Infection Control and Instrument Sterility for Minor Surgery

Changes in the delivery of health care have increased the demand for minor surgical and screening procedures in general practice.
Since the 1990 general practitioner contract, general practitioners have received payment for performing:

• Injections,
• Aspirations,
• Incisions,
• Excisions,
• Curetting,
• Cautery
• and Cryocautery.

• Clinicians taking part in minor surgery should be competent in resuscitation and, as for other areas of clinical practice, have a responsibility for ensuring that their skills are regularly updated.
• Registered nurses can provide care and support to patients undergoing minor surgery.
• Nurses assisting in minor surgery procedures should be appropriately trained and competent, taking into consideration their professional accountability and the Nursing and Midwifery Council guidelines on the scope of professional practice.
• The practices should have such facilities as are necessary to enable them properly to provide minor surgery services. National guidance on premises standards has been issued. (Department of Health. Health building note 46: General medical practice premises. London: Department of Health.)
• Adequate and appropriate equipment should be available for the doctor to undertake the procedures chosen, and should also include appropriate equipment for resuscitation.
• Practices must ensure that details of the patient's minor surgery procedure is included in his or her lifelong record.
• If the patient is not registered with the practice, then the practice must send this information to the patient's registered practice for inclusion in the patient notes.

Full records of all procedures should be maintained in such a way that aggregated data and details of individual patients are readily accessible. Practices should regularly audit and peer-review minor surgery work. Possible topics for audit include:

• Clinical outcomes.
• Rates of infection.
• Unexpected or incomplete excision of basal cell tumours or pigmented lesions which following histological examination are found to be malignant.

Minor surgery in general practice has a low incidence of complications.
It is important that practices providing minor surgery operate to the highest possible standards.
To maintain high standards practices should;

• Have approved sterilisation procedures that reflect national guidelines
• Obtain sterile packs from the local CSSD.
• Use disposable sterile instruments.

Sterilising equipment should be maintained regularly.
The practice must have an infection control policy, which covers excised specimens, the disposal of clinical waste and the handling of used instruments.
This should reflect national guidelines.

The recommendations are divided into three broad recommendation headings:

• Hand hygiene. Hands must be decontaminated immediately before each and every episode of direct patient contact or care and after any activity or contact that could potentially result in hands becoming contaminated
• The use of personal protective equipment Gloves must be worn as single-use items. They must be put on immediately before an episode of patient contact or treatment and removed as soon as the activity is completed. Gloves must be changed between caring for different patients, and between different care or treatment activities for the same patient. In a recent study only 33.1%GPs reported wearing gloves during minor operations.⁴
• The safe use and disposal of sharps.

The DOH states that "All instruments that are used in the clinical environment should be decontaminated without exception."
It is not acceptable that only instruments that have direct patient contact should be cleaned. Thermal dis-infection i.e. by moist heat is the method of choice for all instruments that have direct patient contact and are not heat sensitive or disposable.
Basic requirements for a good decontamination process:⁵

• An effective management control system is in place covering all aspects of the decontamination cycle
• Appropriate facilities are provided;
• Appropriate equipment is utilised which is:
• Fit for purpose;
• Properly maintained and calibrated;
• Properly monitored and validated.
• Staff are properly trained and supervised;
• Single use medical devices, are not reused;
• Records of decontamination are kept.