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.”
How about a rule
prohibiting the clipping of hair in the operating room? My hospital has
decided that if hair is to be clipped, it must be done before the
patient arrives in the OR. One reason for this is said to be prevention
of infection by loose hair.
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?
