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Edition 1: Spring 2015

From the Medical Oversight Team

As an organization, Operation Smile is committed to expanding safe, quality surgical care around the world. We have advocated for knowledge growth and skill training for many years. Through this newsletter, we will provide access to changing global practices in the delivery of safe, evidence based care as well as essential information supporting our Global Standards, policies and equipment. The information may include:

  • Highlighted standard of practice and related policies
  • New equipment information
  • Practice and equipment recalls
  • Audit data and metrics
  • Case studies and stories from the field

In this issue, we will highlight Global Standard 9; protecting volunteers, patients and families on medical missions; Operating Room safety; and provide an update on a dosage error on our medical records, which has been corrected. If you have topic suggestions, case studies or stories from the field to include in upcoming quarterly editions, please contact the Medical Oversight Team via Rachel Scagos, Medical Oversight Coordinator, at


According to the World Health Organization (WHO, 2011) 3 million of the more than 35 million health workers worldwide receive percutaneous bloodborne pathogen exposure each year. These injuries may result in unnecessary exposure to Hepatitis B and C and HIV. Health workers in operating, delivery and emergency rooms have an increased risk of exposure. As we all know, many of these exposures are preventable and the WHO supports strategies to minimize these risks. The WHO “Making Injections Safe” policy (2015) addresses unsafe practices with strategies to decrease unnecessary exposures.

The WHO program recommends that development partners “only fund procurement of safety engineered injection devices in all projects that include administration of injectable medicines.” Funding should also include ancillary needs such as sharps waste management and safety boxes.

Operation Smile is committed to protecting our volunteers and patients by implementing engineering safety strategies that minimize risk throughout the surgical experience. Several of these will be highlighted in this edition of our quarterly newsletter from our Medical Oversight Team.

Lessons from Mission Data

Nineteen needlesticks were reported during the first three quarters of this fiscal year. In an effort to decrease the risk to our volunteers, Operation Smile has the following policies and resources available.

Global Standard 9: Preventing Transmission of
Bloodborne Pathogens: Link to Resource Manual

Operation Smile will ensure protocols are followed to limit exposure to blood borne pathogens:

9.1  Universal precautions protocols will be followed.
9.2  The following strategies should be considered in limiting exposure to blood borne pathogens:

9.2.1  Appropriate handling and disposal of sharps.
9.2.2  Appropriate intervention in needle stick injuries.
9.2.3  When available, the use of needle safe IV systems.

Supporting Policies

  • Blood Supply
  • Pre-Surgical Blood Transfusion
  • Blood Borne Contagions and Post-Exposure Prophylaxis
  • Disposal of Sharps
  • Medical Waste Management
  • Team Vaccination
  • Sterilization
  • High Level Disinfection

In the event of a blood borne exposure the Post Exposure Prophylactic (PEP) Kit would be obtained and the Occupational Guidelines followed. Operation Smile has provided the PEP kit to all foundations. The kit includes:

a. Copy of “Blood Borne Exposure” policy.
b. Two (2) ml red top collection tubes – two (2) for the Operation Smile volunteer and one (1) for the patient (x9).
c. Raltegravir (Isentress: RAL) 400 mg (x14).
d. Truvada – a fixed dose combination tablet (x7).
e. 21 gauge – vacutainer push button venous blood collection set with pre-attached holder (x6).
f. Tourniquet (x3).
g. Alcohol prep (x1box).
h. Gloves (3 of each size) – size 7, 7-1/2.
i. Band-Aids (x1box).

The newest addition to the PEP kit is the OraQuick Rapid HIV test. This rapid test will provide results in 20 minutes to guide timely discussion and treatment decisions. A link is provided to the kit instructions.\

Operating Room Safety

Devon Needle Counter

This device is included in our cargo and provides a fast, easy blade removal system with a magnetic and foam strip to secure, contain and accurately count needles and scalpel blades. The box can be locked for disposal with the option to re-open if a recount is necessary. Directions for use and disposal are included in each container. Operation Smile includes one the Devon 1960 devices in each surgical pack. Additionally, larger needle and blade disposal devices are sent with the OR supplies. Our international OR volunteers should be knowledgeable about their use and it is expected that the team members should review and demonstrate use of these safety devices to the local scrub/OR techs they will be working with before surgery starts. 


Sterilization/New Autoclave

Sterilization of our instruments is a critical part of preventing exposure to pathogens on our surgical instruments. Operation Smile is in the process of replacing older models in the field. Current autoclaves are being replaced with the Tuttnauer Valuklave 1730.

Early use of this new autoclave has revealed challenges in fitting the Dingman into the chamber. We are currently exploring this challenge before wider distribution. In the meantime if you are working with one of these new models, please see the link for instructions to troubleshoot placement of instruments in the tray and chamber.

For more information refer to our Sterilization policy.

An additional resource on Sterilization and Disinfection is the attached presentation by Marie Rathe at our January Nursing Conference.


Needleless system

According to the World Health Organization Safe Management of Wastes from Health-care Activities (2014) the use of a needleless systems is a recommended part of a comprehensive control framework.

Operation Smile is currently researching various needleless IV fluid administration sets to replace the older sets that are currently in our cargo. These should be in place by the next fiscal year and reduce exposure to sharps in the perioperative setting. We will additionally be adding safety angiocaths that retract with a soft metal tip. More to come!

Medication Alert

We have been made aware of a dosage error on our medical records which has been corrected and will be implemented in the next printing of materials. In the meantime be aware of the following:

Post-Operative Order Set reads:

AMOXICILLIN ___________ mg by mouth every 12 hours
40-45 mg/kg/dose (INCORRECT!) 

The orders should read:

AMOXICILLIN ___________ mg by mouth every 12 hours
Infants and Children: 25-50 mg/kg/day; divided every 8-12 hours; by mouth
Adults: 250-500 mg/dose; every 8 hours; by mouth

OS Pharmacopeia (reference)