Victor A. Moore
Western Governors University
Prepping a patient for a surgical procedure usually involves removing the Hair at the incision site. The surgical care improvement project commonly known as SCIP is a national partnership of organizations focused on improving surgical care by significantly reducing surgical complications. One complication is surgical site infections SCIP has developed recommendations for hair removal. There are several SCIP measures, antibiotic within one hour before incision, received prophylactic antibiotic consistent recommendations, prophylactic antibiotic discontinued within 24 hours, control of postoperative serum glucose ...view middle of the document...
The Person who determined that this practice of shaving all patients is the Chief Nursing officer Debbie Hankins . The Chief Nursing Officer of Adventist Health is responsible for the implementation of all procedures used In the Nursing Department and the Operating Room specifically. The rational for this decision to shave all patients in this manner is the reduction of surgical site infections. The increased prevalence of surgical site infections were determined to be reduced by shaving patients with clippers. How ever the fact that this reduced surgical site infections does not mean that it is appropriate in every surgical situation .At Adventist Health the decision was made to shave all patients with clippers which was instituted in the normal preoperative routine according to the evidenced based research at the time. As stated before the basis for the practice is SCIP and the decision of Medicare to link payments with quality. A proposal for value-based purchasing from the Centers for Medicare and Medicaid services (CMS) has made this requirement and affects the financial stability of the hospital. (Patterson, p. 120) A review of whether or not shaving of all patients is appropriate. Surgical Quality Alliance states ”that there is very little data from well-designed, properly powered, carefully controlled studies that demonstrates that removing hair through shaving with razors decreases surgical site infections for neurosurgical procedures”. (Corrigan, p. 79) A study commissioned by the Agency for Healthcare Research and Quality ( AHRQ) performed through to Stanford UCSF Evidence-based practice Center observed” no conclusion can reach regarding the effectiveness of Q I strategies at promoting perioperative glucose control, perioperative normothermia, or decreasing operative shavings. We are able to determine any strategies effectively reducing rates of SS I. In the studies that did not have important mythological flaws surgical site infections were not consistently reduced even when process measurements were improved. (Corrigan, p. 79). At Adventist Health in Bakersfield California the policy for skin Preparation is explained in detail why the procedure is done this way proper preparation of skin for surgery renders it free as possible from microorganisms. The policy explains how to gather equipment and how implement the hair remove in 21 steps and special considerations about various ways to remove hair and where to store the hair. A visual picture is included in the policy to show Nurses what areas to shave such as when shaving patients from shoulder and upper arm, the elbows and arms and thighs and back. The reference used for this policy is the 2012 Lippincott Williams &Wilkins Textbook chapter Skin preparation, preoperative.
Tanner J, Moncaster K.,Woodings D., Perioperative Hair Removal: A systematic review: Journal Perioperative Practice.2007 March; 17(3):118-21
Nowinski G. , Don’t Shave unless you have to! American...