Hair Removal

A subject that has been discussed for years

Hair Removal

A subject that has been discussed for years

Why hair removal is not recommended routinely

Hair removal

Studies showed that preoperative hair removal was associated with anincreased rate of SSIs.1

A meta-analysis comparing clipping and no hair removal vs. shaving showed aclear benefit of either no hair removal or clipping with a significant decrease oft he SSI risk.2

“The increased SSI risk associated with shaving has been attributed tomicroscopic cuts in the skin that later serve as foci for bacterial multiplication.”1

Look closer into the Guidelines

Guidelines
GuidelineRecommendationCategory (if mentioned)
CDC1“Do not remove hair preoperatively unless the hair at or around the incision site will interfere with the operation.”

“If hair is removed, remove immediately before the operation, preferably with electric clippers.

Category IA

Category IA

WHO2“Hair should either not be removed or, if absolutely necessary, it should be removed only with a clipper. Shaving is strongly discouraged at all times, whether preoperatively or in the operating room (OR).”Strong recommendation, moderate quality of evidence
NICE3“Do not use hair removal routinely to reduce the risk of surgical site infection."

“If hair has to be removed, use electric clippers with a single-use head on the day of surgery. Do not use razors for hair removal, because they increase the risk of surgical site infection.”


SHEA4“Do not remove unless hair will interfere with the operation; if hair removal is necessary, remove outside of the operating room by clipping. Do not use razors.”Quality of evidence: HIGH
KRINKO5Removal of hair in the surgical area by clipping and not by shaving.Category IA

Denise Leistenschneider, Senior Clinical Consultant
"When removing hair before surgical procedures, the benefits and risks must be carefully weighed."

Instructions for hair removal

Do not remove hair routinely to reduce the risk of surgical site infection.3

Hair should be only removed if absolutely necessary2 – if it will interfere with the operation.4

Do not use razors3,4, because they increase the risk of SSI.3

Use electric clippers with a single-use head.3

Remove hair outside the operating room.4

Exception

”Razors may be acceptable for hair removal in a subset of procedures (eg, procedures involving male genitalia).”4

HARTMANN: our additional advice

“For an efficient fixation of adhesive drapes remaining hair might interfere with the purpose of sterile draping – preparing a barrier function around the surgical field.”

Razor shave vs. depilatory or no hair remove6

Data on the time of hair removal

  • The WHO stated that there is no clear evidence for favouring any time of hair removal and according to that they give no recommendation regarding the timing.2
  • The CDC mentioned one study in which shaving immediately before the operation compared to shaving within 24 hours preoperatively was associated with decreased SSI rates (3.1% vs. 7.1 %); the SSI rate exceed 20% if shaving was performed > 24 hours prior to operation.1,6
Click to see full list References:

References:
1. CDC (1999) Guideline for Prevention of Surgical Site Infection. Infect Control Hosp Epidemiol. 20(4): 247–278.
2.WHO (2016) Global guidelines for the prevention of surgical site infection. World Health Organization 2016.
3.NICE (2019) Surgical site infections: prevention and treatment. NICE guidelines. Published 11 April 2019. www.nice.org.uk/guidance/ng125.
4.Calderwood MS, et al. (2023) SHEA/IDSA/APIC Practice Recommendation. Stategies to prevent surgical site infections in acute-care hospitals: 2022
Update. Infect Control Hosp Epidemiol. May 4: 1–26.
5.KRINKO (2018) Prävention postoperativer Wundinfektionen. Empfehlungen der Kommission für Krankenhaushygiene und Infektionsprävention
(KRINKO) beim Robert Koch-Institut. Bundesgesundheitsbl 61: 448–473.
6.Seropian R, Reynolds BM (1971) Wound infections after preoperative depilatory versus razor preparation. Am J Surg 121: 251–254.

In focus

Skin care

Consistent skin antisepsis of OR Team significantly reduces the risk of infection and is essential during invasive procedures.

Find out more about this aspect of infection prevention…

Double gloving

Is there evidence to formulate a clear recommendation for double gloving?

Answers to this and other questions you can find here…

Elements of standard precautions

Hand hygiene is the key measure of Elements of standard precautions. In addition to alcohol-based hand disinfection, the main infection protection measure, it comprises skin care, skin protection and skin cleansing.

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