Effects of a modified preoperative shave technique on the incidence on Pseudofolliculitis Pubis by R Beastrom A thesis submitted in partial fulfillment of the requirements for the degree of MASTER OF NURSING Montana State University © Copyright by R Beastrom (1978) Abstract: The problem of this study was to determine the effect of a modified, preoperative shave technique on the postoperative incidence of pseudofolliculitis pubis when compared with the routine, close shave technique. The author reviewed the charts and interviewed a consenting, elective surgical population at a Montana hospital which required a total pubic shave. The sample consisted of nine females and eight males who ranged in age from twenty-nine to eight-three years of age. The population was Caucasian, nourished, and free of subjection to radiation, specific drugs and certain chronic illnesses during a standardized period of time. Each subject was used as his own control receiving a modified shave on the left side of the pubic area and a close shave on the right side. The two shaved areas were examined equally for the presence of papules and pustules by use of a standardized plastic card to delimit the area that had two windows cut out of it which were identical in size. The data were subjected to application of a one-factor, analysis of variance with a two-way classification and significance was determined at the .05 level. It was found that there were significantly fewer incidences of pseudofolliculitis pubis under conditions of the modified shave as compared to the close shave. The following recommendations were made: 1) That further study would increase the number of subjects to a minimum of thirty. 2) That replication be done using exclusively black, male subjects. 3) That replication be done using equal-sized groups' of subjects of different races. 4) That replication be done using equal numbers of male and female subjects. 5) That further study be done using only subjects under fifty years of age. 6) That a different study be done to determine a correlation between pseudofolliculitis pubis and postoperative wound infection. STATEMENT OF PERMISSION TO COPY In presenting this thesis in partial fulfillment of the . requirements,for an advanced degree at Montana State University, I agree that the Library shall make, it freely available for inspection.■ I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by my major, professor, or, in his absence, by the Director of Libraries. It is understood that any copying or publication of this thesis for financial gain shall not be allowed without my written permission. EFFECTS OF A MODIFIED PREOPERATIVE SHAVE TECHNIQUE ON THE INCIDENCE OF PSEUDOFOLLICULITIS PUBIS' by RICHARD ALLEN BEASTROM A thesis submitted in partial fulfillment of the requirements for the degree of MASTER OF NURSING Approved: Chairperson, Graduate Committee Head, Major Department Graduate Dean MONTANA STATE UNIVERSITY Bozeman, Montana August, 1978 iii ACKNOWLEDGEMENTS The writer wishes to express his sincere appreciation to Dr. Anna Shannon, Dean, School of Nursing, and chairperson of the examining committee. The writer also wishes to thank educators Professor Julia Swager, Dr. Douglas Bishop, and Dr. Harold Picton who were members of the examining committee. A special "thank you" is given to Dr. John Tkach, Dermatologist, for his personal interest and concern for this study, and also to Helen Lee, Nursing Instructor, for her support and assistance. A very special "thank you" is given to the following research assistants whose time and effort was unselfishly dedicated to the gathering of the data: Judy Wendt, Nursing Assistant Janet Johnson, Nursing Student Ken Thomas, Nursing Student Janice Johnson, Nursing Student Mimi Emerson, Nursing Student Kathy Jaeger, Nursing Student The writer would like to thank the following individuals and the committees or departments they represent for their cooperation in achieving approval for the collection of data: Dr. George Shroyer, Chairman, Committee on Use of Human Subjects in Experimental Research Dr. Hugh Anderson, M.D., Head of Surgical Committee Mercedes Strain, R.N., Director of Nursing Service Gretchen Hapland, R.N., Head Nurse of the Operating Room Mary Nevins, R.N., Clinical Specialist in Surgery A final thank you is extended to the 22 surgeons who gave indivi dual consent for permission to enlist their patients as subjects. TABLE OF CONTENTS Page VITA .............................................. ii ACKNOWLEDGEMENTS .............................................. ill TABLE OF CONTENTS .................................'........... iv LIST OF TABLES . ............................ ..'.......... vi LIST OF FIGURES . ........................................ vii ABSTRACT . ....................................... viii Chapter 1 INTRODUCTION............................................ I Statement of the Problem ............... 6 ■'Hypotheses ................ ■............. .6 Definitions.............................. ........... 6 2 REVIEW OF LITERATURE ................................ 8 3 ' METHODOLOGY.......................................... 23 Sample Selection .................................... 23 Type of preoperative shave . •...................... 23 Sex ................................................. 23 R a c e .................. 24 A g e ............................................ ' . 24 Nutrition...................................... • . 24 Radiation therapy .................................. 24 D r u g s .................... ...................... 25 Illness .................................. 25 P r o c e d u r e s ........................ 27 The Shave Technique..................... 27 The Close S h a v e ..................... 29 The Modified S h a v e ............................... 30 The Examination .................................. 32 Pilot S t u d y ................ 34 Subject Selection .................... ............ 34. Shaving............. ........ ^ ................. 35 Examination A r e a .................................. 36 V Chapter , Page 4 ANALYSIS OF THE D A T A ................................ 37 5 FINDINGS, 'CONCLUSION, DISCUSSION,■RECOMMENDATIONS ' AND SUMMARY.............. ■.............'........... 45 F i n d i n g s ............................................ .45 C o n c l u s i o n .......... 46 D i s c u s s i o n ........................................ • . 46 Recommendations ...................................... 48 Summary , .......... 51 LITERATURE CITED .................................... .....' 52 APPENDICES . ■.................... ............... ............. 57 A Checklist.for Patient Selection ......... 58 B Patient Consent F o r m ....................................60 C Data S h e e t .............. ........................... 61 : vi LIST OF TABLES Table Page 1 Demographic Characteristics of the Sample ........ 37 2 Raw Score Data of Papule and Pustule Counts on Subjects by Treatment Groups and S e x .......... ; . .41 3 Summary Data for the Analysis of Variance with Two-Way Classification: n=l. Scores for the Sample of Sub­ jects Tested Under Two Different Treatments . 43 vii LIST OF FIGURES Figure Page I Actual-size Diagram of the Plastic Cutout Card. Used for Examination of the Shaved Treatment Areas . 33 viii ABSTRACT The problem of this study was to determine the effect of a modi­ fied, preoperative shave technique on the postoperative incidence of pseudofolliculitis pubis when compared with the routine, close shave technique. The author reviewed the charts and interviewed a consenting, elective surgical population at a Montana hospital which required a total pubic shave. The sample consisted of nine females and eight males who ranged in age from twenty-nine to eight-three years of age. The population was Caucasian, nourished, and free of subjection to radiation, specific drugs and certain chronic illnesses during a standardized period of time. Each subject was used as his own control receiving a modified shave on the left side of the pubic area and a close shave on the right side. The two shaved areas were examined equally for the presence of papules and pustules by use of a standardized plastic card to delimit the area that had two windows cut out of it which were iden­ tical in size. The data were subjected to application of a one-factor, analysis of variance with a two-way classification and significance was deter­ mined at the .05 level. It was found that there were significantly fewer incidences of pseudofolliculitis pubis under conditions of the modified shave as com­ pared to the close shave. The following recommendations were made: 1) That further study would increase the number of subjects to a minimum of thirty. 2) That replication be done using exclusively black, male subjects. 3) That replication be done using equal-sized groups' of subjects of different races. 4) That replication be done using equal numbers of male and female subjects. 5) That further study be done using only subjects under fifty years of age. • 6) That a different study be done to determine a correlation between pseudofolliculitis pubis and postoperative wound infection. Chapter I INTRODUCTION Preparation of the patient's skin for surgery is a nursing responsibility in the preoperative period of care. The purpose of this preparation is "to cleanse the skin and reduce the number of organisms on the skin so as to eliminate as much as possible the transference of such organisms into the incision site."