Evidence based practice and applied nursing research encompasses selecting a perioperative procedure such as routine shaving of a surgical site which is something you would commonly find on a surgical floor. The process of shaving a perioperative site includes cleansing and shaving the site that is to be operated on. Clipping the surgical site of hair is more appropriate because it would decrease the likelihood of surgical site infection. Gregory P Nowinski noted in his article the following:
“ An alternative to using razors is powered surgical clippers. Clippers mechanically trim the hair close to the skin, effectively removing it from the field, and avoid the skin trauma caused by the sharp blade of a razor. A study of open heart surgery patients showed a significant decrease in deep infections in individuals whose hair was removed by clippers compared to those whose hair removal was done with a razor” (Nowinski,2008). Doctor’s and hospital administration determined the best practice for removing the hair from the surgical site.
This would remove the hair completely and all the germs contained in the hair in the hopes it would lead to less infection for the surgery. The rationale for making the decision was based on the knowledge that hair carries a number of germs that could easily infect the site. It also increased visibility of the surgical site making the surgical procedure a smoother adverse free operation. The clinical implications of shaving rather than clipping the site after review of the literature shows that shaving often leads to open areas and ingrown hair which causes surgical site infections.
Clipping the hair however does not damage the skin opening it up for infection and also allows the removal of the hair so that germs from the hair do not enter the surgical site as well as giving the surgeon a better view of the site unobstructed by hair. There are specific guidelines when performing a preoperative procedure checklist including a protocol written by the foot and ankle center: “ Do not shave the surgical area for a minimum of 3 days prior to surgery.
Shaving can cause nicks, cuts and abrasions in the skin, allowing bacteria to enter, increasing the risk of infection. ”(Foot & Ankle Center,2012) The best method of preparing a surgical site for pre operative procedure is to clip the hair rather than shave it. In an article written by David E. Reichman MD and James A. Greenberg MD posted on the internet, http://www. ncbi. nlm. nih. gov/pmc/articles/PMC2812878/ “Studies have shown that shaving the skin as compared with clipping results in a statistically significant increase in the rate of surgical site infection.
Shaving results in microscopic cuts and abrasions, thus acting as a disruption of the skin’s barrier defense against microorganism colonization. Clippers, when used correctly, should not cut into the patient’s skin, potentially explaining the differences in infection” (Greenberg & Reichman, 2009) It is more cost effective because the tools used for clipping could be sterilized and reused while the shaving equipment must be thrown away and also requires cream or moisturizer of some type while shaving does not.
In an effort to involve key stakeholders in the decision to change this procedure or comply with the proposed change a meeting could be held. A report could be drafted showing the evidence based research that clipping causes less infection. But research suggests that shaving a patient’s skin before surgery may raise the risk of an infection. In an article written by Kelly M Pyrek it is stated:
“ A recent OR Manager survey revealed more than half of the respondents said surgeons at their hospitals are still using razors for preoperative hair removal, despite a growing body of research proving that it is unnecessary and perhaps even detrimental. ”(Pyrek,2002) In the meeting the cost effectiveness could be brought to the attention of the stakeholders that the CDC had this to report: “surgical site infections are a leading cause of complications among hospital patients, accounting for nearly one out of five health care-associated infections and thousands of deaths annually” (O’Connor, 2012).
It would be necessary to gather the support of medical personnel such as medical directors, doctors, surgeons and other ancillary staff that not only perform the procedure but provide care to the patients who remain in the hospital longer and receive extra antibiotics to clear up the infection due to shaving instead of clipping. There would be many difficulties in translating the research identified into practice.
These include authorization from appropriate personnel who have the power to make the decision to change and to be sure that it is the right decision. There must be substantial evidence to support that the new theory is correct and will produce the most optimal patient outcome. Training sessions would have to be implemented to teach staff the new proper technique. Protocols would have to be written and followed. Staff would have to be hired and trained to train the current personnel.
The new equipment would have to be ordered and supplied and function properly from a reputable company. Several barriers may prevent the change. The hospital may be under budget and not able to buy equipment needed to perform the procedure properly. Some surgeons set in their ways may not be easily persuaded into changing the way they have always done their procedure. Hospital administration might not feel the benefits outweigh the cost or the risk to the patient.
There are at least two strategies to overcome these barriers to change. The first is to educate as many people as possible about why this clipping is better that shaving using evidence based research to show that studies have determined better patient out comes and even provide surveys or reports from other hospitals that have initiated the new protocol and have had better results and better patient outcomes because of the change.
The second would be to show the administration the proof of cost effectiveness which are people spend less days in the hospital, need less antibiotics, the instruments do not have to be discarded and there fore the money saved would be very practical and could be put to better use in furthering education and improving the facility in other ways. There are several ways to apply the findings and guide the implementation of improvements to the procedure. Produce trial based experimental evidence that is reproducible to show that the hospital could start initiating the practice and begin to see improvement.
Another way to apply the findings and guide implementation would be to have power points during meetings regularly scheduled for doctors and administrative personnel to attend and create protocols and booklets or handouts with the information to encourage application of the new procedure. Reference List: ORIGINAL: David E Reichman and James A. Greenberg. (fall 2009). http://www. ncbi. nlm. nih. gov/pmc/articles/PMC2812878 APA EXAMPLE: Arnold, A. , & Carrington, C. (2011). Welcome to education: A reality check for new college students. Education Today, 76(9), 178-205.
Retrieved from http://www. educationtoday. com REVISED: Reichman, D. & Greenberg, J. (2009). Reducing Surgical Site Infections: A Review. Obstetrics & Gynecology, 2(4): 212–221. Retrieved from http://www. ncbi. nlm. nih. gov/pmc/articles/PMC2812878/ Nowinski,G (May 2008). Don’t Shave Unless You Have To. American Academy of Orthopoedic Surgeons. Retrieved from http://www. aaos. org/news/aaosnow/may08/clinical9. asp Original: Anahad O’Connor. (June 4, 2012). http://well. blogs. nytimes. com/2012/06/04/really-always-[->0]shave-the-patient-before-surgery/ APA Example:
Newspaper Article Author, A. A. (Year, Month Day). Title of article. Title of Newspaper. Retrieved from http://www. someaddress. com/full/url/ Parker-Pope, T. (2008, May 6). Psychiatry handbook linked to drug industry. The New York Times. Retrieved from http://well. blogs. nytimes. com Revised: O’Conner, A. (2012, June 4). Really? Always Shave the Patient Before Surgery. The New York Times. Retrieved from http://well. blogs. nytimes. com/2012/06/04/really-always- Pyrek,K. (2002, March 1). Pre-Op Prep Should Safeguard Skin Integrity.
Infection ControlToday. Retrievedfrom. http://www. infectioncontroltoday. com/articles/2002/03/pre-op-prep-should-safeguard-skin-integrity. aspx Original: The Foot and Ankle Center. (2012). http://www. efahc. com/docs/Guidelines_for_Presurgical_wash. pdf APA Example: PDF Files Article [PDF]. (Year). Retrieved from www. url. pdf Revised: The Foot and Ankle Center. [PDF] (2012). Retrieved from http://www. efahc. com/docs/Guidelines_for_Presurgical_wash. pdf (“The Foot,” 2012) [->0] – http://well. blogs. nytimes. com/2012/06/.