Manual for Male Circumcision under Local Anaesthesia

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Male circumcision under local anaesthesia Version 2.5C (Jan08) Appendix 3.3 SAMPLE CERTIFICATE OF CONSENT FOR ADULTS AND ADOLESCENTS My name is ______________________________ (BLOCK CAPITALS) I am asking you to do a circumcision operation (removal of my foreskin) on me. I give you my permission to do this operation. Signed ……………………………………………………… (client requesting circumcision) If the patient is too young to give legal consent, the form should be countersigned by a parent or legal guardian. I am the parent/legal guardian. I am asking you to do a circumcision operation on my son/ward and I give you permission to do this operation. Signed ……………………………………………………… (parent or guardian requesting circumcision on behalf of a minor) My name is ________________________________ (BLOCK CAPITALS) I am the counsellor/surgeon who has given information to the above client. I have given information about: • what circumcision is; • the benefits of circumcision; • how circumcision is done; • the risks of circumcision; • what to do before circumcision; • what to do after circumcision; • what to do if there are any complications or problems after circumcision; • an emergency contact number and information about where to go in an emergency; • why it is important to use condoms after circumcision. I have given the client an opportunity to ask me questions about all the above. I have asked the client some questions to make sure that he understands the information I have given. To the best of my belief the client is capable of giving consent and has enough information to make a proper decision about whether to proceed with the operation of circumcision (removal of the foreskin). Signed ……………………………………………. (Circumcision clinic counsellor or surgeon) Educating and Counselling Clients and Obtaining Informed Consent Chapter 3-23
Male circumcision under local anaesthesia Version 2.5C (Jan08) Chapter 4 Facilities and supplies, screening of patients, and preparations for surgery Summary EQUIPMENT AND SUPPLIES • 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. 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 Facilities and supplies and preparation for surgery Chapter 4-1 Male circumcision under local anaesthesia Version 2.5C (Jan08) and disinfected starting at the top and continuing to the floor, including all flat surfaces. A liquid disinfectant should be used, diluted as recommended by the manufacturer. Other parts of the clinic, such as the waiting and recovery areas, should be cleaned regularly with water and detergent. The lighting in the procedure room should be arranged so that the penis is well lit, and the surgeon can see what he is doing. Ideally, the clinic should be equipped with an operating theatre minor procedures lamp, but these are expensive. Adequate illumination can be provided by fluorescent lighting over the operating table. Emergency medications and equipment for managing anaphylactic reactions 2 should be available in or near the procedure room. These should be kept in a clearly labelled box, and the contents should be checked periodically (at least every 6 months) to ensure that they are complete and that none of the medications are approaching or beyond their expiry date. The box should be kept in a cool place, away from direct sunlight. In addition, it is important to have available, in or near the procedure room, alternative antiseptic surgical cleaning solution, such as chlorhexidine, for patients allergic to povidone iodine, and spare sutures and needles. The following equipment and instruments are required for standard adult male circumcision: 3 • instrument tray wrapped with sterile drape • dissecting forceps (finely toothed) • artery forceps (2 straight, 2 curved) • curved Metzenbaum’s scissors • stitch scissors • Mayo’s needle holder • sponge-holding forceps • scalpel knife handle and blades • “O” drape (80 cm x 80 cm, with ~5 cm hole) • gallipot for antiseptic solution (e.g. povidone iodine) • povidone iodine (50 ml of 10% solution) • plain gauze swabs (10 × 10 cm; 10 for the procedure, 5 for dressing) • petroleum-jelly-impregnated gauze (5 × 5 cm or 5 × 10 cm) (tulle gras) and sticking plaster • 15 ml of 1% plain lidocaine (without epinephrine) anaesthetic solution • syringe, 10 ml (if single-use syringes and needles are unavailable, use equipment suitable for steam sterilization) 2 Emergency medications and equipment: Essential: pocket mask with one-way valve, atropine (0.6 mg/ml ampoules), epinephrine (1 in 1000 solution (1 mg in 1 ml) ampoules). Desirable: diazepam suppositories for rectal administration (10 mg in 2.5 ml), oxygen supply with mask and reservoir bag, saline for intravenous administration and giving set. 3 Additional information on surgical equipment is available in the WHO Essential Emergency Equipment List (www.who.int/surgery/imeesc) Facilities and supplies and preparation for surgery Chapter 4-2
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Manual for Male Circumcision under Local Anaesthesia

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