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Medical Practice Summer 2015

Edition 1: Summer 2015

From the Medical Oversight Team

Welcome to the Operation Smile quarterly newsletter! The mission of quality, safe and accessible surgical care around the world is impossible without the unmatched dedication of our volunteers. The aim of this publication is to provide our volunteers with information about our Global Standards, policies, and equipment, which can include:

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

This issue highlights Global Standard 9: protecting volunteers, patients and families on medical missions. Additionally, we discuss Operating Room Safety measures and an update on a dosage error on our current medical records, which is corrected for the future.

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

Nurses Week Letter

National Nurses Week begins every year on May 6 and ends on May 12, coinciding with Florence Nightingale’s birthday. We take this time to recognize Operation Smile Volunteer Nurses. The award winning author Maya Angelou stated, “As a nurse, we have the opportunity to heal the heart, mind, soul and body of our patients, their families and ourselves. They may not remember your name but they will never forget the way you made them feel.”

This quote captures the essence of our incredible force of nurse volunteers around the globe. We pause to honor you for the extraordinary contribution you make to provide the safest and most compassionate care to our patients and families. This has been a year of tremendous growth for the organization. You, the nurse force, has stepped to the plate, stretched yourselves and selflessly given your time and talents to ensure that every child has the surgical care they deserve with the quality that our Global Standards require. You embrace the history and passion that Operation Smile has been for the last 33 years.

YOU are the BEST OF THE BEST every day of every mission in the farthest corners of the world. Thank you for your professionalism and commitment to continue to stretch yourselves to provide care to those that most need it.

On behalf of Operation Smile and the Nursing Council our sincere THANK YOU!

Ann Campbell RN, MSN, PNP
Director of Nursing Practice

Protecting Volunteers, Patients and
Families: The Needlestick Problem

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 to needlesticks, but they are preventable. 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.

Nineteen needlesticks were reported during the first three quarters of this fiscal year. Operation Smile is committed to protecting our volunteers and patients by implementing safety strategies that minimize risk throughout the surgical experience In an effort to decrease the risk to our volunteers the following policies and resources are available.

Operation Smile and Needle Safety


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.

Download OraQuick Test Fact Sheet (.pdf)

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.

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.

Download Marie Rathe's Sterilization and Disinfection Presentation (.ppt)


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!

Download Resource Manual (.pdf)

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)

Programs Update

Updates from Team Nicaragua

The first large-scale Operation Smile mission in Nicaragua took place last month with teams on five sites. Over 200 international volunteers screened completed 375 of surgeries.

In order to provide surgery to as many patients as possible, Team Nicaragua overcame the challenges of transporting patients from sites with larger turnouts to sites with smaller patient numbers. This has been an amazing feat of logistics, and we commend our awesome staff and volunteers for pulling this off. Even more importantly, this shows the deep-rooted hope and commitment of our patients and their families. They are willing to go anywhere for the chance to have a whole smile.

Team Nicaragua’s motto is "cien por ciento" (100%) — a phrase inspired by local Program Coordinator Bryan Mejia. Volunteers, staff, and patients alike gave "cien por ciento" and more.

NEXT Conference

During the first week of June, Operation Smile hosted our second annual NEXT Conference to bring together Medical Directors as well as future leaders from our global medical community. The themes of the conference this year included innovation in patient care, education, and training, and the changing global surgery environment. NEXT had about 200 participants from 40 countries. Prior to conference weekend, we hosted small groups in both Norfolk and Washington, D.C. for specialty-specific training.