CLOSE CUT You should remove hair outside of the OR.

When it comes to hair removal, do you just grab a clipper and go? There's more to it that you may be missing. How, when and where you do it — and if you even do it at all — impact your infection rates. Organizations like the Association of periOperative Nurses (AORN) and the Institute for Healthcare Improvement (IHI) have set industry standards, yet an Outpatient Surgery Magazine survey of 128 surgical facility leaders found great variations in hair removal practices. Read on to see how your hair removal practices stack up against professional guidelines and how you compare to your colleagues.

1. Should you even remove hair?
Are you removing hair more frequently than you should? It's likely, since 5% of survey respondents say they remove hair for every case and another 36% say they do so for most cases. Most professional organizations recommend leaving hair alone. AORN's skin prepping guidelines — updated last year — say you should leave hair in place at the surgical site unless it will interfere with the procedure. This falls in line with the latest clinical research on hair removal. For example, in one large study of nearly 24,000 surgical wounds, researchers found that patients who were shaved with a razor had a 2.3% infection rate, while those who were clipped had a 1.7% infection rate. Those who had hair left in place had only a 0.9% infection rate (osmag.net/6RZgqZ).

2. Where do you remove hair?
When you remove hair, AORN guidelines state that you should do it outside of the operating or procedure room. While about two-thirds (65%) of our survey respondents remove hair in pre-op, one-third (33%) say that they do so in the OR. For them, it's often a matter of convenience. "Staff and surgeons prefer to do it in the OR because it's better lighting, the patient is more relaxed and it's more private," says an infection preventionist from California. "Plus, the perception is that it's easier to clean up hair in the OR."

However, most professional organizations discourage performing the practice in the OR. According to AORN, when you remove hair in the OR, you risk dispersing the clipped hair — which could contain microbial contaminants — into the air.

"We would like to change our process of hair clipping in the OR to have it take place in the pre-op area to decrease loose hair in the OR," says one manager. "We are finding this to be challenging to change this culture with surgeons."

A small percentage (2%) of survey respondents instruct their patients to remove hair at home — another practice that's advised against. Only 29% of managers say they tell patients not to shave before surgery — something AORN recommends including in your pre-op instructions — though some note patients still ignore the warning.

"Even though we inform the patients not to perform personal hair removal, some do, especially women who are having knee arthroscopy," says Emily Duncan, RN, BS, CASC, CNOR, CEO of Lakeland Surgical & Diagnostic Center in Lakefield, Fla. "They come in with shaved legs."

HAIR REMOVAL BASICS
5 Keys to Remember

STOP SHAVING Toss out any razors still hanging around your facility.

The Institute for Healthcare Improvement (osmag.net/4NDgMh) spells out a few key points to remember for a successful hair removal policy:

1. Avoid hair removal unless it's necessary for the procedure.
2. When necessary, remove hair with clippers right before surgery — but not in the operating room itself.
3. Remove all razors from the operating room and supply area.
4. Establish protocol for when and how to remove hair in affected areas.
5. Provide patient education and materials on appropriate hair removal techniques to prevent shaving at home.

— Kendal Gapinski

3. How do you remove hair?
Evidence strongly shows that using razors can increase infections as the razor nicks the skin and creates areas for bacteria to harbor. Because of this, IHI recommends tossing any razors you have lying around.

For the most part, leaders are complying with this recommendation. While 3% admit to still shaving patients, 97% of our survey respondents use clippers to remove hair. "It's cleaner and less traumatic," says one medical director. "As standards teach us, it is the best for infection control reasons," adds Betty O'Neal, RN, surgical services manager for Summersville Regional Medical Center in Summersville, W.Va.

Using a clipper requires more work than just running it over the skin. AORN recommends you use single-use clipper heads and disinfect the handle between each use to reduce the risk of SSIs. You have to be extra careful in certain areas of the body, especially around loose skin. "What I do not like about using a clipper for hair removal is that the blade tends to stick in skin folds and anywhere there is moisture," says a nurse from Pittsburgh, Pa.

While clippers are the most popular choice, AORN says you can also use depilatories, alkaline creams or lotions that dissolve hair from the surface. When using depilatories, you should perform a skin test on an area away from the surgical site 24 hours in advance to test for allergies or reactions, says AORN. This, along with their increased costs and mess, may be why zero survey respondents say they use depilatories. For Kathleen Trussell, DNP, of Othello (Wash.) Community Hospital, the reasoning behind choosing clippers over other methods is simple. "Razors cause cuts," she says, "and depilatories can cause skin irritation and chemical burns."