ROUTINE SHAVING OF THE SURGICAL SITE

Routine Shaving of the Surgical Site

Routine Shaving of the Surgical Site

Introduction

Surgical site infections account for 25% of nosocomial infections, thus constituting a serious health problem, and that are associated with high morbidity and increased hospital costs, both for the extension of stay as the need for drugs and high-cost inputs, such as next-generation antibiotics and broad spectrum. Hence the importance of knowing the basic principles that should be considered in the preparation of a patient who will undergo surgery (www.medscape.com).

The association between the presurgical shaving of the incision site and postsurgical infection has been investigated over the last 3 decades, and the results of that research differ greatly from the general consensus among medical professionals (www2.cochrane.org).

Risk factors for surgical wound infection and preventive measures

Although there are many factors associated with increased risk for postoperative wound infection such as malignancy, steroid alcohol usage, nutrition, and smoking, those risk factors of both groups were similar. In our study, the infection rate was higher in the shaved group. Those results suggest that shaving the incision site may not be necessary before spinal surgery and that presurgical shaving may indeed increase the postsurgical infection rate (www.medscape.com).

Although we found a higher incidence of complex spinal operations in the non-shaved group, the reduced infection rate in those patients added significance to the overall findings of our investigation. Shaving performed in the operating room inflicts micro trauma on the skin at the incision site and damages hair follicles just before surgery, and those effects render the area susceptible to colonization by infectious organisms. Other studies have also shown that shaving can increase the risk of infection (www2.cochrane.org).

Perioperative transfusion: the recommendation category 1 B, states that surgical patients should receive blood products only necessary to prevent surgical site infection. It is said that the fact of prior whole blood transfusion or some of its components would favor surgical site infections, but this has not been verified.

Antimicrobial prophylaxis

Antimicrobial surgical prophylaxis is to administer antibiotics, usually given intravenously before surgery begins, in order that the drug acts at the critical time to reduce the microbial load that occurs during intraoperative contamination. The greatest risk of contamination occurs when the incision is made so that at the time the antimicrobial must achieve a bactericidal plasma levels without exceeding the host's defenses (www.medscape.com). To get the most benefit from this resource should be used in patients who really is justified, so the use of certain antibiotics should be supported by studies demonstrating its effectiveness in reducing the rate of surgical site infections. Can also be used, although there is no clear evidence to support their use in situations where the infection would be catastrophic, for example, after the installation of a hip or valve.

Preoperative skin preparation

Clean the skin: the operative site must be free of dirt and detritus, since there are located bacteria endogenous skin flora such as staphylococci, which are the main causes of surgical wound ...