TheatrePracticeStandardsGeneric1

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Generic Theatre Standard No 06A - Management of Patients with Known Clostridium difficile and GDH in the Operating Department Standard Statement: All Theatre staff will have knowledge of the requirements for caring for patients with Clostridium difficile in the operating department to protect self, colleagues and patients from the risk of health care acquired infection. The bacterium produces two potent toxins that cause mucosal damage and inflammation of the large bowel. Although in most cases it causes a relatively mild illness, occasionally, particularly elderly patients may develop a severe form of the disease called ‘pseudomembranous colitis’. This condition is characterised by significant damage to the large bowel, and may lead to gross dilation with possible rupture or perforation of the bowel. C.difficile infection is often acquired in hospital, and almost all patients who develop C.difficile diarrhoea are taking, or have recently been given antibiotic therapy. Nearly all antibiotics have been causally associated with C.difficile however, some such as cephalosporins, (particularly oral cephalosporins) and antibiotic combinations such as cefuroxime and clarithromycin are more strongly associated whereas gentamicin, vancomycin, and trimethoprim are much less often associated. It has been firmly established that person to person transmission can occur in the hospital setting and indeed major outbreaks have resulted. Staff hands are the most important mode of transmission, but studies have also demonstrated that C.difficile, as a spore forming organism, can survive for long periods of time in the environment and on contaminated equipment. The sensible use of antibiotics is the key to the prevention of C.difficile infection. Unnecessary use of antibiotics must be avoided. Where possible, short courses of narrow-spectrum antibiotics, of only three to five days, are preferred to longer courses. All antibiotic prescriptions should be kept under review. Trust antimicrobial prescribing guidance must be followed. Antimicrobial prescribing audits will be conducted regularly. General Considerations RCHT C.Diff Prevention and management of Clostridium difficile infection policy RCHT Generic Theatre Standards 4: Infection Control in the Operating Theatre • Staff very rarely suffer from symptoms related to C.difficile. However, should staff be receiving antibiotics then they may be at some risk of infection, and therefore should avoid contact with known cases of C.difficile infection. • Position on list Symptom free in last 72 hours: DO NOT NEED to be last on list. Symptoms present in last 72 hour: Consider either allowing sufficient time between patients to allow staff to robustly clean, without pressure, using Actichlor Plus AND recover OR placing patient LAST ON LIST • Hand Hygiene Staff hands are the most important mode of transmission from patient to patient. Soap and water must be used for hand hygiene rather than alcohol rub - soap and water is far more effective. Decontaminate hands following Ayliffe’s seven step technique (RCHT ANTT Policy). Patients must also be encouraged to wash their hands. If the patient is bed bound, patient wet wipes should be offered for hand hygiene as an alternative to soap and water. 28
• PPE Gloves and aprons must be worn for direct patient contact with symptomatic patients or when cleaning. Hands must be washed with soap and water following removal of protective clothing. If aprons have not been worn, theatre attire (tops and trousers) should be changed after all direct patient contact has been completed, also after ‘cleaning’. • Environment/equipment cleaning for surfaces that receive direct patient contact e.g. operating tables, other furniture and instruments please follow decontamination and disinfection instructions follow Appendix 1 & 2 of RCHT IPAC Decontamination Policy. A chlorine based disinfectant must be used for daily routine cleaning of the environment. • Recovery/PACU Symptom free in last 72 hours DO NOT NEED to be recovered in theatre. Symptoms present in last 72 hours SHOULD BE recovered in theatre. Compliance: 100% Exceptions: None References: • AfPP Principles of Safe Practice in the Perioperative Environment 2011 • RCHT ANTT Policy • RCHT IPAC Decontamination Policy • RCHT Prevention and management of Clostridium difficile infection policy • RCHT Generic Theatre Standards 4: Infection Control in the Operating Theatre 29
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New Bookmark Drugs Table of Content
Page 4 and 5:
MEMBERSHIP OF THE WORKING PARTY Dr
Page 6 and 7: SECTION I - SUMMARY AND RECOMMENDAT
Page 8 and 9: SECTION III - INTRODUCTION Patients
Page 10 and 11: purchase these services. They must
Page 12 and 13: SECTION VI - PREPARATION FOR THE TR
Page 14 and 15: A patient who remains hypotensive d
Page 16 and 17: A patient who has been made physiol
Page 18 and 19: 4. Other equipment • suction •
Page 20 and 21: important to involve those who take
Page 22 and 23: REFERENCES 1. Association of Anaest
Page 24 and 25: APPENDIX II TRANSFER CHECKLIST FOR
Page 26 and 27: 21 Portland Place, London W1B 1PY T
Page 28 and 29: Storage of Drugs in Anaesthetic Roo
Page 30 and 31: Generic Theatre Standard No 08 - Ca
Page 32 and 33: 6.2. Overall performance against th
Page 34 and 35: • Clean theatre clothing should b
Page 36 and 37: • Protective face shields must be
Page 38 and 39: Generic Theatre Standard No 02 - Op
Page 40 and 41: • Please read NJR Manual and Trai
Page 42 and 43: 13. Positioning of the Patient •
Page 44 and 45: Generic Theatre Standard No 04 - In
Page 46 and 47: Example of Environmental Theatre Cl
Page 48 and 49: 3. Between case cleaning procedures
Page 50 and 51: 6.1. Floor scrubbing machines • C
Page 52 and 53: • Personnel participating within
Page 54 and 55: Generic Theatre Standard No 06 - Ma
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Page 60 and 61: lood, CSF or brain tissue, should b
Page 62 and 63: Exceptions: None References: • Af
Page 64 and 65: • Environment/equipment cleaning
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Page 68 and 69: Generic Theatre Standard No 06G - M
Page 70 and 71: Generic Theatre Standard No 06H - M
Page 72 and 73: Generic Theatre Standard No 07 - De
Page 78 and 79: • The deceased patient should be
Page 80 and 81: 11 Leakages from the oral cavity, v
Page 82 and 83: • Mormonism o It is essential tha
Page 84 and 85: FAITH CONTACT ADDRESS TELEPHONE NO
Page 86 and 87: • The active electrode must alway
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Page 92 and 93: • The labelled container must be
Page 94 and 95: • Staff Responsibility • All st
Page 96 and 97: • It is the responsibility of the
Page 98 and 99: 6. Induction of anaesthesia • See
Page 100 and 101: 4. Time Out - Before start of surgi
Page 102 and 103: • The registered anaesthetic prac
Page 104 and 105: • The Senior Surgeon/Operating Cl
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Generic Theatre Standard No 16 - St
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Generic Theatre Standard No 18 - Us
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Generic Theatre Standard No 20 - Ma
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Generic Theatre Standard No 22 - Ma
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3. Planned over-running sessions
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Generic Theatre Standard No 23 - Bo
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Generic Theatre Standard No 25 - Co
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Generic Theatre Standard No 27 - Ph
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Generic Theatre Standard No 29 - Vi
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Generic Theatre Standard No 31 - Th
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• Advice should be obtained from
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8. Harassment and Bullying • Dign
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Appendix 1. Governance Information
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Appendix 2. Initial Equality Impact
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