Surgical Best Practices for Infection Prevention

Tanner and Parkinson (2006) concluded that there is no direct evidence that additional glove protection worn by the surgical team reduces SSIs in patients; however, the addition of a second pair of surgical gloves significantly reduced perforations to innermost gloves, and perforation indicator systems result in significantly more innermost glove perforations being detected during surgery.

Clipping vs. Shaving

As we have seen, a practice that can have significant consequences for surgical patients is the removal of hair from the surgical site, with some clinicians disregarding best practice and clinging to preoperative shaving when recommended practices indicate that clipping is preferable because it can reduce the incidence of SSI. There is some clinical thought that any kind of pre-operative hair removal is deleterious to patients because this action – by depilatory cream, shaving or clipping — can cause SSIs.

Tanner, et al. (2006) attempted to determine if routine pre-operative hair removal resulted in fewer SSIs than not removing hair. They identified in the literature 11 RCTs comparing hair removal with no hair removal, different methods of hair removal, hair removal conducted at different times prior to surgery and hair removal carried out in different settings. Three trials involving 625 people compared hair removal using either depilatory cream or razors with no hair removal and found no statistically significant difference between the groups in terms of SSIs. No trials were identified which compared clipping with no hair removal. Three trials involving 3,193 people compared shaving with clipping and found that there were statistically significantly more SSIs when people were shaved rather than clipped. Seven trials involving 1,213 people compared shaving with removing hair using a depilatory cream and found that there were statistically significantly more SSIs when people were shaved than when a cream was used. No trials were found that compared clipping with a depilatory cream. One trial compared shaving on the day of surgery with shaving the day before surgery and one trial compared clipping on the day of surgery with clipping the day before surgery; neither trial found a statistically significant difference in the number of SSIs. No trials were found that compared depilatory cream at different times or that compared hair removal in different settings.

Tanner, et al. (2006) concluded the evidence finds no difference in SSIs among patients who have had hair removed prior to surgery and those who have not and note that if it is necessary to remove hair, then both clipping and depilatory creams results in fewer SSIs than shaving using a razor. They found no difference in SSIs when patients are shaved or clipped one day before surgery or on the day of surgery.