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Measure Information Form
Version 2010A1


Measure Information Form

Measure Set: Surgical Care Improvement Project (SCIP)

Set Measure ID: SCIP-Inf-6

Performance Measure Name: Surgery Patients with Appropriate Hair Removal

Description: Surgery patients with appropriate surgical site hair removal. No hair removal, or hair removal with clippers or depilatory is considered appropriate. Shaving is considered inappropriate.

Rationale: Studies show that shaving causes multiple skin abrasions that later may become infected. In a randomized study of 1,980 adult patients undergoing cardiopulmonary bypass surgeries, Ko, et al (1992), reported a significantly higher rate of infection among patients who were shaved with a razor than those who had hair removal by electric clippers before skin incision. In another randomized trial of 200 patients undergoing elective inguinal herniorraphy, Balthazar, et al (1982), concluded that hair removal with electric clippers immediately prior to the procedures “did not increase the risk of postoperative wound infection” (p. 799). In a systematic literature review by Kjonniksen, et al (2002), there was no strong evidence to contraindicate preoperative hair removal; however, there was strong evidence against hair removal with a razor. This review recommended depilatory or electric clippers immediately prior to surgery when hair removal was required. Alexander, et al (1983), reported that clippers, used on the morning of surgery, resulted in reduced surgical site infections and healthcare expenditures.

Type of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: Surgery patients with surgical site hair removal with clippers or depilatory or with no surgical site hair removal.
Included Populations: Not applicable

Excluded Populations: None

Data Elements:

Denominator Statement: All selected surgery patients.

Included Populations: An ICD-9-CM Principal Procedure Code of selected surgeries (as defined in Appendix A, Table 5.10 for ICD-9-CM codes).

Excluded Populations:

  • 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

Data Elements:

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records. Retrospective data sources for required data elements include administrative data and medical records.

Data Accuracy: Variation may exist in the assignment of ICD-9-CM codes; therefore, coding practices may require evaluation to ensure consistency.

Measure Analysis Suggestions: Surgical site hair removal should be performed within the hospital. In the course of quality improvement efforts, hospitals may find it useful to drill down to the responses for the data element Preoperative Hair Removal. It may be instructive to tally frequency with which each allowable value occurs. Possible quality improvement initiatives may include: instructing patients against performing their own hair removal, and instructing staff as to the appropriate methods and timing of hair removal.

Sampling: Yes. For additional information see the Sampling Section.

Data Reported As: Aggregate rate generated from count data reported as a proportion.

Selected References:

  • Kjonniksen I, Andersen BM, Sondenaa VG, et al. Preoperative hair removal-a systematic literature review. AORN J. 2002 May;75 (5):928-938,940. PMID:12063942.
  • Ko W, Lazenby WD, Zelano JA, et al. Effects of shaving methods and intraoperative irrigation on suppurative mediastinitis after bypass operations. Ann Thorac Surg. 1992 Feb;53 (2):301-305. PMID: 1731672.
  • Alexander, JW. Influence of hair removal methods on wound infections. Archives of Surgery Vol 118, March 1983. PMID: 6824435.
  • Balthazar ER, Colt JD, Nichols RL. Preoperative hair removal: a random prospective study of shaving versus clipping. South Med J. 1982 Jul:75(7): 799-801. PMID: 7089645.

Measure Algorithm:

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Related Topics

Measure Information Form SCIP-Inf-6
Specifications Manual for Joint Commission National Quality Core Measures (2010A1)
Discharges 04-01-10 (2Q10) through 09-30-10 (3Q10)