The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [601]
Research from one systematic review found that the surgical site infection rates amongst patients who had hair removed prior to surgery and those who had not were not significantly different (Tanner et al. 2006). However, if hair will interfere with the surgical procedure and removal is essential then the following best practice is advised.
Hair removal should be done on the day of surgery, in a location outside the operating room such as the anaesthetic room or ward. Rationale: prevents infection risk in operating room (Kjonniksen et al. 2002, Murkin 2009).
Only hair interfering with the surgical procedure should be removed (Murkin 2009). Rationale: to prevent unnecessary trauma or visible difference for the patient.
Depilation creams or clipping should be used to remove hair instead of shaving. Rationale: causes fewer SSIs than shaving (JBI 2008).
If clipping is used then the clipper should be single-use electric or battery operated, or a clipper with a reusable head that can be disinfected between patients. Rationale: prevents cross-infection (AORN 2008).
If using clippers it is recommended to do this on the day of surgery. Rationale: fewer SSIs (JBI 2008).
Marking skin for surgery
It may be that the surgeon needs to mark an area of the body for surgery. This is normally a limb to be operated on or the position of an organ such as a specific kidney in a patient undergoing a nephrectomy. The marking should be undertaken by the surgeon performing the operation or a deputy who will be present at the surgery, using an indelible pen, to ensure the correct site is marked and this should be checked against the patient’s consent form (Haynes et al. 2009).
There are some situations in which a specialist nurse may mark the skin. Stoma therapists mark the position on the patient’s skin which is the optimum place for the stoma to be placed (see Chapter 6 for further information).
Preoperative pregnancy testing
A review of the literature regarding the concerns that surgery and anaesthesia can cause congenital abnormalities or spontaneous abortion during the early gestation period has shown that there is no increase in the rate of congenital defects (Allaert et al. 2007). However, there is an increased risk of spontaneously aborting the foetus when undertaking surgery during the first trimester of pregnancy. It is possible that this is affected by surgical manipulation and the patient’s underlying medical condition rather than exposure to anaesthesia (Allaert et al. 2007, Kuczkowski 2004).
Recent guidelines suggest that all women who are able to bear children should undergo pregnancy testing preoperatively to rule out this possibility (NPSA 2010). Local procedures and guidelines should be followed to ensure that the possibility of this is excluded, and that all patients have provided informed consent prior to the test being carried out. (NPSA 2010).
Prevention of toxic shock syndrome from tampon use
Toxic shock syndrome (TSS) is a rare, life-threatening bacterial infection. It happens when the bacteria Staphylococcus aureus and Streptococcus pyogenes, which normally live harmlessly on the skin, enter the body’s bloodstream and produce poisonous toxins. These toxins cause severe vasodilation which in turn causes a large drop in blood pressure (shock), resulting in dizziness and confusion. They also begin to damage tissue, including skin and organs, and can disturb many vital organ functions. If TSS is left untreated, the combination of shock and organ damage can result in death.
Female patients of menstruating age therefore need to be made aware of the dangers of using tampons which can cause infection leading to toxic shock syndrome.