Preoperative Hair Removal A Case Report With Implications For
Preoperative Hair Removal A Case Report With Implications For
Preoperative Hair Removal A Case Report With Implications For
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OVERVIEW
Surgical site infection (SSI) is one of the most common healthcare-associated infections
(HAI) among surgical and hospitalized patients.3 Therefore, it is a significant source of patient
morbidity and mortality, as well as extended hospital stays and increased healthcare costs. In
light of the monetary and non-monetary2 costs of SSI, along with the emergence and spread
of antibiotic-resistant bacteria and the patients pain and suffering, the focus of SSI initiatives
has shifted from treatment to prevention. All members of the surgical team must therefore
understand the risk factors for SSIs and implement effective infection prevention strategies;
proper preoperative hair removal is one strategy that has gained increased recognition.
The purpose of this online activity is to provide an overview of SSIs and the impact of proper
preoperative hair removal technique as an infection prevention measure. It will present
an overview of the perioperative patient implications and impact of SSIs. Current national
initiatives, standards, and professional recommended practices for proper preoperative hair
removal will be outlined. It will also provide a review of the current literature on the clinical
implications of the risks of preoperative hair removal as they relate to SSIs and appropriate
hair removal techniques as infection prevention measures. Strategies to effect practice
changes regarding preoperative hair removal will be reviewed. Finally, advancements in hair
removal device technology will be presented. Case studies will provide the opportunity to
synthesize the information and evaluate patient care scenarios.
OBJECTIVES
After completing this continuing nursing education activity, the participant should be able to:
1. Describe the impact of surgical site infections.
2. Identify national initiatives for the prevention of surgical site infections.
3. Discuss current professional recommended practices for preoperative hair removal.
4. Discuss research findings regarding the risks of preoperative hair removal as they
relate to surgical site infections.
5. Describe strategies to implement practice changes related to preoperative hair
removal.
6. Explain advancements in device technology that improve safety of hair removal.
INTENDED AUDIENCE
This independent learning activity is intended for use by perioperative nurses, certified
surgical technologists, and other healthcare professionals who are responsible for safe
patient practices related to hair removal prior to surgical intervention.
1
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IACET Credit
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AST Credit
This continuing education activity is approved for 3.5 CE credits by the Association of
Surgical Technologists, Inc., for continuing education for the Certified Surgical Technologist
and Certified Surgical First Assistant. This recognition does not imply that AST approves or
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RELEASE DATE
This online activity was released March 2011 and can be used for a period of two years. After
March 2014 it can no longer be used unless it is updated and contains a new release date.
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This material was originally produced in March 2011 and can no longer be used after March
2014.
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SUPPORT
Grant funds for the development of this activity were provided by CareFusion.
PLANNING COMMITTEE
Aurora, Colorado
Aurora, Colorado
Aurora, Colorado
EXPERT REVIEWER
Larkspur, Colorado
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Ms. CG is the circulating nurse assigned to operating room (OR) # 3 today, where Dr.
Jones has three orthopedic cases (all of which are total joint replacements) scheduled.
The first case is a right total knee arthroplasty on a 57-year-old man, Mr. SK. As Ms. CG
greets Mr. SK in the preoperative holding area to do her initial assessment and chart
review, he informs her that he shaved his right leg last night at home since his cousin
had the same surgery last month and told him that he needed to shave his leg the night
before surgery. He adds that he didnt have a new blade in his razor, so it was a little
rough. Ms. CG asks Mr. SK what instructions he received from Dr. Jones regarding
preoperative preparation; he replies that he recalls that he was given a sheet with
instructions, but somehow had misplaced it at home as he prepared for the procedure.
Ms. CG assesses Mr. SKs right leg and notices that the skin immediately surrounding
the knee area is red and also that there are multiple nicks and abrasions on the surface
of the skin; she proceeds to page Dr. Jones to let him know about the condition of Mr.
SKs skin at the operative site.
Preventing the development of a surgical site infection is a goal of every member of the
perioperative team. The Perioperative Nursing Data Set (PNDS) includes, The patient is
free from signs and symptoms of infection as one of the expected perioperative patient
outcomes.1 For the surgical patient, there are numerous factors that may increase his/
her risk for the development of a surgical site infection (SSI). One area that has gained
increased recognition in recent years is that of preoperative hair removal. While once
accepted as the standard of practice for the majority of surgical procedures, hair removal
is now being reconsidered with regard to research findings. This study guide will review
the impact of surgical site infections (SSIs) and the role of preoperative hair removal as
an infection prevention strategy.
Surgical site infections remain a significant source of patient morbidity and mortality,
extended hospital stays, and increased healthcare costs. In the United States, of the
estimated 27 million patients who undergo surgical procedures annually, approximately
500,000 will suffer an SSI; additionally, 10,000 deaths are associated with SSIs on
an annual basis.2 SSIs are the third most frequently reported healthcare-associated
infection (HAI), accounting for 14% to 16% of all HAIs among hospitalized patients.3
Surgical site infections may result in as many as 3.7 million extra hospital days and
increased health care costs of more than $1.6 billion per year.4 An estimated 40% to
60% of SSIs are preventable.5 By implementing projects to reduce SSIs, hospitals could
recognize a savings of $3,152 and a reduction in extended length of stay by seven days
for each patient who avoids an infection.6
5
For the purpose of standardized reporting, SSIs have been classified and defined by the
Centers for Disease Control and Preventions (CDC) and the National Healthcare Safety
Network (NHSN) as superficial incisional SSIs, deep incisional SSIs, and organ/space
SSIs. These definitions are detailed in Table 1.
Table 1 - Definitions of SSIs7
Superficial Incisional SSI
Purulent drainage
Purulent drainage from the deep incision but not from organs/spaces
associated with the surgical site
Organ/Space SSI
Infection involves any part of the body, excluding the skin incision, fascia, or
muscle layers that are opened or manipulated during the operative procedure.
site is contaminated with greater than 105 (100,000) microorganisms, but the dose
required for an infection may be considerably lower if a foreign material (for example,
sutures) is present at the surgical site.10 In general, the risk of an SSI is defined as:11
Dose of bacterial contamination X virulence
----------------------------------------------------------
Resistance of the host patient
Definition
Strength of recommendation
A
Quality of evidence
I
II
III
One of these national initiatives is the Surgical Care Improvement Project (SCIP), which
is co-sponsored by the Centers for Medicare and Medicaid Services (CMS) and the CDC.
The primary goal of SCIP is to reduce the incidence of surgical complications by 25%
by the year 2010.13 One entire section of the SCIP protocol is dedicated to prevention of
surgical site infections. Surgery patients with appropriate hair removal (SCIP INF 6) is
one area of focus outlined in the SCIP protocol.14
In 1999, the CDCs Hospital Infection Control Practices Advisory Committee (HICPAC)
published its Guideline for Prevention of Surgical Site Infection. This guideline remains
the definitive work on evidence-based practice for the prevention of SSI. The CDC
recommendations for preoperative patient preparation in regard to hair removal are:15
Do not remove hair preoperatively unless the hair at or around the incision site
will interfere with the operation (Category IA strongly recommended, due to
support from well-designed experimental, clinical, or epidemiological studies).
If hair is removed, remove immediately before the operation, preferably with
electric clippers. (Category IA).
Another important national initiative is the Institute for Healthcare Improvements (IHI) 5
Million Lives Campaign. This is a voluntaryprogram designed to protect patients from
five million incidents of medical harm from December 2006 to December 2008; it targets
a reduction in surgical complications by reliably implementing all of the changes in care
recommended by SCIP.16 This campaign encourages hospitals to implement four key
interventions for preventing SSIs, one of which is appropriate hair removal.17 Specific
to appropriate hair removal, IHI recommends collecting baseline information on use of
razors within their institutions in order to determine current practice, as the use of razors
preoperatively increases the incidence of wound infection in comparison to clipping,
depilatory use, or no hair removal.18 As hospital teams develop and test process and
system changes to improve performance on the measure for appropriate hair removal,
some of the changes that will result in improvement include:19
Remove all razors from the entire facility;
Work with the purchasing department so that razors are no longer purchased in
the facility;
Educate patients not to self-shave preoperatively; and
Use signs and/or posters as reminders.
A visual aid that was developed to remind and educate caregivers, staff, patients,
and families as part of this initiative is CATS interventions to decrease surgical site
infections:20
o C: Clippers remove hair appropriately
Goal 7 of the 2008 Joint Commission National Patient Safety Goals is: Reduce the risk
of healthcare-associated infections.21 This includes managing as sentinel events all
identified cases of unanticipated death or major permanent loss of function associated
with a healthcare-associated infection. Specifically related to skin preparation, one of
the National Hospital Quality Measures/The Joint Commission Core Measures includes
Surgery patients with appropriate hair removal as one of the SCIP measures. 22
10
With regard to the impact of SSIs and the need for effective infection prevention
strategies, the Association of periOperative Registered Nurses (AORN) Recommended
Practices for Preoperative Patient Skin Antisepsis was recently updated. These
recommended practices provide guidance for achieving skin preparation of the surgical
site in order to achieve the goal of reducing the risk of postoperative surgical site
infection by:23
Removing soil and transient microorganisms from the skin;
Reducing the resident microbial count to subpathogenic levels in a short period of
time and with the least amount of tissue irritation; and
Inhibiting rapid, rebound growth of microorganisms.
Specific to hair removal, recommendation III.e.1 states: The presence of excessive hair
that may interfere with the surgical procedure should be identified. Recommendation
IV states: Hair at the surgical site should be left in place (i.e., not removed) whenever
possible.24 Key points outlined in this recommendation are summarized below. 25
Research studies have demonstrated that preoperative shaving of the surgical site
increases the risk of surgical site infection and also results in higher surgical site
infection rates than using a depilatory cream or clipping.26,27,28 Hair has been left in place
successfully for neurosurgery procedures without an increase in the risk of surgical site
infection.29, 30 The patient should therefore be instructed not to shave or use a depilatory
on the surgical site before surgery. Removing hair at the surgical site abrades the skin
surface and consequently enhances microbial growth. Shaving has been found to
increase the risk of surgical site infection. Depilatory creams may cause skin reactions
in some individuals, which could result in cancellation of surgery. Alternatives to hair
removal for head and neck surgery are braiding the hair or using a nonflammable gel to
keep the hair away from the incision.
If the presence of hair will interfere with the surgical procedure and its removal is in the
best interest of the patient, the following precautions should be taken:
Hair removal should be performed the day of surgery, in a location outside of the
operating or procedure room.
Only hair that will interfere with the surgical procedure should be removed.
Hair should be clipped using a single-use electric or battery-operated clipper, or a
clipper with a reusable head that can be disinfected between patients.
Clipping hair the morning of surgery has resulted in fewer surgical site infections than
shaving or clipping the day before surgery. Limiting the amount of clipping minimizes
the risk of microscopic nicks. Clipping the hair outside of the operating room minimizes
the dispersal of loose hair and therefore the potential for contamination of the sterile
field and/or the surgical wound. During use, the clipper handle is contaminated with the
patients skin flora. The clipper head may also become contaminated with microscopic
blood or body fluids; therefore, decontamination for bloodborne pathogens is necessary
to prevent transmission.
11
Depilatories may be used for hair removal if skin testing has been performed without
tissue irritation. However, the use of depilatories does increase the risk of hypersensitivity
reactions. The manufacturers written instructions regarding skin testing and the use of
chemical depilatories should be followed.
Besides all the recommendations and studies that exist, there is very simple and effective
evidence out there to support using an electrical clipper vs. a prep razor, if there is a
need for hair removal.
Looking at the picture below, the micro abrasions that are caused by a razor are very
evident. These abrasions lead to an increased risk of an infection as micro organisms
flourish in the environment that is created by these cuts.
Research conducted over the last 30 years has demonstrated that preoperative shaving
with the use of safety razors is a risk factor for the development of SSIs.31 Below is
a summary of the most recent studies/articles with outcomes and examples of SSI
reductions when hair was removed by clipping from the surgical site:
In 2008, Trussell et al concluded a 39 month study on 1,827 CABG procedures, where
the protocol called for removal of the traditional shaving utensils and replacing them with
electric clippers. ( Trussell et al. Impact of patient care pathway protocol on surgical site
infection rates in cardiothoracic surgery patients. Am J Surg 2008; 196, 883-889) An inservice was conducted to teach the nursing staff about the potential harm of skin shaving
12
preoperatively, instructing them to use clippers whenever hair removal was warranted.
Hair removal, when deemed necessary, was done immediately before the procedure as
per the CDC guidelines. In the post-intervention period, the use of shaving decreased
from 60% to 20% (P = .001). Because of the intervention of clipping, using timely
antibiotic administration and tighter blood glucose control, the rate of sternal infections
fell from 3.5% to 1.5% (P = .001). It was also noted that replacing shaving utensils with
electric clippers in the surgical pre-op and ORs and instructing the staff not to shave the
skin, adds no cost, time, or difficulty to the surgical preparation process.
The body of knowledge supporting leaving hair at the surgical site continues to grow.
Some of these research findings are summarized below.
In 2007, a review of eleven randomized controlled trials was conducted by Tanner et al.
to determine if routine preoperative hair removal results in fewer surgical site infections
than not removing hair.32 These authors concluded that there is insufficient evidence to
state whether removing hair impacts surgical site infection or when is the best time to
remove hair; however, if it is necessary to remove hair, then both clipping and depilatory
creams result in fewer SSIs than shaving using a razor. Three trials involving 3193
people compared shaving with clipping and found that there were statistically significantly
more SSIs when people were shaved rather than clipped (RR 2.02, 95%CI 1.21 to 3.36).
Celik and Kara, in 2007, conducted a prospective randomized clinical study to determine
whether shaving the incision site before spinal surgery causes postoperative infection.
33
While spine surgeons usually shave the skin of the incision site immediately
before surgery is performed, evidence from some surgical series has suggested that
preoperative shaving may increase the postoperative infection rate. A total of 789
patients scheduled to undergo spinal surgery were randomly assigned to two groups:
those whose surgical site was shaved immediately before surgery (shaved group: 371
patients) and those whose surgical site was not shaved preoperatively (unshaved group:
418 patients). The mean duration of anesthesia and the infection rates in both groups
were recorded and compared. The duration of anesthesia did not differ in the two groups;
a postoperative infection developed in four patients in the shaved group and in one
patient in the nonshaved group. The authors concluded that shaving of the incision site
immediately before spinal surgery may increase the rate of postoperative infection.
Orsi, Ferraro, and Franchi conducted a systematic literature review in 2005 about the
opportunity, the modality and the risks associated with preoperative hair removal.34
The frequency of surgical site infection is influenced by several risk factors, including
perioperative hair removal; it is traditionally part of the procedures carried out
preoperatively. Although preoperative shaving is widely used in many hospitals, its use
should be re-evaluated. The authors found first, that preoperative shaving (with a razor)
is associated with a significantly higher surgical site infection risk; second, when hair
removal is considered necessary by the surgeon, it should be carried out by means of a
clipper or depilatory cream. Furthermore, hair removal should be performed immediately
before surgery and not in advance, to avoid an increased risk of surgical site infection.
13
Process Measure
Percent of surgical cases
with appropriate hair
removal
Rationale
Shaving the surgical site
increases the rate of surgical
site infection and particularly
when it is done earlier than
immediately prior to the
operation.
14
Menendez Lopez, et al. used a randomized control study to assess the effects of
preoperative shaving of the pubic region on postoperative bacteriuria after endoscopic
urological surgery. 36 In one group, the pubic region was shaved according to the
standard techniques while the other group was not shaved; the rest of the preparation
was the same for both groups. Urine samples were collected for culture before the
administration of the prophylactic antibiotic and one week after the removal of the foley
catheter (no postoperative antibiotics had been administered). Special attention was paid
to the postoperative incidence of infections. Of 300 patients who remained in the study,
149 were shaved and 151 were not. In the group of unshaved patients, 19.5% developed
postoperative bacteriuria compared to16.6% in the shaved group; the difference was not
statistically significant. The authors concluded that there is no increase in postoperative
bacteriuria in unshaved patients undergoing endoscopic urological surgery as compared
with the group of patients who were shaved.
Ratanalert, et al compared the surgical infection rate of non-emergency cranial
neurosurgical patients with two different scalp preparations: shaved or nonshaved.
37
Patients were entered in the nonshaved group using the following exclusion criteria:
immunocompromised host, presence of infectious diseases, surgery with foreign material
insertion, multiple operations within one month, and the presence of a traumatic wound
around the operative site. Patients who survived less than one month postoperatively
were excluded, except in cases where death resulted from intracranial infection. During
the 29-month period, 225 of 1,244 cranial neurosurgical procedures were selected for
study; the patients ages ranged from 4 to 86 years; brain tumors were encountered in
57%. In the nonshaved group, there were 89 procedures (80 cases), compared with
136 procedures (123 cases) in the shaved group; surgical infection rates were 3.37%
and 5.88%, respectively. The authors concluded that nonshaved scalp preparation is
recommended for non-emergency cranial neurosurgical procedures.
Remove all razors from operating suites and surrounding patient support
areas, or eliminate razors from surgical prep kits;
Institute a policy to avoid shaving surgical sites, or if hair removal is necessary,
perform hair removal only with clippers right before surgery;
Gain support from chief of surgery;
Send letters to surgeons and staff regarding the change from razors to clippers,
including a timeline;
Institute the placement of electric clippers throughout the areas where hair
removal is likely to occur;
15
Educate surgeons and clinical staff on appropriate hair removal techniques, and
purchasing personnel on appropriate supplies;
Implement No Shave Zone posters throughout the hospital;
Standardize documentation of hair removal technique in the preoperative/
operative record to include no hair removal, clipper, depilatory, eliminating the
razor/shaving option; and
Educate patients to not shave the surgical site before surgery or develop patient
education materials on proper hair removal.
One healthcare facility recently conducted a razor roundup to kick off its surgical
site infection quality improvement process.39 The goal of the project was to minimize
preoperative hair removal and disturbance of skin integrity; the method was to perform
indicated hair removal with clippers immediately prior to surgical skin preparation. Prior
to the initial meeting, the supply techs conducted an inventory and started the razor
roundup by pulling back on the numbers of razors in stock. To gain the support of the
staff, the project team asked the staff to select the style of clippers they wanted; the staff
also planned where the clippers would be stored. Clipper tenders were assigned to
keep the clippers in place where they belonged. Once the clippers were stocked in the
ORs, the next step was to make it less convenient for surgeons to obtain razors. The
razors were gathered and moved onto supply carts in the hallways. When a surgeon
asked for a razor, the staff had a scripted response: I will be happy to get that for you.
It is out on the supply cart. In the meantime, I have these clippers. Next, the razors
were moved a step further, into the supply room. The staff continued using the scripted
response, but now telling the surgeons they would gladly get a razor, but would need
to get it from the supply room. To continue to drive the change, the team recruited two
respected surgeons. On a prearranged day, the team asked the two surgeons to refuse
to start their cases until clippers were used to shave their patients. When this happened,
word traveled quickly. This helped to quiet the voices of those who said using clippers
would never work. From that point on, when a staff member objected to using clippers,
the staff member could reply, Oh, but Dr. So-and-So wants to use them. One overall
benefit of the project was to decrease the amount of hair removal over time. Over the first
year, the percentage of cases with no hair removal rose from 66% to 77%.
In another hospital system, the change concept of avoiding shaving of the surgical site
was tested for one month.40 A multidisciplinary team of nurses from the OR, preop,
and postanesthesia care, plus an anesthesiologist, planned the implementation of
the no-razor practice. The circulating nurses talked up the plan, and the director of
inpatient surgical services discussed the plan at staff meetings. The project began with
hysterectomies performed by two surgeons and colon procedures performed by one
surgeon. The team proposed that the surgeon champion the use of clippers for one
day on his patients. He liked the clippers and was interested in seeing the statistics on
infection risks with razors. He then shared the information with his partners, and they also
began using clippers. After just two months, all of the surgeons were using clippers on all
procedures in all four of the hospital systems surgical facilities.
16
One hospital has seen the use of clippers increase from 25% to 96% in a one year
period.41 A major impetus for this change was the hospitals participation in the states
surgical infection prevention collaborative. Previous efforts had been unsuccessful,
but this time, the change went smoothly. The success was attributed to support from
administration, the surgeons, and the perioperative nursing staff. The key was enlisting
staff support and providing education; both the staff and surgeons were interested in
learning about the research that supported clipping. A series of one-hour educational
programs with continuing education credit were provided for over 90 employees. The
perioperative division care manager reviewed the information about the mandatory use of
clippers and also asked for the staffs input regarding the problems with razors. Most staff
responded by saying, Clippers are never available and The surgeons dont want to
wait for the staff to find clippers. The clipper heads werent being stocked appropriately
and the clippers were disappearing. The department negotiated with the vendor for new
clippers for the 15 ORs. Having the clippers readily available solved the delay problems
expressed by the surgeons. The staff accepted the clippers so well that they persuaded
the surgeons to use the clippers instead of razors. In addition, No shave zone posters
were displayed above the scrub sinks and in all the rooms.
Nurses and all members of the surgical team serve as the patients advocate; in this role,
they must internalize the belief that engaging in any practice that may cause harm to a
patient or increase the risk for a surgical site infection could be considered a breech of
professional standards of care.42 Nurses and other team members can use the following
strategies to maximize their advocacy role in regard to preoperative hair removal: 43
Work with staff in infection control, risk management, supply management,
and perioperative departments to eliminate the use of safety razors for hair
removal.
Post, in a prominent location, a list of researchers who recommend that safety
razors not be used the list can include author names and publication dates as a
reference list and tool to educate other perioperative team members.
If clippers are used, nurses can ensure that there are adequate units and supplies
based on the daily OR schedule; in addition, nurses can ensure that the clipper
units are fully charged and stored in a convenient location.
If depilatories are used, nurses must remember to assess the patients allergies,
test the products on a small area, and keep the products away from the patients
eyes and genitalia.
17
18
Surgical clippers available today offer advancements in device technology and design
to provide perioperative practitioners with devices that improve compliance with
professional recommendations and also promote patient safety. Wider blades clip hair
smoothly and closely, thereby avoiding infection-causing nicks and cuts. Disposable,
single-use blades help to prevent cross contamination. Devices specifically designed for
clipping hair in sensitive areas (i.e., for urologic, gynecologic, and obstetric procedures)
are also available. These devices promote patient safety by providing:
A specially tapered head this allows the practitioner to reach tight areas.
A very narrow blade this provides ease and maneuverability when clipping in
tight, sensitive areas.
Uniquely designed cutting blade geometry this design adds protection when
clipping loose skin or especially sensitive areas.
Clippers should also be able to effectively clip fine or coarse hair, wet or dry. Other
design features that promote staff compliance and patient safety include:
Cordless, rechargeable operation
Ergonomic, non-slip handle that fits comfortably in the users hand
High performance clipping ability
Ability to effectively disinfect the clipper handle between patients
Handles that can be cleaned quickly and easily; for example, those that are
waterproof and submersible for thorough cleaning and disinfecting
SUMMARY
Every patient expects that his/her surgical experience will be uneventful. The
development of a surgical site infection is an inherent risk for any patient entering the
operating room. Every surgical site infection results in additional postoperative hospital
days, thousands of dollars in extra charges, and increased patient discomfort. Both the
clinical and economic implications of surgical site infections are of greater significance in
todays dynamic healthcare environment. As the patients advocate, every member of the
surgical team plays an important role in reducing the incidence of surgical site infections
by implementing effective infection prevention strategies throughout the patients surgical
journey. Through an understanding of the concepts and research findings related to the
risks of removing hair from the surgical site, as well as their implications for prevention of
surgical site infections, the surgical team can implement effective hair removal practices.
Awareness of the advancements in technology that provide safe and effective hair
removal devices is also important in establishing best practices. Through these efforts,
the surgical team can provide the safest possible environment for surgical intervention,
reduce the risk for the development of a surgical site infection, and ultimately promote
positive outcomes for all surgical patients.
19
Case Studies
Case Study 1 Ms. MC
Ms. MC is a 21-year-old female scheduled for a craniotomy for a glioblastoma. Both the
diagnosis of the tumor and the proposed surgery have been very stressful for Ms. MC
and her parents. Ms. MC has long, black hair and is quite upset at the prospect of having
it shaved for her surgery. During the preadmission testing appointment, Ms. MC asks
about having her head shaved and begins to cry uncontrollably. Ms. VT, the preadmission
clinic nurse, informs Ms. MC and her parents that the hospitals policy is not to shave the
hair for patients undergoing neurosurgical procedures since Dr. Reeves, who had been
at a large research facility, started practicing at the hospital. They are surprised and ask
Ms. VT why this is possible.
Points to Consider:
1. What is the rationale for leaving hair in place for neurosurgical procedures?
2. What are some alternatives to hair removal for craniotomy procedures?
Discussion of Points to Consider:
1. What is the rationale for leaving hair in place for neurosurgical procedures?
- Research studies have demonstrated that shaving of the surgical site
increases the risk of surgical site infection.
- Research findings have also shown that hair has successfully been left
in place for neurosurgery without increasing the risk for surgical site
infection.
- Based on this knowledge, not shaving the hair will also provide some
emotional support for Ms. MC and her family.
2. What are some alternatives to hair removal for craniotomy procedures?
- Braiding the hair
- Use of a nonflammable gel to keep the hair away from the incision site
20
21
22
2. What steps should Ms. GV take to ensure success with the new policy and
procedure?
- Present the concept to the staff educate them on the research findings
regarding preoperative hair removal as well as the risks associated with
shaving.
- Present a draft policy that outlines not shaving surgical sites, and if
hair removal is necessary, perform hair removal only with clippers
immediately prior to surgery.
- Develop a proposed timeline for the change in practice from razors to
clippers communicate this with surgeons and staff.
- Select clippers for evaluation based on:
product research regarding safety, performance, quality, ease of use,
impact on quality patient care and outcomes, product efficacy, and
cost analysis
input from the staff and surgeons
23
GLOSSARY OF TERMS
Bacteriuria
Clean Wounds
Contaminated Wounds
Contamination
Depilatory
Endogenous
Euglycemia
Exogenous
Flammable
Infection
Microorganism
Normothermia
Pathogen
Resident Microorganisms
Stratum Corneum
Superficial SSI
Surgical Site Infection (SSI) Risk Index Measure of the likelihood that a patient will suffer
an SSI.
25
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