Contraceptive Implants Session VI: Infection Prevention Technical Resource Package for Family Planning Contraceptive Implants Module Session VI

Preparing for Insertion Have the client wash her entire arm (one she uses less often). Cover the procedure table and arm support with a clean cloth. Ask client to lie on her back so that implant arm is turned outwards and bent at the elbow and is well supported. Prepare clean instrument tray, open sterile instrument pack. For Jadelle and Sino-Implant (II), carefully open sterile pouch containing implants by pulling apart, without touching the rods, allowing them to fall into a sterile cup or bowl. For Implanon NXT, remove the sterile applicator with the preloaded implant by allowing it to fall on the sterile tray. Technical Resource Package for Family Planning Contraceptive Implants Module Session VI 2

Before Insertion Wash hands with antiseptic soap and water, dry with clean towel or air-dry. Put sterile or high-level disinfected (HLD) gloves on both hands before procedure. Clean insertion site with a cotton soaked in antiseptic solution and held in a sterile or HLD forceps. When giving local anesthetic, use a new disposable syringe and needle, if available, an autodisable syringe is preferable. 3 Technical Resource Package for Family Planning Contraceptive Implants Module Session VI

During Insertion: Jadelle and Sino-Implant To minimize risk of infection and/or expulsion, make sure ends of rods nearest to the incision are not too close (not less than 5 mm) to incision. If tip of rod is too close to the incision, it should be carefully removed and reinserted. To enable easy removal of both rods from a single incision, it is important that ends of rods closest to the incision are not farther apart, than the width (not length) of one implant. While inserting implants, try not to remove trocar from incision. Keeping trocar in place minimizes tissue trauma, decreases chances of infection, and minimizes insertion time. Technical Resource Package for Family Planning Contraceptive Implants Module Session VI 4

During Insertion: Implanon NXT The applicator should not be used if sterility is in question If partial protrusion occurs, discard the implant and reinsert a new sterile implant using a new applicator If contamination occurs, use a new package. Technical Resource Package for Family Planning Contraceptive Implants Module Session VI

After Insertion Clean around insertion site with antiseptic. Cover insertion site with bandage and cover with gauze. Dispose of applicator, syringe and needle in sharps container. Burn or bury when ¾ full. Decontaminate non-disposable instruments in 0.5% chlorine for 10 minutes. Dispose of contaminated items like gauze, cotton, etc. in leak-proof container or plastic bag. Technical Resource Package for Family Planning Contraceptive Implants Module Session VI