Reference Manual - IARC Screening Group

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Infection Prevention ProcessesMoist heat at 80°C kills essentially all bacteria, viruses, parasitesand fungi in 20 minutes. Unless the altitude of the health facility isover 5,500 meters (18,000 feet) it is not necessary to increase thesteaming or boiling time (Favero 1985).High-LevelDisinfection byBoilingOpen or take apart all instruments and other items. Submerge them inwater and cover pan. Boil for 20 minutes. Timing should begin when thewater is at a rolling (bubbling) boil and all items should be totally underthe water. Nothing should be added to the container after the waterbegins to boil. After boiling for 20 minutes, remove boiled items usinghigh-level disinfected forceps, place in a high-level disinfected containerand allow to cool and air dry.Use instruments and other items immediately or leave in a covered, dry,high-level disinfected container. (The container used for drying theinstruments can be used for storage only if there is no water in the bottomof the container.) Store for up to 1 week.Boiling Tips• Always steam or boil for 20 minutes using a pot with a lid.• Start timing when the water begins to boil.• Items should be covered completely a with water.• Do not add anything to the pot after the water begins to boil.a An IPAS report documented that the interior temperature of a plastic cannula floatingon the surface of boiling water reaches a temperature of 96–98 °C in less than a minute(IPAS 1993). For items that float (e.g., plastic syringes, surgical gloves or rubber items),it is not absolutely necessary that they be fully covered by the water to achieve HLD.High-LevelDisinfection bySteamingSteaming surgical gloves has been used as the final step in processinggloves for many years in Indonesia and other parts of South East Asia. In1994 a study by McIntosh et al confirmed the effectiveness of this process.In this study, the steamer used (Figure C-3) consisted of:• a bottom pan (approximately 31 cm in diameter) for boiling water;• one, two or three circular pans with multiple, 0.5 cm (diameter) holesin their bottoms to permit the passage of steam up through them andwater back down to the bottom pan; and• a lid that fits on the top pan.C-6 Cervical Cancer Prevention Guidelines for Low-Resource Settings
Infection Prevention ProcessesFigure C-3. Steamer Used for HLDTwo types of tests were conducted to determine whether surgical glovescould be high-level disinfected using this process.In the first set of experiments, a thermocouple was placed inside aglove in each of the three pans and the rate and extent of the temperaturechange recorded. As shown in Figure C-4, when from 5 to 15 pairs ofsurgical gloves were placed in each of the three pans, the temperaturereached 96–98 °C in less than 4 minutes in the bottom and middle pansand within 6 minutes in the upper pan. Thereafter the temperatureremained constant throughout the remaining 20 minutes.Figure C-4. Temperature Rise in Gloves as a Function of Tray PositionIn the second set of experiments, batches of new surgical gloves werecontaminated with Staphylococcus epidermidis, Staphylococcus aureus,Pseudomonas aeruginosa and Candida albicans as well as Bacillussubtilis (heat-sensitive) and Bacillus stearothermophilus (heat-resistant)endospores. Next the gloves were placed in one of the three pans andCervical Cancer Prevention Guidelines for Low-Resource Settings C-7
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Cervical Cancer PreventionGuideline
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TABLE OF CONTENTSPREFACE AND ACKNOW
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How to High-Level Disinfect Surgica
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Table C-2Figure C-1Preparing a Dilu
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PREFACE AND ACKNOWLEDGMENTSThis ref
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ONEINTRODUCTIONMAGNITUDE OF THE PRO
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IntroductionFigure 1-3. Incidence o
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Introductionprevalence areas, a sta
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Table 1-2. Reduction in Cumulative
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Introductiontheir performance was t
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Introductionlesions, or a false pos
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IntroductionCompared to other metho
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Introductionsignificantly to women
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IntroductionBelinson JL et al. 2001
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IntroductionMitchell MF et al. 1998
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IntroductionYlitalo N et al. 1999.
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TWOHUMAN PAPILLOMAVIRUS AND CERVICA
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Human Papillomavirus and Cervical C
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THREEPATHOPHYSIOLOGY OF CERVICAL CA
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With the onset of puberty, whichis
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Pathophysiology of Cervical Cancerp
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Pathophysiology of Cervical CancerP
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Pathophysiology of Cervical CancerI
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Pathophysiology of Cervical CancerR
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FOURTALKING WITH WOMEN ABOUTCERVICA
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Talking with Women About Cervical C
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FIVEPREVENTING INFECTIONS INHEALTHC
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Preventing Infections in Healthcare
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Page 79 and 80: SIXCLIENT ASSESSMENT AND VIA TESTIN
Page 81 and 82: Client Assessment and VIA TestingFi
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Page 91 and 92: SEVENTREATMENT AND FOLLOWUPBACKGROU
Page 93 and 94: Treatment and Followupregardless of
Page 95 and 96: Treatment and FollowupFigure 7-1. L
Page 97 and 98: Treatment and FollowupTable 7-6. Co
Page 99 and 100: Treatment and FollowupFigure 7-2 is
Page 101 and 102: Treatment and Followup• Regulator
Page 103 and 104: Treatment and FollowupCRYOTHERAPY P
Page 105 and 106: Treatment and FollowupStep 6 Point
Page 107 and 108: Treatment and FollowupNote: When CO
Page 109 and 110: Treatment and FollowupStep 5Advise
Page 111 and 112: Treatment and FollowupBerget A, B A
Page 113 and 114: APPENDIX ATESTS FOR CERVICAL CANCER
Page 115 and 116: Tests for Cervical Cancer Screening
Page 121 and 122: APPENDIX BSCREENING TEST QUALITIES
Page 123 and 124: Screening Test Qualities and Their
Page 125 and 126: APPENDIX CINFECTION PREVENTION PROC
Page 127 and 128: Infection Prevention Processesfor m
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Page 133 and 134: Table C-4. Preparing and Using Chem
Page 135 and 136: Infection Prevention ProcessesStora
Page 137 and 138: Infection Prevention Processes• h
Page 139 and 140: APPENDIX DTECHNICAL OVERVIEW OF THE
Page 141 and 142: Technical Overview of the Cryothera
Page 143 and 144: Figure D-5. Removing Protector Tube
Page 145 and 146: Technical Overview of the Cryothera
Page 147 and 148: Figure D-11. Gas Cylinder Secured t
Page 149 and 150: APPENDIX ETROUBLESHOOTING WITH THEC
Page 151 and 152: Table E-1. Following-Up on Commonly
Page 153 and 154: APPENDIX FPROCESSING SURGICAL GLOVE
Page 155 and 156: Processing Surgical GlovesTable F-1
Page 157 and 158: Processing Surgical GlovesSTEP 10:
Page 159 and 160: APPENDIX GPERFORMING BREAST AND PEL
Page 161 and 162: Performing Breast and Pelvic Examin
Page 163 and 164: Figure G-2. Breast Puckering or Dim
Page 165 and 166: Figure G-5. Checking for Nipple Dis
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Figure G-18. Speculum in Place with
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Performing Breast and Pelvic Examin
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APPENDIX HPERCEIVED BARRIERS TO PRO
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AVAILABILITY OF BASIC SUPPLIES AND
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GLOSSARYAcetic AcidAcetowhite Chang
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PatulousSquamocolumnarJunction (SCJ
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ADDITIONAL READINGAlliance for Cerv
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Reference Manual - IARC Screening Group

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