Reference Manual - IARC Screening Group

Client Assessment and VIA TestingCotton swabs are used to remove mucus and discharge from the cervixand to apply acetic acid to the cervix. These swabs should be generouslycovered with clean cotton so that they will be able to wash the cervixthoroughly with acetic acid and not scratch or injure the cervix. Thecotton swabs do not have to be sterile. Cotton “wool” formed into ballsand applied to the cervix with a forceps is also acceptable.Examination gloves should be new. (If surgical gloves are being reused,they should be decontaminated, cleaned and high-level disinfected aftereach use. Sterile gloves are not necessary.) Use a new pair of gloves forevery woman.The wooden spatula is used to push away the lateral walls of the vaginaif they protrude through the speculum blades. Use a new spatula for everywoman. Alternatively, a condom with a cut tip can be rolled over thespeculum blades to prevent the walls of the vagina from pushing into thespace and preventing an adequate view of the cervix.Acetic acid is the main ingredient of vinegar. A dilute (3–5%) solution isrecommended. In some countries, vinegar is not available. Often what issold in the market is a “vinegar-substitute” that in fact is acetic acid. Ifneither vinegar nor an acetic acid substitute is available, apharmacist/chemist or local chemical supplier can make the dilute aceticacid using the following formula:% ConcentrateTotal Parts (TP) water = ⎡ 1⎣ ⎢ ⎤% Dilute ⎦⎥ −For example, to prepare a dilute solution (5%) from a 20% concentratedacetic acid solution:20%TP water = ⎡ 1 = 4 -1 = 3 parts water to 1 part concentrate⎣ ⎢ ⎤5% ⎦⎥ −20%concentratedacetic acidsolutionWater1 partacetic acidsolution1 partwater1 partwater1 partwaterand1part1part1part1part5%dilutesolutionChlorine solution (0.5%) is used to decontaminate the speculum andsurgical gloves after each use. After decontamination, the speculum,instrument tray or container and surgical gloves should be washed withsoap and water, thoroughly rinsed and then high-level disinfected or6-6 Cervical Cancer Prevention Guidelines for Low-Resource Settings