Hair removal policies in clean surgery: systematic review of randomized, controlled trials.
ABSTRACT To determine whether certain hair removal policies are better than others to prevent surgical-site infections in patients undergoing clean surgery.
Publications were retrieved by a systematic search of Medline, the Cochrane Library, and EMBASE up to February 2005. Additionally, the reference lists of all identified trials were examined. All randomized trials, quasi-randomized trials, and systematic reviews or meta-analyses of randomized or quasi-randomized trials comparing hair removal policies in clean surgery were selected. Trials involving patients undergoing cranial neurosurgery were excluded. Two reviewers independently assessed trial quality and extracted data. Disagreements were resolved by discussion with a third reviewer. Data from the original publications were used to calculate the relative risk or risk difference of surgical-site infection. Data for similar outcomes were combined in the analysis, where appropriate, with the use of a random effects model.
Four trials were included in the review. No eligible systematic review or meta-analysis of randomized or quasi-randomized trials was found. The quality of the trials and how they were reported were generally unsatisfactory. Evidence regarding whether preoperative hair removal has any effect was inconclusive. When hair removal was considered necessary, evidence about the best time for removal was inconclusive. There was some evidence that hair removal by clipper is superior to removal by razor.
Because of insufficient evidence as a basis for recommendations, the practical consequences for ward management were essential when the Dutch Working Party on Infection Prevention formulated its recommendations for hair removal policies. Large randomized, controlled trials are needed to determine the optimal policy for preoperative hair removal.
- Annales de Chirurgie Plastique Esthétique 11/2014; 60(1). DOI:10.1016/j.anplas.2014.09.005 · 0.59 Impact Factor
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ABSTRACT: Jährlich werden in Deutschland ca. 6,4Mio. operative Eingriffe durchgeführt. Nach nosokomialen Pneumonien und Harnwegsinfektionen sind postoperative Wundinfektionen mit einem Anteil von ca. 16% die dritthäufigste nosokomiale Infektionsart in deutschen Akutkrankenhäusern. Das Erregerspektrum hängt dabei von der Art und Lokalisation des Eingriffes ab. Die Erreger können exogen (von außen) oder endogen (von Haut- oder Schleimhautflora des Patienten) in das Wundgebiet gelangen. Bei den Risikofaktoren können patienteneigene und nur bedingt beeinflussbare Faktoren von solchen unterschieden werden, die durch geeignete infektionspräventive Maßnahmen im Rahmen der Organisation der perioperativen Betreuung beeinflussbar sind. Approximately 6.4 million operative procedures are carried out each year in Germany. Besides nosocomial pneumonia and urinary tract infections, postoperative wound infections account for 16% and are the third most common kind of infection in German hospitals. The spectrum of pathogens depends on the type and localization of the operative procedure. The pathogens can penetrate the wound from outside (exogenic) or from the patient’s own skin or mucosal flora (endogenic). There are different kinds of risk factors whereby those of the patient can be influenced in a limited manner and are differentiated from those which can be influenced by preventive actions against infections in the context of the organization of perioperative nursing. SchlüsselwörterWundinfektion-Prävention-Hygiene-Antisepsis-Perioperative Behandlung KeywordsWound infection-Prevention-Hygiene-Antisepsis-Perioperative treatmentDer Chirurg 06/2010; 81(6):577-586. DOI:10.1007/s00104-009-1860-3 · 0.52 Impact Factor
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ABSTRACT: The objectives of this multicenter study are to evaluate current clinical practices in cardiac surgery concerning the prevention and management of sternal wound infections, to identify room for improvement, and to support implementation of systematic measures. As a part of a campaign for infection prevention in cardiac surgery in Germany, a multiple-choice questionnaire with two main sections was developed and submitted to all cardiac surgery units in Germany (79). The project was realized in cooperation with the German Society for Thoracic and Cardiovascular Surgery, the BQS Institute for Quality and Patient Safety, and the National Reference Center for Nosocomial Infection Surveillance. A representative number (54 of 79 or 68%) of German cardiac surgery centers participated in the survey, in which heterogeneous procedures and various standards for prevention were observed. Surveillance, standards, and advanced training regarding hygiene measures are present in almost all participating hospitals. Methicillin-resistant Streptococcus aureus (MRSA) screening is performed in 81.5% (44/54) of all participating departments. A little less than one-tenth (7.4%) perform decolonization measures on all patients, while 85.2% perform decolonization measures only on MRSA-positive patients. Application of perioperative antibiotic prophylaxis ranges from single-shot application to 3 days of treatment. Longer treatment is expensive and time-intensive, and also increases the risk of Clostridium difficile-associated diarrhea. Nearly three-quarters (70.4%) of all participating hospitals perform preoperative hair removal 1 day before surgery. Common techniques are clipping machines (53.7%), razors (40.7%), clipping machines and depilatory cream (1.9%), or depilatory cream only (1.9%). Remanent (37.0%) and non-remanent disinfectants (55.6%) are used for preoperative skin disinfection. The time of the first wound-dressing change varies from the day of surgery (1.9%) over the first (42.6%) or second (46.3%) day after surgery to up to 3 or more days after surgery (9.3%). The results of the evaluation show that basic measures for infection prevention in cardiac surgery in Germany are well implemented. Nevertheless, a relevant heterogeneity in the use of special measures was observed, although research-based guidelines for infection prevention in surgery do exist and many studies have demonstrated the usefulness and feasibility of these measures.European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 01/2011; 40(2):347-51. DOI:10.1016/j.ejcts.2010.12.016 · 2.81 Impact Factor