Pre-operative clipping: Identifying the best tools and practices for infection prevention

Hair removal is an important part of prepping a patient for many types of surgical procedures. A patient's hair can interfere with surgical field of vision and serve as a potential source of infection, according to studies and guidelines.

When it comes to the preferred method of hair removal before a surgical procedure, a recent survey among members of the Association of periOperative Registered Nurses (AORN), found 98 percent of surgical nurses opt for clipping instead of shaving their patients, according to a May 25 webinar presented by Kathleen Hall-Meyer RN, MBA, CIC and hosted by Becker's Hospital Review. Clipping is widely considered the preferred method of pre-operative hair removal, as shaving has been linked to skin damage and increases the risk of infection. Shaving with razors creates micro-abrasions that can act as a portal for infection and allow microorganisms dwelling on the skin to enter the incision site.

Clipping: When and where?

"Both the CDC and AORN recommend that hair should not be removed at all unless that hair interferes with the incision site and/or the surgical procedure," said Ms. Hall-Meyer.

However, surgical staff should be aware that antisepsis agents used for skin prep require extended dry times (up to an hour) when hair is still present. If hair removal is required, the groups recommend that clipping be done outside of the operating room. Despite this, surveys suggest most clipping is done inside the OR. Reasons cited for this practice include patient privacy, to reduce delays, emergency circumstances and a preference to clip while a patient is under anesthesia. Though some clinicians might prefer to clip inside the OR, performing this practice in a separate location may avoid the dispersion of hair fibers and possible contamination of the operative field

When it comes to clipping, technique is crucial to safety and success. It is essential that whoever is operating the clippers adhere to the manufacturer's directions for proper use of the equipment. Improper technique can lead to raking, which can severely damage the skin, both harming the patient and exposing him or her to potential infections.

Surgical hair clipping waste - more than a mess, an infection risk

Anyone working in surgery knows that a major drawback of standard surgical clippers is the cleanup. Hair and airborne particles left behind on the patient, linens and floor can potentially contaminate the surgical environment and may increase risk for healthcare-acquired infections.

While adhesive tapes and sticky mitts are commonly used to cleanup patient hair, they may unintentionally exacerbate the problem of pathogen dissemination. This is because adhesive tapes are neither sterilized nor kept under controlled conditions — they are also frequently used on multiple patients.

"Nurses are good stewards of resources and do not want to throw away anything that may be useful later," said Ms. Hall-Meyer. "Tape is a big cross contamination issue and in my opinion, under-recognized."

In a study published in The Journal of Internal Medicine, researchers examined the contamination rates of adhesive tape rolls obtained from a large hospital. The team found that 74 percent of the tape specimens were colonized by pathogenic bacteria.

For those hospitals and ASCs that might advocate throwing out the roll of tape after each use to avoid possible cross-contamination, studies highlight the massive waste this practice imposes. In one such study published in the Cochrane Database, researchers collected unused adhesive tape from 20 patient rooms across two hospitals. The team then projected the annual waste of adhesive tape at said hospitals to be approximately 126 miles long.

In addition to increasing hospital waste, tape can harm a patient's skin and tear surgical gloves. Furthermore, cleaning stray patient hair with sticky gloves and tape is time consuming.

An all-in-one approach: Vacuum-assisted surgical clipping

"There is a new vacuum-assisted technology that eliminates the need for surgical clipping. I think it's pretty exciting," said Ms. Hall-Meyer.

A recent study conducted by Bioscience Laboratories for Becton Dickinson (BD) found vacuum-assisted clippers were statistically significantly more efficient in both collecting patient hair and reducing the saturation of contaminates when compared to surgical tape. Researchers also found that the benefits of the technology as perceived by nurses and study subjects to include a perceived increase in the speed of the clipping process, improved cleanliness and a more comfortable patient experience.

BD's ClipVac™ - the vacuum -assisted pre-surgical hair removal system tested in this study, is now readily available. By clipping and cleaning up in a single step, ClipVac™ offers more effective and more efficient surgical hair cleanup. On average, the ClipVac™ surgical-grade filter has demonstrated capturing 98.5 percent of clipped hair and debris. The product is portable, powered by a long-lasting lithium ion battery and specifically designed to exclusively fit the CareFusion brand surgical clipper.

In the era of patient safety, it is crucial that medical professionals use the most effective tools and methods to limit the potential risk of HAIs and improve patient satisfaction. Surgical nurses have moved away from shaving in favor of clipping. Now, focusing on adhering to clipping best-practices is the critical next step.

To view the Webinar, click here.

To download the webinar slides, click here.

To view past webinars, click here.

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