Preoperative hair removal to reduce surgical site infection.

楚楚

Cochrane Database Syst Rev. 2011 Nov 9;11:CD004122.

Preoperative hair removal to reduce surgical site infection.

Tanner J, Norrie P, Melen K.

Source

De Montfort University and University Hospitals Leicester, Charles Frears Campus, 266 London Road, Leicester, UK, LE2 1RQ.

AbstractBACKGROUND:

Although preparation of people for surgery has traditionally included removal of hair from the incision site, some studies claim that preoperative hair removal is harmful, causes surgical site infections (SSIs), and should be avoided.

OBJECTIVES:

To determine if routine pre-operative hair removal (compared with no removal) and the timing or method of hair removal influence rates of SSI..

SEARCH STRATEGY:

For this second update we searched the Cochrane Wounds Group Specialised Register (searched 12 August 2011); TheCochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3); Ovid MEDLINE (1950 to August Week 1 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations August 11, 2010); Ovid EMBASE (1980 to 2011 Week 31) and EBSCO CINAHL (1982 to 11August 2011). No date or language restrictions were applied.

SELECTION CRITERIA:

Randomised controlled trials (RCTs) or quasi randomised trials (QRCTs) that compared:1) hair removal with no hair removal; 2) different methods of hair removal; 3) hair removal at different times before surgery; and, 4) hair removal in different settings (e.g. ward, anaesthetic room).

DATA COLLECTION AND ANALYSIS:

Three authors independently assessed relevance and quality of each trial. Data were extracted independently by two authors and cross-checked.

MAIN RESULTS:

We included 14 trials (17 comparisons) in the review; three trials involved multiple comparisons. Six trials, two of which had three comparison arms, (972 participants) compared hair removal (shaving, clipping, or depilatory cream) with no hair removal and found no statistically significant difference in SSI rates however the comparison is underpowered. Three trials (1343 participants) that compared shaving with clipping showed significantly more SSIs associated with shaving (RR 2.09, 95% CI 1.15 to 3.80). Seven trials (1213 participants) found no significant difference in SSI rates when hair removal by shaving was compared with depilatory cream (RR 1.53, 95% CI 0.73 to 3.21), however this comparison is also underpowered. One trial compared two groups that shaved or clipped hair on the day of surgery compared with the day before surgery; there was no statistically significant difference in the number of SSIs between groups however this comparison was also underpowered.We identified no trials that compared clipping with depilatory cream; or investigated application of depilatory cream at different pre-operative time points, or hair removal in different settings (e.g. ward, anaesthetic room).

AUTHORS' CONCLUSIONS:

Whilst this review found no statistically significant effect on SSI rates of hair removal insufficient numbers of people have been involved in this research to allow confidence in a conclusion. When it is necessary to remove hair, the existing evidence suggests that clippers are associated with fewer SSIs than razors. There was no significant difference in SSI rates between depilatory creams and shaving, or between shaving or clipping the day before surgery or on the day of surgery however studies were small and more research is needed.

星梦78

背景
手术前除毛减少手术部位伤口感染
传统上认为手术部位毛发应常规性清除，但是有些研究指出手术前清除毛发对病人有可能造成手术部位伤口感染而不应该执行。
目标
这篇评论主要的目标为：确认手术前常规性清除毛发是否可以降低手术部位伤口感染。
搜寻策略
作者搜寻了Cochrane Wounds Group Specialised Register (October 2005) ，The Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3， 2005) 资料库,同时也搜寻了MEDLINE (​​1966年到2005年) ，EMBASE (1980年到2005年) ，CINAHL (1982年到2005年) ， and the ZETOC database of conference proceedings (1993年到2005年) 等资料库。我们同时与除毛产品制造商联系。
选择标准
在随机对照临床试验(Randomised controlled trials (RCTs))中，我们比对了清除毛发与否、不同的除毛方法、手术前不同时间除毛以及不同环境下完成除毛。
资料收集与分析
3位作者独立评估各试验的特性与相关性。数据资料是由1位作者摘录，并由另外1位作者确认其正确性。
主要结论
这篇评论中，我们总共收纳11份随机对照试验。其中3个临床试验总共收纳625病人，来比较使用除毛膏或剃刀清除毛发与保留毛发，我们发现在手术部位感染方面，并没有统计学上的差异。没有找到文献探讨修剪毛发与保留的差异。另外3个试验一共纳入3193病人则比较剃毛与修剪毛发，发现剃毛较易引起手术部位感染，且具有统计学上的意义(RR 2.02, 95% CI 1.21 to 3.36) 。另外7个试验纳入了1213病人，则是比较除毛膏或剃刀清除毛发，发现剃毛较易引起手术部位感染(RR 1.54, 95% CI 1.05 to 2.24) 。我们没有找到任何临床试验，是在探讨修剪毛发与使用除毛膏来清除毛发的差异。我们找到有1个试验，是在比较手术当天与手术前1天剃毛; 还有1个试验，是在比较手术当天与手术前一天修剪毛发。这2个临床试验在手术部位感染方面，均无统计学上的差异。我们没有找到任何探讨在不同时间点，利用除毛膏除毛或不同环境下除毛的临床试验。
作者结论
证据显示手术前除毛与否，并不会影响手术部位感染的机会。若手术前需要除毛，剪毛或除毛膏除毛，会比剃刀剃​​毛造成较少的手术部位感染。至于手术当天或前1天剃毛或除毛并不会影响感染机会。
翻译人
本摘要由成功大学附设医院蔡佩蓉翻译。
此翻译计画由台湾国家卫生研究院(National Health Research Institutes, Taiwan) 统筹。
总结
当医护人员在帮手术前的病人做皮肤准备的时候，会清除手术部位附近的毛发，以降低手术伤口感染的机率。传统上，病人要接受手术治疗前，清除手术部位附近的毛发，被认为是可以降低手术伤口感染的机会。目前有3种清除毛发的方法：用剃刀剃除毛发、修剪毛发以及使用除毛膏来除毛。相较之下，在手术前清除手术部位附近的毛发，使用除毛膏比使用剃刀引起伤口感染的机率较低。然而，如果真的需要清除毛发，是比较建议以修剪的方式，而不是使用剃刀，因为修剪毛发跟剃刀比起来，修剪的方式较不易引起伤口感染。