Minimizing hair dispersal: an opportunity for improvement in HAI prevention?
The Surgical site hair (SSH) is perceived to be lack of cleanliness. To minimize airborne hair dispersal as the possible contaminants of the operative field, the current evidences suggest to only remove SSH when necessary, use clipping instead of shaving to remove SSH and clip outside of operation room (OR). The major hospital acquired infection (HAI) prevention organizations such as CDC, AORN and SHEA have all recommended those practices. However, little evidence exists to measure the current compliance rate of the recommendations for hair dispersal minimization.
An online national survey was conducted in April 2015 among 2500 AORN members. The members were randomly selected from the 40,000 AORN member databases of either operating room staff nurses or nurse managers. The data was collected from the first 250 respondents who have at least 2 years' OR experience and 2 surgical site hair (SSH) collection completions in 10 day prior survey date.
The compliance rates of using clipping method and clipping use single use clip head are 98% and 96% respectively. However, only 40% of SSH removals are done outside OR (Fig 1). When SSH removed inside OR, only half of respondents thought that most (>=90%) of the clipped loose hair were collected (Fig 2). The “complete removal of the clipped loose hair” is believed by the clinicians as important as the “control and limit OR traffic” in improving surgical outcome (Fig 3).
To our knowledge, this is the first report on the SSH removal compliance rate. Although it is unknown for specific infection risk factors represented by hair disperse, techniques of minimizing the hair disperse such as performing outside OR and complete cleanup of the clipped loose hair are recommended. However, such recommendations are not well followed in the practice. While the complete cleanup of the clipped hair is perceived as important as the control/limit OR traffic (which is often used in the bundled interventions with proven success), there are few studies explored the benefit of minimizing hair dispersal as part of intervention. Our findings revealed a potential improvement opportunity in HAI prevention by minimizing hair dispersal with better cleanup of clipped loose hair and/or removing SSH outside OR.