Infection Prevention in Contraceptive Procedures

Infection prevention during contraceptive procedures protects patients and providers from infection by correct hand hygiene, protective barriers, safe handling of sharps, instrument processing and waste disposal. These measures apply to every patient regardless of diagnosis and are known as universal precautions. They are what prevent device-related infection and bloodborne exposure.

Core measures.

• Hand hygiene before and after every patient contact.

• Protective gear: sterile gloves for implant, IUD, vasectomy and sterilisation procedures; examination gloves for other contact; face protection where splashes are likely.

• Safe use and disposal of needles and sharps.

• Instrument and equipment processing: decontamination, cleaning, high-level disinfection or sterilisation, and storage.

• Housekeeping, prompt cleaning of spills and safe waste management.

Hand hygiene. Rub hands with an alcohol-based rub for 20 to 30 seconds, or wash with soap and water for 40 to 60 seconds when hands are visibly dirty; do this before putting on gloves and after removing them. Dry on a clean single-use towel.

Antiseptics.

• Skin (implant, vasectomy, sterilisation): chlorhexidine 2% in 70% alcohol, or povidone-iodine 10%; let it dry before the incision.

• Cervix and vagina (IUD): povidone-iodine 10% or chlorhexidine 0.05% to 4% aqueous solution; check for allergy.

Preparation. Check that the room, couch, instruments and device packaging are clean and intact, that sterile items are in date, and that waste and sharps containers are in place before the patient arrives.

Instrument processing.

• Decontaminate used instruments immediately by soaking in 0.5% chlorine solution for 10 minutes while wearing utility gloves.

• Rinse, then wash thoroughly with detergent and water, using a brush, to remove blood and tissue; cleaning removes most organisms.

• Rinse and dry.

• Sterilise: autoclave at 121 degrees Celsius for 20 minutes unwrapped or 30 minutes wrapped; or dry heat if autoclave is not available.

• High-level disinfection when sterilisation is not available (for example, speculums and sounds that do not enter sterile tissue): boil for 20 minutes from the time of rolling boil, steam for 20 minutes, or soak in 2% glutaraldehyde for 20 minutes then rinse in sterile water.

• Store sterilised or high-level disinfected instruments in covered sterile containers in a clean, dry place.

• Single-use items: discard implant applicators and trocars after use; do not reuse the device.

Sharps.

• Never recap, bend or break needles.

• Dispose of sharps immediately in a puncture-resistant container; close and replace it when three-quarters full.

• Never pass sharps hand to hand; use a tray.

IUD insertion. Use the no-touch technique: the device stays in its package until placed, and the inserter and device do not touch the vaginal wall or speculum blades. Clean the cervix with antiseptic. Do not give routine antibiotic prophylaxis.

Waste. Place contaminated waste in a leak-proof container with a lid; burn or autoclave as the facility arranges; dispose of sharps containers safely.

Spills. Clean blood and body fluid spills at once with 0.5% chlorine solution while wearing gloves.

Implant site infection. Pain, heat, redness, pus: flucloxacillin 500 mg orally four times daily for 5 to 7 days, or cefalexin 500 mg orally four times daily for 5 to 7 days; remove the implant if there is no improvement in 48 to 72 hours or an abscess forms.

Pelvic infection after IUD insertion. Fever, lower abdominal pain, pain during sex, discharge, most often in the first 20 days: ceftriaxone 500 mg intramuscularly as a single dose, doxycycline 100 mg orally twice daily for 14 days and metronidazole 400 mg orally twice daily for 14 days. Leave the device in place if the patient wishes and improves; remove it if there is no improvement in 48 to 72 hours or if the patient is severely ill.

Needle-stick or sharps injury.

• Wash the site with soap and water; do not squeeze or scrub.

• Report the incident at once and test the source patient for HIV, hepatitis B and hepatitis C with consent.

• Start post-exposure prophylaxis within 72 hours if the source is HIV positive or unknown: tenofovir disoproxil fumarate 300 mg, lamivudine 300 mg and dolutegravir 50 mg orally once daily for 28 days.

• Check the provider's hepatitis B vaccination status and give vaccine or immunoglobulin where needed.

• Baseline and follow-up HIV testing at 6 weeks and 3 months.

Splashes to eyes or mucous membranes. Rinse with clean water or saline for at least 10 minutes, then report.

Patient instructions. Keep the insertion or incision site clean and dry, and return for pain, heat, redness, pus, fever or unusual discharge.

Facility quality. Keep a log of sterilisation cycles, check indicators on every load and record instrument failures. Review infection rates and adverse events regularly.

Staff protection. Vaccinate providers against hepatitis B, provide protective gear, and offer post-exposure prophylaxis and counselling after any exposure.

Special groups. Patients living with HIV can receive any procedure with the same precautions; their status never changes the precautions used. Patients with cervicitis or pelvic infection need treatment before IUD insertion.

Referral and escalation. Refer or escalate sterilisation failures, clusters of device-related infections, exposures to bloodborne pathogens and procedure room contamination to the facility infection prevention lead and report adverse events through the pharmacovigilance system.