Care and guidance instructions on eye surgery performed under the National Blindness Control Program
Guidelines from the Ministry of Health and Family Welfare, Government of India regarding the care to be taken for eye surgery under the National Blindness Control Program.
General instructions
1. Cataract surgery should be done in a separate eye surgery house in the hospital and the surgery should be done taking care of the necessary disinfection in this operating room.
2. In cataract surgery camp, the patient should be examined only and his surgery should be performed only in the hospital which is the operating room for cataract surgery.
3. Adequate number of beds, separate ophthalmic surgery homes are available in the inpatient wards of the hospital and the hospitals which are in regular operation and the operating room is always used with proper disinfection will be allowed to conduct camps. Minor eye surgery camps should not be allowed in a hospital where the operating room is closed for more than seven days.
4. Do not put any kind of photo, incandescent lamp, mirror, calendar, notice board etc. on the wall in the operating room.
5. Water tanks supplying eye surgery department and operating room should be cleaned regularly.
6. Samples of water supplied to the eye surgery house should be sent regularly and their separate records should be kept.
7. Patients who should not undergo surgery at district level on single eye patients should be counseled and referred to JJ Hospital, Mumbai. Instead, surgery should be planned and performed by a senior ophthalmologist.
8. The eye surgery team must have two eye surgeons, two staff nurses, one ophthalmology officer, one surgery home assistant with the required experience.
9. The senior eye surgeon in the eye surgery squad should have at least five years of working experience in government or government sector or have a certificate of having performed at least five hundred surgeries after obtaining post graduate degree or diploma in Ophthalmology. Under no circumstances should the junior ophthalmologist perform the surgery independently.
10. Every ophthalmologist should have a good quality microscope for eye surgery. Do not rush into eye surgery.
11. No more than 25 eye surgeries a day should be performed by the Chief Ophthalmologist in the second surgery camp.
12. Disinfection of Materials Used for Eye Surgery Separate autoclaves should be used to prevent disinfection of materials in other departments. However, if a separate machine is not available, the time for disinfection of surgical instruments should be fixed. It is the sole responsibility of the ophthalmic surgeon to ensure that all materials are properly autoclaved before surgery.
13. After the disinfection of the operating room, at least once a month, by taking Air Settle plate or signing, make sure that the operating room is free of germs.
14. The above ingredients should be used within 12 hours after disinfection of tools, linen, all materials required for surgery. If the material needs to be used for surgery after 12 hours, it should be re-sterilized and used only later.
15. The cataract surgery record should be kept by mentioning each patient's photo, identity card, address, contact number so that it is convenient to contact early if needed.
Pre-operative surgery
16. Cataract Before glaucoma surgery, pre-surgical examination is required to check the patient's suitability for surgery.
17. Microscope, Surgical Trolley, Clothes used by the patient and the surgical team, All the materials used for surgery, Inter Operative Surgical, Visco, IOL, etc. Make sure the material is completely sterile. Under no circumstances should low quality disinfectants like acetone be used.
18. Patients selected for cataract glaucoma surgery should be given antibiotic eye drops for eye treatment as needed.
Intra-Operative Instructions
19. The surgery team should use a separate cataract surgery set for each patient and ensure that they are properly sterilized. Ophthalmic surgeons should ensure that adequate cataract surgery sets are available according to the number of patients before starting the operation.
20. While disinfection, all the cataract material should be combined and disinfected by separating each sheet without disinfection. Apply indicator tape in two places on top and inside of this set while sterilizing. The strip should have the date, time and signature of the staff. Each set should be wrapped separately.
21. Strict action will be taken against the concerned District Surgeon and Senior Ophthalmologist if it is found that in any case cataract surgery equipment and chemicals should not be sterilized by boiling in water.
22. Chital forceps should not be used in the operating room for writing or prescribing instruments and other things.
23. Liquid soap should be used for hand washing, soap bar and simple hair should not be used.
24. The sticker should be affixed on the discharge card and case paper of the patient just like the lens of the operating room. Disinfection Register Fabrication Register Add swab reports from microbiology. Government records should also be kept and signed on daily basis by the pediatrician and ophthalmologist.
25. Surgical grapes should be used preferably during the surgery so that the germs on the skin and around the eyes do not get into the hands or the eyes and the water or saline herbs used on the ground do not get wet.
26. If more surgery is to be performed in an OT, fumigation should be done after 8 hours by giving a volume of 2 hours in between or by bacillosid spray and keeping the OT closed for 2 hours after which the rest of the operation should be done.
27. An iPad must be properly fitted to the eye of a patient undergoing surgery at an eye surgery home.
28. Separate set of sterile and separate disposable serine, surgical drapes etc. should be used for each patient.
29. It is necessary to check the supply company, expiration, packing and cleanliness of all the materials used in the government pre-camp. It is necessary to move the smell bottle and observe it to see if there is any impurity in it.
Post operative information.
30. In order to prevent post-operative infections and other diseases, appropriate treatment should be given to each patient after ophthalmic surgery.
31. Future follow-up is required to regain full vision.
32. The eye surgeon along with his team should regularly examine each patient on the first, third and seventh day after eye surgery.
33. On the seventh day of surgery, however, the surgeon should examine the patient himself and record the extent of vision loss. Also in 35 to 40 days the disease should be re-examined and the number of spectacles should be taken out. In next fortnight they should be given spectacles.
34. All patients who underwent surgery on that day, even if one patient suffered, should be followed up for one month.
35. As soon as more than two patients become infected, the specialist should be called and the seniors should be informed within twelve hours. Failure to report will result in penal action against the officer.
36. As soon as more than two persons are found to be infected, samples of surgical instruments, instruments, medicines, etc. should be sent for examination and the responsibility of finding the cause of infection should be given to them by the surgeon.
Suggestions for NGOs
37. Permission should be granted by the District Surgeon to the District Program Manager after verifying their previous history for conducting camps for NGOs such as NGOs registered under the National Blindness Control Program.
38. Permission should be given to conduct camps after evaluation of eye surgery homes and materials used for their disinfection proposed by NGOs.
39. All NGOs and private hospitals operating under the National Blindness Control Program are required to enter into agreements with district level officials as per the guidelines of the National Blindness Control Program.
Action should be taken as per the useful guidelines. Action will be taken against the officers and employees who do not heed the instructions and are negligent in their duties.
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Cataract surgery guideline