Dear Editor:
I take objection to the Evidence Corner department by Laura L. Bolton, PhD, FAPWCA, that appeared in the July 2006 issue of WOUNDS.
In the Clinical Perspective section regarding the first article, “Preoperative Hair Removal Effects on SSI,” Dr. Bolton concludes that immediate shaving before the procedure has been shown to cause more wound infections and says, “Shaving surgical sites preoperatively increases the likelihood of SSI compared to clipping.”
To the best of my knowledge, this has not appeared in any medical literature. I have challenged both the operating room manager and our director of nursing education to find any studies that show immediate shaving before a surgical procedure causes more postoperative wound infections.
I understand the logic behind the position to reduce or completely avoid sharp razor prep; however, there is no evidence to support the presented conclusions.
Charles J. McGaff Jr, MD, MBA, FACS
Medical Director
Wound Care Clinic at River Parishes Hospital
LaPlace, Louisiana
Dear Editor:
Please extend warm thanks to Dr. McGaff for his query about the evidence base for fewer surgical site infections (SSIs) with preoperative clipping versus shaving with a razor. The evidence cited for the Cochrane reviewers’ conclusion that “clipping results in fewer SSIs than shaving using a razor” is based on 3 references1–3 that are described in more detail within the Cochrane review cited in the July 2006 Evidence Corner. A July 19 update of that Cochrane review by the same authors4 reaffirmed that “If it is necessary to remove hair then both clipping and depilatory creams [result] in fewer SSIs than shaving using a razor.”
Regarding the issue of “immediate shaving before the procedure” (Dr. McGaff’s words, not mine), a growing body of literature suggests that longer intervals between shaving and surgery are associated with more SSIs,5 but to my knowledge, the randomized, controlled studies to affirm this conclusion remain to be published. Perhaps Dr. McGaff’s group will make that contribution to the literature. A good aspect of evidence-based medicine is that we all build on each other’s knowledge.
Laura L. Bolton, PhD, FAPWCA
Adjunct Associate Professor
Department of Surgery
University of Medicine & Dentistry of New Jersey
New Brunswick, NJ
References
1. Alexander WJ, Fisher JE, Boyajian M, Palmquist J, Morris MJ. The influence of hair removal methods on wound infections. Arch Surg. 1983;118(3):347–352.
2. Balthazer ER, Colt JD, Nichols R. Preoperative hair removal: a random prospective study of shaving versus clipping. South Med J. 1982;75(7):799–801.
3. Ko W, Lazenby WD, Zelano JA, Isom OW, Krieger KH. Effects of shaving methods and intraoperative irrigation on suppurative mediastinitis after bypass operation. Ann Thorac Surg. 1992;53(2):301–305.
4. Tanner J, Woodings D, Moncaster K. Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Rev. 2006;19(3):CD004122.
5. Razavi SM, Ibrahimpoor M, Sabouri Kashani A, Jafarian A. Abdominal surgical site infections: incidence and risk factors at an Iranian teaching hospital. BMC Surg. 2005;27(5):2. |
