Minor surgery and general practice

BMJ, 1991

Objective-Assessment of facilities for minor surgery in general practitioners' premises. Design-Independent inspection of premises and equipment. Setting-Large urban district. Subjects-Premises of all general practitioners who applied to be reimbursed for minor surgery. Main outcome measure-Fulfilment of 14 preselected criteria. Results-69 of 111 premises met all criteria and were approved; 23 failed on only one criterion. The commonest reasons for failure were inadequate record keeping and lack of resuscitation equipment. Twelve practices had out of date adrenaline. Conclusions-Most premises are suitable for minor surgery, some with attention needed to record keeping. Practices must pay careful attention to the expiry date of adrenaline.

Clinical Infectious Diseases, 2005

There is currently no public policy that provides guidance concerning whether and when physicians infected with hepatitis B virus (HBV), hepatitis C virus (HCV), and/or human immunodeficiency virus (HIV) can safely perform invasive procedures. A committee of experts in the fields of medicine, law, and biomedical ethics and 1 community member, aided by an advisory board, was established to produce recommendations for policy reform. An extensive literature review was conducted for these 3 infectious diseases, medicine, surgery, epidemiology, law, and bioethics to gather all relevant data. Special recommendations are made regarding the management of physicians who are infected with HIV, HBV, and/or HCV. This policy proposal includes a list of exposure-prone procedures and a decision chart that indicates under what conditions infected physicians can practice beyond the need for disclosure of their serological status.

The British Journal of General Practice the Journal of the Royal College of General Practitioners, 1990

Infection control procedures among New Zealand general practitioners: changes since the emergence of HIV infection J CHETWYND widespread. Findings reported earlier showed that almost all general practitioners had had contact with patients concerning AIDS in the last 12 months.10 SUMMARY A random sample of 1000 general practitioners in New Zealand were surveyed to assess their infection control procedures in the surgery, particularly since the emergence of the human immunodeficiency virus (HIV). Forty three per cent of the sample routinely used surgical gloves for minor surgical procedures, 8% used gloves for venepuncture, and 7% for blood glucose testing. Thirty two per cent reported a change in glove use since the emergence of HIV infection. Changes in sterilization procedures were also studied. Thirty eight per cent of the sample reported increased use of disposable equipment, and 38% reported changes in the sterilization solution used. Increased time spent by equipment in the sterilizer was reported by 33% of respondents and increased use of an autoclave by 18%. In general, women were more likely to have adopted infection control procedures than men. Infection control was also more common among those doctors having the greatest number of patients requesting HIV testing. ington to end of 1988). However, concern about the disease is

Journal of Hospital Infection, 2011

Surgical patients are particularly at risk of healthcare associated infection (HCAI) by virtue of the presence of a surgical site leading to surgical site infections (SSI) and because of the need for intravascular access resulting in catheter-related bloodstream infection (CRBSI). A two-year initiative commenced with an initial audit of surgical practice which was used to inform the development of a targeted educational initiative by surgeons as being specific for surgical trainees. Parameters assessed during initial and repeat audits after the educational initiative were related to the intra-and post-operative aspects of the prevention of SSI as well as care of peripheral venous cannulae (PVC) in surgical patients. The proportion of prophylactic antibiotics administered pre-incision across 360 operations increased from 30% to 59.1% (p<0.001). Surgical site dressings were observed in 234 patients, with a significant decrease as observed in the percentage tampered during the initial 48 hours post-operatively (6.2% vs. 16.5%, p=0.030). A total of 574 PVCs were assessed over the two-year period. Improvements were found in the proportion of unnecessary PVC in-situ (37.9% vs 24.4%, p<0.001), PVC in-situ for more than 72 hours (10.6% vs 3.1%, p<0.001) and PVC covered with clean intact dressings (87.3% vs 97.6%, p<0.001). Significant improvements in surgical practice were established for SSI and CRBSI prevention through a focused educational programme developed by and for surgeons. Potentially, other specific measures might be also warranted in order to achieve further improvements in the infection prevention in the surgical practice.

Indian Journal of Medical Microbiology, 2012

PURPOSE: The fight against Healthcare-associated infections is a public health priority and a major challenge for the safety and quality of care. The objective was to assess hygiene in general practitioners&#39; (GPs&#39;) office and identify barriers to and drivers for better practice. MATERIALS AND METHODS: We performed a cross-sectional study in which a questionnaire was sent to a randomly selected, representative sample of 800 GPs. We used a self-administered questionnaire. The first part assessed current practice and the second part focused on barriers and motivating factors for better practice. We performed a descriptive statistical analysis of the responses to closed questions and a qualitative analysis of the responses to open-ended questions. RESULTS: Only a third of the GPs were aware of the current guidelines. Disposable equipment was used by 31% of the GPs. For the remainder, only 38% complied with the recommended procedures for sterilisation or disinfection. Seventy-two percent of the GPs washed their hands between consultations in the office. A significant minority of physicians disregarded the guidelines by never wearing gloves to perform sutures (11%), treat wounds (10%), fit intrauterine devices (18%) or perform injections (18%). The main barriers to good practice were the high cost of modifications and lack of time/space. Two third of the GPs did not intend to change their practices. The drivers for change were pressure from patients (4.8 on a scale of 1 to 7), inspection by the health authorities (4.8) and the fear of legal action (4.4). CONCLUSIONS: Our results show that there are significant differences between current practice and laid-down professional guidelines. Policies for improvement of hygiene must take into account barriers and motivating factors.

Journal of Hospital Infection, 1991

There is a need for wider adoption of safer surgical techniques to reduce the chances of human immunodeficiency virus (HIV) transmission in the operating theatre. When a patient is known to have HIV infection extra precautions, including the wearing of additional protective clothing, should be carried out, even though it is not known whether such special measures are of value.

International Journal Of Community Medicine And Public Health, 2018

Background: Health-care workers are at risk of many infections at their workplace through airborne, blood borne, fecal-oral transmission and direct contact. Universal precautions are not well understood or implemented by health care practitioners. The knowledge and understanding of UPs among HCWs in developing countries is inadequate. The study was done to assess the awareness of universal precautions among the house surgeons and knowledge about precautionary measures. Methods: The present questionnaire based cross sectional study was carried out on the house surgeons who were posted in the department of community medicine, KLE University"s J N medical college, Belagavi. A total of 136 house surgeons were interviewed. Pretested, pre designed multiple response type questionnaire were administered to them. Results: Out of 136 study participants, 118 (87%) have heard about the term universal precautions, 118 (87%) self protection against body and blood fluids. 113 (83.1%) have correctly answered about precautionary measures for internal body fluids. Disposal of sharp items, 117 (86.1%) have told puncture proof container should be used, 128 (94.1%) have answered to use gowns, face mask to avoid splashing of blood while doing procedures. and 100 (73.5%) have told to apply universal precautions even on HIV-ve patients. Conclusions: The awareness about universal precautions among the study subjects was good in some aspects but not satisfactory in many others.

2014

Disclaimer and Waiver of Liability This document represents the opinion of the SARI Infection Prevention and Control Subcommittee, following a review of the scientific literature and an extensive consultation exercise. Responsibility for the implementation of these guidelines rests with individual practice staff and practice managers. The guide does not however override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of individual patients in consultation with the patient and/or guardian or carer.  Code of practice for decontamination of RIMD (HSE 2007).  Irish Medicines Board (IMB) (2005) Guide: Manufacture of Medical Devices within Healthcare Institutions.  Safe and Effective Use of Bench-top Steam Sterilisers, IMB SN2009 (04).  Irish Medicines Board (IMB): Cleaning and decontamination of reusable medical devices IMB safety notice; SN2010 (11) (Please refer to Appendix 7 and chapter 8) The Quality and Patient Safety Directorate have identified the need to develop Standards and Recommended Practices for decontamination of RIMD in General Practice, this piece of work will be incorporated into the Directorate plan. Practice staff should be offered vaccination if a risk assessment reveals that there is a risk to their health and safety due to their exposure to a biological agent for which effective immunisation is available. Healthcare workers who are at occupational risk of exposure to blood or bodily fluids or who perform exposure prone procedures must be immunised against hepatitis B. Staff should Key Messages be instructed in the safe handling and packaging of pathology specimens for transport (Chapter 2). Standard Precautions break the chain of infection. They are a set of practices that should be used in the care of all patients regardless of whether they are known or suspected to be infected with a transmissible organism. Additional precautions known as Transmission Based Precautions are required where the patient is known or suspected of having a highly transmissible infection e.g. Contact Precautions for patient with Clostridium difficile (Chapter 1). Personal Protective equipment (PPE) should be used after a risk assessment determines the risk of transmission of microorganisms to the patient and the risk of contamination of the healthcare workers skin or clothing by the patient's blood body fluid/secretions/excretions, contact with mucous membranes and non-intact skin. Examples of PPE are gloves, aprons, respiratory mask. (Chapter 4) Safe handling use and disposal of sharps is essential to prevent injury/ transmission of disease to patients, healthcare workers and cleaning staff. Each practice needs to have a policy in place for assessment and management of a needle stick injury. Education of all practice staff in sharps injuries prevention and management is essential. (Chapter 7) Safe injection practices recommend the use of one sterile needle and one sterile syringe a single time. Single dose vials should be used wherever possible. (Chapter 6) The correct management of blood and bodily fluid spills is described for spots, splashes, small and large volume spills. All practice staff need to be trained in the correct management of spills. (Chapter 10) Cleaning and/or decontamination after risk assessment of common pieces of medical equipment used in Irish general practice are detailed. (Chapter 8) Cleaning and/or decontamination after risk assessment of the general practice environment are detailed. (Chapter 9) Laundry from infected patients can be contaminated with microorganisms. Disposable linen or paper towels are recommended. A contracted laundry service compliant with current Irish legislation should be used for reusable linen. Linen should be changed between patients. (Chapter 11) Health care risk waste is defined as hazardous or dangerous due to the risk of it being infectious or because it contains used sharp materials that could cause injury. Current Irish legislation places the primary responsibility for waste and its disposal on the producer i.e. general practitioner. Proper segregation, packaging, labeling, storage and transport of health care waste are outlined. The Segregation, Packaging and Storage Guidelines for Healthcare Risk Waste (DOHC, 2010) recommends a uniform system of segregation and packaging in the provision of patient care in the Republic of Ireland. Education and training of staff in this area to prevent injury is essential (Chapter 1). For practices considering refurbishment or new build please refer to the following documents for advice regarding infection prevention and control considerations:SARI, 2009, Infection Prevention and Control Building Guidelines for Acute Hospitals in Ireland.Health Building Note (HBN) 11-01: Facilities for Primary and Continuity Care Services. Audit tools are included to assess current practices and plan for future practice development and training. (Chapter1) This document also highlights areas in need of further support and development to enable general practice to provide treatment and services to patients in a safe environment. Individual practices will be unable to implement best practice in this area without local and national investment in infrastructure and services. Practical support, single use medical devices, spill kits, central supply of approved cleaning and disinfectant agents, funding, education and dedicated infection prevention and control expertise for general practice are essential requirements for this to succeed.

International Wound Journal, 2014

Surgical site infections (SSIs) are probably the most preventable of the health careassociated infections. Despite the widespread international introduction of level I evidence-based guidelines for the prevention of SSIs, such as that of the National Institute for Clinical Excellence (NICE) in the UK and the surgical care improvement project (SCIP) of the USA, SSI rates have not measurably fallen. The care bundle approach is an accepted method of packaging best, evidence-based measures into routine care for all patients and, common to many guidelines for the prevention of SSI, includes methods for preoperative removal of hair (where appropriate), rational antibiotic prophylaxis, avoidance of perioperative hypothermia, management of perioperative blood glucose and effective skin preparation. Reasons for poor compliance with care bundles are not clear and have not matched the wide uptake and perceived benefit of the WHO 'Safe Surgery Saves Lives' checklist. Recommendations include the need for further research and continuous updating of guidelines; comprehensive surveillance, using validated definitions that facilitate benchmarking of anonymised surgeon-specific SSI rates; assurance that incorporation of checklists and care bundles has taken place; the development of effective communication strategies for all health care providers and those who commission services and comprehensive information for patients.

Academia Materials Science, 2024

Spread tow carbon fiber composites are receiving increased attention for diverse applications for space, and sports gear due to thin form suitable for deployable structures, and high tensile strengths. Their compressive strengths, however, are much lower than their tensile strengths due to low interlaminar strengths. Herein we report a facile technique to enhance their performance through interlaminar insertion of aligned carbon nanotube (CNT) sheets. The inserted CNT sheets also provide electrical conductivity in the composites even at a low CNT loading below the electrical percolation threshold established for CNT filled composites. Mechanical and electrical characterization was conducted on the CNT sheet inserted composites and the baseline composites. Results show that the CNT sheets increase the compressive strength by 14.7% compared with the baseline. Such an increase is attributed to the increased adhesion provided by the inserted CNT sheets at interface between neighboring plies, which increases the interlaminar shear strength by 33.0% and the interfacial mode-II fracture toughness by 34.6% compared with the baseline composites without inserting CNT sheets. The CNT also provided bridging between carbon fibers in the neighboring plies, contributing to 64.7% of electrical conductivity increase compared with the baseline composites. The findings indicate that the insertion of well-aligned ultrathin CNT sheets in the interlaminar region of a spread tow carbon fiber composite provide significant enhancement in mechanical and electrical performance, paving the path towards applications where both mechanical and electrical performances are crucial, such as for structural health monitoring, lightning protection, and de-icing in aircraft and wind blades.