Surgical Site Infection

It has come to the attention at the Surgical Site Infection committee for General Surgery, that many patients are showing up for surgery and they have shaved the area where they think they are going to be operated on, at home.
The CDC Guidlelines recommends that patients are clipped (not shaved) just prior to going into the OR. This helps to prevent Surgical Site Infections (SSI’s).
The following guidelines were found in this article: http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/SSI.pdf


2. Operative Characteristics: Preoperative Issues
a. Preoperative antiseptic showering
A preoperative antiseptic shower or bath decreases
skin microbial colony counts. In a study of >700 patients
who received two preoperative antiseptic showers,
chlorhexidine reduced bacterial colony counts ninefold
(2.83102 to 0.3), while povidone-iodine or triclocarbanmedicated
soap reduced colony counts by 1.3- and 1.9-fold,
respectively.155 Other studies corroborate these findings.
156,157 Chlorhexidine gluconate-containing products
require several applications to attain maximum antimicrobial
benefit, so repeated antiseptic showers are usually indicated.
158 Even though preoperative showers reduce the
skin’s microbial colony counts, they have not definitively
been shown to reduce SSI rates.159-165
b. Preoperative hair removal
Preoperative shaving of the surgical site the night
before an operation is associated with a significantly higher
SSI risk than either the use of depilatory agents or no
hair removal.16,100,166-169 In one study, SSI rates were 5.6% in
patients who had hair removed by razor shave compared to
a 0.6% rate among those who had hair removed by depilatory
or who had no hair removed.166 The increased SSI risk
associated with shaving has been attributed to microscopic
cuts in the skin that later serve as foci for bacterial multiplication.
Shaving immediately before the operation compared
to shaving within 24 hours preoperatively was associated
with decreased SSI rates (3.1% vs 7.1%); if shaving
was performed >24 hours prior to operation, the SSI rate
exceeded 20%.166 Clipping hair immediately before an operation
also has been associated with a lower risk of SSI than
shaving or clipping the night before an operation (SSI rates
immediately before = 1.8% vs night before = 4.0%).170-173
Although the use of depilatories has been associated with a
lower SSI risk than shaving or clipping,166,167 depilatories
sometimes produce hypersensitivity reactions.166 Other
studies showed that preoperative hair removal by any
means was associated with increased SSI rates and suggested
that no hair be removed.100,174,175

I know that you are not encouraging patients to shave pre-op, but perhaps some patients think that they are ‘helping’ or perhaps they are modest and think that they can avoid having the doctor shave them in sensitive areas. At any rate, I will add a statement in out new PAC Booklet to emphasize that patients are NOT to shave themselves at their surgical site. Please emphasize this to the patients when you are doing your teaching.