Hostname: page-component-848d4c4894-xm8r8 Total loading time: 0 Render date: 2024-06-26T19:35:21.210Z Has data issue: false hasContentIssue false
  • English
  • Français

Hair Removal Policies in Clean Surgery: Systematic Review of Randomized, Controlled Trials

Published online by Cambridge University Press:  21 June 2016

B. S. Niël-Weise ,
J. C. Wille  and
P. J. van den Broek
B. S. Niël-Weise*
Affiliation:
Dutch Working Party on Infection Prevention, Leiden, the Netherlands
J. C. Wille
Affiliation:
Dutch Institute for Healthcare Improvement, Utrecht, the Netherlands
P. J. van den Broek
Affiliation:
Department of Infectious Diseases, Leiden University Hospital, Leiden, the Netherlands
*
C9-43 P. 0. Box 9600, 2300 RC Leiden, the Netherlands, B.S.Niel-Weise@lumc.nl
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To determine whether certain hair removal policies are better than others to prevent surgical-site infections in patients undergoing clean surgery.

Methods:

Publications were retrieved by a systematic search of Medline, the Cochrane Library, and EMBASE up to February 2005. Additionally, the reference lists of all identified trials were examined. All randomized trials, quasi-randomized trials, and systematic reviews or meta-analyses of randomized or quasi-randomized trials comparing hair removal policies in clean surgery were selected. Trials involving patients undergoing cranial neurosurgery were excluded. Two reviewers independently assessed trial quality and extracted data. Disagreements were resolved by discussion with a third reviewer. Data from the original publications were used to calculate the relative risk or risk difference of surgical-site infection. Data for similar outcomes were combined in the analysis, where appropriate, with the use of a random effects model.

Results:

Four trials were included in the review. No eligible systematic review or meta-analysis of randomized or quasi-randomized trials was found. The quality of the trials and how they were reported were generally unsatisfactory. Evidence regarding whether preoperative hair removal has any effect was inconclusive. When hair removal was considered necessary, evidence about the best time for removal was inconclusive. There was some evidence that hair removal by clipper is superior to removal by razor.

Conclusions:

Because of insufficient evidence as a basis for recommendations, the practical consequences for ward management were essential when the Dutch Working Party on Infection Prevention formulated its recommendations for hair removal policies. Large randomized, controlled trials are needed to determine the optimal policy for preoperative hair removal.

Type
Orginal Article
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 12 , December 2005 , pp. 923 - 928
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection. Infect Control Hosp Epidemiol 1999;20:250–278.CrossRefGoogle ScholarPubMed
2.Alexander, JW, Fischer, JE, Boyajian, M, Palmquist, J, Morris, MJ. The influence of hair-removal methods on wound infections. Arch Surg 1983;118:347–352.CrossRefGoogle ScholarPubMed
3.Balthazar, ER, Colt, JD, Nichols, RL. Preoperative hair removal: a random prospective study of shaving versus clipping. South Med J 1982;75:799–801.CrossRefGoogle ScholarPubMed
4.Court-Brown, CM. Preoperative skin depilation and its effect on postoperative wound infections. Journal of the Royal Colleges of Surgeons of Edinburgh 1981;26:238–241.Google ScholarPubMed
5.Goeau-Brissonniere, O, Coignard, S. Preoperative skin preparation: a prospective study comparing a depilatory agent in shaving. Presse Med 1987;16:1517–1519.Google Scholar
6.Hoe, NY, Nambiar, R. Is preoperative shaving really necessary? Ann Acad Med Singapore 1985;14:700–704.Google Scholar
7.Ilankovan, V, Starr, DG. Preoperative shaving: patient and surgeon preferences and complications for the Gillies incision. Journal of the Royal Colleges of Surgeons of Edinburgh 1992;37:399–401.Google ScholarPubMed
8.Ko, W, Lazenby, WD, Zelano, JA, Isom, OW, Krieger, KH. Effects of shaving methods and intraoperative irrigation on suppurative mediastinitis after bypass operations. Ann Thorac Surg 1992;53:301–305.CrossRefGoogle ScholarPubMed
9.Lui, PS, Ching, KC, Salmon, YM, Choo, HT, Yeo, GC, Sng, EH. Post-operative wound infection following gynaecological operations. Singapore Med J 1984;25:46–47.Google ScholarPubMed
10.Meiland, HT, Feder, E, Roseno, H. Episiotomy infections after shaving or cutting. Ugeskr Laeger 1986;148:2481–2482.Google Scholar
11.Powis, SJ, Waterworth, TA, Arkell, DG. Preoperative skin preparation: clinical evaluation of depilatory cream. Br Med J 1976;2:1166–1168.Google Scholar
12.Rojanapirom, S, Danchaivijtr, S. Pre-operative shaving and wound infection in appendectomy. J Med Assoc Thai 1992;75(suppl 2):20–23.Google Scholar
13.Seropian, R, Reynolds, BM. Wound infections after preoperative depilatory versus razor preparation. Am J Surg 1971;121:251–254.Google Scholar
14.Thur de Koos, P, McComas, B. Shaving versus skin depilatory cream for preoperative skin preparation: a prospective study of wound infection rates. Am J Surg 1983;143:377–378.Google Scholar
15.Mishriki, SF, Law, DJW, Jeffery, PJ. Factors affecting the incidence of postoperative wound infection. J Hosp Infect 1990;16:223–230.CrossRefGoogle ScholarPubMed
16.Moro, ML, Carrieri, MP, Tozzi, AE, Lana, S, Greco, D. Risk factors for surgical wound infections in clean surgery: a multicenter study. Ann Ital Ckir 1996;67:13–19.Google ScholarPubMed
17.Cruse, PJE, Foord, R. The epidemiology of wound infection: a 10-year prospective study of 62,939 wounds. Surg Clin North Am 1980;60:27–40.Google Scholar
18.Bird, BJ, On, RG. Extensive pre-operative shaving: a costly exercise. JV Z Med J 1984;97:727–729.Google Scholar
19.Vandenbroucke, JP. When are observational studies as credible as randomised triais? Lancet 2004;22:1728–1731.CrossRefGoogle Scholar
20.Mehta, G, Prakash, B, Karmoker, S. Computer assisted analysis of wound infection in neurosurgery. J Hosp Infect 1988;11:244–252.Google Scholar
21.Sellick, JA, Stelmach, M, Mylotte, JM. Surveillance of surgical wound infections following open heart surgery. Infect Control Hosp Epidemiol 1991;12:591–596.Google Scholar
22.Kjonniksen, I, Andersen, BM, Sondenaa, VG, Segadal, L. Preoperative hair removal: a systematic literature review. AORN J 2002;75:928–940.Google Scholar