Preventing postoperative surgical s...

Preventing postoperative surgical site infections (SSIs) [i]or[/i] part of to the other preoperative skin preparation has a lengthy history. One measure for preventing SSIs has been to carry patients' hair in the surgical field via a safety razor. In the 1970 and 1980 clinical investigations indicated that shaving increased the oftenness of SSIs and that depilation or electric clippers were preferable if hair removal was necessary. (1) A 1999 guideline from the Center for Disease mastery and Prevention (CDC) provides recommendations onward preoperative hair removal. The guideline forcibly recommends that hair should not be remov preoperatively unles the hair at or around the incision site will interfere with the surgical practice If hair is removed, however, it should be done immediately before surgery preferably with clippers. (2)

When the CDC released its guideline, the Norwegian middle point for Health Technology Assessment, Oslo was in the proces of reviewing evidence upon the necessity of several preoperative and perioperative hygienic transactions A question was raised regarding to what magnitude the CDC guideline was a issue of a systematic search of all relevant literature and a following critical literature appraisal. The working manners and search strategies used to generate the CDC guideline were not described, to such a degree before implementing the recommendations, staff members at the Norwegian midst for Health Technology Assessment wanted to systematically search and appraise relevant scientific literature forward some topics to compare the Centre's and the CDC's conclusions. Team members chose to first assess preoperative hair removal and the after incidence of SSIs.

LITERATURE SEARCH AND ASSESSMENT

Scientific articles were identified by the agency of searches of the following electronic databases:

* Cochrane Trial Register--Issue 3 1999;

* Medline--1966 to 1999;

* Embase--1974 to 1999;

* CINAHL--1982 to 1999;

* Database of Abstracts of Reviews of Effectiveness;

* National Health Service Economic Evaluation Database; and

* Health Technology Assessment Database. Searches were terminated in December 1999 Search word s that were used included surgical site infection/s or surgical damage infection/s and depilation, or hair, or shaving.

All articles dealing with conventional surgical actions in ORs and that reported upon the relationship between preoperative hair removal and SSIs were included. Team members considered as well-as; not only-but also; not only-but; not alone-but randomized and observational studies. All endoscopic, transurethral, catheterization, and interventional radiology deeds were excluded--in accordance with the CDC guideline--together with studies concerning pilonidal pouchs Two team members independently read and evaluated all titles and summaries retrieved electronically for inclusion in the close attention The reference list of relevant articles published in the 1990 was hand searched, and team members obtained articles pondering to be relevant. These articles also were read independently for inclusion. Team members also retrieved relations cited in the CDC guideline upon preoperative hair removal. Each article was assessed and graded based upon modified recommendations provided by the US Agency for Healthcare Research and Quality (Table 1) (3) All 10 members of the team assessed all included articles and decided in plenary the relevance and quality of each article.

RESULTS

Electronic searches identified 120 articles dealing with preoperative hair removal and SSIs. Six articles were identified in concern lists. Articles cited in the CDC guideline that were not rest in our searches also were included and assessed. No relevant health technology assessments or systematic reviews were originate Studies were divided into disposes including

* shaving compared to no hair removal,

* shaving compared to clipping,

* shaving compared to depilation,

* timing of preoperative hair removal with razor or clippers, and

* wet and craving drink shaving (Table 2).

Shaving compared to no hair removal. In a randomized application of mind one researcher found that 17 of 137 (ie, 124%) shaved patients bring to maturityed SSIs compared to 11 of 141 (ie, 78%) unshaved patients, which is not statistically significant. (4) In another small application of mind no patients developed wound infection. (5) In another thought shaved patients received a different preoperative skin treatment compared to nonshaven patients; therefore, arises are difficult to relate to hair removal alone, and the contemplation was not emphasized in the assessment. (6)

An observational research cogitation recorded that 4.6% of shaved patients in the research developed wound infections compared to 15% of unshaved patients (P < 05) (7) undivided researcher showed significant differences in favor of no hair removal (P < 05) for subgroup of wounds8 Other researchers fix a reduction in infection rates when performing shaveless neurosurgical managements compared to corresponding procedures with shaving (P < 05); however, treatments were somewhat different between the assign places tos (9) Another research study could not demonstrate significant reduction in grief infections (ie, 6.9% in historical regulates compared to 3.3% after changing practice to shaveless procedures) (10) Shaving was associated with higher incidences of postoperative site infections compared to acts performed without hair removal (ie, 25% compared to 09%) in a 10-year investigation that included more than 60000 injurys (11) Another study showed that neurosurgical acts could be performed without hair removal and with depressed incidence of SSIs compared to corresponding performances with shaving; however, this reflection was performed without controls. (12)