surgical prep shave vs clip???

[topkat, ADN, RN]

I work for a Neurosurgeon that has always shaved the scalp in preparation to perform a craniotomy. Our Infection Control dept. has sent an article to me regarding the controversy surrounding this...

Question: "In 1996, convinced by an operating room nurse and the literature, our cardiac sugical team abandoned the use of razors to prep patients for any procedure. At the same time, we limited the amount of hair removal to a minmum. Most surgeions, when presented with the literature (even though it may not be perfect and answer every question), do not cling to the razor prep. We instituted using clippers for all surgeries. However, the neurosurgeions want to use razors just for their craniotomy cases. They are telling me that they need to get a close shave to properly prepare the patient. Please share with me how people are dealing with this in their hospitals. Are they making exceptions and allowing razors for use on craniotomy cases?

Answer: This is a common question, but there are places that have solved it. No razors really means no razors in successful hospitals.

When one uses clippers properly, it is possible to get the same "close shave" as with a razor, but with less risk of cuts to the skin. The important thing is to ensure user training, because clippers in an untrained hand are worse than a razor.

I would suggest seeing if you can get a neurosurgeon to agree to a small test of change: test removing the hair on one patient with clippers, and see if the surgeon feels that it is acceptable."

My Neurosurgeon is not willing to change his practice. I am looking for practice guides from other Neurosurgeons. Does anyone out there have any information on this topic? articles, infection control study results, etc. thanks in advance for any help...topkat

[Marie_LPN, RN, LPN, RN]

I'll have to check with one of our neuro docs. Last year, she'd come up with an article about a study that was done in 2003 about shaving vs. clipping in various surgical specialties, and i don't recall offhand when the article was from.

We actually do either/or in each of our specialties, mainly surgeon preference. However, if a razor blade is used, it's the surgeon that shaves the site.

[augigi, CNS]

I believe the CDC site has recommendations about this (clip and not shave).

http://www.cdc.gov

[topkat, ADN, RN]

thanks augigi...I did find one article on the CDC website!!