Preoperative preparations

Staff

Health and safety policies

The following health and safety policies should be imple­mented for all theatre staff:

  all staff should have a chest X-ray before commencing work;

       appropriate vaccination schedules, e.g. hepatitis B, and tetanus immunisation policies should be in place;

  policies for staff protection when handling patients with a high-risk transmittable disease, e.g. hepatitis B or C, human immunodeficiency virus (HIV);

  protocols for accident procedure;

  protocols for incident procedure;

  ionising irradiation guidelines with instructions for use for the X-ray image intensifier. All staff who use such instruments must be in possession of the Irradiation Protection Certificate;

  policy with regard to the adequacy of exhaustible anaesthetic gases;

  guidelines for the use of a laser;

  infection control policy with regular monitoring.

Staff facilities

  Changing area — this should be adequate inside with secure lockers, and with clean and adequate supplies of clean clothing, which should be of a close-woven coloured mate­rial with trousers for both sexes which should have elasticated ankles. Appropriate disposal bags for dirty linen, adequate toilets and washing facilities including hand basins and showers. Caps, masks and aprons should be available. Staff should have their own comfortable, regularly cleaned, antistatic footwear.

  Masks — these are important for staff protection and for

operations involving splashing, such as drilling, there

should be visor protection of the eyes. They are of ques­tionable value in reducing infection rate. They should be:

   fabric not cotton;

   not touched by hands;

   not put in pockets;

    destroyed after single use.

Equipment

  Trolleys should be clean, have safety rails and have oxygen cylinders with well fitting tubes and masks, all of which are regularly checked so that empty cylinders are replaced. Trollies must be able to be tipped into the Trendelenburg position in case of regurgitation of gastric contents.

  The operating table should be cleaned with regular checks to see that it can be raised and lowered smoothly with the appropriate gears for Trendelenburg tilt, lateral tilt and an adequate braking system. Accessories should be clean and available and fit well, and it is particularly important to ensure that stirrups fit well.

    Settlement of negligence claims in this area is very costly.

  The lights should be modern and easily movable by members of the scrubbed team and by other theatre personnel.

  The suction apparatus should be clean and thoroughly checked, with spare suction tubes and catheters available.

       Anaesthetic machines should be in good working order —many of them are now supplied on a loan basis with a strict policy as to the correct connections and nontransferable piping. They must be regularly serviced and a record of this must be maintained.

   All electrical equipment should be regularly checked and marked accordingly.

   A fire policy, regular fire drills and weekly testing of fire doors are essential safety precautions.