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Advanced Levels of Clinical Inquiry and Systematic Reviews Impact of hair removal on surgical site infections

Walden University

NURS 6052

Ingrid Gamboa

Impact of hair removal on surgical site infections

Surgical site infection is a complication that no patient expects to develop. Surgical site infection is an infection that develops after a surgical procedure has been performed. Professional organizations continue to develop and work on evidence-based guidelines to implement them into the surgical practice. Preoperatively hair removal is commonly performed in the operating room every day. Preoperative hair removal is done to facilitate access to the surgical site, and to facilitate the closure of the wound; it is mistakenly known that it also decreases the risk of surgical site infection. This paper will review research literature that reflects that there is no specific evidence that demonstrates that hair removal reduces the risk of surgical site infection, on the other hand, it demonstrates that it can potentially increase the risk of, and it is no longer recommended even though it is continuously performed.

Picot question

When searching for the best evidence-based information, a search should begin with the elements of the PICOT question: P=patient or population, I=intervention or issue, C=comparison intervention, O=outcome, T=time frame (Mazurek Melnyk & Fineout-Overholt, 2019, p.18).

My PICOT question is: Does removing hair from the surgical site before surgical procedure reduces the risk for infection?

P= Patients having a surgical procedure.

I= Preoperative hair removal.

C=Hair removal and method of hair removal.

O=Surgical site infection.

T= Postoperative.

Comparison of preoperative hair removal methods for the reduction of surgical site infection: meta-analysis.

Database: CINAHL

Shi, D., Yao, Y., & Yu, W. (2016, November 22). Comparison of preoperative hair removal methods for the reduction of surgical site infections: a meta analysis. , 26. Retrieved from doi- org.ezp.waldenulibrary.org/10.1111/jocn.13661

Systematic Review. Level I

High level of evidence provided; numerous studies identified. Quantitative statistical research combined. This meta-analysis included 7278 patients in 10 different countries. A large number of studies was analyzed. This systematic literature review searched twelve databased to retrieved all possible information. The studies compared shaving vs. no hair removal, shaving vs. clipping, shaving vs. depilatory cream. No significant difference between any of the different methods was observed about the development of surgical site infection. Two readers analyzed the articles independently to avoid discordance.

Surgical site infection 2.5% shaved with manual razor, 1.4% with an electric razor, 0.9% no hair removal preoperative. (Shi, Yao, & Yu, 2016)

Impact of hair removal on surgical site infection rates: a prospective randomized noninferiority trial

Database: Medline

Kowalski, T. J., Kothari, S. N., Mathiason, M. A., & Borgert, A. J. (2016, November 5). Impact of hair removal on surgical site infection rates: a prospective randomized noninferiority trial. , 223, 704-711. Retrieved from doi.org/10.101/j.jamcollsurg.2016.03.032

Randomized Controlled trial. Level I

One thousand five hundred forty-three patients were included in this randomized clinical trial,768 patients were clipped before surgical procedure, and 775 not clipped. Patients with similar characteristics were selected for both groups. The strengths of this clinical trial are that patients were selected with same features such as the demographic, clinical, and surgical history for each group and that the trial included a large number of patients to analyze. No significant difference was noted on the results of the study, between clipped and not clipped patients. The incidence of surgical site infections was 6.12% on clipped patients and 6.32% on not clipped patients.

Clinical Research - Clinical Trials and Studies; Reports Outline Clinical Trials and Studies Study Results from Department of Nursing (Comparison of preoperative hair removal methods for the reduction of surgical site infections: a meta-analysis)

Database: Nursing & Allied Health Database

Medical Devices & Surgical Technology Week. (2017, April 09). Clinical Research - Clinical Trials and Studies; Reports Outline Clinical Trials and Studies Study Results from Department of Nursing (Comparison of preoperative hair removal methods for the reduction of surgical site infections: a meta-analysis). . Retrieved from https://search-proquest- com.ezp.waldenulibrary.org/nahs/docview/1882251688/fulltext/3F7C98 84BA67439BPQ/5?accountid=14872

Randomized controlled trials and controlled clinical trials. Level II

This Meta-analysis review of randomized controlled and clinical controlled trials analyzed a large number of databases to assess the impact of hair removal and its methods regarding the incidence of surgical site infections. This study carefully summarized the interventions of hair removal preoperatively and the effect that this has on the impact of surgical site infections. This trial contains current data. This research included fourteen trials. Seven thousand two hundred seventy-eight patients were studied in ten different countries. No difference demonstrated that hair removal reduces the risk of surgical site infection, the only conclusive result showed that when it is necessary to perform hair removal, clipping is the better choice. A large amount of data analyzed gives strength to this study.

Preoperative Hair removal a systematic literature review

Database: National Institute for Health Research.

Systematic Review Level I

Kjonniksen, I., Anderson, B. M., Sondenaa, V. G., & Segadal, L. (2002). Preoperative hair removal a systematic literature review. association of perioperative registered nurses, 75, 928-940. Retrieved from https://aornjournal.onlinelibrary.wiley.com/doi/epdf/10.1016/S0001- 2092(06)61457-9?r3_referer=wol

One hundred and twenty articles involved hair removal and surgical site infection, obtained from seven different databased were studied. This systematic studied provides strong information guidelines from expert organizations such as the association of perioperative nurses and the centers for disease and prevention. 17 out of 137 shaved patients compared to 11 out of 141, not shaved patients developed a surgical site infection. Observational research showed that 4.6 % of shaved patients compared to 1.5% of unshaved patients developed surgical site infection. (Kjonniksen, Anderson, Sondenaa, & Segadal, 2002).This study showed a significant correlation between shaving and surgical site infection development.

Conclusion

Surgical site infections are a significant complication. The conclusion for this systematic literature research demonstrates that there is no factual evidence that demonstrates that hair removal could reduce the risk of surgical site infection even though preoperatively hair removal it is continuously performed in the operating room. This research demonstrates that some of the clinical practice that is still being performed are not beneficial for patients not can even place them at risk for a complication such as a surgical site infection.

Reference

Library of Congress. (n.d). Search/browse help-Boolean operators and nesting. Retrieved September 27, 2019, from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html

Mazurek Melnyk, B., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare (4 ed.). : Wolters Kluwer.

Medical Devices & Surgical Technology Week. (2017, April 09). Clinical Research - Clinical Trials and Studies; Reports Outline Clinical Trials and Studies Study Results from Department of Nursing (Comparison of preoperative hair removal methods for the reduction of surgical site infections: a meta-analysis). . Retrieved from https://search- proquest-com.ezp.waldenulibrary.org/nahs/docview/1882251688/fulltext/3F7C9884BA67439BPQ/5?accountid=14872

Walden University Library. (n.d.-b). Databases A-Z: Nursing. Retrieved September 27, 2019, From https://academicguides.waldenu.edu/az.php?s=19981