Preoperative procedures involve the care accorded to a patient before, during, and after a surgery process. The procedures aim to provide better conditions for patients before the operation, during the operation, and after the operation. Some of the preoperative procedures, which are carried out on the surgical floor, are questionable (Rosdahl & Kowalski, 2012). One is left to wonder if some of the procedures have a basis in research. This paper will look at the basis of one of some of these procedures and make suggestions on the relevant changes that ought to be implemented. Furthermore, it will identify barriers that might arise when it comes to the implementation of the revised clinical practice guidelines.
Among the preoperative procedures that are questionable is the shaving of areas where to make the incisions of a surgery. Shaving is a routine procedure that the majority of surgeons worldwide use before an operation. It can be done just before one goes to surgery or a day before. The hair removal procedure is done in different ways. Some of these ways include the use of clippers, razor blades for shaving, electric shavers, and hair dissolving creams. They facilitate removing hair in areas where surgeons intend to make the incision. Before shaving, several pre-surgical skin preparations are done. They include full body wash with povidone-iodine or chlorhexidine.
The basis of the practice
The practice is acceptable by surgeons worldwide and they consider it mandatory. The hospital management and doctors also fall in this category. Therefore, the entire management of the hospital establishes the basis for the procedure since all their colleagues in other hospitals worldwide use it.
Rationale for decision
The majority of the people believe that shaving lowers contagion risk at the spot of the incision. Nonetheless, this does not always happen. Shaving is also believed to remove anything that might obstruct a surgeon from viewing the area of the incision. Therefore, it enables the surgeons to access the incision site with ease. Some surgeons believe that shaving is a way of removing bacteria found in the surgery area, which could otherwise lead to contamination (Celik & Kara, 2007). The other rationale is the belief that the procedure leads to the reduction of infections of wounds, increases the site’s exposure, and facilitates the process of dressing the wounds. Shaving is necessary in the case where there is a need to apply adhesive leads on a patient’s skin. The presence of hair around the operated area makes it hard for adhesive lead to reach the wound (Celik & Kara, 2007).
Clinical implications of the procedure
Research has shown that shaving of hair before surgery raises the risk of infection of the area after the surgery. Intensive antibacterial handling that is done before shaving the area can disrupt the healthy skin flora, enabling pathogenic agents to colonize the area (Celik & Kara, 2007). The alteration of flora found on the skin because of shaving is also tied to the increase of bacterial growth, which might lead to infection. Surgical site infections increase complications in patients, and they account for the majority of the infections associated with the health-care and eventual death of patients. This, therefore, shows that the procedure is quite inappropriate. Therefore, there is an implication that the shaving procedures are done before an operation should be transformed particularly in areas that involve the actual hair removal process. The infection threat is seen to increase as the length of time between shaving and the actual surgery increases (Celik & Kara, 2007).
Shaving done in the operating room inflicts micro trauma on a patient’s skin at the site of the incision. Besides, it damages hair follicles that are located on the site before surgery. Hence, the area becomes susceptible to colonization by infectious organisms. There exists an indirect connection between hair removal before operation and surgical contamination. Therefore, it is implied that failure to remove hair or shave is a way of reducing infections (Celik & Kara, 2007). There is evidence that hairy incision sites do not encounter surgical infections (Celik & Kara, 2007). Because of the clinical implications that result from shaving, there have been suggestions that show that it is not quite necessary to remove the hair that is around the operation sites unless it directly interferes with the operation process.
Several changes ought to be put into consideration to stop the different implications that result from shaving of the surgery sites. For instance, nurses ought to attempt utilizing depilatory creams as opposed to shaving the patient whenever they require operating on their sick persons. Shaving might lead to minute cuts and scratches exposing the patient to bacterial infection. Using depilatory creams would avoid such cuts and abrasions. This indicates that we ought not to accord the preoperative procedures such as shaving, high value or view them as highly appropriate and acceptable. However, the justification regarding the procedure may be based on humanitarian grounds. For example, in cases where the presence of hair tends to make it difficult for the surgeons to see the site of incision, shaving would be necessary. According to Perry, Potter, and Elkin (2012, p. 45), “another scenario, which may call for the removal of hair from the patient by the surgeon is when there may be the need to apply adhesive leads to the skin before surgery is done.” Despite all the opinions gathered from various literature sources, debates are still ongoing where most people are arguing out whether it is necessary for the intended surgical sites to be shaved or not (Perry, Potter & Elkin, 2012).
The other suggested changes that are significant include the need to change the staff’s perception by telling them that, shaving is mainly significant in reducing the risks of surgical site infections. According to research conducted on hospital personnel regarding preoperative shaving procedures, the majority of the surgeons believe that the procedure may help in reducing the rate of infections. Most people believe that the practice of preoperative shaving mainly enables surgeons to have easy access to the exact point of incision. The data gathered also indicate that the nurses carry out the procedure a day before the surgery (Altman, 2004). However, the most appropriate time to remove hair around the site of the incision is some minutes before surgery. This would facilitate circumventing chances of bacterial infection.
Nurses should opt to use clippers as an alternative when shaving the surgery sites. Additionally, they might alternatively use dissolving creams in place of shaving the patient. Dissolving creams are good because they do not breach the skin. Another preferred practice is carrying out the preoperation shaving close to surgery time. The findings from various data collected from the nurses indicate that most cases of wound infection result from shaving. Therefore, there is a need for urgent changes in the preoperative procedures to stop such cases. Conversely, hair removal before surgery helps in reducing the rate of infection (Altman, 2004).
Barriers to implementation
Various barriers may arise when implementing the changes. Altman (2004, p. 19) posits that “the key stakeholders should be included in making the decision. To transform the appropriate and desired preoperative procedure it may require the contribution of the patients, nurses, and the clinicians.” Therefore, it would be difficult to implement the changes unless one knows the reaction of all the stakeholders. The health experts would also help in creating awareness as well as enlightening the nurses on the merits and demerits of conducting shaving around the surgery areas (Altman, 2004).
One of the challenges in implementing the proposed changes would be the communication barrier. Failure to communicate with the parties involved in the surgery processes would lead to the parties subjecting the patients to bacterial infection. To ensure that the surgery process is carried out securely, one ought to make sure that all the participants in the surgery process are aware of the most appropriate process to follow. Another barrier that might arise during the process is a lack of commitment from the surgeons to employ the novel preoperation process. The majority of the surgeons are used to shaving their patients before operation. They might not be ready to accept the new process since it might appear time-consuming. Conventionally, people prefer maintaining the status quo to embracing changes even if the changes come with immense benefits. This might apply in the medical field. Hence, to ensure that all accept the new changes, it would be appropriate to emphasize the benefits associated with the new procedure.
Altman, G. (2004). Delmar’s fundamental & advanced nursing skills (2nd ed.). New York: Thomson/Delmar Learning.
Celik, S. E. & Kara, A. (2007). Does Shaving the Incision Site Increase the Infection Rate After Spinal Surgery? Web.
Garber, J. S., Gross, M. & Slonim, A. D. (2010). Avoiding common nursing errors. London: Wolters Kluwer Health.
Perry, A. G., Potter, P. A. & Elkin, M. K. (2012). Nursing interventions & clinical skills (5th ed). New York: Mosby.
Rosdahl, C. B. & Kowalski, M. T. (2012). Textbook of basic nursing (10th ed.). London: Wolters Kluwer Health.