Reference Manual - IARC Screening Group

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Infection Prevention Processessteamed for 20 minutes. After this, they were removed from the pans andincubated for 24 hours in sterile media and then plated on blood agar. Inall cases (6, 15 and 30 gloves per pan), there was no growth of anymicroorganisms or B. subtilis endospores at 24 hours and, as expected,only a reduction in the number of B. stearothermophilus endospores.Based on the results of these experiments, it would appear that steamingis effective in high-level disinfecting surgical gloves.Use of Steaming forHLD: Advantagesand DisadvantagesSteaming has several distinct advantages over boiling for the finalprocessing of surgical gloves. Although boiling and steaming gloves areequally easy to do, drying boiled gloves is not practical because it isdifficult to prevent contamination while they are air-drying. Aftersteaming, the gloves do not need to be handled and can be stored in thesteamer pan, so there is less chance of contaminating them. An additionaladvantage is that steaming is more cost-effective because it uses muchless fuel than does boiling.The major disadvantage of steaming is that if the steamers availablelocally are small, it is only practical to use them for small items (e.g.,surgical gloves and syringes). Large boiling pots are easier to use withmetal instruments and require less attention to be sure that the boilingprocess is being done correctly.High-LevelDisinfection bySoaking in aChemical SolutionAt present, only four chemicals are approved worldwide for use as highleveldisinfectants:• chlorine,• glutaraldehyde,• formaldehyde (formalin), and• hydrogen peroxide.Formaldehyde is very irritating to the skin and, eyes and respiratory tract,and is suspected to be a human carcinogen; hydrogen peroxide is highlycorrosive and is unstable in the presence of heat and light. Thus, in thecontext of this manual, chlorine solutions and glutaraldehydes are thepreferred chemicals for use in high-level disinfection. Although alcoholsand iodophors are inexpensive and readily available, they are no longerclassified as high-level disinfectants (Rutala 1997). Alcohols do not killsome viruses, and Pseudomonas species have been known to multiply iniodophors. These chemicals should be used for disinfection only whenthe high-level disinfectants listed above are not available or appropriate.Table C-4 provides guidelines for preparing and using these chemicaldisinfectants.C-8 Cervical Cancer Prevention Guidelines for Low-Resource Settings
Table C-4. Preparing and Using Chemical DisinfectantsChemicals for Sterilization or High-Level DisinfectionPREPARING AND USING CHEMICAL DISINFECTANTSDisinfectant(commonsolution orbrand)EffectiveConcentrationHow to DiluteSkinIrritantEyeIrritantRespiratoryIrritantCorrosiveLeavesResidueTimeNeededfor HLDTimeNeeded forSterilizationActivatedShelf Life a,bChlorine(3–15%)Glutaraldehyde(Cidex)0.1% Dilutionprocedures vary cVaries(2–4%)Varies: readinstructions oncontainerYes (withprolongedcontact)YesYes Yes Yes d Yes 20minutesYesvaporsChemicals for Disinfection (alcohols and iodophors are not high-level disinfectants)Alcohol(ethyl orisopropyl)Iodophors(10% povidoneiodine/PVI)60–90% Use full strength Yes (candry skin)Approximately2.5%1 part 10% PVIto 3 parts waterYes No Yes 20minutesat 25°C eYes No No No Do notuseNo Yes No Yes Yes Do notusea All chemical disinfectants are heat and light sensitive and must be stored appropriately.b Always check manufacturer’s instructions for when to discard.c See Tables C-3 and C-4 for instructions on preparing chlorine solutions.d Corrosive with prolonged (> 20 minutes) contact and/or concentrations ≥ 0.5% if not immediately rinsed with boiled water.e Different commercial preparations of Cidex and other glutaraldehydes are effective at lower temperatures (20 °C) and for a longer activated shelf life.Do not use10 hours forCidexDo not useDo not useChange daily;sooner if cloudyChange every14 days; soonerif cloudyChange weekly;daily if heavilyused; sooner ifcloudyChange dailyAdapted from: Rutala 1997.C-9 Cervical Cancer Prevention Guidelines for Low-Resource Settings
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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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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
Page 129 and 130: Infection Prevention Processeswith
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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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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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