JUNE 28.] THE NEW ZEALAND GAZETTE. 2097

(3) Every midwife and every maternity nurse shall whenever she has removed any of the above-mentioned articles from her midwifery-bag for use in connection with a patient—
(a) If necessary, clean the same :
(b) Sterilize the same by boiling if its nature permits :
(c) Sterilize the same by any other available means if its nature does not permit of sterilization by boiling—
before such article is replaced in the midwifery-bag.

20. Requirements of Practice.

(1) Every midwife or maternity nurse attending a case shall observe strict cleanliness in her person and her clothing.

(2) A midwife or a maternity nurse shall not attend a case while she is suffering from any septic sores, boils, or any other septic disease.

(3) A midwife or a maternity nurse who is attending a case in which there are foul-smelling discharges shall not go to another case without first changing her dress, and thoroughly cleansing and disinfecting in an approved manner her hands and forearms, and sterilizing in an approved manner such appliances as she may have had occasion to use and is obliged to take with her.

(4) After any confinement every midwife or maternity nurse shall carefully cleanse her hands, arms, and finger-nails from all remains of blood, lochia, or liquor amnii. She shall keep her nails cut short, and preserve the skin of her hands, as far as possible, from chaps and other injuries.

(5) On each occasion on which the genital organs or their neighbourhood have to be touched, or before passing a catheter, every midwife or maternity nurse shall previously cleanse and disinfect such parts in an approved manner, and shall disinfect her hands and forearms by scrubbing vigorously with hot water and antiseptic soap for five minutes at least, rinsing with fresh water and soaking in an approved antiseptic solution for five minutes.

(6) All instruments and other appliances brought into contact with the patient’s generative organs shall be sterilized by boiling in water for at least ten minutes.

(7) (a) Vaginal examination shall not be made by maternity nurses, except under the explicit directions of the medical practitioner responsible for the care of the patient, and shall be made by midwives only when necessary. Before making any such examination the patient’s external parts shall be washed with soap and water, and shall then be swabbed with an antiseptic solution. The midwife shall then disinfect her hands in the manner hereinbefore prescribed, and put on the hand a sterilized glove or guarded finger-stall. The perineum and vulva and such parts of the patient as may come into contact with the gloved hand shall be protected by covering them with guards or with towels properly sterilized by boiling, or by other adequate means.

(b) For all washing of the external parts during labour or the lying-in period sponges or flannels shall not be used, but materials which can be boiled before use and burned afterwards, such as linen, cotton-wool, cotton-waste, or tow. When possible such materials shall be sterilized by steam or by boiling, and if this is impossible they shall be placed to soak in a basin of antiseptic lotion in which they shall remain for at least one hour before use.

(c) A midwife shall not make a vaginal examination during the third stage of labour unless some serious complication has occurred.

(8) Whenever any midwife or maternity nurse has been in attendance upon a patient suffering from puerperal infections, scarlet fever, erysipelas, or from any illness of a suppurative character, she shall disinfect herself and her clothing, and shall sterilize all her instruments and other appliances in accordance with the directions of the Medical Officer of Health, or, in the absence of any specific direction, in accordance with the provisions of the Fifth Schedule hereto. She shall not attend any other patients until the Medical Officer of Health has certified that she may do so.

(9) Whenever any midwife or maternity nurse has attended a case of puerperal fever or other infectious disease she shall immediately report the fact to the Medical Officer of Health.

(10) Every midwife and every maternity nurse when in attendance on a woman about to be confined shall see that all unnecessary furniture, clothing, and hangings are removed from the room in which the confinement is to take place, and that the floor is clean.