Manual for Male Circumcision under Local Anaesthesia

Male circumcision under local anaesthesia
Version 3.1 (Dec09)
Chapter 4
Facilities and supplies, screening of patients and
preparations for surgery
Summary
• Circumcision should be performed in appropriate facilities,
with proper equipment and supplies.
• Surgical instruments wear out with use and with repeated
disinfection and sterilization. Therefore, each clinic should
carry out a periodic review of all surgical instruments.
• The surgeon must use good aseptic technique to prevent
infection.
• Before circumcision, clients should be assessed for
contraindications to surgery and conditions that need
treatment or referral.
• The assessment includes history-taking and physical
examination.
EQUIPMENT AND SUPPLIES
This chapter describes the facilities and equipment needed to
perform male circumcision safely in a clinic setting. The clinic
should be equipped with a narrow operating table, which is high
enough to allow the surgeon to operate without stooping or
bending. Ideally, this should be a purpose-built operating or
minor procedures table, which can be pumped up and down
according to the surgeon’s height. Also, ideally, the table should
tip so that, if the client feels faint, he can be put in the headdown
position. However, such tables are expensive and
circumcision under local anaesthetic can be safely performed
with a fixed-height table. Steps can be provided for the client to
climb up onto the table, and bricks can be put under the table
legs to create the head-down position.
An instrument trolley or table is required on which the instrument
tray can be unpacked.
The procedure room floor should be made of material that can
be easily cleaned and disinfected. Between cases the instrument
trolley and the operating table top should be disinfected. If there
is any spillage on the floor, this should be mopped with clean
water and detergent and then disinfected. At the end of the
operating day, the procedure room should be thoroughly cleaned
and disinfected starting at the top and continuing to the floor,
including all flat surfaces. A liquid disinfectant should be used,
Facilities and supplies and preparation for surgery Chapter 4-1