Ophthalmic Operating Theatre Practice: A manual for lower-resource settings Editor: Heather Machin SECOND EDITION Alone we can do so little: Together we can do so much “ - Helen Keller ” This book is dedicated to: First edition authors – Ingrid Mason (Cox) and Sue Stevens Ophthalmic Operating Theatre Practice – A manual for lower-resource settings © Second Edition 2016 Editor Heather Machin Published by the International Centre for Eye Health, London School of Hygiene and Tropical Medicine http://iceh.lshtm.ac.uk ISBN # 978-0-9955190-0-8 Contact: [email protected] The editor and authors share copyright for this work with the publisher. The work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License https://creativecommons.org/licenses/by-nc/4.0/ Unrestricted use, distribution, and reproduction of any part of this manual is permitted in any medium for non-commercial purposes, provided that the licensors are acknowledged, any changes are indicated and a link to the license is provided. 2 Contents Section 1: General – Something eyeryone should know...................................................................................10 Contributors: David Lewis, Heather Machin and Babar Qureshi Professionalism.........................................................................................................................................................11 Caring for Ourselves...................................................................................................................................................12 Global Initiates …........................................................................................................................................................12 Section 2: Ocular Conditions Requiring Surgical Treatment.............................................................................17 Contributors: Hunter Cherwek, John Cooper, Kristen A Eckert, Heather Machin, Ingrid Mason, Neil Murray, Heiko Philippin, S. Grace Prakalapakorn, Van C. Lansingh and the Aravind Hospital Team: Indira Durai, Namratha Gaikwad, Deeba Ishrath, Dr.Jyothirathod, Usha Kim, A.Karthik Kumar, Vrushali Patil, R.Sharmila, and Sr.Sundari Anatomy Diagrams.....................................................................................................................................................18 Cataract......................................................................................................................................................................20 Glaucoma (Trabeculectomy)......................................................................................................................................21 Diabetic Eye Disease.................................................................................................................................................25 Vitreoretinal Surgery (Vitrectomy).............................................................................................................................26 Oculoplastics..............................................................................................................................................................27 Paediatric Ophthalmology.........................................................................................................................................28 Corneal Surgeries......................................................................................................................................................35 Pterygium...................................................................................................................................................................38 Combined Surgeries..................................................................................................................................................40 Trachoma (Trichiasis).................................................................................................................................................40 Section 3: Emergency Triage for Surgery and Ocular Hospital Acquired Infections and Inflammatory Conditions.............................................................................................................................................................................44 Contributors: Hunter Cherwek and Janet Marsden Emergency Triage for Surgery...................................................................................................................................45 Ocular Hospital Acquired Infections and Inflammatory Conditions (Endophthalmitis and TASS)........................48 Section 4: Care of the Surgical Patient.....................................................................................................................51 4a-Communication, Pre-Arrival and Pre-Operative (and Biometry).....................................................................................51 Contributors: Heather Machin, Mariano Yee Melgar, Fiona O’Sullivan, Krystal Henry, Krystal Lovell-Yarde and Marilyn Watkins-Ramdin Building Relationships, Communication and Trust.................................................................................................52 Biometry – for cataract surgery patients only.........................................................................................................52 Pre-Operative Care....................................................................................................................................................53 Informed Consent and Day of Surgery.....................................................................................................................53 Transferring and Positioning a Patient.....................................................................................................................56 4b - Anaesthetics, Recovery and Discharge..........................................................................................................................58 Contributors: Sandra P Burnett and Heather Machin Anaesthetics...............................................................................................................................................................59 Patient Fasting...........................................................................................................................................................61 Pre-Operative Anaesthetic Care................................................................................................................................62 During and After the Surgery.....................................................................................................................................63 Local Anaesthetic.......................................................................................................................................................63 Sedation.....................................................................................................................................................................66 General Anaesthetic..................................................................................................................................................66 Caring for special categories of patients..................................................................................................................69 Anaesthetic Emergencies..........................................................................................................................................71 Recovery (Post-Operative Care)................................................................................................................................71 Discharge...................................................................................................................................................................74 3 Contents Section 5: Operating Theatre Processes..................................................................................................................77 Contributors: Elise Chick, Heather Machin, and Sofia Solazar Tamay Theatre Design...........................................................................................................................................................78 Dress Code, Personal Protective Equipment (PPE) and Personal Hygiene............................................................81 Cleaning the OT..........................................................................................................................................................82 Commissioning an OT................................................................................................................................................83 Surgical Hand Washing.............................................................................................................................................84 Gowning......................................................................................................................................................................86 Gloving.........................................................................................................................................................................88 Drapes, Patient Preparation and the Sterile Field...................................................................................................89 Preparing the patient................................................................................................................................................91