The practice of medicine often involves “rules” that are not based on fact or evidence. Many of them are justified in a manner similar to that which we use with our children—“because.” The rationale for some rules is “that’s the way we’ve always done it.”
Wait a second. It is generally agreed that the fewest wound infections result when patients are not shaved or clipped at all. If that is so (and the evidence is convincing), then why would hair cause a problem if loose? I am not aware of any data that supports the claim that clipping hair in the OR causes wound infections.
After asking about the source for this rule, I find it originates in standards promulgated by the Association of periOperative Registered Nurses (AORN). On page 367, the AORN 2011 Perioperative Standards and Recommended Practices states “Hair removal should be performed the day of the surgery, in a location outside the operating or procedure room.” The justification is said to be “Clipping the hair outside of the operating room minimizes the dispersal of loose hair and the potential for contamination of the surgical field and surgical wound.” No reference is cited.
Other sources such as the Association of Surgical Technologists’ Standards (I.3.B.) say the “shave prep should be performed in the preoperative holding area where the privacy of the patient can be maintained.” I don’t know about your OR holding area, but every holding area I’ve ever seen is far less private than the operating room itself.
The AST apparently hasn’t received the memo that “shave” is not the correct term and has not been for many years. So it’s not infection that’s the problem; it’s privacy?
In addition to not being evidence-based, the recommendation would be difficult to follow because clipping in an area outside of the OR itself will delay the case. If clipping is necessary for the purpose of applying tape after the operation, I prefer to do it myself because 1) I know it will be done without inflicting injury and 2) it will encompass only the area that I want clipped.
I performed a thorough literature search and found nothing to justify this rule regarding infection or privacy.
The problem with rules like these is that, as is the case with the 55 MPH speed limit, rules without reason are often not followed. This breeds mistrust of authority leading to failure to abide by reasonable rules too. General anarchy follows and civilization as we know it will be destroyed.
Do you know of any other "made up" rules like this?