Preoperative Procedures

Contents

TOC o “1-3” h z u Introduction PAGEREF _Toc380753116 h 1The procedure PAGEREF _Toc380753117 h 1The basis of the practice PAGEREF _Toc380753118 h 1Rationale for decision on procedure PAGEREF _Toc380753119 h 2Clinical implications of the procedure PAGEREF _Toc380753120 h 2

IntroductionPreoperative procedures involve the care that is given to a patient before, during, and after a surgical process. The aim of the procedures is to provide better conditions for surgical patients prior to the operation, during the operation and after the operation. Some of the preoperative procedures, which are conducted in the surgical floor, are questionable (Rosdahl & Kowalski, 2012). In fact, one is left to wonder if some of the procedures have a basis in research. This paper will look at the basis of one of some of these procedures, make suggestions on the relevant changes that ought to be implemented them and identify barriers that might arise when it comes to the implementation of the revised clinical practice guidelines.

The procedureAmong the preoperative procedures that are questionable is the shaving of areas where to make the incisions of surgery. Shaving is a routine procedure that the majority of the surgeons worldwide use before an operation. The shaving can be done just before one goes to surgery or a day before. The hair removal procedure is done in different ways including the use of clippers, razor blades for shaving, electric shavers and hair dissolving creams to remove hairs that might be present on the area where an incision has to be made. Before shaving, several pre-surgical skin preparations are done. They include full body wash with povidone-iodine or chlorhexidine.

The basis of the practiceThe practice is acceptable by surgeons worldwide and they consider it mandatory. The hospital management and doctors also fall in this category. Therefore, the entire management of the hospital is the one that determines the basis for the procedure since all their colleagues in other hospitals worldwide use it.

Rationale for decision on procedureShaving is believed to lower infection risk at the site of incision, this is not always the case. Shaving is also intended to remove anything that might obstruct a surgeon from viewing area of incision. Therefore, it enables the surgeons to access the incision site or area. Some surgeons believe that shaving is a way of removing bacteria found on the surgical area, which could otherwise cause contamination of the surgical area (Celik & Kara, 2007). The other rationale is the belief that procedure leads to reducing infections on wounds, increasing in exposing of the sites of surgery and also because it helps when the area is being dressed and closed. It is also seen that in cases where there is need of applying lads on a patient’s skin removing hair is a necessity. If hair is present, then it means that there can be no way that the leads can reach the incision area (Celik & Kara, 2007).

Clinical implications of the procedureResearch has shown that the shaving of hair before surgery raises the risk of infection of the area after the surgery. Intensive antibacterial handling that is done before the shaving of the area can cause the disruption of the healthy skin flora, enabling pathogenic agents to colonize the area (Celik & Kara, 2007). The alteration of flora found on the skin as a result of shaving is also tied with the increase of bacteria growth which will lead to infection. The surgical site infections increase complications in patients, and they account for the majority of the infections associated with health-care and eventual death of patients. This therefore, shows that the procedure is quite inappropriate. Therefore there is an implication that the shaving procedures done before an operation should be transformed particularly in areas that involve the actual hair removal process. Threat to infection is seen to increase as the length of time between shaving and the actual surgery increases (Celik & Kara, 2007). Shaving done in the operating room inflicts micro trauma on a patient’s skin at the site of incision. Besides, it damages hair follicles that are located on the site before surgery. Hence, the area becomes susceptible to colonization by infectious organisms. It is clearly indicated that an indirect connection exists between surgical infections and removing of hair before an operation. Therefore, it is implied that failure to remove hair or shave is away of reducing infections (Celik & Kara, 2007). There is evidence that hairy incision sites do not encounter surgical infections (Celik & Kara, 2007). Due to the clinical implications that result from shaving there have been suggestions that show it not really necessary for hair to be removed in operation sites unless the hair directly interferes with the operation process