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

Abstract

The current practice of perioperative hair removal reflects research-driven changes designed to minimize the risk of surgical wound infection. An aspect of the practice which has received less scrutiny is the clean-up of the clipped hair. This process is critical. The loose fibers represent a potential infection risk because of the micro-organisms they can carry, but their clean-up can pose a logistical problem because of the time required to remove them. Research has demonstrated that the most commonly employed means of clean-up, the use of adhesive tape or sticky mitts, can be both ineffective and time-consuming in addition to posing an infection risk from cross-contamination. Recently published research evaluating surgical clippers fitted with a vacuum-assisted hair collection device highlights the potential for significant practice improvement in the perioperative hair removal clean-up process. These improvements include not only further mitigation of potential infection risk but also substantial OR time and cost savings.

Prevention and Control of Trichotomy Infection in the Elderly Surgical Patient: An Umbrella Review

“…The surgical site infection classification system according to the Centers for Diseases Control (CDC) that summarizes the following description: superficial incision, deep incision or organ/space incision, and states that the presence of infection should be identified using both the patient's clinic and laboratory findings and may include the presence of at least one of the following characteristics: pus, pain, edema or redness 13 . They also mention that infections of the surgical site affect a large percentage of patients, and can result in delayed wound healing and consecutively increased length of hospital stay, unnecessary pain and in extreme cases death as already mentioned by other authors 13 .…”

“…More recent studiesMore studies that are recent still innovate in the practice of the device used, "this innovation has demonstrated that the new technology will potentially transform this practice, reducing the time needed to cut and clean the hair and significantly reduce the microbial load associated with cut loose hair", with the use of the device with aspiration of hair to a reservoir 13 .…”

Prevention and Control of Trichotomy Infection in the Elderly Surgical Patient: An Umbrella Review

“…The surgical site infection classification system according to the Centers for Diseases Control (CDC) that summarizes the following description: superficial incision, deep incision or organ/space incision, and states that the presence of infection should be identified using both the patient's clinic and laboratory findings and may include the presence of at least one of the following characteristics: pus, pain, edema or redness 13 . They also mention that infections of the surgical site a ect a large percentage of patients, and can result in delayed wound healing and consecutively increased length of hospital stay, unnecessary pain and in extreme cases death as already mentioned by other authors 13 .…”

Infection prevention practices and the use of medical tapes

“…Using microbial cultures once per month, 506 cultures were obtained for 361 patients over one year. Several factors were significantly correlated with colonization, including the In vitro work using tape samples from patients Berkowitz et al, 1974 9 Marples et al, 1985 10 Keys et al, 1978 11 Aziz et al, 1984 12 Rammaert et al, 2012 13 Livesley and Richardson,1993 14 Bundy, 1989 15 Powell et al, 1987 16 CDC, 1978 17 Diaz et al, 1986 18 Love, 2013 19 Krug et al, 2016 20 Oldman, 1991 21 James et al, 2000 22 Gartemberg et al, 1978 23 Stiller et al, 1994 24 Krug et al, 2014 25 Lindberg et al, 2017 6 Redelmeier & Livesley, 1999 26 Arpin et al, 2002 27 Bauer and Densen, 1979 28 Hughes et al, 1995 29 Mantyh et al, 2017 30 Cady et al, 2011 31 Lipscombe and Juma, 2007 32 Everett et al, 1979 33 du Plessis et al, 1997 34 Spencer et al, 2018 35 Harris et al, 2012 36 Bottone et al, 1979 37 Dickinson et al, 1998 38 Hooker et al, 2020 7 Mead et al, 1979 39 Alsuwaida 2002 40 Dennis et al, 1980 42 Garg et al, 2009 43 Patterson et al, 1986 44 McClusky et al, 2015 41 Endoh et al, 2004 45 Christiaens et al, 2005 46 Lalayanni et al, 2012 47 Foster ...…”

“…Interestingly, a few articles described the use of tape to remove surgical site hair after clipping; one mentioned that several respondents reported noticing contamination of the tape roll used for hair removal. 30,35 This illustrates an example where tape is creatively used for a purpose other than for what it is intended and can once again become a vector for infection if it has time to collect environmental microorganisms prior to its use. Finally, a few articles were identified in which tape was used as a collection device to sample microorganisms from various environments suspected to be contaminated.…”