Manual for Male Circumcision under Local Anaesthesia

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Male circumcision under local anaesthesia Version 3.1 (Dec09) BASIC CONCEPTS Measures to prevent infection in male circumcision programmes have two primary objectives: • to minimize the risk of infections in people having surgery; • to minimize the risk of transmitting HIV and other infections to clients and health care staff, including cleaning and housekeeping staff. In the context of circumcision services, there are two important pathways for transmission of infection: • Direct transmission. Enteric and skin infections can be transmitted by this route, as can bloodborne pathogens, such as HIV and hepatitis B virus, either by direct contact with an open wound or blood, blood products and body fluids, or by accident through a needle stick injury. • Airborne transmission. Pneumonia, pertussis, diphtheria, influenza, mumps, and meningitis can be transmitted through droplets in the air, usually within a range of about 1 m, while active pulmonary tuberculosis, measles, chickenpox, pulmonary plague, and haemorrhagic fever with pneumonia can be transmitted via droplet nuclei (small-particle aerosols) over larger ranges. In male circumcision programmes, a major concern is the potential direct transmission of bloodborne pathogens, such as HIV and hepatitis B virus, to health care workers or patients. Exposure may take place during patient care, clinical or surgical procedures, processing of soiled instruments, cleaning and waste disposal. Needle-stick injuries carry a high risk of infection; the actual level of risk will depend on the type of needle, the depth of the injury, the amount of blood or blood product on the needle, and the viral load in the blood. The risk of acquiring HIV from an HIV-infected person through a needle-stick injury is estimated at 0.3% (three HIV infections for every 1000 injuries). The risk of acquiring hepatitis B virus infection, after being stuck with a needle that has been used on a person with hepatitis B infection ranges from 6% to 37%, with an average of 18%. Finally, the risk of acquiring hepatitis C infection after being stuck with a needle that has been used on a hepatitis-C-infected person is 1.8%. 1 Most instances of transmission of infection in health care facilities can be prevented through the application of basic infection control precautions. In the circumcision clinic, standard precautions, as described below, should be applied to all patients at all times, regardless of their infection status. Prevention of Infection Chapter 8-2
Male circumcision under local anaesthesia Version 3.1 (Dec09) STANDARD PRECAUTIONS Standard precautions are a set of practices to prevent and control infection. They include the use of personal protective equipment, designed to protect health care workers and patients from contact with infectious agents. Laboratory and health care workers can protect themselves and their patients from exposure to HIV and other infections by following standard precautions. Often, during clinical care, it is not known whether a patient is infected or colonized with potentially pathogenic microorganisms. Every patient, and every member of staff, should therefore be considered at risk, both of infecting others and of acquiring an infection. Standard precautions should be applied during all contact between health care workers and patients, in all health care facilities at all times. The key components of standard precautions are: • hand washing and antisepsis (hand hygiene); • use of personal protective equipment when handling blood, blood products, body fluids or excretions, mucous membranes, non-intact skin, or wound dressings; • prevention of needle-stick and sharp injuries; • appropriate handling of patient care equipment, environmental cleaning and management of spills; • appropriate handling of waste. Each of these components is discussed in detail below. HAND HYGIENE Hand hygiene is the single most important and cost-effective measure to eliminate disease-causing microorganisms that contaminate hands, and to limit the spread of infection. Proper hand hygiene can be accomplished by frequent hand washing and frequent use of an alcohol-based handrub. In most clinical situations, an alcohol-based handrub should be used for routine hand antisepsis. Commercial handrubs, liquid soaps and skin-care products are sold in disposable containers, and may be used provided they meet recognized international standards (such as those of the American Society for Testing and Materials or the European Committee for Standardization), and are well accepted by health care workers. Where such products are not available or are too costly, an alcohol-based handrub can be produced locally at low cost. 2 Prevention of Infection Chapter 8-3
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Manual for Male Circumcision under Local Anaesthesia

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