Perioperative Procedures Around the World

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Introduction

Surgical procedures are quite common in most health centers. This is based on the fact that some health complications are well-corrected through surgical means. Additionally, advancement in knowledge and medical technology has significantly augmented the adoption of operative procedures to correct medical problems among patients. While this is a common and an effective way of handling such problems, it might lead to other infections if preoperative procedures are not performed accordingly (Tanner, Norrie & Melen, 2011). This research paper focuses on the concept of preoperative procedures, which are widely used by medical practitioners around the world.

Preoperative procedure

Surgery is a very important procedure in medicine. Whilst a lot of attention is mainly accorded the actual technical process performed by surgeons, there are several essential stages, which a patient undergoes before the operation is done. These preoperative preparations are quiet important in facilitating the process and preventing infections that arise from improper procedures (Tanner, Norrie & Melen, 2011). Traditionally, preparation of patients for surgical processes mainly included the removal of hair, covering the area to be operated. Although there could be other methods of achieving this, hair removal has dominated the field.

There is always the need for shaving, since the presence of hair may affect the entire process and lead to aftermath infections. For instance, the presence of hair is known to affect the visibility and exposure of the incision. Additionally, its presence may affect the wound created after surgery, stitching and application of chemicals for quick recovery and during dressing. Besides these implications, it is believed that hair is commonly associated with insufficient cleanliness and hair removal is considered to be one of the ways of preventing surgical site infections. Importantly, other schools of thought argue that some preoperative processes like hair removal lead to surgical site infections (Dellinger et al., 2005).

Abbreviated as SSI, surgical site infections generally encompass deep or superficial incisional. The presence of an infection is always characterized by redness, tenderness or pain, among other signs. According to the Center for Disease Control, these can be observed physically or diagnosed through laboratory testing. It further notes that approximately 10% of patients in the United Kingdom suffer from these infections annually (Dellinger et al., 2005). The survey found that SSIs may result into delayed healing of wounds, higher levels of hospital stays and death in extreme cases.

Old practice

One important fact is that there were a variety of infections related to surgical procedures before the end of 19^th century. Some of the infections were highly fatal during any major operation in hospitals around the world. Credit has always been given to Joseph Lister, who contributed to the understanding of major infections, which were as a result of surgical procedures performed by medical experts (Clinical Update, 2008). His input influenced most surgeons and other medical experts to appreciate the need for safe operations to minimize cases of such avoidable health complications.

He carried out a survey in 1865 on surgical infections based on Pasteur’s germ theory, which had been published in1857. During the survey, it was hypothesized that tiny bacteria in the environment were responsible of infections in case they gained access to body tissues via broken skin. As a result, it was concluded that measures were needed to prevent entry of these pathogens into the body before and after a surgical process. Additionally, it was necessary to limit the spread of micro-organisms to other parts of the body. These surgical principals have continually been observed to-date. Despite Lister’s contribution and other medical advances, which followed, surgical site infections remain a major cause of concern (Clinical Update, 2008).

Preoperative hair removal

Although it is not precisely known when doctors and other medical practitioners adopted hair removal on surgical sites, many believe that this was highly appreciated in the 20^th century. Removal of hair was traditionally carried out to allow stitching of wounds, easy access to the site, accurate estimation of edges, and proper bandaging of the wound (Small, 1996). The commonest method of hair removal, which was applied, was traditional shaving. This was carried out at an appropriate time before the patient was allowed into the operating room. Due to advancement in technology, there have been other methods of hair removal, including use of depilatory creams and clipping. Besides this, research has indicated that hair removal is unnecessary especially when wound asepsis is to be carried out, because of possible harm associated with it.

Literature review

As mentioned before, there are three methods of hair removal, which are commonly applied today. These include shaving, chemical depilation and clipping. While shaving is considered as the commonest method applied, it is believed that there are several factors, which contribute to this trend. For example, shaving is quite affordable. It can therefore be used across people from various social classes. It is also simple and lacks the need for technical skills as required by other methods of hair removal. It also uses simple equipment like razor blades, whose cost is highly affordable (Small, 1996).

The head of the razor ensures that the blades are held in good position to allow proper shaving, without harming the skin. On the other hand, hair clipping makes use of clippers, which are fitted with fine teeth, to cut hair close to the surface of the skin. The effect of this method is a stubble, which is approximately one millimeter long. It is worth noting that the heads of the clippers used can be reused by disinfection in between patients or disposed immediately to prevent the risk of cross-infection among patients (Taylor & Tanner, 2005).

Apart from the above mechanical methods, hair can also be removed by use of chemicals referred to as depilatory chemicals. Their mode of action is that they dissolve the hair, leaving the surgical site clean. This method is practically slow compared to clipping and shaving since the cream is allowed to remain at the site for a t least five minutes and a maximum of twenty minutes (Taylor & Tanner, 2005). Besides this, there is the likelihood of some patients being allergic to the chemical used. The chemical also causes the risk of irritation at the place of application. As a result, it is recommended to carry out patch tests for such possibilities, twenty-four hours before the cream is applied.

Unlike shaving chemicals, clipping and shaving can be done at home, in wards or even in surgical theaters by people with relevant skills. On the other hand, application of depilation chemicals is mainly done at home since its action takes long. Even though hair removal can be done from the surgical room, this is highly discouraged because loose hair can contaminate the sterile surgical environment (Tanner, Moncaster & Woodings, 2007). Moreover, preoperative removal of hair needs to be done by a skilled person to prevent skin abrasions, which may lead to infections.

One obvious thing about shaving is the fact that it leads to tiny cuts and abrasions. These are believed to be entry points for bacteria and other disease-causing micro-organisms. This exposes patients to contracting postoperative wound infections. In addition, abrasions may contribute to oozing of exudates, which provide a convenient medium for the multiplication of pathogens (Tanner, Moncaster & Woodings, 2007). Clippers are considered to be safer as compared to depilatory chemicals and shaving, since clippers do not get in contact with the skin.

Recommended practices

Hair can be removed by use of various methods, which are commonly applied around the world. For instance, the Center for Disease Controls discourages the removal of hair on the surgical site, unless the hair affects the efficacy of the operation (Tanner, Moncaster & Woodings, 2007). However, this view is contradicted by the Norwegian Centre for Health Technology Assessment, which strongly supports preoperative removal of hair. According to this organization, there exists no evidence that supports or condemns removal of hair on surgical sites prior to the operation. The Hospital Infection Society Working Party does not support the removal of hair before an operation is done.

If hair removal has to be done before an operation is carried out, the above mentioned organizations recommend that alternative methods be adopted to reduce the exposure of patients to other infections. For example, CDC recommends the immediate removal of hair using clippers, the Norwegian Centre for Health Technology Assessment recommends the use of clippers or creams as close to the surgical areas as possible and the Hospital Infection Society Working Party guidelines recommend the use of chemical creams, twenty-four hours prior to the operation day (Bratzler & Hunt, 2006).

Surgical Site Infections

SIS is a common healthcare problem in the world today. In a survey conducted in 2006 in the United Kingdom, 4.6% of patients who underwent surgical procedures developed SSIs (Stoessel, 2008). This is definitely a major problem since such infections result into delay in the healing of wounds and are expensive to the National Health Society. The survey further indicated that SSIs result into congestion of patients in hospitals since most of them have to spend more days in hospital. This has a direct impact on the country’s economy as more money is used to support such cases. Another important concern about SSI is the extent to which they affect patients.

It has been found that patients who develop SSI are more likely to succumb to their illness and are five times more likely to suffer from a disease that would require admission in hospital. Additionally, these patients are prone to physical suffering (Tanner & Khan, 2008).

While there is evidence showing the effects of SSI, it is believed that existing findings might be underestimating the problem due to the fact that surgical site investigations are given minimum attention compared to other health complications affecting people in most parts of the world. Consequently, it is essential to understand some of the factors, which contribute to unreliable SSI surveillance. The first explanation is lack of organized survey programs. Many leaders and stakeholders have not laid down proper structures to address the issue of SSI through empirical analysis. Additionally, it is believed that most surveyors lean on a wrong definition of SSI.

As a result, the findings upon which conclusions are drawn do not reflect the situation in different parts of the world (Tanner & Khan, 2008). Lastly, follow-up on patients who have recovered from a surgery is never effective. It is recommended for medical practitioners to find out the health status of a patient, thirty days after being discharged from the hospital or a year if the patient underwent organ transplant.

Risk factors

Like in other infections, there are factors which increase the chances of a person developing SSIs. These factors are classified into different groups: those linked to the surgical procedure, aesthetic and those related to the patient. Importantly, they affect the patient’s exposure to bacteria and his or her ability to fight pathogens (Stoessel, 2008). On the other hand, the CDC classifies surgical operations depending on their infection risk. In general, SSIs are likely to occur in contaminated and dirty surgery environments than in places where surgery is carried out under sterile conditions. This is based on the fact that the body might contain several bacteria in the digestive system, genital and urinary tract.

Clinical implications

Surgical site infections resulting from preoperative removal of hair have several implications in the medical industry. These emanate from exposure of patients, which may lead to other infections. When patients contract new infections, the cost and duration spent in the hospital may widely differ, depending on the impact of the postoperative infection. On average, these patients spent approximately seven more days in the hospital, causing congestion and competition for resources. Due to these conditions, patients are likely to suffer a lot because of limited resources and attention from medical practitioners. It is therefore clear that surgical site infections have an array of implications (Dizer, 2009).

In dealing with SSIs, most hospitals are advised to improve their hair removal techniques, which cause minimal abrasions and do not expose other people to contracting infections. To achieve this, stakeholders need to acquire better equipment, which are recommended by experts in the field. Apart from acquisition of equipment, training of nurses and other medical practitioners is necessary. Lastly, there is need for sterile and healthy conditions during preoperative procedures (Dizer, 2009). Training would ensure that all the processes meet minimum requirements to prevent the occurrence of surgical site infections. Nevertheless, these developments are necessary in ensuring that patients who undergo surgeries do not pass on because of infections, which are caused by contaminated surgical rooms.

How to improve the procedure

According to the CDC, there is need for healthy preoperative strategies in order to prevent the occurrence of SSIs among patients across the world. For example, effective surgical equipment are essential for the purpose of maintaining the body’s homeostasis and removal of unwanted body tissues and foreign materials as far as possible (Dizer, 2009). Moreover use of sterile drapes, gloves, gowns, caps and facemasks are highly recommended to avoid contamination of the wound.

This minimizes the transmission of pathogens like bacteria in the body through the wound. Sterilization of surgical equipment is equally important in improving the entire process of minimizing the survival chances of pathogens. Besides sterilization and cleanliness, it is paramount to note that some pathogens may remain active at the site even after a thorough process of sterilization. As a result, the use of emerging technologies is important to overcome the challenge of stubborn microorganisms. A good example of this technology is the use of microbial sealants, which lower the likelihood of getting infected by such pathogens (Mangram et al., 1999).

Involvement of stakeholders

In order to realize healthy preoperative procedures and safe operative processes in medical facilities, there is need to involve every stakeholder in the entire process. While doctors and other medical practitioners may hold high responsibility in determining the safety of these processes, all organs have to be consulted (Mangram et al., 1999). For example, the use of sterilizers, good shaving chemicals and proper hair clippers require the input of the government and other donors. This would ensure that the equipment, which are bought meet the required standards. Good chemicals and shaving equipment will minimize abrasions on the skin during preoperative procedures.

Additionally, the involvement of all stakeholders would be appropriate for support. In cases where training of medical practitioners and the public require education on perioperative procedures, it would be easy to implement if every stakeholder is involved. Importantly, stakeholders would need to be convinced in order to ratify change of these procedures. To achieve this, it is essential to let everyone understand the negative effects of existing procedures as compared to benefits of adoption of preoperative and postoperative procedures, which limit the exposure of patients to SSIs (Mangram et al., 1999).

Barriers

There are several barriers and challenges, which are likely to be encountered during the implementation of Evidence-Based Practice. One of these factors is insufficient resources. It is worth noting that these resources include assets and human resources. As mentioned before, perioperative procedures need to be done skillfully in a sterilized environment (Thompson et al., 2005). As an important stage before a surgical procedure, effective equipment and chemicals are quite significant. This ensures that the process does not expose patients to being affected by the nature and status of the equipment used.

Besides the facilities, qualified manpower is necessary. Training of medical practitioners is essential in ensuring that they are equipped with professional skills and knowledge, necessary to lower the prevalence of SSI. Lack of knowledge within the public domain may also be an impediment towards the implementation of safe perioperative procedures (Thompson et al., 2005). Many people do not understand the importance of professional removal of hair before an operation is carried out. In order to tame this situation, there is need for massive public education on issues, which have constantly been ignored. Poor survey on SSIs is also a major barrier towards this change. Most research findings are no reliable, thus affecting the entire process of change.

Conclusion

Perioperative procedure is quite essential in the entire field of surgery. This is based on the fact that most surgeries involve breaking of the skin, which is covered by hair. The removal of this hair is sensitive since it may allow pathogens into the body as a result of abrasions caused on the skin, either by depilatory chemicals or shaving blades. Improper removal of hair causes SSIs, which may be fatal or lead to increase in treatment cost. There is need for all stakeholders to be involved in promoting safe and healthy preoperative procedures.

References

Bratzler, D., & Hunt, D. (2006). The Surgical Infection Prevention and Surgical Care Improvement Projects: National Initiatives to Improve Outcomes for Patients Having Surgery. Infectious Diseases Society of America, 43, 322-330.

Clinical Update. (2008). Pre-operative hair removal to reduce surgical site infection. Australian Nursing Journal, 15 (7), 27-29.

Dellinger et al. (2005). Hospitals collaborate to decrease surgical site infections. The American Journal of Surgery, 190, 9–15.

Dizer, B. (2009). The effect of nurse-performed preoperative skin preparation on postoperative surgical site infections in abdominal surgery. Journal of Clinical Nursing, 18, 3325–3332.

Mangram et al. (1999). Guideline for prevention of Surgical Site Infection. Infection Control and Hospital Epidemiology, 20 (4), 247-278.

Small, S. (1996). Preoperative hair removal: a case report with implications for nursing. Journal of Clinical Nursing, 5, 79-84.

Stoessel, O. (2008). Surgical site infections: epidemiology, microbiology and prevention. Journal of Hospital Infection, 70 (2), 3–10.

Tanner, J., & Khan, T. (2008). Surgical Site Infection, Zone preoperative body Washing and hair removal. Journal of Perioperative Practice, 18 (6), 232-241.

Tanner, J., Moncaster, K., & Woodings, D. (2007). Preoperative hair removal: a systematic review. Journal of Perioperative Practice, 17 (3), 118-132.

Tanner, J., Norrie, P., & Melen, K. (2011). Preoperative hair removal to reduce surgical site infection. Cochrane Database System Review, (11), 1-50.

Taylor, T., & Tanner, J. (2005). Razors versus clippers. British Journal of Perioperative Nursing, 15 (12), 518-523.

Thompson et al. (2005). Barriers to evidence-based practice in primary care nursing – why viewing decision-making as context is helpful. Journal of Advanced Nursing, 52 (4), 432–444.

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