Studies showed that preoperative hair removal was associated with anincreased rate of SSIs.1
A meta-analysis comparing clipping and no hair removal vs. shaving showed aclear benefit of either no hair removal or clipping with a significant decrease oft he SSI risk.2
“The increased SSI risk associated with shaving has been attributed tomicroscopic cuts in the skin that later serve as foci for bacterial multiplication.”1
| Guideline | Recommendation | Category (if mentioned) |
| CDC1 | “Do not remove hair preoperatively unless the hair at or around the incision site will interfere with the operation.”
“If hair is removed, remove immediately before the operation, preferably with electric clippers. | Category IA Category IA |
| WHO2 | “Hair should either not be removed or, if absolutely necessary, it should be removed only with a clipper. Shaving is strongly discouraged at all times, whether preoperatively or in the operating room (OR).” | Strong recommendation, moderate quality of evidence |
| NICE3 | “Do not use hair removal routinely to reduce the risk of surgical site infection."
“If hair has to be removed, use electric clippers with a single-use head on the day of surgery. Do not use razors for hair removal, because they increase the risk of surgical site infection.” | |
| SHEA4 | “Do not remove unless hair will interfere with the operation; if hair removal is necessary, remove outside of the operating room by clipping. Do not use razors.” | Quality of evidence: HIGH |
| KRINKO5 | Removal of hair in the surgical area by clipping and not by shaving. | Category IA |
"When removing hair before surgical procedures, the benefits and risks must be carefully weighed."
1. CDC (1999) Guideline for Prevention of Surgical Site Infection. Infect Control Hosp Epidemiol. 20(4): 247–278.
2.WHO (2016) Global guidelines for the prevention of surgical site infection. World Health Organization 2016.
3.NICE (2019) Surgical site infections: prevention and treatment. NICE guidelines. Published 11 April 2019. www.nice.org.uk/guidance/ng125.
4.Calderwood MS, et al. (2023) SHEA/IDSA/APIC Practice Recommendation. Stategies to prevent surgical site infections in acute-care hospitals: 2022
Update. Infect Control Hosp Epidemiol. May 4: 1–26.
5.KRINKO (2018) Prävention postoperativer Wundinfektionen. Empfehlungen der Kommission für Krankenhaushygiene und Infektionsprävention
(KRINKO) beim Robert Koch-Institut. Bundesgesundheitsbl 61: 448–473.
6.Seropian R, Reynolds BM (1971) Wound infections after preoperative depilatory versus razor preparation. Am J Surg 121: 251–254.
Consistent skin antisepsis of OR Team significantly reduces the risk of infection and is essential during invasive procedures.
Is there evidence to formulate a clear recommendation for double gloving?
Hand hygiene is the key measure of Elements of standard precautions. In addition to alcohol-based hand disinfection, the main infection protection measure, it comprises skin care, skin protection and skin cleansing.
Colored skin antiseptic for preoperative use with 24 hours long-term effect.
How can disposable surgical products reduce the risk of infection?
How to support the change-over process between patients treated in sequential interventions?