Evaluate the evidence surrounding hair removal from the surgical site prior to surgery and demonstrate safe effective and timely methods (Theory and rationale behind the practice)
There are various aspects involved in patient preparation for surgery. Since the inception of surgical procedures, preparing the patient preparation has included the routine removal of body hair from the intended surgical wound site (Tanner J et al 2007). The sites whereby hair is normally removed occasionally include the head for neurosurgical procedures, the pubic area especially while doing caesarean sections in obstetric surgeries and for men while doing scrotal surgeries such repairing hernias (Tanner J et al Cochrane systematic Reviews 2011).
However, even though the practice of hair removal is widely performed, there are studies which suggest that preoperative hair removal is harmful to patients. The main reason that is cited is that by removing hair there is an increased risk of causing surgical site infections (SSIs) (Ban K A et al 2016). The studies go further to recommend that the hair removal before surgery should not be carried out (Tanner J et al 2007, NICE 2008, WHO GUIDELINES, Ban K A et al 2016, Tanner J et al Cochrane systematic Reviews 2011).
In surgery, as the patient is being prepared before the operating surgeon can start, there are various mechanisms through which hair is removed from the skin surface that will be cut (Mangram et al 1999). In subsequent research that has been done over the years, it has been demonstrated that perioperative hair removal can potentially compromise the skin barrier depending on the method of hair removal employed (Celik & Kara 2007). The compromised barrier creates a portal of entry for skin microorganisms, some of the most common pathogens associated with nosocomial infections ((DeGeest et al 1995, Mangram et al 1999, Celik & Kara 2007, Adisa et al 2011 Cited by Spencer M B et al 2018, Tanner J et al 2011).
Some studies state that the hair removal should be done dependent on the site of incision and the amount of hair present. The studies suggest that there is no need to remove minimal amounts of hair. Evidence from the Cochrane Systematic Review of preoperative hair removal showed no difference in numbers of SSIs among 625 patients who did, or did not, have hair removed (Tanner et al 2006). However, to note is that the sample size used in this study is very minimal hence the results cannot be fully reliable.
As such, currently, the best practice is that hair should only be removed if it gets in the way of the surgical procedure for example in neurosurgical procedures whereby one has to make incisions on the head and the presence of hair will pose a hindrance. National Institute for Health and Care Excellence (NICE) that perioperative hair removal should not be performed unless the hair at or around the incision site will interfere with the surgical procedure (NICE 2008).
The methods of hair removal commonly used are razors, clippers and depilatory creams. Shaving with a razor is the oldest and perhaps the cheapest method which is why it is the most common method used in the UK (Tanner J et al 2008). Currently unlike in the past disposable razors are being used instead of using sterilised razors which were shared between patients. Depilatory creams are probably used least in hospitals. These creams contain chemicals which dissolve hair (Tanner J et al 2008).
According to studies, the hair removal should be done just shortly before the surgery begins. Timely removal decreases the chance of surgical site infection. Removing the hair the day before surgery may increase the risk of transferring infection from the skin to the inside organs (Al Maqbali M A H 2016).
References
Al Maqbali M A H (2016) Pre-operative hair removal journal of nursing and clinical practices (3)
Ban K A et al (2016) American college of surgeons and surgical infection society Surgical site infection guidelines 2016 update, I am coll surg 224(1):59-74,2016.
National Institute for Health and Care Excellence (NICE) (2008) Surgical site infections prevention and treatment – NICE clinical guideline 74 On-line. Last accessed 17-03-2019 https://www.nice.org.uk/guidance/CG74/chapter/1-Guidance#intraoperative-phase
Spencer M et al (2018) Perioperative hair removal: A review of best practice and a practice improvement opportunity Journal of peri operative practice 28(6)P 159-166 Online. Last accessed 28-05-2019
https://journals.sagepub.com/doi/full/10.1177/1750458918767592
Tanner J, Khan D (2008) Surgical Site Infection, preoperative body washing and hair removal journal of peri operative practitioners 18(06) P 232-243 online. Last accessed 28-05-2019 https://journals.sagepub.com/doi/pdf/10.1177/175045890801800602
Tanner J Norrie P Melen K (2011) Cochrane Database systemic reviews Peri operative hair removal to reduce surgical site infection Cochrane .org On-line. Last accessed 17-03-2019 https://www.cochrane.org/CD004122/WOUNDS_no-evidence-that-routine-preoperative-hair-removal-reduces-surgical-site-infection
