Evaluation of Preoperative Hair Removal and its Relationship with Postoperative Wound Infection at a Tertiary Health Facility in North-eastern Nigeria
AbstractBACKGROUND: The general surgery unit of Federal Teaching Hospital Gombe performs several surgeries via the hair bearing areas. A pilot study by the unit on the incidence of SSI for all clean surgeries showed an alarming forty- six percent. (38) The reported infection rate for such infection is <2% by CDC standard. This study was done to probe the role of preoperative hair removal in such high infection rate. OBJECTIVES: the study aimed to determine the relative postoperative wound infection rates of Razor blade shaving and cream depilation. It also assessed the adequacy of hair removal by both methods and the type of skin injuries or reactions that follow each method METHODS: a prospective, cross-sectional, double-blinded study was done between July 1st to December 31st 2016 on 98 patients that met the inclusion criteria and randomized by balloting. BIC shaving stick produced by BIC SOCIETE, FRANCE and VEETO CREAM(thioglycollate) produced by RECKIT BENCKISER, were used for preoperative hair removal. Adequacy of hair removal, post shaving skin injuries and reactions were assessed preoperatively by research assistants. Post-operative wounds were graded using the Southampton wound scoring system for SSI. Data obtained was analyzed with SPSS software version 20.0 and statistical relationships were assessed using Chi-square. RESULTS: a total of 98 patients were recruited for the study. 53(54.1%) were males and 45(45.9%) were females. The mean age was 45.99(+ 12.522) with a range of 16-76 years. Majority (88.8%) had open repair of abdominal wall hernia, followed by Scalp lipoma (6.1%), groin lipoma (3.1%) scalp osteoma and superficial Parotidectomy (1%) each. 57(58.2%) had razor blade shaving and 41(41.8%) had cream depilation. 91(92.9%) had adequate hair removal considering both methods. Depilatory cream use is however, more effective, with (97.6%) adequacy. Razor blade shaving recorded (89.5%) adequacy. Out of the patients, only 4(4.1%) had skin injuries and all are in the razor blade group. Depilatory cream use caused more skin reactions (7.3%) compared to razor blade use (1.8%). 6(6.1%) of all the patients developed SSI and 5(83.3%) (x2 1.6662) are in the razor blade group. Majority of the postoperative wounds (83.3%) are Southampton class A &B. 16.7% is class C CONCLUSION: preoperative hair removal using razor blade or cream depilation is associated with postoperative wound infection (6.1%). Razor blade shaving is how ever more prone to postoperative wound infection, although, the difference in the infection rate is not statistically significant (p-value 0.197). Preoperative cream depilation is more efficient and safer. LIMITATIONS: The sample size is rather small, as only patients presenting at the general surgery unit were recruited. This limited the scope of subjects that were assessed, as other units in the surgery department also operate in hair bearing areas. Multiple nurses were involved in the razor blade shaving and cream application, inter-personal differences in technique may affect the outcome in terms of skin injury. Subjective method of direct visual assessment of skin injury was resulting in missing non obvious skin injuries. The use of electron viewing microscope would have improved the discovery of such injuries.
A.P. Wilson, G. C. and . R. C. B., "Surgical wound infection as a performance indicator: agreement of common definitions of wound infection in 4773 patients’," BMJ, pp. 329-7468, 2004.
J. Tanner, W. D. and M. K. , "Preoperative hair removal to reduce surgical site infection," Cochrane Database System Review , vol. XI, no. 004122 , 2006.
O. Adewale, . O. A. O. and . A. O. L, "Evaluation of two methods of preoperative hair removal and their relationship to surgical site infection," J Infect Dev Ctries , vol. V, no. 10, pp. 717-722 , 2011.
W. A. J, F. E. J., B. M. and P. J., "The influence of hair removal methods on wound infections," Arch Surg, vol. IXVI, pp. 347-352, 1983.
R. H, B. R. A and M. W. A.J, "Surgical skin and soft tissue infections, current opinion on Infectious Diseases," vol. VI, pp. 683-690 , 1993.
E. S.E.E, A. A. A.J and I. U, "Surgical wound infection rate in Calabar University Teaching Hospital," West Afr J Med , vol. V, pp. 61-68 , 1986.
W. H. R, C. D.H, W. Morgan and W. J.W, "‘Identifying patients at high risk of surgical wound infection: a simple multivariate index of patient susceptibility and wound contamination," AM J Epidemiol , vol. 121, no. 2, pp. 206-215 , 1985.
B. J, "Clinical issues: surgical site infection study," AORN J , vol. V, pp. 99-104 , 2004.
B. F and G. J, "Post-operative wound infections: the influence of ultraviolet light irradiation of the operating room and various other factors," Ann Surg, 1964.
C. H. T, A. M and D. M.A, "CDC/NHSN Surveillance definition of health care associated infection and criteria for specific types of infections in the acute care setting," AM J Infect Control, vol. IIIVI, pp. 309-332, 2008.
K. I, A. B.M, S. V.C and S. L., "Preoperative hair removal;a systematic review of literature," AORN Journal, vol. VIIV, no. 5, p. 928, 2003.
N. I. f. H. a. C. Excellence, "Prevention and treatment of surgical site infection," in NICE Clinical Guidelines 74, Abuja, 2008.
S. R and R. B.M, "Wound infections after preoperative depilatory cream versus razor preparatio," AM J Surg , vol. 121, pp. 115-154 , 1971.
J. A.K, J. I.P and P. A, " Online continuing education activity," 10 october 2012. [Online]. Available: www. Pfedlerenterprises.com . [Accessed 20 febraury 2019].
O. D. C, "AORN Recommended practices for preoperative patient skin antisepsis: per-operative standards and recommended practices," AORN, inc, pp. 537-555 , 2008.
E. E. C, R. S. G and G. M.P, "Bacterial adherence to surgical suturescan anti-bacterial coated sutures reduce the risk of microbial contamination?," J Amer Col Surg, vol. 203, no. 4, pp. 481-489 , 2006.
P. W. A, T. T, S. M.F and G. R.N, "A scoring method (ASEPSIS) for postoperative wound infections for use in clinical trials of antibiotic prophylaxis," LANCET , vol. I, no. 8476, pp. 311-3 , 1986.
O. A. M, "Sample size," in Research methodology with statistics for Health and Social Sciences, ILORIN, Nathadex publishers, 2004, pp. 115-120.
B. S, Perioperative Nursing Data Set: The Perioperative nursing vocabulary, Denver: AORN, inc, 2002.
J. A. P. S, W. w. T.A and A. D.G, "Per-operative skin preparation: clinical evaluation of depilatory cream," BMJ, vol. II, pp. 1166-1168, 1976.
V. P. C, P. L and W. S, "Surgical wound infections’. Current treatment options in infectious disease," vol. II, pp. 147-153 , 2000.
E. D, "Orthop Nurs," vol. 28, no. 3, pp. 141-5, 2009.
Q. A. E, . B. E,A and d. R.-A. J,T, "Wounds and wound healing," in Principles and Practice of Surgery including Pathology in the Tropics, Accra, Ghana publishing corporation, 2009, pp. 63-68.
C. A, G. P, D. A and B. N, "Prophylaxis in clinical surgery," in Essential Surgical Practice, Massachusetts, Blackwell science limited, 2003, pp. 72-73.
E. P. D, . H. S,M, . B. D, W, J. R,M, . D. D,M, . B. K,M, G. B. G,A and . S. m. J,R, "Hospital collaborate to decrease surgical site infection," AM J Surg, vol. 190, no. 1, pp. 9-15 , 2005.
H. P, A. N and T. J, "Pre-operative hair removal to reduce surgical site infection," Joanna Briggs Institute Best Practice Technical Report, vol. II, no. 4, 2007.
K. J.A, P. J.I and M. R, "Preoperative Hair Removal: Impact on Surgical Site Infection," Pfielder Enterprises, Colorado, 2012.
"Changing Practice for Preoperative Hair removal’. Supplement to OR Manager," vol. 23, no. 3, 2007.
O. D. C, "Recommended practices for product selection in Perioperative practice setting," Perioperative Standards and Recommended Practices, pp. 521-524 , 2008.
M. B. C. C, "Preoperative skin depilation and its effect on postoperative wound infections," J Royal College of Surgeons of Edinburgh, vol. 26, pp. 238-41, 1981.
R. B. E, C. J.D and N. R, "Preoperative hair removal: a random prospective study of shaving versus clipping," Southern Medical Journal, vol. 75, pp. 799-801, 1982.
F. M. S, L. D. J and J. P.J, "Factors affecting the incidence of postoperative wound infection," J Hosp Infect, vol. XVI, pp. 223-230, 1990.
B. A, K. E, D. S, Y. S and B. K. Z, "The effect of hair on infection after cranial surgery," Acta Neuro (Wien), vol. 143, pp. 533-6, 2001.
K. T, B. V and R. P. H, "Neurosurgery without shaving: indications and results," Br J Neurosurg, vol. XIV, pp. 41-344, 2000.
E. C. S and K. A, "Does shaving the incision site increase the infection rate after spinal surgery," Spine, vol. 32, no. 15, pp. 1575-1577, 2007.
B. O. G, F. F and F. C, "Preoperative hair removal review," Ann Ig, vol. XVII, no. 5, pp. 401-12, 2005.
"Preoperative Hair Removal to Prevent Surgical Site infection," The Joanna Briggs Institute, vol. XI, no. 4, 2007.
A. A. A, "Incisional SSI following laparotomies in adult patients at FMC GOMBE," NPMCN, Gombe, 2014.
K. R. H. F. J. L. H W. Hamilton, "Pre-operative hair removal," Can J Surg, vol. 20, pp. 269-75, 1977.
T. D. M. F. J. E. C. E. D. Grober, "Preoperative hair removal on the male genitalia: clippers vs. razors," J Sex Med , vol. X, pp. 589-594, 2013.
Copyright (c) 2019 American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who submit papers with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
- By submitting the processing fee, it is understood that the author has agreed to our terms and conditions which may change from time to time without any notice.
- It should be clear for authors that the Editor In Chief is responsible for the final decision about the submitted papers; have the right to accept\reject any paper. The Editor In Chief will choose any option from the following to review the submitted papers:A. send the paper to two reviewers, if the results were negative by one reviewer and positive by the other one; then the editor may send the paper for third reviewer or he take immediately the final decision by accepting\rejecting the paper. The Editor In Chief will ask the selected reviewers to present the results within 7 working days, if they were unable to complete the review within the agreed period then the editor have the right to resend the papers for new reviewers using the same procedure. If the Editor In Chief was not able to find suitable reviewers for certain papers then he have the right to accept\reject the paper.B. sends the paper to a selected editorial board member(s). C. the Editor In Chief himself evaluates the paper.
- Author will take the responsibility what so ever if any copyright infringement or any other violation of any law is done by publishing the research work by the author
- Before publishing, author must check whether this journal is accepted by his employer, or any authority he intends to submit his research work. we will not be responsible in this matter.
- If at any time, due to any legal reason, if the journal stops accepting manuscripts or could not publish already accepted manuscripts, we will have the right to cancel all or any one of the manuscripts without any compensation or returning back any kind of processing cost.
- The cost covered in the publication fees is only for online publication of a single manuscript.