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removal, although Dr. Saleh notes that it's not always needed. Even though
national guidelines instruct facilities to use clippers or a depilatory to remove
hair only when necessary and to perform the task before patients enter the OR,
he says facilities are still having trouble standardizing these steps.
"AORN made a recommendation several years ago that hair removal, if per-
formed, should be done outside of the OR and in a pre-op holding area. Hair
removal in the OR, if the situation mandates, should involve a wet clip or vacu-
um device," he says. "But, here we are 5 years later, and there are still many
facilities that are clipping in the OR, which, by and large, will leave hair hang-
ing around that could find its way into the wound to cause an infection."
Ms. Ripplinger notes that her hospital had high variability in this area,
spurring a project to standardize the practice. But making the move took more
than just updating their policy to say that hair must be clipped in pre-op. When
the hospital informed pre-op staffers about the change, they found that they did-
n't know as much about hair removal as leadership thought they did. "They
were removing only a little bit of hair from the expected surgical site, because
they were worried about clipping too much," says Ms. Ripplinger.
To fix that, the hospital held several education sessions, purchased easy-to-
use clippers and made sure that staffers had access to instructions on how to
clip patients. "We made a prep book that's kept in the pre-op area, which shows
the diagrams of where to remove hair for certain procedures, so they have refer-
ence material," she says. "That really helped inspire the change of practice and
ensure that it's done correctly each time."
It's still a work in progress, she notes, but the hospital has made strides
toward standardization. Now, after patients are brought into the pre-op area,
the pre-op nurse looks at the physician's order to see if hair clipping is needed.
If it is, a nursing assistant clips the hair using a battery-powered clipper,
according to the pre-op prep guidelines and physician's instructions.
Exceptions to the practice include clipping hair on the head and at the per-
ineum and groin, and in cases where the patient is concerned about privacy.
