October 2009

Surgical Care Improvement Project – Infection-6 – Appropriate Hair Removal

By Yvonne Acker, RN, BSN, CPHQ

The Surgical Care Improvement Project (SCIP) is a national campaign aimed at reducing preventable surgical complications (i.e. infection, blood clots and cardiac events) through the use of evidence based practices.

The SCIP Infection-6 measure addresses the use of appropriate surgical site hair removal. Hair removal that is considered appropriate would include no hair removal, hair removal with electric clippers or hair removal with a depilatory. Shaving with a razor to remove surgical site hair is considered inappropriate.

Studies show that shaving causes multiple skin abrasions that later may become infected. The reviews recommend electric clippers or depilatory immediately prior to surgery when hair removal is required.

The Infection-6 measure applies to all surgical patients that fall into a hospital’s SCIP population. The only exclusions are the following:

• Patients less than 18 years of age.
• Patients who have a length of stay > 120 days.
• Patients whose ICD-9-CM principal procedure was performed entirely by laparoscope.
• Patients enrolled in clinical trials.
• Patients whose ICD-9-CM principal procedure occurred prior to the date of admission.
• Patients who performed their own hair removal.

The data abstractor must determine the method of surgical site hair removal that was used prior to the principal procedure. Suggested data sources to find this information would include but are not limited to the following:

• Nursing notes
• Operating room record
• OR nurses record
• Preoperative checklist
• Preoperative report
• Surgical checklist

The following is the list of allowable values that can be chosen. The selection should be based on documentation that reflects actual hair removal. Do not include hair removal that is not at the surgical site or hair removal that is involved in daily hygiene. The abstractor should select all that apply:

• No documented hair removal or no hair removal performed.  Select this option if there is no documentation of hair removal.  This option cannot be combined with any other options.

• Razor.  Select this option if “shaved” is documented as the method of hair removal.

• Clippers/Scissors.  Select this option if documentation indicates that clippers or scissors were used as the method of hair removal.  This option may also be chosen if the documentation indicates that a “shave prep was done with clippers” or “clippers were used to perform the shave prep”.

• Depilatory.  Select this option if documentation indicates that a depilatory was used as the method of hair removal.  Examples of depilatories would include the following: Nair™, Neet™, One Touch Hair Removal™, other brands of depilatory, as well as Surgi-Lotion Hair Removal™.

• Other.  Select this option if documentation indicates that a method of hair removal was used that is not included in the list of allowable values.

• Patient performed their own hair removal.  Select this option if documentation indicates that the patient performed their own surgical site hair removal.

• Unable to determine method.  Select this option if there is documentation that hair removal was performed but it is not indicated what method of hair removal was used.  This option cannot be combined with any other options.

The case will pass the measure if 1, 3 or 4 are chosen. The case will fail the measure if 2, 5 or 7 are chosen. If 6 is chosen, then the case is excluded from the measure.

For questions that are not clearly addressed in the Specifications Manual for National Hospital Inpatient Quality Measures, it is recommended that you use QNet Quest which is an on-line questions and answers database. QNet Quest can be found on the Quality Net website at www.qualitynet.org.

Editor’s Note: Yvonne Acker, RN, BSN, CPHQ is a Data Abstractor in Chapel Hill, NC for Clinical-Insights

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