American Academy of Nursing

View all recommendations from this society

April 19, 2018

Don’t remove hair at the surgical site including the hair on the patient’s head, but if hair must be removed it should be clipped not shaved.

Removing hair at the surgical site has long been believed to be associated with an increased rate of surgical site infections because of razor-induced microtrauma. Specifically, shaving the patient’s head prior to neurosurgery can disturb the natural protective effects of hair and skin flora, also causing micro-abrasions to the scalp that can increase the risk of infection. Postoperative wound infections increase the costs and the length of hospital stay. In any type of surgery there are times when hair removal should be considered. For example, during emergent craniotomies or any time a surgeon deems hair removal necessary for the surgical procedure. When hair removal is necessary, hair at the surgical site should be removed by clipping or depilatory methods. A razor should not be used. In a landmark nonexperimental study of 23,649 surgical wounds, Cruse (1973) found a 2.3% infection rate for surgical sites shaved with a razor, 1.7% for sites that were clipped, and 0.9% when no hair removal was performed. Yet shaving hair at the surgical site continues to be practiced. In addition, most patients dread the thought of having the hair on their head removed, and hair shaving can negatively affect their body image.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a health professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician or nurse.

How The List Was Created

The American Academy of Nursing has convened a Task Force of member fellows who are leaders of professional nursing organizations representing a broad range of clinical expertise, practice settings and patient populations. The Task Force collaboratively identifies nursing/interdisciplinary interventions commonly used in clinical practice that do not contribute to improved patient outcomes or provide high value. An extensive literature search and review of practice guidelines is conducted for each new proposed recommendation for the list. The supporting evidence is then reviewed by the respective nursing organization(s) with the most relevant expertise to each recommendation. The Academy Task Force narrows the recommendations through consensus, based on established criteria. The final recommendations are presented to the American Academy of Nursing’s Board of Directors for approval to be added to the Choosing Wisely list created by the Academy. Once approved by the Academy’s Board of Directors, the recommended statements are sent to the ABIM Foundation for an external review by physician(s) and nurse(s) and final approval for consistency with the ABIM Foundation principles.

Recommendations were developed in partnership with the following organizations: Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), recommendations 1, 11, 12, & 13; Academy’s Expert Panel on Aging, recommendations 2, 3, 14, 15, & 24; American Association of Critical- Care Nurses (AACN), recommendations 4 & 5; Oncology Nursing Society (ONS), recommendations 6, 7, 8, 9, & 10; American Association of Neuroscience Nurses (AANN), recommendations 16, 17, 18, 19, & 20; Academy’s Expert Panel on Acute & Critical Care, recommendation 21; Society of Pediatric Nurses (SPN), recommendation 22; American Pediatric Surgical Nurses Association, Inc. (APSNA), and the American Pediatric Surgical Association (APSA), recommendation 23; and the Association of periOperative Registered Nurses (AORN), American Association of Nurse Anesthetists (AANA), and the American Association of Neuroscience Nurses (AANN), recommendation 25.

The American Academy of Nursing’s conflict of interests and disclosures policy can be found at www.AANnet.org.

Sources

Cruse, PJ. A five-year prospective study of 23,649 surgical wounds. Arch Surg. 1973;107(2):206–210.

National Institute for Health and Care Excellence. (2013). Surgical site infection. Quality standard [QS49]. Retrieved from https://www.nice.org.uk/Guidance/QS49.

Sebastian, S. (2012). Does preoperative scalp shaving result in fewer postoperative wound infections when compared with no scalp shaving? A systematic review. J Neurosc Nurs. 44(3):149-156.

Tanner J, Norrie P, Melen K. Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Rev. 2011;11:CD004122.

Tanner, J., Moncaster, K., & Woodings, D. “Preoperative Hair Removal: A Systematic Review”. Journal of Perioperative Practice 17.3 (2007): 118-121, 124-132. Print.

WHO: Patient Safety. WHO Guidelines for Safe Surgery. 2009.