Evidence-based practice & applied nursing research

Perioperative procedures are the practices carried out before during and after a surgical operation. There are various such procedures and some of them need to be changed or improved to prevent the surgical site infections after the operation. These surgical site infections are major cause of the patient’s prolonged stay at the hospital, the extra cost and in some cases death. Discussion Shaving is one of the Perioperative procedures that have now become a routine in the surgical process. A research was conducted to investigate the effects of the practice on the patient’s health after surgery, and the cost of the patient’s recovery.

The research was conducted in several health centers that performed surgical operations. It involved observing the patients who were shaved before the operation, those who were not shaved and those who were shaved chemically. Results from the research shows that most of most of the patients who were shaved before the operation were at high risk of infections whereas those who were not shaved and those shaved chemically were at very low risks of suffering the infections. The process of shaving involves the removal of hair from the surgical site either by wet shaving, using a razor blade or dry shaving.

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Shaving or hair removal is aimed at reducing the risk of infection of the surgical site but in most of the cases it results in the infection. Wet shaving is the most dangerous because wet skin provides a good medium for the bacteria on the skin than the dry shaving (Richard & Wenzel, 2010). These Perioperative procedures require critical evaluation and change to reduce the case of surgical site infections. Shaving and hair removal have been found to increase the postoperative surgical site infections. This is because the process leaves some notches or cuts in the skin that can be entry of micro-bacteria during or after the operation.

The practice should be eliminated from the procedure unless it interferes with incision process. According to research conducted by Seropian and Reynolds in 1971, the number of patients who suffered the surgical site infections due to shaving was 10 times more than those who had no hair removal. According to Nichols, a professor at the Tulane University School of Medicine in New Orleans, the practice of shaving the surgical patients can be dated back in the 18th century where patients were shaved to reduce the risk of surgical site infections and to allow for the surgical incision to be made.

The practices performed in this manner because in most of the cases presence of hair on the surgical site is a major interference with the process. It hinders the making of an incision on the skin and in some cases may cause the infection due to the pieces of hair that may enter the open body part. This is the argument behind most of the surgeons shaving their patients. Shaving hair from the site of operation is a risky move because it provides an entry point of micro-organisms into the open wound. Micro-organisms are present all over the skin surface and any wound into the body serves as an entry point causing infection.

Surgical site infections are the most common types of nosocomial infections that that surgical patients may suffer from due to the shaving practice (Richard & Wenzel, 2010). These infections increase the length of stay of a patient at the recovery room for more than five days. Extended stay at the hospital results in increased cost of treatment. According to Rusciani et al (2008), the cuts caused by the shavings causes some superficial excoriations that increase that rate of bacterial penetration into the surgical section.

The author of this book suggests that the practice should only be carried out if examinations show that presence of hairs should only be done on sections that are too hairy or where they might interfere with the process. This process can be performed better without causing any implications to the patient’s body by either avoiding it or using some depilatory creams and sprays to allow for a chemical shave (Altman, 2010). Research shows that the patients who are shave using razor blade either a wet shave or a dry one are at a high risk of surgical site infection.

Clipping hair from the area of operation is a good option but it also leaves some pores on the skin. Shaving can also be done immediately before the operation rather than 24 hours before. This is because the micro-organisms only have a short time to infect the area unlike the shave done some hours before. However a chemical shave remains the best option to allow for an infection free surgery. These depilatories react by breaking the chemical bonds between sulfur atoms, changing the structure of the keratin component of hair (Rusciani et al, 2008).

Rusciani suggests that shaving should only be done in cases where the patient is allergic to the chemicals in use or in cases of excessive hairs around the area of operation. She continues to argue that the use of chemical shaving reduces the cost of taking care of the patients by a great percentage. In the US economy use of the chemical shaves saves the economy over $4 billion every year. All the concerned bodies in the surgical field have a responsibility to ensure the safety of the patients.

However, in spite of the evidence portrayed by research, which shows that shaving patients before surgery results in surgical site infections , most of the surgeons still shave their patients. This is according to a report by the New York Times, (Altman, 2010). In a move to change this practice as nurse, the major stakeholders should be shown the reports and results from research studies concerning the effects of shaving patients. The stakeholders should be made to understand that the practice endangers the patient’s life since it puts them at the risk of internal infections that may lead to death or more complications.

Pudner. (2005) in her nursing and surgical works suggests that all the surgeons should adopt a no removal of hair system from the patients to reduce the rate of the infections. The evidence based research should be presented to the surgeons to prove that the use of chemical shaving or adopting a no hair removal approach during surgery save the cost of the operations by reducing the recovery time of the patients. This are some of the ways to prevent the increase in the cases of infection and all the involved stakeholders should be encouraged to take the initiative and abolish the shaving system unless it is very necessary.

The results from the research show that shaving exposes the patients to post surgical infections and so a change is needed. The change involves abolishing shaving patients and adopting the no hair removal practice or use of chemical shaving. Implementing this changes is however very difficult because despite the clear evidence showing the dangers of shaving the patients, most of the surgeons still prefer to use the method. They argue that shaving removes the hairs that might interfere with making the surgical incision. Another major challenge is the fact that some patients are allergic to the chemicals used to shave them (Nichols, 2009).

If for instance the operation is to be performed on the head, the hair must be shaved. If the patient is allergic to the chemicals then it means that the risk has to be taken. The major barriers in changing the practice are the lack of cooperation from the concerned parties. Due to the common belief that the hair around the area of surgery can cause interference with making of incisions, most of the surgeons will tend to shave their patients irrespective of the existing dangers. This is the major obstacle to implementing the findings of the study research.

Another barrier that may not be avoided is a situation where the patient is allergic to the chemicals that are used to shave them. To overcome these changes, the patients who are undergoing surgery should be educated to request for a no hair removal surgical operation if they are not allergic to the chemical shaving. This way the involved surgeons and nurses have no option but to perform the operation without shaving. The patients should be enlightened on the effects of shaving as major causes of post surgical infections and the high costs of the operations.

The study reports should also be given to the major nursing bodies and the surgeons should be instructed to avoid shaving the patience before surgery. The patients can have their hair clipped which is safer than shaving. Clipping hair does not cause any major damage to the skin before surgery which may result in entry of bacteria. Results from the research shows that shaving the surgical site is dangerous due to infections. This research found out that removal of hair during surgery is not necessary so as to avoid infections. The involved surgeons should consider effects of the practice before the decisions.

Any nurse should avoid the practice while preparing the patient and instead consider clipping the hair or using the shaving chemicals. The nurses should be made to understand the effects of the shaving and advised accordingly. Before embarking on the practice, nurses should assess the patient’s reaction to chemicals and the surgical site. Clipping hair should be adopted because it has lesser implications than the chemical type. Conclusion Findings from the research show that the practice of shaving the surgical site should be stopped to prevent surgical site infections and to reduce the patients stay at the recovery room.

Such infections increase the period of stay at the hospital and the cost of the operation. In extreme cases it may result in death. Implementing these changes is faced by several challenges. The main challenges are the ignorance by the involved doctors and nurses and patients who are allergic to the chemical shaving. These challenges can be met by educating the patients and nurses and imposing measures to prevent the surgeons from intentionally shaving the patients. REFERENCES Altman, L. (2010). The doctor’s world; shaving area of operation now seems dangerous.

The New York Times. 18 august 2010. Nichols, R. L. (2009). Preventing Surgical Site Infections: A Surgeon’s Perspective. New Orleans, Louisiana: Tulane University School of Medicine, March 05, 2009. 7(3). Pudner, R. (2005). Nursing the surgical patient. Philadelphia: Elsevier Health Sciences. Richard, P. & Wenzel, M. D. (2010). Minimizing Surgical-Site Infections. The New England journal of medicine. 362:75-77. January 7, 2010. Rusciani, R. et al. (2008). Textbook of dermatologic surgery. Padova: Piccin publishers

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