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CENTRAL STERILISING WITHOUT A C.S.S.D.
1117 Roy PFALTZGRAFF
(Northern Nigeria) spoke on B.C.G. protective against leprosy infection. 30% of 83 B.c.G.-vaccinated child contacts had developed leprosy within four years, but never of the lepromatous type. All control unvaccinated child contacts developed leprosy, many vaccination
as a
of lepromatous type. He is convinced that has
B.c.G.
vaccination
prophylactic value against leprosy. AFRICA’S
NEED
An outstanding feature of the conference was the repeated emphasis by medical workers in Africa on the great and urgent need for more personnel and increased resources to bringthe treatment of tuberculosis and leprosy to the submerged rural part of the population.
long view, this cannot be done effectively except by indigenous centres helped from outside. This cry for help is not new. In his presidential address to the British Medical Association, last year,9 entitled Medicine and Health on a Commonwealth Basis, Sir Douglas Robb said:" We need-even as doctors-more of the compassion On the
towards our fellow men that is our distinctive mark so that He we will want to spread our net of service wider." emphasised the need to give " help on a basis of mutual respect and equality, coupled with a readiness to retire as soon as the need is met and the developing country can manage on its own ". Political and social adjustment in newly independent African countries has been sudden, rapid, and demanding. More new universities and technical training centres are badly wanted, with good teachers to start them working
excitingly. Margery Perham in her B.B.C. Reith lectures has been speaking of the lack of Africans trained to take over senior posts in their countries’ administration. We bear some responsibility to help still more the impatient emerging countries of our former Empire to achieve the means to peaceful rapid physical health, as well as intellectual health and development.
CENTRAL STERILISING WITHOUT A C.S.S.D.
advantages of central sterile supply departments to hospitals have been much discussed on occasions recently 10 and many such units are now many being planned or built in Great Britain.11 Many hospitals, however, will have to continue without one for years to come. A scheme whereby local boiling sterilisers may be THE
serve one or more
abolished in advance of the establishment of a c.s.s.D. was advocated at a study day for matrons held by the North West Metropolitan Regional Hospital Board on
May
15.
It was suggested that every item required sterile in wards and outpatient and casualty departments should be sent to the main autoclave, just as linen and dressings are now; the time taken to place instruments and utensils in bags is no longer than that required to put them into a steriliser. Three or four pairs of dressing-forceps, sufficient for each dressing, may be separately wrapped for inclusion in a drum or box, or alternatively they may be placed in aluminium tubes for sterilisation in a hot-air oven. Similarly syringes may be prepared in a ward for central sterilisation if a syringe service or commercially sterilised syringes are not available. The matrons were invited to consider the dressing techniques in their hospitals in order 9. Robb, D. Brit. med. J. 1961, i, 375. 10. See Lancet, 1960, ii, 353; ibid. 1961, i, 152. 11. Central Sterile Supply. A Nursing Times publication.
London,
1961.
to see
whether the size and number of bowls used could be
reduced; dressing-packs prepared by most central sterile supply departments and commercial firms contain only one galley pot, and it was suggested that, if wards were able to manage with
one for each dressing, the extra load on the autoclave would not be excessive. Many ward sisters are already preparing lumbar puncture, cut-down, and even aspiration sets in drums which they send with the other drums for sterilisation. Catheters and rubber tubing, glass connections, spigots, and safety-pins can easily be placed in bags and included in drums or boxes; and instruments which are not needed for every dressing, such as scissors, clip-removing forceps, sinus forceps, and probes, can also be individually wrapped. Larger items such as douche cans and jugs may be sent for sterilisation in paper bags.
As a development of the scheme it was suggested that packs for individual dressings, with or without instruments, could be prepared in wards and other departments; but it was emphasised that nurses cannot spend more time than they do at present on sterilising practice. In fact, at the meeting it was demonstrated that a sister could get ready to do a dressing and then prepare a pack to replace the one she has used in less time than it took a colleague to lay up and clear a conventional dressing-trolley. In effect everything is collected for a dressing before it is sterilised rather than after, which means that the dressing and linen is transferred from stock to the dressingpack by hand instead of first to a drum and then to the dressingtrolley using forceps. Further, this work can be done by less senior staff at off-peak periods, and trained staff do not need to supervise it so closely because each pack will be sterilised after it has been sealed. Finally, as the pack does not need to be opened until it is at the patient’s bedside, the risk of contamination is reduced.
It is estimated that the cost of additional instruments and bowls for a busy surgical ward-allowing sufficient for two days’ supply on the assumption that each drum is away for a day being sterilised-is in the region of El 00. A gas or electric boiling steriliser consumes about E200 worth of fuel annually, 11 and a new boiler costs up to E140, hence the adoption of this scheme could be financially attractive. By building up the stock of instruments and utensils on each ward, the cost of setting up a central sterile supply department will be reduced and its advent may be accelerated. But more important is the prospect of an end to the need for boilers in wards and other departments. Moreover centralising the sterilisation eases supervision by the control-of-infection officer.
Medicine and the Law Incapacity not Incurable A HUSBAND petitioned for nullity on the grounds that the marriage had not been consummated due either to the incapacity of his wife or to her wilful refusal to consummate.
The parties had been married in 1945 and although there had been attempts at sexual intercourse during their 16 years’ cohabitation the marriage had never been consummated. The husband had attended at the court medical inspector’s examination and was found to be fully capable. The wife had not attended the examination, but after consulting a gynaecologist she underwent an operation for a hymenectomy 8 days before the hearing of the petition. The gynaecologist gave evidence that as a result of the operation the wife was fully capable of sexual intercourse. The court medical inspector said that there was no physical impediment to intercourse, but he considered that the wife would be psychologically incapable. Mr. Justice CAIRNS held that the onus was on the wife to prove that her
(Northern Nigeria) spoke on B.C.G. protective against leprosy infection. 30% of 83 B.c.G.-vaccinated child contacts had developed leprosy within four years, but never of the lepromatous type. All control unvaccinated child contacts developed leprosy, many vaccination
as a
of lepromatous type. He is convinced that has
B.c.G.
vaccination
prophylactic value against leprosy. AFRICA’S
NEED
An outstanding feature of the conference was the repeated emphasis by medical workers in Africa on the great and urgent need for more personnel and increased resources to bringthe treatment of tuberculosis and leprosy to the submerged rural part of the population.
long view, this cannot be done effectively except by indigenous centres helped from outside. This cry for help is not new. In his presidential address to the British Medical Association, last year,9 entitled Medicine and Health on a Commonwealth Basis, Sir Douglas Robb said:" We need-even as doctors-more of the compassion On the
towards our fellow men that is our distinctive mark so that He we will want to spread our net of service wider." emphasised the need to give " help on a basis of mutual respect and equality, coupled with a readiness to retire as soon as the need is met and the developing country can manage on its own ". Political and social adjustment in newly independent African countries has been sudden, rapid, and demanding. More new universities and technical training centres are badly wanted, with good teachers to start them working
excitingly. Margery Perham in her B.B.C. Reith lectures has been speaking of the lack of Africans trained to take over senior posts in their countries’ administration. We bear some responsibility to help still more the impatient emerging countries of our former Empire to achieve the means to peaceful rapid physical health, as well as intellectual health and development.
CENTRAL STERILISING WITHOUT A C.S.S.D.
advantages of central sterile supply departments to hospitals have been much discussed on occasions recently 10 and many such units are now many being planned or built in Great Britain.11 Many hospitals, however, will have to continue without one for years to come. A scheme whereby local boiling sterilisers may be THE
serve one or more
abolished in advance of the establishment of a c.s.s.D. was advocated at a study day for matrons held by the North West Metropolitan Regional Hospital Board on
May
15.
It was suggested that every item required sterile in wards and outpatient and casualty departments should be sent to the main autoclave, just as linen and dressings are now; the time taken to place instruments and utensils in bags is no longer than that required to put them into a steriliser. Three or four pairs of dressing-forceps, sufficient for each dressing, may be separately wrapped for inclusion in a drum or box, or alternatively they may be placed in aluminium tubes for sterilisation in a hot-air oven. Similarly syringes may be prepared in a ward for central sterilisation if a syringe service or commercially sterilised syringes are not available. The matrons were invited to consider the dressing techniques in their hospitals in order 9. Robb, D. Brit. med. J. 1961, i, 375. 10. See Lancet, 1960, ii, 353; ibid. 1961, i, 152. 11. Central Sterile Supply. A Nursing Times publication.
London,
1961.
to see
whether the size and number of bowls used could be
reduced; dressing-packs prepared by most central sterile supply departments and commercial firms contain only one galley pot, and it was suggested that, if wards were able to manage with
one for each dressing, the extra load on the autoclave would not be excessive. Many ward sisters are already preparing lumbar puncture, cut-down, and even aspiration sets in drums which they send with the other drums for sterilisation. Catheters and rubber tubing, glass connections, spigots, and safety-pins can easily be placed in bags and included in drums or boxes; and instruments which are not needed for every dressing, such as scissors, clip-removing forceps, sinus forceps, and probes, can also be individually wrapped. Larger items such as douche cans and jugs may be sent for sterilisation in paper bags.
As a development of the scheme it was suggested that packs for individual dressings, with or without instruments, could be prepared in wards and other departments; but it was emphasised that nurses cannot spend more time than they do at present on sterilising practice. In fact, at the meeting it was demonstrated that a sister could get ready to do a dressing and then prepare a pack to replace the one she has used in less time than it took a colleague to lay up and clear a conventional dressing-trolley. In effect everything is collected for a dressing before it is sterilised rather than after, which means that the dressing and linen is transferred from stock to the dressingpack by hand instead of first to a drum and then to the dressingtrolley using forceps. Further, this work can be done by less senior staff at off-peak periods, and trained staff do not need to supervise it so closely because each pack will be sterilised after it has been sealed. Finally, as the pack does not need to be opened until it is at the patient’s bedside, the risk of contamination is reduced.
It is estimated that the cost of additional instruments and bowls for a busy surgical ward-allowing sufficient for two days’ supply on the assumption that each drum is away for a day being sterilised-is in the region of El 00. A gas or electric boiling steriliser consumes about E200 worth of fuel annually, 11 and a new boiler costs up to E140, hence the adoption of this scheme could be financially attractive. By building up the stock of instruments and utensils on each ward, the cost of setting up a central sterile supply department will be reduced and its advent may be accelerated. But more important is the prospect of an end to the need for boilers in wards and other departments. Moreover centralising the sterilisation eases supervision by the control-of-infection officer.
Medicine and the Law Incapacity not Incurable A HUSBAND petitioned for nullity on the grounds that the marriage had not been consummated due either to the incapacity of his wife or to her wilful refusal to consummate.
The parties had been married in 1945 and although there had been attempts at sexual intercourse during their 16 years’ cohabitation the marriage had never been consummated. The husband had attended at the court medical inspector’s examination and was found to be fully capable. The wife had not attended the examination, but after consulting a gynaecologist she underwent an operation for a hymenectomy 8 days before the hearing of the petition. The gynaecologist gave evidence that as a result of the operation the wife was fully capable of sexual intercourse. The court medical inspector said that there was no physical impediment to intercourse, but he considered that the wife would be psychologically incapable. Mr. Justice CAIRNS held that the onus was on the wife to prove that her