Disinfection, sterilization and operation theater guidelines for dermatosurgical practitioners in India.

Modern day dermatologists conduct different esthetic and surgical procedures, with risk of infective complications. Hence, infection control practices need to be established in dermatological practice to minimize the risk of exogenous infections. These practices include hand washing, cleaning, sterilization, disinfection, operation theater sterilization and specifications. Proper hand washing after examination of each patient and prior to any surgery with a formulation containing alcohol alone or as a combination with other agents reduces the chances of transferring infections to and from patients. Sterilization and disinfection constitute the most important aspect of infection control. Disinfectants and disinfecting procedures vary according to the environment and equipment. Proper knowledge of different processes/agents for sterilization and disinfection is essential. Disinfectants for use in hospitals should always be freshly prepared and should be of adequate strength. Sterilization is carried out most commonly using steam sterilizers or ethylene dioxide sterilizers. The waste generated during practice is a potential source of nosocomial infections and should be treated as per the proper protocol and guidelines. Trained staff to carry out these practices is essential.

Guidelines for cryotherapy.

Introduction: Cryotherapy is a controlled and targeted destruction of diseased tissue by the application of low temperatures. It is a simple, cost-effective, efficacious and esthetically acceptable modality for the treatment of various dermatoses. Indications: It is indicated in the treatment of a wide variety of skin conditions, including benign tumors, acne, pigmented lesions, viral infections, inflammatory dermatoses, infectious disorders and various pre-malignant and malignant tumors. Facility: Cryosurgery is an out patient department procedure and can be undertaken in a clinic or minor procedure room. Instrumentation and Equipment: Several cryogens such as liquid nitrogen, nitrous oxide and carbon dioxide are available, but liquid nitrogen is the most commonly used. Techniques: Different techniques of application of the cryogen include the timed spot freeze technique (open spray and confined spray method), use of cryoprobe or the dipstick method. The choice of the method is based on the type of lesion. The procedure is undertaken under aseptic conditions, usually without any anesthesia. The number of freeze thaw cycles needed may vary from lesion to lesion. It is important to know the freeze time for each condition, number of sessions required and the interval between the sessions to achieve good cosmetic results with minimal complications. Contraindications: The treating physician should be aware of the absolute and relative contraindications of the procedure, such as cold urticaria, cryoglobulinemia, Raynaud's disease, collagen vascular diseases, etc. Complications: While cryosurgery is usually a safe procedure, complications may occur due to inappropriate patient selection, improper duration of freezing and freeze thaw cycles. The complications may be acute, delayed or protracted. In Indian skin, post-inflammatory pigmentary changes are important but are usually transient. Physician qualification: Cryotherapy may be administered by a dermatologist who has acquired adequate training during post-graduation or through recognized fellowships and workshops dedicated to cryotherapy. He should have adequate knowledge of the equipment and pre- and post-operative care. Understanding the underlying pathology of the lesion to be treated, particularly in malignant and pre-malignant lesions, is important.

Standard guidelines for setting up a dermatosurgery theatre.

Introduction, definition, rationale and scope: Dermatologists in India are now increasingly performing surgical and cosmetic procedures in their practice. This calls for minimum standards at the national level with the main focus of patient safety and hence the guidelines for setting up a dermatosurgical theatre. Facility: The dermatosurgery theatre can be created in either physician's clinic, or a hospital depending on the procedure to be performed. The dermatosurgery theatre requires careful planning with regards to - location, dimension, shell design, lighting, electrical requirements, operation table, chair, trolley, surgical instruments, sterilization of devices, asepsis and advanced life support. Apart from physical considerations, other considerations including theatre etiquettes, consent for surgery, safety of dermatosurgeon, theatre staff and lastly biomedical waste management should be looked into. These issues are discussed in detail in the recommendations.