Pre-Operative Shaving of the Surgery Site
Changing the Practice Shaving the Surgery Site
A1. The preoperative process of shaving the surgery site is a common medical practice that is believed to be necessary to avoid the risk of the surgery incision area from being infected. When a patient is scheduled for a surgery, practitioners’ advice patients to shave the surgery site prior to the surgery procedure. For the longest time, the medical practice believes that the culprit to surgical site infection was due to the hair follicles being contaminated with bacteria. Surgical site infection was reported to be the third most occurring incident of nosocomial infection among patients (Reichman and Greenberg, 2009). Normally, a surgical incision should be made free from infection within 30 days of the surgery. These occurrences surgical site infection is among the largest contributor to a number of morbidity and mortality every year (Reichman and Greenberg, 2009). However, recent studies suggest that the preoperative procedure of shaving the surgery site also causes infection. Having to mention the possibilities of SSI from shaving the surgery site, it is apparent that the practice should be changed.
The practice should be changed for a number of reasons. For one, a new guidance was issues by the National Institute for Health and Care Excellence stipulating that the patient should not do shaving, but rather left to the doctors in order to ensure that the tools being used are sterilized (Collins, 2013). The advice was also given to introduce a new set of standard geared towards surgical site infection prevention (Collins, 2013). Another reason for changing the usual practice is that shaving the surgical area before operation increases the chance of the skin being damaged during the process, which may lead infection to occur prior to the scheduled surgery (Tanner, Norrie and Melen, 2011). In addition, there is no evidence suggesting that shaving prior to surgery can eliminate the chances of surgical incision. This is because the chance of post-operational infection to occur when shaving is the same with the use of clipping and depilatory cream (Tanner, Norrie and Melen, 2011). Having no evidence supporting the practice and the new standard proposed by the National Institute for Health and Care Excellence, it is apparent that preoperational shaving of the surgery area should be changed.
B2a. The current practice of shaving the surgical site prior to operation is indicated in the CDC (Center for Disease Control) guideline for prevention of surgical site infection released in 1999 (cdc.gov, 1999). According to the guidelines, preoperative hair removal must be done the night before the scheduled operation. This was because of the perceived high instances of high risk of SSI as compared leaving the hair on or using depilatory agents. The problem with the practice policy is that the basis of the recommendation is already outdated since the study pertaining to the SSI infection due to non-shaving was made back in 1980’s (cdc.gov, 1999). Other organization such as the Hospital Infection Control Practices Advisory Committee is also responsible in implementing such practice as indicated in the guideline they have published in the same year as CDC (The Hospital Infection Control Practices Advisory Committee, 1999).
B2b-c. The rationale for implementing the guideline was due to the perceived high instances of high risk of SSI as compared leaving the hair on or using depilatory agents. The problem with the practice policy is that the basis of the recommendation is already outdated since the study pertaining to the SSI infection due to non-shaving was made back in 1980’s (cdc.gov, 1999). Other organization such as the Hospital Infection Control Practices Advisory Committee is also responsible in implementing such practice as indicated in the guideline they have published in the same year as CDC (The Hospital Infection Control Practices Advisory Committee, 1999).
A4. According to evidence given by the sources listed in the above, the implications of shaving the surgery area prior to operation is the slight scraping of the skin, which exposes the damaged tissue into environmental elements and bacterial organisms (Pfiedler Enterprises, 2012; Tanner, Norrie and Melen, 2011). Bacteria are likely to enter the exposed tissues and infect it prior to surgery. As a result, infection may occur just before the incision was made and may further spread to exposed tissues as soon as the surgical incisions are made. Razors in particular may cause abrasions and small cuts on the skin leading to infection (Collins, 2013). Therefore, the clinical implications of the change in practice may result to patients being prevented from injuring themselves and avoid additional treatments caused b the infection.
A5. The clinical implications of the suggested change to practice setting is the significant improvements on postoperative procedures wherein the practitioners will not need to worry about the patients being treated for infection. In addition, the change will also lessen the possibilities of disputes from the patient regarding allegations of negligence on the part of the practitioner due to occurrence of infection.
A6. Involving the stakeholders such as the hospital administrators, policy makers, practitioners, care providers, health provider organizations, and patients to decide in changing the practice will take a tremendous effort. However, such change can be advocated by conducting evidence-based researches that will provide a stronger ground to the imposition of the proposed changed. Showing evidence in research to justify the advocacy for change is a powerful tool in influencing change of the practice that when implemented will have significant impact on all stakeholders particularly the patients that are burdened with higher treatment cost due to infection treatment.
Changing a long-standing paradigm in medical practice is a monumental task that will require cooperation of both the medical community and policy makers. Preoperative shaving of the surgery site is attributed to the prevention of infection of the surgical incision. On the other hand, there was no apparent study supporting the claim that it can in fact prevent SSI. Clipping and or application of depilatory agents are safer to than shaving. This is because shaving may lead to damaging the sin tissue resulting to abrasion and tiny cuts that is prone to infection.
Changing the practice is not a walk-in-the-park type of change that may happen in immediately. Difficulties that are likely to be encountered in the process include opposition from practitioners that still believes in the conventional practice. If shaving is inevitable, it is recommended that the doctor should be the one to perform the shaving instead of the patient. However, not all doctors would be kind enough to perform the task or the other care professionals for the matter. On the other hand, attempting to institute the proposed practice may encounter barriers such as legislative and organizational policies since government agencies are also involved in practice recommendations. Overcoming such barrier should employ an open dialogue between the policy makers and other practitioners. In addition, an evidence-based study of the proposed changed should also be performed to frame the concept of the practice and establish the factual basis of the proposal. In cases where the proposed change gets the implementation approval, the strategies involved in the process is information dissemination and training (Pfiedler Enterprises, 2012).
Changing the conventions of care practices is a monumental task that needs coordination with the stakeholders. However, the necessity of the proposed change justifies its need for implementation. The patient cannot always be expected to know nor blamed for the consequences of their actions. As care professionals, the responsibility to educate and save the people from health risks is the first priority. If new practices are the key to improving the quality of care, then there is no reason not to consider them.
American College of Surgeons (2009). Surgical removal of the gallbladder. Cholecystectomy. Retrieved from http://www.facs.org/public_info/operation/cholesys.pdf
Association of Surgical Technologies (2009). Recommended standards of practice for skin prep of the surgical patient. Standards of Practice. Retrieved from https://www.ast.org/pdf/Standards_of_Practice/RSOP_Skin_Prep.pdf
Cdc.gov (1999). Guidline for prevention of surgical site infection. Infection Control and Hospital Epidemiology, 20(4), 247-277. Retrieved from http://www.cdc.gov/hicpac/pdf/SSIguidelines.pdf
Collins, N. (2013, October 31). Wash but don't shave before surgery, patients told - Telegraph. Retrieved February 14, 2014, from http://www.telegraph.co.uk/health/10415993/Wash-but-dont-shave-before-surgery-patients-told.html
The Hospital Infection Control Practices Advisory Committee (1999). Guideline for Prevention of Surgical Site Infection, 1999. Infection Control and Hospital Epidemiology, 20, 247-278.
Pfiedler Enterprises (2012). Preoperative hair removal: Impact on surgical site infection. Online continuing education activity. Retrieved from http://www.pfiedler.com/1091/1091.pdf
Reichman, D. E., & Greenberg, J. A. (2009). Reducing surgical site infections: A review. Rev Obstet Gynecol, 2(4), 212-221. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2812878/
Tanner, J., Norrie, P., & Melen, K. (2011). Preoperative hair removal to reduce surgical site infection. Cochrane Database of Systematic Reviews, Art. No.: CD004122, 11. doi:10.1002/14651858.CD004122.pub4