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Atlas of visual inspection of the cervix with acetic acid for screening, triage, and assessment for treatment

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Infection prevention Ė Essential steps for infection prevention in VIA screening or triage


  • Wash your hands thoroughly with soap and water, following the steps recommended by the World Health Organization.
  • Wipe your hands with a clean towel or air-dry. Avoid using shared towels, to prevent contamination.
  • Wear sterile gloves on both hands before starting the procedure.

  • Perform handwashing before and after examining each woman.
  • Make sure to always wear gloves before making contact with any secretions, body fluids, or blood.
  • Change gloves after completing each examination, to prevent cross-contamination.

  • Arrange the sterile or HLD instruments for VIA on the instrument tray.
  • During the examination, maintain a unidirectional flow of instruments and consumables:

    • Pick up sterile instruments from the VIA instrument tray.
    • Examine the woman on the examination table.
    • Place the used instruments in a separate bowl or container with 0.5% chlorine solution.
    • Place the used cotton swabs and gloves in a separate bowl or waste disposal container.

  • Soak the used instruments and other items in 0.5% chlorine solution for 10 minutes. (It is important to remove the instruments from the chlorine solution after 10 minutes, to prevent corrosion and discolouration.)
  • Remove the instruments from the chlorine solution and wash them thoroughly under running tap water and then place them in detergent solution.
  • Clean the instruments gently by scrubbing them with a soft brush to remove any organic material, tissue, and blood. Particular care should be given to the curved inner edges, joints, and screws of self-retaining specula, where organic material may remain adherent along with the microorganisms trapped inside.
  • Rinse all instruments thoroughly with clean water to remove any detergent residues.
  • Sterilize the instruments by using high-pressure saturated steam (autoclaving), by using dry heat, or by soaking the instruments in chemicals such as 2Ė4% glutaraldehyde or 8% formaldehyde. If chemical sterilization is used, rinse all instruments with sterile water before use.
  • If performing HLD by boiling:

    • Submerge the cleaned instruments in water in a covered pot or sterilizer.
    • Heat the water to a rolling boil, and keep the instruments in boiling water for 20 minutes.
    • Do not add any instruments after the water starts boiling.

  • If performing HLD by chemicals:

    • Soak the cleaned instruments in 0.1% chlorine solution or in 2% glutaraldehyde solution for 20 minutes.
    • Rinse the instruments thoroughly with sterile water before use.

  • Dispose of all items contaminated with blood and body fluids, including cotton balls, cotton swabs, and gauze, in properly marked leak-proof containers or plastic bags. Other waste materials generated from the cleaning of clinic premises and disinfection activities should also be discarded in the container or bag.
  • Send the leak-proof container or bag for incineration or appropriate disposal. (Arrange for daily collection of wastes from screening clinics.)
  • Decontaminate all objects (e.g. focusing lights) and surfaces (e.g. the examination table) that have come into contact with body fluids and secretions, by wiping them with 0.5% chlorine solution or 90% ethyl alcohol.
  • Immerse both gloved hands in 0.5% chlorine solution briefly, and remove the gloves by turning them inside out.
  • Decontaminate the used gloves by soaking them in 0.5% chlorine solution for 10 minutes.


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