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First infection control guidance for surgery in primary care

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Practice nurses assisting in minor surgical procedures in primary care settings must be able to prove they are competent in aseptic technique, according to the first ever guidance on the area.

They must also have knowledge and understanding of facilities in their practice that are used for minor surgical procedures and minimal access interventions (MAIs), for example proper ventilation and storage of instruments.

The Healthcare Infection Society guidelines are the first specifically aimed at minimising infection risk in primary care settings where surgical procedures are performed.

The authors say the guidance is a response to the increasing number of minor operations taking place outside of conventional hospital theatres and “recognition” that many such procedures are currently carried out in sub standard facilities. Resulting infections not reported, they add.

The guidance states that sterile gloves and an apron are the “minimum” protective equipment for carrying out minor procedures but masks are not usually required. More thorough precautions, including a fresh sterile gown for each case, are required when a sterile device is being implanted or an MAI taking place.

All surgical procedures should involve World Health Organization’s surgical safety checklist, which has been adapted for the NHS by the National Patient Safety Agency.

The guidance also states: “All staff involved in MAI and minor surgical procedures must be able to provide evidence of competency in aseptic technique and in their knowledge and understanding of the facilities that are provided.”

It notes that natural ventilation – windows that open – is acceptable for minor procedures, but a fly screen must be in place and patient privacy must not be “compromised”. But for MAIs windows should be non-openable and mechanical ventilation in place that changes the air 15 times per hour.

Doors should be self closing and have a vision panel, and scrub-up basins should be far enough away from surgical instruments that splashing does not take place.

Single-use instruments are “encouraged” by the guidelines but if re-usable instruments are used they should be stored in “dedicated secure” place.

The society said the guidance, which is published in the Journal of Hospital Infection, should be referred to by all infection prevention control teams and clinicians involved in such procedures.

Mitch Clarke, an infection control clinical nurse specialist at Nottingham University Hospitals Trust, said the guidance was “timely”.

“Nurses have a responsibility to ensure that we advocate the best facilities on the best available evidence,” he told Nursing Times. “It is important to state that this is the first time we have had had this type of guidance on minor procedures, and from my perspective is long awaited.”

He added: “Fully functioning and effective facilities are vitally important. GP and practice managers may ask for the expertise of nurses and doctors working in infection prevention and control to advise on design and ongoing maintenance. 

“Moreover, distinguishing the types of procedure which can and cannot be undertaken is equally important, as there is no previous guidance on this issue. Part of the reassessment of some current facilities may find that they are not adequate, and that either the procedures undertaken would need to be reassessed, or the facilities upgraded.”





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