The rules on pre-operative hair removal are fairly straightforward: Leave hair in place whenever possible, but if you need to remove hair because it might interfere at or around an incision or port site, electric or battery-operated clippers or depilatory creams are less abrasive and harming to the patient's skin than a razor is. There you have it. Here's advice on putting surgical authorities' hair removal guidelines into practice at your facility.

Razors be banned
If there's a razor hiding in a drawer at your facility, you should find it and throw it away, says the Institute for Healthcare Improvement, which has urged the prohibition of all razors at surgical facilities. Even in the gentlest hand, a sharp razor blade scraping across a patient's skin can do damage. Clinical studies have shown the practice can cause micro-abrasions in the surface, creating a portal of entry for bacteria residing on the skin and thus increasing the risk of surgical site infection.

Some patients shave their surgical sites at home in advance of a procedure, believing it to be necessary and expected. This is a no-no. Tell them in pre-op materials and phone calls not to shave on or near the sites and to leave hair removal to your staff. And you should also educate surgeons who still request patients be razor-shaved on the need for patient safety.

Clippers, the safer and faster option
From AORN to the Centers for Disease Control and Prevention, most authorities favor clippers as a safer option than razors for pre-op hair removal. Clippers have fine teeth that cut the hair extremely close to the skin, leaving very short stubble and intact skin with less of a risk of micro-abrasions and SSIs. They're also quicker to use than a razor. However, you can scrape or break the skin if you clip too aggressively or press too hard. Just as you include proper pre-op skin prepping in new employee orientation, you should teach the proper use of clippers to all incoming staff.

Depilatory creams are another acceptable method of hair removal, though they're not the preferred method in many surgical facilities. A chemical that dissolves a patient's hair also runs the unpredictable risk of irritating his skin, a reaction that may end up leading a surgeon to cancel a case.

When to clip?
When does a surgery require hair removal? The decision — and it's almost always the surgeon's request — will be based on the type of procedure, the location of the incision and the amount of hair there. General abdominal surgery on male patients, whether open or laparoscopic, most often requires clipping, as do knee and other orthopedic procedures and spine cases, even if there isn't much visible hair. On the other hand, women's abdominal cases don't usually require hair removal, nor do pediatric ENT surgeries or natural orifice cases.

Hair removal, when requested, should be undertaken immediately before surgery. The question of where to remove hair is also often a physician's preference. In laparoscopic procedures, for instance, some request clipping just around the port sites, while others request a wider area of the abdomen clipped.

Hair removal tips
Here are some pearls to make the job easier.

• Use water. Wetting the hair before clipping it can make it easier to clean up.
• Use surgical tape to collect loose hair. Alternatively, 1 surgical staffer can operate the clippers while another taps at the patient and drape with a piece of surgical tape, lint-roller-style, to pick up the hair, as we do to collect the loose hair.
• Use a dab of petroleum jelly. When preparing for head or neck surgery, petroleum jelly can be used to slick the unremoved hair back from the incision site.
• In holding or the OR? Hair removal can be done either in the pre-op holding area or the OR. We prepare all of our patients in the OR except for those undergoing orthopedic surgeries. Since orthopedic cases can encompass larger areas of the anatomy than other procedures, and since the potential for complications could be more devastating for orthopedic patients, they're clipped ahead of time in pre-op in order to save time and ensure the site is prepped effectively.
• Find the right clippers. Look for surgical clippers that not only operate safely, without compromising skin integrity, but also effectively, clipping quickly and leaving a minimum of stubble. Trial the products you're considering to ensure they deliver suitable results. A clipper with single-use, disposable heads is ideal from an infection prevention standpoint. After the head is used, you deposit it in a sharps container with no concerns of cross-contamination between patients. Once the clipper head is removed, the handle should be easy to clean for reuse. A fully submersible handle would allow thorough disinfection between cases and also let you clip hair whether it's wet or dry. While reusable heads that you can disinfect between patients are available, and while reprocessing the heads may prove more economical than disposing of them after 1 use, it's possible that they'd dull over time and wouldn't remove hair as neatly.