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The strict control of infection, especially control of the lethal HIV virus and the hepatitis B and C viruses, is fundamental to the surgical procedures outlined in this book. Summarised guidelines include:

  • All doctors and staff need to be taught and demonstrate competency in hand hygiene, dealing with blood and body fluid spills, standard precautions and the principles of environmental cleaning and reprocessing of medical equipment.

  • Practices should appoint an infection prevention and control coordinator with responsibility for overseeing a comprehensive infection prevention and control program including implemention of practice cleaning policies.

  • Practices should perform regular infection prevention and control risk assessments, and determine how best to manage any identified risks through a combination of education and training, as well as redesign of work practices.

  • Use single-use pre-sterilised instruments and injections wherever possible.

  • The use of single-use sterile equipment minimises the risk of cross-infection. Items such as suturing needles, injecting needles, syringes, scalpel blades and pins or needles used for neurological sensory testing should be single-use.

  • Assume that any patient may be a carrier of hepatitis B and C, HIV and the human papilloma virus.

  • Hand washing is the single most important element of any infection control policy: hands must be washed before and after direct contact with the patient. For non-high-risk procedures, disinfect by washing with soap under a running tap and dry with a paper towel, which is discarded.

  • Antiseptic handwash (e.g. 2% chlorhexidine) or alcohol hand rubs or wipes have also proven to be effective in reducing the spread of infection.

  • Alcohol-based hand rubs, used according to product directions, are appropriate where hand hygiene facilities are not available (e.g. home visits).

  • Promote the ‘5 moments of ‘hand hygiene’ ’ as an important part of infection control and practice.

  • Disposable auroscope tips should be used.

  • Sterile gloves and goggles should be worn for any surgical procedure involving penetration of the skin, mucous membrane and/or other tissue.

  • Avoid using multi-dose vials of local anaesthetic. The rule is ‘one vial—one patient’.

  • Safe disposal of sharp articles and instruments such as needles and scalpel blades is necessary. Needles must not be recapped.

  • Instruments cannot be sterilised until they have been cleaned. They should be washed as soon after use as possible.

  • Autoclaving is the most reliable and preferred way to sterilise instruments and equipment. Bench-top autoclaves should conform to Australian Standard AS 2182.

  • Sterilisers without a printer or data logger are obsolete and should not be used.

  • Chemical disinfection is not a reliable system for routine processing of instruments, although it may be necessary for heat-sensitive apparatus. It should definitely not be used for instruments categorised as high risk.

  • Boiling is not reliable as it will not kill bacterial spores and, unless timing is strictly monitored, may not be effective against bacteria and viruses.

  • All staff should be immunised according to standard immunisation recommendations.

  • Masks may be used by unimmunised staff and also by patients to prevent the spread of disease (suspected or known) by droplets.

  • Ensure the application and removal of personal protective equipment is consistent with the Australian Guidelines for the Prevention and Control of Infection in Healthcare.

  • Include information stating the management of waste must conform to state or territory regulations.

  • Goggles and face shields need to be used by staff where there is a risk of splashing or spraying of blood or body fluids such as during surgical procedures, venepuncture or cleaning of instruments.

Note: For skin antisepsis for surgical procedures, swab with povidone-iodine 10% solution in preference to alcoholic preparations.

Reference: RACGP Infection control standards for office based procedures (5th Edn). standards/Infection-prevention-and-control.pdf

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