Efficacy of Pre-Operative Hair Removal on the Day Before Surgery by Routine Razor Shaving Versus Depilatory Cream in Prevention of Post Surgical Site Infection in Patients Admitted with Inguinal hernias”- A Comparative Study at KLES Dr. Prabhakar Kore Hospital and MRC, Belgaum

Abstract

Background and objectives: Surgical wound infections are a major source of post-operative illness, accounting for approximately a quarter of all nosocomial infections resulting in longer hospitalization and higher cost of care. Previous studies taken up in the institution favouring use of intra incisional antibiotic instillation before closure of wounds suggested wound contamination as the cause of high wound infection rates. It was thought that a review of skin preparation protocol could bring about reduction in the wound contamination from the skin.Review of literature showed the changing trends in skin preparation. So evaluation of alternate methods of depilation was planned. Depilatory cream was chosen as the alternative method due to easy availability and apparent lesser cost compared to other alternative methods like clippers. The objective of this study was to compare the efficacy, safety and cost of hair removal before surgery by safety razor ( RS ) versus a depilatory cream ( DC ) , and to recognize the best technique of pre-operative hair removal and study the patients preference, operating surgeons preference and personnel ( nursing staff ) response to the two methods. X Methodology: The present study was conducted in the Department of Surgery K.L.E.S Dr. Prabhakar Kore Hospital and Medical Research Centre , Belgaum on 60 patients with inguinal hernias between March 2009 to February 2010. The patients were randomized in two groups of 30 each and they were subjected to different techniques of hair removal i.e., by razor shaving vs depilation using a depilatory cream and incidence of post-operative SSI was noted. The outcomes were categorised, tabulated and analysis was done. Also the patients and the operating surgeons satisfaction level, time and cost between two groups was evaluated. Results: There were 30 patients each in RS group and DC group. 7 patients in RS group had post-operative SSI while only one patient in DC group had post-operative SSI. Therefore post SSI was higher in RS group. Patients and surgeons satisfaction score is higher in DC group.Time required forshaving was 15.6 min while depilation took 25.1 min. Time required for hair removal is significantly higher in depilation group compared to razor shaving. Cost of hair removal in RS group was Rs 10 while the same in DC group was Rs 30. So hair removal by razor shaving was cheaper than that by depilation. Conclusion: Pre-operative hair removal by depilatory cream is superior to razor shaving in terms of safety, satisfaction and efficiency of prevention of SSI. The cost and time needed for procedure though apparently higher compared to razor shaving, is not prohibitive for implementation. It can be safely followed with prior administration of ‘skin test’ XI and patients can be depilated any time before surgery without increased risk of wound infection.