PROUD OF THE PAST, PLANS FOR THE FUTURE
Blood Tranfusion Reactions
Catherisation procedure
Disinfection and Sterilization
flatus tube insertion
Gallstone disease
Prevention of Surgical site infections
Resistant to antibiotics
Injection
Hand Hygiene
Ryles tube insertion
Single incision Laproscopic cholecystectomy
Single trocer STILS appendectomy
Single trocer STILS hysterectomy
temperature
Bio safety guidlines
Role of Paramedics
Prevention of surgical siteinfections in the operation theatre
SILS

BIOSAFETY GUIDELINES FOR DOCTORS AND PARAMEDICAL STAFF

• Wear gloves while dealing with patients who are bleeding or while dealing with potentially infected material or while collecting blood or starting I. V. infusions dressings. Use disposable syringe and needles as far as possible.
•All syringes and needles if required to be re-used must be autoclaved. Disposable syringes and needles should be de-contaminated with hypo-chlorite solution prior to disposal. Ideally needle shredding units for destruction of needles are used.
•Wash your hands frequently with soap and water. Other skin surface if contaminated with blood should be washed immediately.
•All instruments soiled with blood or potentially infected secretion should be thoroughly cleaned with soap and after and then boiled for 30 minutes. Sharp instruments should be sterilised by keeping them in dettol or gluteraldehyde solution. Wear gloves while cleaning.
•If there is spillage of blood or infected secretion on the floor sprinkle bleaching powder over it and cover with absorbent material and leave it for 10 minutes and then wipe it off. Clean the flooring again with hypochlorite solution.
•Floors and walls should be mopped with 0.1 % hypochlorite solution instead of phenyle. Floors should be cleaned at least twice a day.
•Lines soiled with blood or potentially infected secretion should be kept in 0.5% hypochlorite solution for 30 minutes.
•Table tops, cots, etc. should be routinely cleaned with 0.1% hypochlorite solution, once a day. When contamination occurs immediate cleaning with 0.1% hypochlorite solution should be carried out.
•Bathrooms, commodes should be cleaned with 0.5% hypochlorite solution instead of phenyle.
•All health care workers should wear gloves during cleaning procedures and while dealing with bedpans, urine pots and potentially infected material. After every handling, the hands with the gloves on should be washed with soap and water.
•All soiled mattresses should be autoclaved. After discharge of each patient the mattresses should be sent for autoclaving. In the meantime all mattresses should be covered with PVC material which will prevent contamination with urine, stool, sputum, CSF, semen, pleura! fluid, peritoneal fluid, blood, serum, surgical tissues and other body fluids/discharge of the mattresses. The PVC covers can be easily decontaminated with 0.5% hypochlorite solution be soaking for 30 minutes whenever the patient is discharged the old PVC cover should be changed with fresh clean PVC cover.
•Handle sharp objects such as needles, etc. with utmost care to prevent accidental injury. In case of injury get it properly attended. Wash with soap and water, Apply or Pour 70% ISOPROPYL ALCHOHOL / BETADINE / DETTOL.
•Management of waste.
•All dry waste such as paper, plastic, PVC, bottles, tubings should be collected separately in PVC garbage bags. All infected waste such as patients dressings, bandages, swabs should be collected separately in PVC bags and sent for disposal.
•Kitchen waste should be collected separately. Do not litter floors with dressings, swabs, etc.
•All operating personnel and anesthetist must put on gown, cap, masks, gloves and glasses during surgical procedures. Wear double gloves while doing major surgical procedures. Glasses are necessary to prevent accidental entry of blood in the eyes. Change the glove immediately if punctured. Ideally the gown should be resistant to fluid penetration and withstand frequent washing. Such a type of fabric is not available locally and hence the operating team must wear PVC apron for protection.
•Surgical mark should be changed if splattered or moist
•For protection of feet P. V. C. leggings should be worn.
•Take great care while handling sharp instruments so as to avoid accidental injury. Sharp instruments should not be passed directly to the Surgeon, instead use a small tray to pass such instruments. Simultaneous suturing of wound by two persons should be avoided to prevent injury. In case of injury allow the blood to flow fora while and then get treated with 70% isopropyi alchohol / povidone Iodine /1 % Sodium hypochlorite.
•All paramedical staff should also put on gloves for protection of hands.
•Don't hurry, excess speed may result in an injury.
•All instruments must be either autoclaved or kept in gluteraldehyde solution for twenty minutes before reusing.
•Whenever possible use disposable material like syringes, needles, etc.
•Non-disposable endotracheal tubes should be kept in gluteraldehyde solution for twenty minutes prior to use, or should be sterilised with ethylene-oxide gas.
•Clean the flooring, walls and other surfaces with 1%hypochlorite solution.
•Operating table, matress, Boyle's apparatus should be cleaned with mythylated spirit 1% Hypochlorite solution.
•Wear gloves while dealing with patients who are bleeding or while dealing with potentially infected material or while collecting blood or starting I. V. infusions dressings. Use disposable syringe and needles as far as possible.
•All syringes and needles if required to be re-used must be autoclaved. Disposable syringes and needles should be de-contaminated with hypo-chlorite solution prior to disposal. Ideally needle shredding units for destruction of needles are used.
•Wash your hands frequently with soap and water. Other skin surface if contaminated with blood should be washed immediately.
•Do not litter the floor with gloves, gause pieces, mops, linen etc.
•Avoid spillage over the floor. In case of spillage of blood and / or other infected secretion sprinkle bleaching powder immediately and leave it for fifteen minutes after which mop with hypochlorite solution.
•All soiled gauze pieces should be collected in a P. V. C. bag at the end of the operation and sealed prior to disposal. Similarly all used mops should be collected in a separate P. V. C. bag. The mops should be decontaminated by dipping in 1% sodium hypochlorite solution for 30 min. and then washed as usual.
•All disposable sharp objects like needles and blades should be collected in separate small boxes to be kept in sodium Hypochlorite sol. 1% for 30 min. for decontamination and then disposed off.
•In each 0. T. one separate big sized bin should be provided for collecting Linens and another separate bin to be provided for collecting gloves. All bins in 0. T. should have garbage collection bags.
•Each theatre should be fumigated once a week or more frequently when necessary.
Precautions during an operation:
i.   Be aware and cautious at all times; think before acting.
ii.   Instruct and orient the surgical team at the beginning of the case about the potential of glove penetration or skin contamination.
iii.   Use instrument ties and other non-touch suturing and sharp instrument techniques whenever possible. Do not tie with the suture needle in your hand.
iv.   Do not pass sharp instruments and needles from hand to hand; pass them on an intermediate tray.
v.   Announce when instruments are being passed.
vi.   Avoid suturing simultaneously on the same wound, on surgeon.
vii.  Consider checking on a periodic basis (e.g. hourly) to evaluate whether blood and body fluids have contaminated the gowns or shoe protectors. If so, the skin should be immediately cleaned and gown and shoe protectors should be removed and changed.
viii. Clean gowning and gloving of all operative personnel should be practiced. If an individual scrubs into a surgical case after it has started and the gloves of the scrub nurse are already contaminated with blood, the gloves should be removed and replaced before passing sterile gowns and gloves to the surgeon to avoid the possibility of skin contamination.
Precautions at completion of the case:
i.   Put on pair of clean gloves for application of the dressing without removing the first level of gloves. Do not remove surgical garb until the wound has been dressed and the risk of contact with bloody drapes had been eliminated.
ii.   Immediately remove all blood-and body fluid-contaminated clothing in a manner that avoids contact with the blood.
iii.   Take boots off before taking gloves off. Remove the outside blood-contaminated shoe covers and replace with fresh shoe covers, if necessary, prior to leaving the operating room. Leave gloves on until all contaminated garments have been removed.
iv   Wash hands, forearms and face at the surgical scrub sink with antiseptic soap. Do not leave the operating suite with bloody shoe covers, as this will potentially contaminate the hallway and doctors' lounge.
v.   Do not touch anything (including storage facilities and telephones) with bloody gloves.