Evidence Based Practice Research

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Evidence Based Practice and Applied Nursing Research
Western Governor’s University

Evidence based practice and applied nursing research encompasses selecting a perioperative procedure such as routine shaving of a surgical site which is something you would commonly find on a surgical floor. The process of shaving a perioperative site includes cleansing and shaving the site that is to be operated on. Clipping the surgical site of hair is more appropriate because it would decrease the likelihood of surgical site infection. Gregory P Nowinski noted in his article the following:

“ An alternative to using razors is powered surgical clippers. Clippers mechanically trim the hair close to the skin, effectively removing it from the field, and avoid the skin trauma caused by the sharp blade of a razor. A study of open heart surgery patients showed a significant decrease in deep infections in individuals whose hair was removed by clippers compared to those whose hair removal was done with a razor” (Nowinski,2008).

Doctor’s and hospital administration determined the best practice for removing the hair from the surgical site. This would remove the hair completely and all the germs contained in the hair in the hopes it would lead to less infection for the surgery. The rationale for making the decision was based on the knowledge that hair carries a number of germs that could easily infect the site. It also increased visibility of the surgical site making the surgical procedure a smoother adverse free operation. The clinical implications of shaving rather than clipping the site after review of the literature shows that shaving often leads to open areas and ingrown hair which causes surgical site infections. Clipping the hair however does not damage the skin opening it up for infection and also allows the removal of the hair so that germs from the hair do not enter the surgical site as well as giving the surgeon a better view of the site unobstructed by hair. There are specific guidelines when performing a preoperative procedure checklist including a protocol written by the foot and ankle center: “ Do not shave the surgical area for a minimum of 3 days prior to surgery. Shaving can cause nicks, cuts and abrasions in the skin, allowing bacteria to enter, increasing the risk of infection.”(Foot & Ankle Center,2012)

The best method of preparing a surgical site for pre operative procedure is to clip the hair rather than shave it. In an article written by David E. Reichman MD and James A. Greenberg MD posted on the internet, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2812878/ “Studies have shown that shaving the skin as compared with clipping results in a statistically significant increase in the rate of surgical site infection. Shaving results in microscopic cuts and abrasions, thus acting as a disruption of the skin’s barrier defense against microorganism colonization. Clippers, when used correctly, should not cut into the patient’s skin, potentially explaining the differences in infection” (Greenberg & Reichman, 2009) It is more cost effective because the tools used for clipping could be sterilized and reused while the shaving equipment must be thrown away and also requires cream or moisturizer of some type while shaving does not.

In an effort to involve key stakeholders in the decision to change this procedure or comply with the proposed change a meeting could be held. A report could be drafted showing the evidence based research that clipping causes less infection. But research suggests that shaving a patient’s skin before surgery may raise the risk of an infection. In an article written by Kelly M Pyrek it is stated:

“ A recent OR Manager survey revealed more than half of the respondents said surgeons at their hospitals are still using razors for preoperative hair removal, despite a growing body of research proving that it is unnecessary and perhaps even...
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