Undersökning av spill och läckage vid hantering av antibiotika inom sjukvården Slutrapport AFA-projekt 07-0043 Olle Nygren och Roger Lindahl Gruppen för Arbetsmiljökemi Miljö- och Biogeokemi Kemiska Institutionen Umeå Universitet Projektet, som redovisas i denna rapport, är ett tillämpat projekt med syfte att dels beskriva omfattningen av det spill och läckage av antibiotika, som förekommer vid svenska sjukhus, dels att ta fram exempel och förslag på åtgärder som kan vidtas för att minska omfattningen och spridning detta spill och läckage. En viktig del av detta projekt är därför en återkoppling av resultat till den undersökta och berörda målgruppen. Denna rapport utgör en viktig del av denna återkoppling.
Gs16 surgery for ingrowing toenail (adult).fm
Mr. Sanjay Singh MBBS, MS, FRACS, FRCS (UK)
2 - 4 Charles Street Tel: 02 4474 3774 Fax: 02 4474 3775 Write questions or notes here: Surgery for Ingrowing Toenail (adult) Further Information and Feedback:
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Brochure code: GS16
Expires end of December 2012 Issued December 2011
What is an ingrowing toenail?
What will happen if I decide not to have
An ingrowing toenail happens when thetoenail grows into the skin around it (see You should keep your feet clean. Soak your figure 1). The skin can get damaged, feet in warm water a few times a day to causing infection and pain. The problem soften the skin.
usually happens to the big toe.
Your GP or podiatrist (a specialist in treatingproblems of the lower legs and feet) may be able to push the skin away from the into the skin and ingrowing toenail or cut away the piece of causing infection nail that has grown into the skin.
If your toe gets infected, you may needantibiotics but this will not treat youringrowing toenail.
An ingrowing toenail is not life-threateningbut the problem tends to get worse with timecausing infection, pain and difficultywalking.
What does the operation involve?
Ingrowing toenail The healthcare team will carry out a numberof checks to make sure you have the Your doctor has recommended an operation operation you came in for and on the correct to treat your ingrowing toenail. However, it is side. You can help by confirming to your your decision to go ahead with the operation doctor and the healthcare team your name or not. This document will give you and the operation you are having.
information about the benefits and risks to Surgery for an ingrowing toenail is usually help you make an informed decision.
performed under a local anaesthetic. Your If you have any questions that this doctor will inject local anaesthetic into your document does not answer, you should ask toe and usually place a tourniquet (tight your doctor or any member of the healthcare strap) around the base of your toe. Your doctor will only begin the operation whenboth of you are satisfied that the local How does an ingrowing toenail happen?
anaesthetic is working. You may be given The most common cause of an ingrowing antibiotics during the operation to reduce toenail is not cutting your toenails properly, the risk of infection.
by cutting them too short or down the sides The operation usually takes about ten of the toenail. The problem often runs in minutes and may involve one or more of the families as a common cause is having toenails that do not grow straight.
Nail avulsion – Removing the whole Wearing shoes that do not have enough toenail. The nail will regrow.
width to fit the toes in their natural position Wedge excision – Removing part of your can also cause an ingrowing toenail.
nail where it is growing into the skin, alongwith the area of tissue in the corner that the What are the benefits of surgery?
nail grows from (see figure 2). The nail will Removing the ingrowing toenail or part of regrow but will be narrower than before.
the toenail should take away the infection Nail-bed ablation – Removing part of the nail or the whole nail and then applying achemical (usually phenol) or an electric Are there any alternatives to surgery?
current to the area of tissue that the nail Try to cut your toenails straight across and grows from. This will prevent the nail from avoid leaving sharp edges. Wear shoes that growing back, either partially or completely fit the shape of your feet comfortably.
depending on how much was removed.
Copyright 2011 Expires end of December 2012
What can I do to help make the
operation a success?
If you smoke, stopping smoking severalweeks or more before an operation mayreduce your chances of gettingcomplications and will improve yourlong-term health.
Try to maintain a healthy weight. You havea higher chance of developingcomplications if you are overweight.
You can reduce your risk of infection in asurgical wound.
• Try to have a bath or shower either the day before or on the day of your operation.
• Keep warm around the time of your operation. Let a member of the healthcare Zadek's procedure – Removing the team know if you are cold.
whole nail and then cutting away the area oftissue that the nail grows from (see figure 3).
What complications can happen?
This will prevent the nail from growing back.
The healthcare team will try to make youroperation as safe as possible. However, complications can happen. Some of thesecan be serious. You should ask your doctorif there is anything you do not understand.
Any numbers which relate to risk are fromstudies of people who have had thisoperation. Your doctor may be able to tellyou if the risk of a complication is higher orlower for you.
1 Complications of anaesthesia
Your anaesthetist will be able to discuss with you the possible complications of Zadek's procedure having an anaesthetic.
2 General complications of any
What should I do about my medication?
You should let your doctor know about all Pain, which happens with every
the medication you are on and follow their operation. The healthcare team will try to advice. This includes herbal remedies and reduce your pain. They will give you medication to control diabetes and blood medication to control the pain and it is pressure. If you are on beta-blockers, you important that you take it as you are told so should continue to take them as normal.
you can move about as advised.
You may need to stop taking warfarin or Bleeding during or after surgery. You
clopidogrel before your operation.
will normally have a tourniquet around yourtoe during the operation, so there isnormally little bleeding.
• Unsightly scarring of the skin, if your
doctor uses the wedge excision technique.
Copyright 2011 Expires end of December 2012 3 Specific complications of this
If your toe bleeds, press firmly on the wound for fifteen to twenty minutes and thengradually release the pressure. Keep your Infection of the surgical site (wound)
(risk: 1 in 8). The risk is higher if your doctor For the first two weeks you should avoid uses phenol. It is usually safe to shower sports and other strenuous activities. You after 48 hours. However, you should check should keep the dressing dry.
with a member of the healthcare team. Let Your doctor will tell you when you can return your doctor know if you get a temperature, to normal activities.
notice pus in your wound, or if your wound Do not drive until you are confident about becomes red, sore or painful. An infection controlling your vehicle and always check usually settles with antibiotics but you may your insurance policy and with your doctor.
need another operation.
• The future
How soon will I recover?
Try to cut your toenails straight across and • In hospital
avoid leaving sharp edges.
After the operation you will be transferred to Wear shoes that fit the shape of your feet the recovery area. You will have a thick, padded bandage on your foot. You should An ingrowing toenail can happen again (risk: keep your foot raised up to reduce swelling.
less than 1 in 10 if phenol is used). This may Your doctor will tell you if you need to have need another operation.
any stitches removed. After a short whileyou will be able to go home. Open toe shoes will be more comfortable and will allow room Surgery to remove an ingrowing toenail can for the dressing. A responsible adult should take away infection and pain.
take you home in a car or taxi and stay with Surgery is usually safe and effective.
you for at least 24 hours. You should be However, complications can happen. You near a telephone in case of an emergency.
need to know about them to help you make If you are worried about anything, in hospital an informed decision about surgery.
or at home, contact a member of the Knowing about them will also help to detect healthcare team. They should be able to and treat any problems early.
reassure you or identify and treat anycomplications.
Keep this information leaflet. Use it to
help you if you need to talk to a
• Returning to normal activities
You should not drive, operate machinery (this includes cooking) or do any potentially Author: Mr Simon Parsons DM FRCS (Gen. Surg.) dangerous activities for at least 24 hours and Maria Laye, Surgical Care Practitioner and not until you have fully recovered Illustrations: Medical Illustration Copyright 2011 feeling, movement and co-ordination. If you Nucleus Medical Art. All rights reserved.
had a general anaesthetic or sedation, you should also not sign legal documents or Australian Chief Editor: Associate Professor SteveTrumble MBBS, MD, FRACGP.
drink alcohol for at least 24 hours.
For more information about the SMS Editorial For the first few days you will need to spend Review Board, go to www.smservices.net.au.
most of the time with your leg raised up sothat the swelling settles. After that, you can This document is intended for information
purposes only and should not replace advice
usually start to be a little more active.
that your relevant health professional would
You may need to have your dressings give you.
changed to check the skin is healing and toremove any stitches.
Copyright 2011 Expires end of December 2012
Material Safety Data Sheet MSDS Report Shenzhen Herewin Technology Co., Ltd. Side A, 2 F, A14 Building, No. 26 of Kukengdafu Industrial Prepared For : Park, Guanlan Aobei Community, Longhua New District, Shenzhen City, P.R.C Product Name: Polymer Li-ion Battery Voltage: Typical 3200mAh, 11.84Wh