Evaluation of Preoperative Hair Removal and its Relationship with Postoperative Wound Infection at a Tertiary Health Facility in North-eastern Nigeria

Abstract

BACKGROUND: The general surgery unit of Federal Teaching Hospital Gombe performs several surgeries via the hair bearing areas. A pilot study by the unit on the incidence of SSI for all clean surgeries showed an alarming forty- six percent. (38) The reported infection rate for such infection is <2% by CDC standard. This study was done to probe the role of preoperative hair removal in such high infection rate. OBJECTIVES: the study aimed to determine the relative postoperative wound infection rates of Razor blade shaving and cream depilation.  It also assessed the adequacy of hair removal by both methods and the type of skin injuries or reactions that follow each method METHODS: a prospective, cross-sectional, double-blinded study was done between July 1st to December 31st 2016 on 98 patients that met the inclusion criteria and randomized by balloting. BIC shaving stick produced by BIC SOCIETE, FRANCE and VEETO CREAM(thioglycollate) produced by RECKIT BENCKISER, were used for preoperative hair removal. Adequacy of hair removal, post shaving skin injuries and reactions were assessed preoperatively by research assistants. Post-operative wounds were graded using the Southampton wound scoring system for SSI. Data obtained was analyzed with SPSS software version 20.0 and statistical relationships were assessed using Chi-square. RESULTS: a total of 98 patients were recruited for the study. 53(54.1%) were males and 45(45.9%) were females. The mean age was 45.99(+ 12.522) with a range of 16-76 years. Majority (88.8%) had open repair of abdominal wall hernia, followed by Scalp lipoma (6.1%), groin lipoma (3.1%) scalp osteoma and superficial Parotidectomy (1%) each. 57(58.2%) had razor blade shaving and 41(41.8%) had cream depilation. 91(92.9%) had adequate hair removal considering both methods. Depilatory cream use is however, more effective, with (97.6%) adequacy. Razor blade shaving recorded (89.5%) adequacy. Out of the patients, only 4(4.1%) had skin injuries and all are in the razor blade group. Depilatory cream use caused more skin reactions (7.3%) compared to razor blade use (1.8%). 6(6.1%) of all the patients developed SSI and 5(83.3%) (x2 1.6662) are in the razor blade group. Majority of the postoperative wounds (83.3%) are Southampton class A &B. 16.7% is class C  CONCLUSION: preoperative hair removal using razor blade or cream depilation is associated with postoperative wound infection (6.1%). Razor blade shaving is how ever more prone to postoperative wound infection, although, the difference in the infection rate is not statistically significant (p-value 0.197). Preoperative cream depilation is more efficient and safer. LIMITATIONS: The sample size is rather small, as only patients presenting at the general surgery unit were recruited. This limited the scope of subjects that were    assessed, as other units in the surgery department also operate in hair bearing areas. Multiple nurses were involved in the razor blade shaving and cream application, inter-personal differences in technique may affect the outcome in terms of skin injury. Subjective method of direct visual assessment of skin injury was resulting in missing non obvious skin injuries. The use of electron viewing microscope would have improved the discovery of such injuries