American Association of Neuroscience Nurses, Society of Pediatric Nurses & American Pediatric Surgical Nurses Association, Inc.

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December 1, 2022

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

(1–5 & 8) Members of the American Association of Neuroscience Nurses formed a task force to review evidence and make a recommendation of 5–10 things nurses should tell neuroscience patients to consider. AANN’s Special Focus Groups, which are composed of subject matter experts in various subspecialties of neuroscience, were consulted to help identify topics and provide supporting evidence. The task force reviewed the items for possible inclusion to determine the top recommendations. The top recommendations were presented to the AANN Board for review and approval.

(6) SPN initially reached out to several subject matter experts to learn about topic areas where they were aware of both evidence of overuse of health care resources and evidence-based resources to support addressing that overuse. SPN then chose two experts with research experience within the topic area we identified. One served as the main author while the other served as the reviewer. After the initial review was completed, we shared the content with the SPN Board of Directors for further input. Finally, colleagues at the American Academy of Nursing provided a final review.

(7) Once the American Pediatric Surgical Nurses Association, Inc. (APSNA) received an invitation from the Institute of Pediatric Nursing (IPN) to participate in the initiative, the APSNA Board was queried to identify pediatric nursing practices that should be modified based on evidence. The identified practice was presented to experts from APSNA’s Board of Directors, General Membership and Trauma Special Interest Group (SIG). The preliminary statement was reviewed and revised by content experts from both within and outside of the organization. Subsequently, the statement was submitted to the APSNA Board for final discussion and review. The final statement was reviewed and approved by the American Academy of Nursing.

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.