OCH-A-DRARR

OCH-A-DRARR

mnemonic for treatment of localized infection; see Table 1
Table 1: Treatment of local sepsis
MnemonicRationaleTreatment modality
OOperateRemove the cause of the infection where possible, e.g. remove focal hyperkeratosis/foreign body/nail spike
CCleanseIrrigate area/cleanse cavity with Warmasol delivered under pressure from a sterile syringe
HHeatAssist drainage of pus/exudate by applying heat, e.g. immersion in a warm hypertonic NaCl bath
AAntisepticApply a liquid or powder antiseptic (e.g. Betadine)
DDressCover the lesion with a sterile dressing (e.g. sterile gauze; Lyofoam)
RRestImpose rest, e.g. deflective padding; shoe modification; walking cast; crutches, as necessary
AReappointArrange to review case in 24-72 hours
RReviewAt the subsequent appointment, review progress
If resolution has been initiated, continue to treat as above (O-A) and review weekly until healing is complete
If the infection has not improved, arrange for antibiosis, and continue to review and dress until healing is complete
RReferRefer for specialist review via GP: remember, slow-to-resolve infection can characterize undiagnosed diabetes, or other 'at-risk' patient category

Use all normal preoperative procedures; keep infected lesions covered until ready to treat; take a swab for pathology laboratory analysis of any exudate; use a sterile dressings pack; follow the OCH-A-DRARR treatment mnemonic.

'At-risk' patients presenting with infection or patients presenting with acute or spreading infection should be treated using the OCH-A-DRARR protocol, but provided with or referred for immediate antibiosis.