Preoperative hair removal to reduce surgical site infection

Background The preparation of people for surgery has traditionally included the routine removal of body hair from the intended surgical wound site. However, there are studies which claim that pre-operative hair removal is deleterious to patients, perhaps by causing surgical site infections (SSIs), and should not be carried out. Objectives The primary objective of this review was to determine if routine pre-operative hair removal results in fewer SSIs than not removing hair. Search strategy The reviewers searched the Cochrane Wounds Group Specialised Register (October 2005), The Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2005), MEDLINE (1966 to 2005), EMBASE (1980 to 2005), CINAHL (1982 to 2005), and the ZETOC database of conference proceedings (1993 to 2005). We also contacted manufacturers of hair removal products. Selection criteria Randomised controlled trials (RCTs) comparing hair removal with no hair removal, different methods of hair removal, hair removal conducted at different times prior to surgery and hair removal carried out in different settings. Data collection and analysis Three authors independently assessed the relevance and quality of each trial. Data was extracted independently by one author and cross checked for accuracy by a second author. Main results Eleven RCTs were included in this review. Three trials involving 625 people compared hair removal using either depilatory cream or razors with no hair removal and found no statistically significant difference between the groups in terms of surgical site infections. No trials were identified which compared clipping with no hair removal. Three trials involving 3193 people compared shaving with clipping and found that there were statistically significantly more SSIs when people were shaved rather than clipped (RR 2.02, 95% CI 1.21 to 3.36). Seven trials involving 1213 people compared shaving with removing hair using a depilatory cream and found that there were statistically significantly more SSIs when people were shaved than when a cream was used (RR 1.54, 95% CI 1.05 to 2.24). No trials were found that compared clipping with a depilatory cream. One trial compared shaving on the day of surgery with shaving the day before surgery and one trial compared clipping on the day of surgery with clipping the day before surgery; neither trial found a statistically significant difference in the number of SSIs. No trials were found that compared depilatory cream at different times or that compared hair removal in different settings. Authors' conclusions The evidence finds no difference in SSIs among patients who have had hair removed prior to surgery and those who have not. If it is necessary to remove hair then both clipping and depilatory creams results in fewer SSIs than shaving using a razor. There is no difference in SSIs when patients are shaved or clipped one day before surgery or on the day of surgery.