Author: safmed_admin

Have you ever heard of NOTES or TAMIS?

NOTES stands for natural orifice tansluminal endoscopic surgery and TAMIS stands for transanal minimally invasive surgery. Surgeon’s used to use flexible scopes to diagnose conditions and perform simple procedures like removing a foreign object, (a fish bone for example). Advances in technology and design of scopes have created a whole new approach to MIS (minimally invasive surgery).

We in CSSD need to be able to clean and sterilize the medical devices used to perform these types of surgery. Read more

1. Is the patient a risk?

When doing a risk assessment with regards to positioning of a patient, the follow factors must considered:

• How old the patient is
• How long the surgery will take
• What the overall condition of the patient is
• Does the patient smoke
• How will be patient need to be positioned in order to access the surgical site
• What positioning devices will be required
• Does the patient have any underlying conditions that would increase his/her risk, for example diabetes, obesity, malnutrition, vascular disorders
• Has the patient had previous surgery, if so what surgery was done
• Has the patient had a joint replacement
• Is the patient pregnant

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Various methods are used to monitor the efficacy of a sterilization process. This would include physical monitoring, chemical indicators (CI) and the use of biological indicators (BI).

In CSSD we should read the sterilization process print out in order to verify that the parameters of the sterilization cycle were met. Chemical indicators will verify that one or more conditions needed for sterilization (for example time, steam and temperature) have been achieved within a specific instrument set. Read more

It is critical that Surgeons have access to good lighting when performing surgical procedures. Most commonly Surgeons ask for adequate illumination of the surgical site (including deep cavities), minimal heating of the surgical site, helpful colour that renders tissue in a familiar way, convenient positioning of the light head and convenient control of the lighting systems features. Read more

In 2006 I had the pleasure of touring a purpose built outsourced CSSD in Manchester, England. It was a fascinating tour, but the most amazing feature that stood out for me at the time, was the bank of automated instrument washers. I watched in amazement as the operator received the dirty sets, scanned the set’s barcode and loaded it into a pass through washer disinfector. Read more

Research was undertaken to assess compliance to the implementation of the WHO’s (World Health Organisation) Hand Hygiene Programme.
The research was undertaken in 43 hospitals situated in Africa, Costa Rica, Italy, Pakistan and Saudi Arabia.

The study found that nurses were far more compliant with hand hygiene (71%) then doctors who were only 60% compliant.
The implementation of the hand hygiene programme improved overall hand hygiene compliance from 51% to 67%.

ALLEGRANZI, B., GAYET-AGERON, A., DAMANI, N., BENGALY, L., MCLAWS, M.-L., MORO, M.-L., MEMISH, Z., URROZ, O., RICHET, H. & STORR, J. 2013. Global implementation of WHO’s multimodal strategy for improvement of hand hygiene: a quasi-experimental study. The Lancet Infectious Diseases, 13, 843-851.

Never drop a blade from the protective packaging into a metal bowl as this can reduce the keenness of the cutting edge. Remember to handle sharps carefully.

How to attach a Surgical Blade

1. Grip blade with forceps, or similar, avoiding contact with cutting edge.
2. Hold handle in left hand with bayonet fitting uppermost.
3. Place blade partway over handle fitting and engage slots.
4. Slide blade until it clicks into position.
5. To improve assembly, flex blade slightly upwards when sliding onto the handle.

How to remove a Surgical Blade:

1. Grip blade with forceps, or similar.
2. Lift heel of blade at point ‘A’ with tip of finger, avoiding contact with cutting edge and carefully slide the blade away from the handle.

In a study published in  The Lancet Infectious disease  in 2013 (Allegranzi et al., 2013) it was noted that the hands of doctors were not as clean as those of nurses.

Research was undertaken to assess compliance to the implementation of the WHO’s  (World Health Organisation) Hand Hygiene Programme. Read more

Disinfection is defined as the reduction in the number of viable microorganisms on a surface of a medical device, to a level previously specified.

Medical devices are disinfected in order to render them safe to use. Thermal disinfection is often used in washer disinfectors to render surgical instruments safe to handle after washing. Chemical disinfection is used to process semi-critical medical devices. Semi critical medical devices are devices that come into contact with intact mucous membranes or non-intact skin. Examples of semi-critical medical devices include flexible endoscopes, rigid endoscopes, and ultrasound probes. Surgical instruments that come into contact with a sterile cavity should rather be sterilized and not disinfected. Chemical disinfection is achieved by soaking a device in a disinfectant. There are various products available on the market that can be purchased to disinfect semi-critical medical devices. Disinfectant formulations may and sometimes do sound similar but they can vary in their antimicrobial activity (efficacy), surface compatibility and safety aspects.

Always follow the manufacturers’ instruction for use carefully when using chemical disinfectants. The manufacture will stipulate how long the device should soak for and how many times the device should be rinsed with sterile water afterwards. Always wash, rinse and dry instruments thoroughly before immersing them in the disinfectant. If this is not done the disinfectant can easily be diluted, and may no longer be effective.

Some disinfectants remain active for long periods of time whilst other disinfectants need to be mixed on a daily basis. There are advantages and disadvantages associated with this. Disinfectants that remain active for long periods of time may be become soiled with patient debris, may become diluted and are often ‘topped up’ which is not good clinical practice. Disinfectants that remain active for one day must be mixed on a daily basis.

It is safe to use high level disinfection if the manufactures instructions are followed precisely, and as long as only semi-critical items are being disinfected.

It seems like robotic surgery is here to stay. In a study published in the Journal of Minimally Invasive Gynaecology, it was concluded that patients who underwent robotic assisted hysterectomy were less likely to need to be readmitted to hospital than those who underwent open surgical procedures. These patients also had less blood loss during surgery and were able to be discharged from hospital sooner than those who had open surgery (Martino et al., 2013). In South Africa we are more familiar with the use of robotic surgery in urological procedures. Read more