied including a "turbo" and a regular model. There were a total of 421 shaves with the turbo and 429 with the regular model. The most frequently shaved sites were the groin (107) and the leg (94). The type (coarse, medium, fine) and amount of hair (light, moderate, heavy) were equivalent for each of the groups. The case of use with respect to blade removal was equivalent between the 2 groups but the portability was rated as favorable/very favorable in 92/98 (93.5%) cases with the turbo and in 79/98 (80.6%) cases with the regular model. There was no difference in post-op rash or cuts. Blade sharpness and the need for oil were equivalent for both groups. The cost analysis indicated an estimated net savings of $6,700 (US) per annum with the reusable clipper blades (regular model), averaged over a 4 year period of use.
Conclusion: A reusable clipper blades was trialed and found to meet the requirements for safety and quality which are required for this product. A net savings of approximately $6,700 (US) could be realized on an annual basis by switching to a reusable product, averaged per annum over a 4 year period of use.
BACKGROUND
For over 5 years our institution had used a disposable blade clipper system for pre-operative shaves. We were using 5,000 blades per year at a cost of $3.95 (Canadian) each. The handles had been donated by the company. The new contract offered by the company lowered the cost of blades to $3.75 however they were charging $95.00 for each of the handles. The durability of the handles was inconsistent (the shave team found life expectancy to be six to eight weeks) and a box of the defective clipper blades(40/box) had to be returned to the manufacturer approximately every two weeks.
Current literature suggests the optimal approach is either no shaving or clipping to decrease surgical site infections [1-3]. Surgeons maintain hair removal is necessary for better visibility and access to the surgical site, for patient comfort (removing tape from hairy areas may be painful), and for fine equipment manipulation near the entrance site (e.g. angiography).
Given these positions and the high cost/poor quality of the current disposable clipper blades we searched for a safe and less costly alternative. Investigation of the marketplace for other disposable clippers proved fruitless. The alternative was to look for a reusable clipper blade and develop a means to assess the costs, safety, and user satisfaction of this alternative.
PURPOSE
The purpose of our analysis was to design a suitable trial for a reusable clipper blade and develop a survey form to assess user acceptability, safety, costs and cleaning protocols. Cleaning protocols would be concomitantly trialed at the same time.
It was hoped that this approach would not only be more scientific but would eventually enhance user acceptability and justify initial cost outlay to administration.
METHODS
Patient Population and Facility Description
The Toronto Hospital is a two site 1,220 bed acute care tertiary referral Centre affiliated with the University of Toronto. The Toronto General Site (where this survey was conducted) is a 900 bed facility, that does 19,000 surgeries/year and 4,030 angiographies/year. The Toronto General Division has a designated shave team (2 male members) which is responsible for clipping all pre-operative male patients as close to the time of the procedure as possible. Females are shaved by the nursing staff on each patient unit.
Reusable Clipper Blades
A review of the marketplace for reusable clipper blades which met acceptable standards of durability, dependability and quality was conducted. Two models of the "Oster" clipper were chosen for the trial following the review, a "Turbo" model and the "89-61" model.
Trial Design
Because different surgical services were divided between the two members of the shave team, it was decided that the trial would start with just half of the surgical services. After three weeks all surgical services would be included. This would allow the surveyor adequate time to optimize clipping speed efficiency in completing the form. Neurosurgery was not included to the trial and therefore only scalp hair was not included in the trial. The clipper sites included the following: sternum, thorax, abdomen, groin, leg, flank, arm, neck, axilla, and upper arm/shoulder.
Survey Form
A survey form was designed to provide an objective evaluation of the use of the reusable
blade. One member of the hospital shave team was chosen to assist in both the design of the
survey form and its implementation. Included in the evaluation were demographics,
type/amount of hair, ease of use, patient problems and clipper care (Table 1). A Likert type
rating scale was used. The member of the shave team also assisted in developing and assessing
the cleaning procedures that were trailed.
One form would be filled out for each patient and it would be noted on the form if the
patient required more than one site clipped. The team member reviewed the clipped site 24 to
72 hours post clipping.
RESULTS
In the seventh week survey, there were a total of 421 sites clipped with the turbo and 429 with the regular model (Table 2). The most frequently clipped sites were the groin (107) and the leg (994) accounting for 23.6% of all sites. The type (coarse, medium, fine) and amount of hair (light, moderate, heavy) were equivalent for each of the groups (Table 3). The ease of use with respect to blade removal and cord length was equivalent between the 2 groups but the portability was rated as favorable/very favorable in 92/98 (93.5%) cases with the turbo and 79/98 (80.6%) cases with the regular model (Table 4). There was no difference in post-op rash or cuts. Blase sharpness and need for oil were equivalent for both groups.
One area of difficulty was that the clippers had blades too wide to clip valley areas (groin, axilla, neck and extremely thin patients) without fear of pinching. After the formal survey, a smaller reusable clipper was tested for those small confined areas that were a problem for the larger clippers. The user found the smaller clipper easier to use and there was less chance of pinching in confined areas.
CONCLUSION
1. USER ACCEPTABILITY
The user found both clippers trialed acceptable, although the increased speed of the Turbo model was preferable. When clipping confined areas like the groin, some problems were encountered. As a result after the survey another small bladed clipper was sampled and found effective.
2. SAFETY
The only two injuries to patients were skin tags being nicked and both of these sites were in confined areas, made more difficulty by the 7 foot electrical cord. Of the 800 sites clipped there were only a few patients pinched by the blades and usually these were in confined areas (groin and axilla). The user's impression was that the reusable clipper had far less incidence of pinching and nicking of skin tags than the disposable clipper currently in use at the facility although no objective data for the latter was available.
3. DEPENDABILITY
After over 400 clip sites, no perceptible decrease in the blade sharpness was detected. There were no breakdowns and no overheating.
4. COST ANALYSIS
A cost analysis estimates a net savings of approximately $17,600 CDN ($12,500 US)/5000 clips which may be realized on an annual basis by switching to a reusable product (Table 5). Further cost savings would be realized if 20 of the smaller clippers ($89/clipper) are ordered instead of the larger unit.
This is an outline of the cleaning of the Oster clipper blades. Several solutions have been trialed during the survey. The following solutions and procedures were found to be the best.
BETWEEN PATIENTS
Cleaning with a disinfectant, after each patient clipped, is more than adequate. The blade does not need disinfecting except when body substance contaminate the blade. The blade will be cleaned between all patients using the following method.
Contaminated and Terminal (End of Day) Disinfection
If the blade becomes contaminated at any time during the day with blood or any other
substance, then the blade is to be removed from the handle, cleaned throughly with soap and
water and them soaked in 0.5% Chlorhexidine Gluconate with 0.5% Sodium Nitrate for twenty-five minutes before reuse. If a mole or skin tag has been damaged (bleeding), the blade should
be treated as contaminated even through there may be no visual signs of body fluid on the blade.
Terminal (end of the day) cleaning and disinfection procedure will be the same as if the
blade has become contaminated.
The handle will be cleaned off with soap and water at the end of day. The brush will be
washed with soap and water and then soaked in Chlorhexidine 2% for 20 minutes at the end of
the day. Both can then be stored clean in a cupboard.
| NUMBER OF CLIPPED SITES PER YEAR | 5,000 | 10,000 |
| CURRENT SYSTEM-3M DISPOSABLE | ||
| Disposable blades @ $3.75 | $ 18,750 | $37,500 |
| Replacement handles @ $95. (10/year) | 950 | 950 |
| Total cost | $ 19,700 | $ 38,450 |
| PROPOSED SYSTEM-OSTER TURBO III | ||
| 40 clippers @ $175-$7,000-life expectancy 10 years- annualized cost is | $700 | $700 |
| Replacement of "lost" hand pieces @4/year | 700 | 700 |
| Replacement blades @ 5/year | 150 | 150 |
| Cleaning after each use-Alcohol pladget @ $.04 | 200 | 400 |
| Terminal cleaning solution- $5.70/2 L $ 5.70/100/2x40x260 (100 cleaning/L) | 297 | 297 |
| Total Cost | $ 2,047 | $ 2,247 |
| SAVINGS | $ 17,653 | $ 36,203 |
REFERENCES
Alexander JW, Fischer JE, Boyajian M, Palmquist J, Morris MJ. The influence of hair-removal methods on wound infections. Arch Surg 1983:118:347-52.
Hallstrom R.Beck SL. Implementation of the AORN skin shaving standard evaluation of a planned change. AORN Jnr1993:58:498-506.
Hamilton HW, Hamilton KR, Lone FJ. Pre-operative hair removal. Cdn Jrn Surg19977:20:269-275.
