Abstract
Routine shaving of surgical site on preoperative patients is an issue that has raised heated debate over the past thirty or so years, and one that is yet to be resolved. Initially, it was thought and continues to be argued that shaving of surgical sites on preoperative patients reduces the risks of surgical site infection. This however has found different results with some in support of shaving while providing unquestionable evidence while others oppose and provide similar yet contradicting evidence on the utility of shaving on preoperative. However, despite this bewilderment, shaving continues to be a practice that is embedded and sort of engraved in the nursing practice, one that seems almost impossible to eliminate. In this research, the learner will take a look at routine shaving of the surgical site while providing increased safety in its application and education to the relevant stakeholders for success in its utility.
Introduction
Routine shaving of the surgical site is a practice that is here to stay. In this research, it is important to clarify the stance by which the research is written. In this research the learner argues that shaving is not as evil as depicted in some research works by some authors. The problem arises on the methods of application and the time that shaving occurs. In most cases, the most applied approach is one of using a razor blade to shave the surgical site. According to RSOP (2011) there are two main approaches that are used; either dry razor shaving that has higher possibilities of inflicting cuts as well as skin irritation, or use of wet razor shaving where water is applied to soften the skin and hair.
The procedure that is used ordinarily includes requesting the patient to have a bath on the eve of the surgery using antiseptic agents like chlorhexidine or povidone-iodine (RSOP, 2011). However, according to Çelik and Kara (2007) the uses of such “strong antiseptics” have adverse effects on the patients since they tend to “alter the skin flora” and thus increase the likelihood of surgical site infections (p. 1575). Secondly, there is consideration of the patient’s history on allergic reactions like latex and a decision is made on which shaving tools to use and which to avoid. Thirdly, the patient is then shaved as s/he waits for the surgery on the holding area (RSOP, 2011). Hair disposal is later conducted after shaving is done.
However, this approach has some flaws that need to be corrected. To start with, the surgeon determines on whether there is need to have shaving of the surgical site. This is made in consultation with the patient. However, in practice, the patient is mostly notified that they need to be shaved and thus offered relatively limited choice on whether they should actually undergo the procedure or not. In as much as the patient accepts this to be done, the approach cannot be termed as an informed decision procedure since the patient is not quite granted other alternatives and the pros and cons of either of the approaches – an aspect that needs change.
It is thought that by shaving the surgical site, there will be elimination of debris, dried and dead skin, elimination of some bacteria and aiding in ease of surgery since the hair does not hinder incision (Tanner, Norrie & Melen, 2011), (Heaton, 2007), (RSOP, 2011) and (Kneedler, 2011). Unlike other practices, using a razor is more rampant an approach due to the fact that it is perceived to chop the skin at the right point and clears the surface (Çelik & Kara, 2007).
Literature Review Synthesis
It is noted that there are contradictory results that emanate from different researchers. Take for example, in the works of Tanner, Norrie and Melen (2011), there is a clear stance that traditional notion that some preoperative hair removal can at times be harmful is supported. However, through an analysis of research on Cochrane, Ovid MEDLINE, Ovid EMBASE and EBSCO CINAHL, the researchers note that hair removal is a practice that ought to be abolished since there is no statistical evidence that indicate that hair removal diminishes the likelihood of surgical site infection (Tanner, Norrie & Melen, 2011) and (Tanner, Woodings & Moncaster, 2006). In terms of clinical implication, this research points to the fact that there is no need to continue practicing shaving on surgical sites. However, this notion is opposed by the works of Çelik and Kara (2007), RSOP (2011) and Kneedler (2011) who note that shaving surgical site reduces the likelihood of infection, just that the approaches are what needs to be changed.
The procedure can be done with much ease if application of electric shaving machines is done and sterilization of the shaving blades done aptly. Shaving through clipping and using electric shaving machines makes work both easier and efficient at the same time. The challenge that these approaches have is in the bureaucratic procedures that are put in place before application of new technologies and procedures are put in place. In as much as having committee that look into ways and means of application of new technologies and changes in the medical field is apposite, it should be noted that the time it takes to have these changes implemented is equally important.
As noted earlier, the current trend of decision making on shaving on surgical sites is, to a great extent the work of the surgeon. However, it is important to note and honor that the patient possesses the right to information. Hiding vital information from the patient can have detrimental effects especially in the event that the patient develops postoperative infection on surgical site that can be attributed to shaving. This would have legal repercussion on both the health facility and the administering personnel. To avert this, the patient should be duly informed on the available options, the pros and cons and the reason that the surgeon finds it necessary to have hair clipped from the surgical site (Kneedler, 2011).
Additionally, it is important for the surgeon to be present during this crucial decision-making process in addition to the informing and conducting nurses so as to know what steps to take from the decision made by the patient and the doctor. It is also possible to have simplified booklets that detail these steps which potential patients that might undergo through this process are given in advance to peruse through such information. All hospital personnel, including doctors, nurses and other service providers need to be educated on the changes that are taking place in the hospital and banners and posters placed strategically such that they cannot be missed by appropriate personnel.
Implementation
In as much as an old adage claims that change is as good as a rest, it is equally important to note that there are people who vehemently detest change, even if moving from what another adage calls “from hell to heaven”. This means that challenges are likely to be faced. The first challenge is in formulation of unambiguous policies and guidelines on the procedures that are both easy to understand and easy to apply (Kneedler, 2011). Secondly, it is important to note that there is a hard piece of work that will involve explaining and convincing the nurses and other relevant professionals on the proposed changes since there is ample research that seems to support either of the sides of the coin.
Secondly, employing the services of professional policy makers would be prudent to avoid irrelevance, ambiguity and incoherence of the policies so made. This shall be done in conjunction with other nurses and doctors such that they also feel a part of the change process and thus make it easier to implement change in the facility.
Conclusion
In conclusion, it was thought and continues to be argued that shaving of surgical sites on preoperative patients reduces the risks of surgical site infection. Routine shaving of the surgical site is a practice that is here to stay. All that needs change is the approach used. Shaving through clipping and using electric shaving machines makes work both easier and efficient at the same time. As noted earlier, the current trend of decision making on shaving on surgical sites is, to a great extent the work of the surgeon. Hiding vital information from the patient can have detrimental effects especially in the event that the patient develops postoperative infection on surgical site that can be attributed to shaving. Involving all stakeholders in the change process helps them own the procedure as well as appreciate the change.
References
Çelik, S. E., & Kara, A. (2007). Does shaving incision site increase the infection rate after spinal surgery: Results. Medscape Today: Spine, 32(15), 1575-1577.
Kneedler, J. A., Pfister, J. I., Austin, P., & Moss, R. M. (2011). Preoperative hair removal: impact on surgical site infections – A nursing continuing education self-study activity. Pfiedler Enterprises, 1-32. Retrieved from http://www.pfiedler.com/1091/1091.pdf
Recommended standards of practice for skin prep of the surgical patient. (2011). Association of Surgical Technologists. 1-12. Retrieved from http://www.ast.org/pdf/Standards_of_Practice/RSOP_Skin_Prep.pdf
Tanner, J., Norrie, P., & Melen, K. (2011). Preoperative hair removal to reduce surgical site infection. Cochrane Wound Group. John Wiley & Sons, Ltd. Doi: 10.1002/14651858.CD004122.pub4
Tanner. J., Woodings, D., & Moncaster, K. (2006). Preoperative hair removal to reduce surgical site infection. (Heaton 2007 Eds.). Cochrane Database System Rev. 18(7), A20-A22.
