Manual for Male Circumcision under Local Anaesthesia

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Male circumcision under local anaesthesia Version 3.1 (Dec09) immediately after caring for a patient. Gloves should not be used for the care of more than one patient. Change or remove gloves in the following situations: during patient care if moving from a contaminated body site to a clean body site within the same patient; after patient contact before touching another patient. In countries with a high prevalence of hepatitis B, hepatitis C and HIV infection, wearing two pairs of gloves (double gloving) may be appropriate for surgical procedures lasting more than 30 minutes or involving contact with large amounts of blood or body fluids. This situation is not likely to apply with properly screened patients undergoing clinic-based circumcision. Table 8.1 Gloving requirements for common tasks in a male circumcision service Activity Checking blood pressure or temperature, giving an injection Drawing blood and testing for HIV Handling and cleaning instruments, handling contaminated waste, cleaning spills of blood or other body fluid Surgery Type of gloves No gloves required Examination Utility Sterile surgical Keep in mind the following: • Wear gloves of the correct size, particularly for surgery. • Use water-soluble (non-fat-containing) hand lotions and moisturizers, to prevent skin from drying, cracking, and chapping. Avoid oil-based hand lotions and creams, because they can damage latex rubber surgical and examination gloves. • Keep fingernails short: they should not extend beyond the fingertip. Bacteria and other microorganisms that cause disease can collect under long nails. Long nails also tend to puncture gloves more easily. • Store gloves in an area where they are protected from extremes of temperature. • Glove reprocessing is strongly discouraged and should be avoided. There is currently no standardized, validated and affordable procedure for reprocessing gloves. • Using gloves when they are not necessary represents a waste of resources. Masks, caps and protective eyewear Masks protect the mucous membranes of the mouth and nose from possible infections, as well as reduce the risks of transmission of infections from the health care worker. They should be worn by anyone undertaking a procedure Prevention of Infection Chapter 8-8
Male circumcision under local anaesthesia Version 3.1 (Dec09) that is likely to generate splashes of blood, blood products and body fluids. Surgical masks are designed to resist fluids, and are preferable to cotton or gauze masks. Caps or hair covers and eyewear, such as plastic goggles, safety glasses, face shields and visors, protect against accidental splashes, spills and leaks of blood and other body fluids. Protective eyewear should be worn by theatre staff during circumcision surgery. Caps are recommended, but are not essential. Aprons and the surgeon’s gown Aprons made of rubber or plastic provide a waterproof barrier to keep contaminated fluids off the health worker’s clothing and skin. Staff should wear aprons when cleaning instruments and other items used for patient care. If an apron is used, it is worn under the surgical gown. During circumcision surgery a surgeon’s gown is recommended, though some surgeons prefer to use a clean or disposable apron. Footwear Appropriate footwear is necessary to protect the feet from injury from sharp or heavy items. Rubber boots or leather shoes provide the best protection, but must be regularly cleaned. Avoid wearing sandals, thongs, or shoes made of soft material. Immunizations Certain vaccines, such as hepatitis B, can be useful for protecting health care workers and laboratory staff against diseases they may be exposed to during their work. Prevention of Infection Chapter 8-9
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Manual for Male Circumcision under Local Anaesthesia

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