Surgical Procedure Research Paper

Pages: 5 (1820 words)  ·  Bibliography Sources: 6  ·  File: .docx  ·  Level: College Senior  ·  Topic: Health - Nursing

Surgical Procedure

Before a patient undergoes surgery, a nurse removes hair from the surgical site. The rationale behind this practice is that hair may interfere with the opening and closing of the surgical incision and with the use of surgical drapes and dressings, and that it may harbor bacteria that could cause infection of the surgical site (Tanner, Moncaster, & Woodings, 2007, p. 118.)

Shaving is the oldest and most common method used to remove hair from the surgical site prior to surgery (Tanner & Khan, 2008, p. 241). The perioperative nurse uses a sharp blade that is contained in the head of a razor and pulls it over the skin of the patient to remove hair from around the area where the surgical incision will be made (Tanner et al., 2007, p. 119; Taylor & Tanner, 2005, p. 519).

Shaving is also the cheapest method of hair removal (Tanner & Khan, 2008, p. 241; Tanner et al., 2007, p. 119). Its relatively lower cost, compared to other methods such as clipping and depilatory creams, probably makes it the most popular hair removal procedure to budget-conscious health care administrators.

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The research literature does not support shaving with a razor as the best method of preoperative hair removal. There is no conclusive evidence that any means of hair removal significantly reduces surgical site infections ("Infection control; usual practices in surgical site preparation do not reduce infections," 2006; "Preoperative hair removal and surgical site infection," 2006; Tanner et al., 2007). Some studies suggests that shaving might increase infection rates due to creating nicks and scrapes on the skin in which bacteria can grow ("Preoperative hair removal," 2006; Tanner & Khan, 2008). Some research indicate that both of the other methods of hair removal, clipping with scissors or an electric clipper and depilatory creams which remove hair chemically, are more effective than shaving is at preventing surgical site infection ("Preoperative hair removal," 2006; Tanner & Khan, 2008; Tanner et al., 2007).

Research Paper on Surgical Procedure Assignment

Preoperative hair removal from the surgical site is one of the sacred cows of the medical profession. According to Mellinger and McCanless (2010), "Sacred cows can impede the introduction of best practice in the patient care environment because they are often practices based on tradition, not science" (p. 572). There are probably many surgeons like the one quoted in "Infection control" who said, "There is no information available regarding the necessity to remove hair from a surgical site. I almost always remove hair at the site of a planned operation, but there is little research to support or refute this practice (2006)."

All health care procedures should be rooted in evidence demonstrated through scientific research, and perioperative procedures are no exception. Because there is no firm evidence in support of shaving the surgical site prior to surgery, the practice should be ended. Perioperative protocol should follow the recommendation of the Centers for Disease Control (CDC) and only remove hair from the surgical site when it is necessary to prevent the hair from interfering with the operation (Tanner et al., 2007, p. 119). Researchers of this issue also make that recommendation. When hair removal is necessary to allow unobstructed access to the surgical site, the CDC and researchers recommend using clippers or a depilatory cream instead of shaving, based on the evidence of the available studies. Although most of those studies are of low quality due to problems such as small sample sizes and no information on randomization, they do provide some evidence for their suggestions, albeit it inconclusive ("Preoperative hair removal," 2006; Tanner & Khan, 2008; Tanner et al., 2007). What is more, Taylor and Tanner's randomized controlled trial investigating whether patients had a preference for preoperative hair removal by shaving or clippers found that shaving produced more infections, caused problems with hair growing back, and left minor cuts (2005, p. 523).

Adjusting perioperative protocol to align with these recommendations and the research would mean less hair removal procedures before surgery. Fewer procedures would result in savings of time and money. As several studies suggest, there would be no negative effect on surgical site infection rates ("Preoperative hair removal," 2006; Tanner et al., 2005). A brief article published in Consumer Reports on Health points to a growing public awareness of the lack of scientific basis for preoperative hair removal ("Shaving before surgery doesn't reduce the risk of infection," 2006). Thus, ceasing the practice would meet growing public expectations.

Ending the practice of preoperative shaving in favor of not removing hair unless necessary to permit unfettered access to the surgical site would yield benefits for all stakeholders. Perioperative nursing staff would have more time to concentrate on other areas of patient care and would learn techniques of hair removal that have support in the research literature and from organizations such as the CDC and the Association of Perioperative Registered Nurses (Mellinger and McCanless, 2010, p. 573). They would enjoy the confidence that comes from practicing evidence-based nursing. Health care administrators and board personnel would see reduced costs associated with the operation of the surgical unit. The health care facility waste stream would be positively impacted with fewer disposable razors going into the garage, and thus the institution could raise its green, pro-environment profile in the community. Many patients would have to undergo one less perioperative procedure and would not experience the discomfort or possibly higher infection risks associated with shaving with a razor.

Perioperative nurses would need to be training in the techniques of preoperative clipping. Helping them gain a familiarity with the literature on the topic would convince them of the greater legitimacy of removing hair only when necessary. One would need to persuade surgeons to let go of the expectation of always beginning surgery on a shaved, hairless surface. Cultivating awareness of the lack of evidence in support of preoperative shaving institution-wide would make it more difficult for them to protect this sacred cow. Involving them in the process of creating the guidelines that determine when it is necessary to clip the hair from the surgical site would give the guidelines legitimacy in their eyes.

The difficulties in translating the information found in the research into procedural guidelines and practice are few but significant. The primary difficulty in this regard might be in the creation of guidelines to be used to determine the instances when preoperative hair removal is necessary. If the goal is to significantly reduce the cases in which hair removal is ordered, in order to be in better alignment with the recommendations and the research-based information, then the guidelines need to be firm, detailed, and unambiguous. The literature does not offer details or concrete examples concerning the real limits of an approach to the issue that supports not removing hair from the surgical site most of the time. Crafting the guidelines could likely be a lengthy process. Those drafting the guidelines would have to ensure they are creating a policy that reflects the institution's mission of high-quality patient care.

Another difficulty would be in determining the measures that indicate success or failure of the new guidelines and the protocol and procedures they define. One has to resist the temptation to expect large, sustainable declines in the use of preoperative hair removal. To do so would be to turn a blind eye toward the wide range of patient circumstances, the peaks and valleys and the ebb and flow of the various kinds of surgical cases. Cost reduction should not weigh too heavily in judging the success or failure of the initiative. More important measures include surgical site infection rates, patient comfort and satisfaction, productivity of the perioperative nursing staff, and waste stream impacts.

Barriers to implementing this change in preoperative procedure are large but not impossible to overcome. Surgeons might feel that this nurse-sponsored initiative is an invasion of their domain and an attack on their authority in the operating room. Also, they might find it hard to give up the expectation of a cleanly shaved surgical area every time they enter the or. Soliciting their input in creating the guidelines would help lessen the sense of infringement and the fear or reluctance to change.

Perioperative nurses might balk at the need to learn a new procedure to do a task that they already do by a familiar technique. They would have to be persuaded to put down the razor and pick up the clippers. Raising their awareness of the research information and the recommendations in support of the change would help win them over intellectually. They would see the change in protocol as something that makes them better educated nursing professionals. Thus educated, they could take part in the creation of guidelines and thus have a role in creating the rules that govern their new and improved workflow. Also, perioperative nurses would need to undergo training, which they might view as an infringement on their time. Nurses are busy and their attention is in high demand on the job. One would have to create a training schedule that… [END OF PREVIEW] . . . READ MORE

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