Minimizing Hair Dispersal: Is This an Opportunity for Improvement in HAI Prevention?

Perioperative hair removal: A review of best practice and a practice improvement opportunity

“…Despite the recommendation to leave surgical site hair in place whenever possible, perioperative hair removal is still a relatively common practice, particularly for orthopedic, cardiovascular, OB/GYN, abdominal and neurosurgical procedures (Xi & Pearson 2015). This is often a practitioner-specific practice, rooted in how a surgeon was trained.…”

“…As a result, United States and international guidelines overwhelmingly recommend the use of clippers over razors when perioperative hair removal is necessary (NICE 2008, AHRQ 2009, TJC 2013, Anderson et al 2014, AORN 2014). A recent survey of 250 AORN members indicates that these recommendations are being followed as 98% of respondents indicated that they were clipping rather than shaving patients (Xi & Pearson 2015). An analysis of perioperative skin removal methods by NICE actually concluded that, despite the fact that razors are often a less costly option for hair removal, when all costs including those for treating surgical wound infections were factored into the analysis, clipping with electric clippers was both more effective and less costly (NICE 2008).…”

“…This could also be viewed as a more efficient practice, as the lengthy clean-up process can occupy valuable OR time. Nonetheless, surveys and observational data have indicated that the majority of clipping is still occurring inside the OR (Xi & Pearson 2015). In the above-mentioned survey of 250 perioperative nurses from different facilities, 60% of respondents reported clipping inside the OR, citing a number of reasons for the practice: surgeon preference, patient privacy, reduced potential for delays, emergency situations, and preference for clipping while the patient is under anesthesia (Xi & Pearson 2015).…”

“…If removed in the area, hair can settle on linens, wheels and the floor and may inadvertently be transported into the OR. In the survey of AORN members, respondents reported ranking complete removal of hair clippings as important as controlling OR traffic in terms of reducing surgical wound infection risk in their personal perception (Xi & Pearson 2015). Table 2 shows respondents’ reported clean-up methods.…”

“…Evidence pointing to the impact that method, timing, and physical location of hair removal have on infection rates has led to new recommendations from professional organizations such as the Centers for Disease Control and Prevention (CDC) and the Association of periOperative Registered Nurses (AORN) as well as accrediting bodies such as The Joint Commission (TJC) and Centers for Medicaid and Medicare Services (CMS). While all of these groups have concluded that hair at the surgical site should be left in place whenever possible, the practice of hair removal continues to be undertaken in many procedures, and not always in accordance with guideline recommendations (Xi & Pearson 2015).…”