Abstract
Background: Inappropriate hair removal increases the risk of surgical site infections which are associated with a higher morbidity and mortality of surgical patients. Here, the effects of a clipping device and a disposable razor on the skin barrier, microbial burden and surface structure were compared. Methods: Changes in bacterial colonization, transepidermal water loss, antioxidant status and the skin surface structure were investigated on the calves of 12 healthy volunteers. Measurement time points were at baseline (t base ) and 24 hours after hair removal (t 24 ). Results: Both, the disposable razor and the clipper showed a decrease in log colony-forming units count from t base (mean(t base ) ± standard deviation = 2.6 ± 1.27, median ± standard error = 2.6 ± 0.37) to t 24 at p razo r = 0.05 and p clipper = 0.06 respectively. At t 24 clipping resulted in a higher reduction of log colony-forming units (mean(t 24 ) = 1.76 ± 0.8, median = 1.69 ± 0.23) compared to the use of the disposable razor (mean(t 24 ) = 1.84 ± 0.85, median = 1.91 ± 0.24). Furthermore, the razor-treated group showed an increase in colony-forming units from t 0 to t 24 , whereas clipping lead to a continuous decrease in colony-forming units from t 0 to t 24 . An enhanced appearance of microlesions and a significant increase of transepidermal water loss after shaving using the disposable razor (p = 0.005) were found indicating skin barrier disruptions. Clipping showed no significant effect on transepidermal water loss. Conclusion: Hair removal using the clipping device results in less disruption of the skin barrier compared to the razor, avoiding the development of microlesions. This could be favorable for the prevention of surgical side infections and postoperative wound management.
Highlights
Preoperative hair removal within the scope of surgical disinfection has been controversially discussed and is a critical factor for the prevention of postsurgical wound infections
The average log10 colony-forming units (CFU) of both unshaved calves at tbase showed a high individual variance and showed a mean count of 2.6 ± 1.27. Both the conventional razor and the clipper showed a reduction of bacterial colonisation 24 hours after hair removal
Shaving by using the disposable razor lead to a significant reduction in log reduced CFU values from tbase to t24 significant at p = 0.05, while the clipper showed an even higher mean reduction in CFU from tbase to t24 at p = 0.06 (Figure 3)
Summary
Preoperative hair removal within the scope of surgical disinfection has been controversially discussed and is a critical factor for the prevention of postsurgical wound infections. Several clinical studies have shown that hair removal by conventional razors can cause incisions and other microscopic injuries, to the epidermis, which serve as a reservoir for bacterial colonisation This may favour bacterial contamination of the surgical field and lead to an increased risk of surgical site infections (SSI) [4,5,6,7,8,9,10,11,12]. The prevention of SSI is of great importance, since surgical wounds show a delayed wound healing process after infection prolonging the duration of the hospital stay [13] This can cause unnecessary pain, it can have a negative impact on the operation result and is associated with substantial morbidity and mortality [14,15,16]. Only few studies have been conducted investigating the most convenient point in time for clipping and these studies did not include the effect on the outcome in surgical patients [1]
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