Proposal for the implementation of surgical clippers/shavers versus razors to comply with best practices and the reduction of surgical site infections
1.0 Background of Evaluation
Preventing surgical site infection is a health care intervention which is based on scientific evidence. The prevention is perceived to improve patient care and prevent avoidable deaths during the preoperative period that is why the intervention is strongly advocated. The preoperative period refers to the time period encompassing a patient’s surgical procedure including ward admission, anesthesia, surgery and recovery. Generally, the term preoperative refers to the three phases of surgery namely preoperative, intraoperative and postoperative. Surgical site infection, on the other hand, refers to the infection at the site of an operation caused by the operation. Surgical site infection is one of the most common types of adverse events occurring in hospitalized patients. As such, infections are identified to increase preoperative mortality, re-admission rate, length of stay and incurred cost for patients.
The care components of surgical site infection include the day of surgery admission, the appropriate use of prophylactic antibiotics, appropriate hair removal and compliant with local surgical wound dressing protocol. Such ‘bundle’ is a group of evidence-based intervention for patients who will and is currently undergoing surgery. It was believed that when these care components are implemented together, substantial improvement will be achieved. Historically, preoperative hair removal had been a customary preoperative practice thought to offset the increased risks for post-surgical infections. Multiple studies revealed, however, that hair removal may be a contributing risk factor for developing infections. It has been demonstrated that the act of shaving causes skin abrasions or microscopic nicks that can provide a favorable avenue for bacterial colonization.
According to the CDC 1999 Guideline for Prevention of Surgical Site Infection, preoperative shaving of the surgical site the night before an operation is associated with a significantly higher risk for surgical site infections than either the use of depilatory agents or no hair removal.[26] In a randomized study of 1,980 consecutive adult patients undergoing cardiopulmonary bypass surgeries over a two-year period, reported that the infection rate was significantly higher in the manually shaven (13/990, 1.3%) than in the electrically clipped patients (4/990, 0.4%). In another randomized study of 200 patients having elective inguinal herniorrhaphies, ., concluded that “preoperative clipping of hair with electric barber’s clippers immediately before operation is a safe, well tolerated procedure that does not increase the risk of postoperative wound infection.” There was also a systematic literature review by, which states that depilatory or electric clipping, preferably immediately before surgery, should be used and that shaving should be avoided.
A number of studies have also been conducted on neurosurgical patients that assessed the effects of hair removal or skin shaving on postoperative infection rates. In all of these studies, no hair was removed. Instead, the incision was made after the hair was thoroughly scrubbed with an antiseptic solution and parted with a sterile metal comb or clamp. Results showed no differences in the reported surgical site infections.
If hair removal must be practiced, shaving the night before surgery or at any time other than immediately prior to the operation is considered inappropriate. It is preferable to use electric clippers. Hospitals must increase the level of physician and clinical staff awareness, including purchasing personnel, on the increased infection rates associated with preoperative shaving. Patients should also be informed about the risks of shaving the surgical site before surgery as part of their preoperative preparation. All razors should be removed from stock carts and surgical prep kits. Heavy-duty clippers are an appropriate alternative and can be purchased should hair removal be necessary.
Traditionally, surgical sites have been shaved with disposable razors due to the belief that hair would interfere with proper wound closure and healing. For decades, however, studies have been published demonstrating that shaving damages the skin and increases the risk of infection. Razor shaving increases the risk of infection by creating micro abrasions in the skin that allow skin-dwelling microorganisms to collect and multiply. These organisms may then migrate into the incision site and may also collect on catheters or sheaths that must remain in place for a period of time following the procedure. In contrast to shaving, clipping hair using a rechargeable electric trimmer with a disposable head does not damage the skin and is associated with lower infection rates In a prospective study that compared infection rates among 1,980 surgical patients whose hair was either shaved or clipped pre-operatively, patients who were clipped had a statistically significantly lower infection rate than patients who were shaved.
These results support an earlier study of the effects of shaving versus clipping on infection rates among 1,013 patients undergoing elective surgery. Clipping decreased infection rates both at discharge and at 30-day follow-up. Cost savings of 0,000 per 1,000 patients were estimated (in 1983 dollars) if clipping replaced shaving. A study comparing the clinical and cost outcomes of shaving and clipping found a moderate initial increase in hospital cost when converting from razors to clippers, but concluded that substantial long-term cost savings could be expected due to the decreased incidence of postoperative wound infections. This study further recommended discontinuation of razor shaving because of its associated risk of infection. Depilatories also have been evaluated, although recent data demonstrating a beneficial effect on infection rates are not available. The primary advantage to using depilatories is for hair removal in areas that are difficult to shave. However, depilatories are associated with hypersensitivity reactions.
2.0 Justification for Evaluation
3.0 Review of Literatures
4.0 Relevant Stakeholders
Basically, the evaluation will include the surgery ward and operating suite as well as the surgeons, anesthetists, nursing staff from ward and operating suite, infection control professional and nursing clinical coordinator.
5.0 Criteria for Evaluation
6.0 Resource Implications/Requirements
7.0 Data Sources and Collection
8.0 Data Analysis and Interpretation
9.0 Communication of Results
10.0 References
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