John S. Kurien, Sansho E. U, Adarsh I. Nath, Sandeep A. Varghese
BACKGROUND Despite major advances in infection control interventions, health care-associated infections (HAI) remain a major public health problem and patient safety threat worldwide. The global data suggests that the SSI incidence rate varies from 0.5 to 20% depending upon the type of operation and underlying patient status. Several factors preoperative, intraoperative & postoperative, determine the occurrence of surgical site infections, Preoperative hair removal is considered as a risk for the development of surgical site infections. The objective of the study is to find out the difference in the incidence of surgical site infections in patients undergoing pre-operative hair removal by shaving with Razor blades and hair trimmers prior to elective inguinal hernia surgery. MATERIALS AND METHODS Written informed consent from 160 patients with no significant comorbidities planning to undergo elective inguinal hernia surgery at the general surgery wards in Government Medical College Kottayam and who were willing to participate in the study were to be obtained. 80 of them to undergo pre-operative hair removal with hair trimmers and 80 to undergo preoperative hair removal by shaving with razor blades on the day prior to the surgery randomised into two groups. During their stay in the post-operative ward the surgical wounds of the patients were examined daily for the development of erythema, pain, discharge, induration and gaping of the wound. The daily findings were noted down till the patient was discharged from the ward. The patients were again reassessed 2 weeks later, when they came for review in the Surgery OPD after their discharge from the ward; finally the patients were examined on the 30th day post-surgery to look for the clinical features of surgical site infections. RESULTS Out of the total 160 patients who were studied, 29 (18.1%) of them had post-operative infection within 30 days, in the form of erythema, induration, discharge and gaping. Most of the symptoms of surgical site infections were during the initial 3 days (69%), with the most common symptom being erythema (18.1%) followed by induration (12.5%). Gaping (0.6%) and discharge from wound (3%) were very minimal. Those individuals who had undergone preoperative hair removal with trimmers (11.2%) had a lower incidence of surgical site infection when compared to those with razors (20%). The difference was statistically significant, with a p value of 0.024 by Chi-Square tests. The difference in erythema (p- 0.024) and induration (p-0.017) between the two groups was also found to be statistically significant. Other factors, namely type of surgery, age of the individual and sex did not have a statistically significant difference. CONCLUSION In this study there is evidence of definite reduction in surgical site infection rates when trimmers were used for pre-operative hair removal than razors in elective inguinal hernia surgery. The difference is statistically significant (p Value – 0.024).
