1
|
Huang Q, Tang J, Zhu J, Tan H, Huang Y, He G. Updated review of wet pack complications in pulse vacuum pressure steam sterilisation processes in central sterile supply departments. Trop Doct 2024; 54:116-122. [PMID: 38105600 DOI: 10.1177/00494755231217322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
The quality of sterilisation and disinfection in a central sterile supply department is directly related to the quality of the hospital services and the patients' safety. Wet packs occasionally occur following the process of pressure steam sterilisation; reducing this occurrence is an important issue. Therefore, the causes of wet pack following sterilisation were analysed to identify the influencing factors and suggest improvements to prevent its occurrence. Understanding the sterilisation process and possible causes of exposure helps with risk assessment and identifying necessary corrective measures.
Collapse
Affiliation(s)
- Qiyun Huang
- Chief Nurse, Department of CSSD, Xiangtan Central Hospital, Xiangtan, China
| | - Jing Tang
- Chief Nurse, Department of CSSD, Xiangtan Central Hospital, Xiangtan, China
| | - Jie Zhu
- Deputy Chief Physician, Department of Medical, Xiangtan Central Hospital, Xiangtan, China
| | - Huan Tan
- Chief Nurse, Department of CSSD, Xiangtan Central Hospital, Xiangtan, China
| | - Yan Huang
- Chief Nurse, Department of CSSD, Xiangtan Central Hospital, Xiangtan, China
| | - Guxiang He
- Chief Nurse, Department of CSSD, Xiangtan Central Hospital, Xiangtan, China
| |
Collapse
|
2
|
Lagos-Palomino L, Rueda-Torres L, Sanchez-Holguin G, Soncco-Llulluy F, Rosales-Rimache J. Performance evaluation of the sterilization process with Bowie & Dick test and biological indicator in the quality control of a blood bank in Peru. Medicine (Baltimore) 2023; 102:e35293. [PMID: 37960832 PMCID: PMC10637551 DOI: 10.1097/md.0000000000035293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/29/2023] [Indexed: 11/15/2023] Open
Abstract
Managing contaminated waste in blood banks is a crucial process that must end with the safe disposal of blood products. In this sense, practical methods and indicators must be used to guarantee the operability of autoclave equipment and the sterility of treated waste to mitigate the risk of biological exposure and hospital biosafety. We designed a cross-sectional study to evaluate the performance the autoclaving process with Bowie & Dick test and biological indicator at the Hemotherapy and Blood Bank Unit of the Cayetano Heredia Hospital in Peru. Fifty autoclaving processes were carried out independently for the Bowie & Dick tests and biological indicators based on Geobacillus stearothermophilus spores. Autoclaving was programmed at 134°C for 3.5 minutes for the Bowie & Dick test, while, for the biological indicator, it was programmed at 121°C for 5 minutes. Both in the presence of contaminated waste. The autoclaving process evaluated by the Bowie & Dick test had a compliance rate of 80% (CI95: 66.3%-90.0%), while, by the biological indicator, 90% (CI95: 78.2%-96.7%). We did not find significant differences between the results of both tests (P = .689; Fisher exact test). The compliance rate in the autoclaving process within the blood bank of a Peruvian Hospital is acceptable; however, there are actions for continuous improvement, especially at the vacuum level in the autoclaving process.
Collapse
Affiliation(s)
| | - Lenin Rueda-Torres
- Centro Nacional de Salud Ocupacional y Protección del Ambiente para la Salud, Instituto Nacional de Salud, Lima, Perú
| | | | | | - Jaime Rosales-Rimache
- Vicerectorado de Investigación, Universidad Privada Norbert Wiener, Lima, Perú
- .Escuela Profesional de Tecnología Médica, Universidad Continental, Lima, Perú
| |
Collapse
|
3
|
Panta G, Richardson AK, Shaw IC, Coope PA. Healthcare workers’ knowledge and attitudes towards sterilization and reuse of medical devices in primary and secondary care public hospitals in Nepal: A multi-centre cross-sectional survey. PLoS One 2022; 17:e0272248. [PMID: 35913951 PMCID: PMC9342727 DOI: 10.1371/journal.pone.0272248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background Healthcare facilities reprocess and sterilize reusable medical devices before each invasive clinical procedure, such as surgery, to prevent person-to-person or environmental transmission of pathogens through medical devices. We conducted a nationwide multi-centre cross-sectional survey in primary and secondary-care public hospitals in Nepal to assess the knowledge and attitudes of healthcare workers towards sterilization and reuse of medical devices. Methods We carried out a multi-centre cross-sectional survey comprising eleven primary-care (two district-level and nine district hospitals) and two secondary-care (zonal hospitals) public hospitals which covered all seven provinces of Nepal. Survey questionnaires were distributed to 234 healthcare workers including doctors, nurses, paramedics, and office assistants (involved in medical device reprocessing); 219 (93.6%) returned the completed questionnaire. Descriptive analyses of demographic information, knowledge and attitude responses of survey participants were performed. Logistic regression and ordinal regression models for complex samples were used to investigate associations between responses and independent variables. Results Except for a few areas, more than 70% of healthcare workers had proper knowledge about different aspects of sterilization and reuse of medical devices. Paramedics and office assistants were less likely to have the correct knowledge in different aspects compared to nurses. Permanent staff were more likely to give correct answers to some knowledge questions compared to temporary staff. Previous infection control training was positively associated with correct responses to some knowledge items. Most of the healthcare workers had positive attitudes towards different aspects of sterilization and reuse of medical devices, and nurses were more likely to have positive attitudes compared with other staff categories. Conclusions Most of the healthcare workers had correct knowledge and positive attitudes towards most areas of sterilization and reuse of medical devices. However, they need proper education and training in some areas such as sterilization procedures, storage of sterilized devices, prion decontamination and standard precautions.
Collapse
Affiliation(s)
- Gopal Panta
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
- * E-mail:
| | - Ann K. Richardson
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | - Ian C. Shaw
- School of Physical and Chemical Sciences, University of Canterbury, Christchurch, New Zealand
| | - Patricia A. Coope
- College of Education, Health and Human Development, University of Canterbury, Christchurch, New Zealand
| |
Collapse
|
4
|
Zaman SU, Sadia I, Yasmin N, Islam KN, Rahman MM, Haq A, Mou TJ, Azmuda N, Haque M, Adnan N. Application of Rapid Biological Indicators Coupled With Auto-Reader for the Quality Assurance of Surgical Instruments After Sterilization at a Cardiac Hospital in Bangladesh. Cureus 2021; 13:e19428. [PMID: 34926019 PMCID: PMC8654048 DOI: 10.7759/cureus.19428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 12/02/2022] Open
Abstract
Background Sterilization failure is one of the main reasons for surgical site infections (SSIs). The biological indicator (BI) test is the most reliable test to check sterilization efficiencies. But 48 hours BI test result makes the monitoring process time-consuming. Rapid BI testing can be time demanding in this regard. Therefore, the objective is to determine the importance of rapid BI monitoring for the quality assurance of sterile surgical instruments. Methods This study was conducted in the Labaid Cardiac Hospital, Bangladesh from April 1, 2021, to July 8, 2021. A total of 100 steam and 100 ethylene oxide (EO) rapid BIs and an auto reader incubator were used to conduct this research. Quick BI of steam and EO were used once per day and tested by the auto reader. Later, all the tested BIs were incubated for 48 hours by a conventional incubator to confirm the auto reader's rapid BI test results. Result All the EO BI results were found negative, but the BI was found positive twice in steam sterilization. Surgical items of those two loads were re-sterilized. Again, after checking the BI result, the items were released. All BIs except positive steam rapid BIs were found with no growth after 48 hours of incubation for cross-checking of auto reader results. In positive rapid BI of steam, growth was found after 48 hours of incubation. Conclusion When sterilization failure occurred, process recall could not be possible at that time if rapid BI tests were not performed. So, integration of a rapid BI test with an auto reader can save the patient from critical SSI.
Collapse
Affiliation(s)
- Sifat U Zaman
- Department of Microbiology, Jahangirnagar University, Dhaka, BGD
- Division of Infection Prevention and Control, Medlife Healthcare Limited, Dhaka, BGD
| | - Israt Sadia
- Department of Infection Control, Labaid Cardiac Hospital, Dhaka, BGD
| | - Nawzia Yasmin
- Department of Public Health, State University of Bangladesh, Dhaka, BGD
| | | | | | - Ahsanul Haq
- Department of Statistics, Gonoshasthaya-RNA Molecular Diagnostic & Research Center, Dhaka, BGD
| | - Taslin Jahan Mou
- Department of Microbiology, Jahangirnagar University, Dhaka, BGD
| | - Nafisa Azmuda
- Department of Microbiology, Jahangirnagar University, Dhaka, BGD
| | - Mainul Haque
- Department of Pharmacology and Therapeutics, National Defence University of Malaysia, Kuala Lumpur, MYS
| | - Nihad Adnan
- Department of Microbiology, Jahangirnagar University, Dhaka, BGD
| |
Collapse
|
5
|
Panta G, Richardson AK, Shaw IC. Quality of water for reprocessing of medical devices in healthcare facilities in Nepal. JOURNAL OF WATER AND HEALTH 2021; 19:682-686. [PMID: 34371503 DOI: 10.2166/wh.2021.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Reusable medical devices are decontaminated and sterilized often many times by healthcare facilities across the globe. Reprocessing of medical devices comprises several processes and water plays an important role in some of these, including cleaning and steam sterilization. The water used is required to have certain qualities to ensure the effectiveness of the processes. In this short communication, we report findings of our study which measured quality parameters (pH, total hardness) for water used for medical device reprocessing in 13 primary and secondary care public hospitals in Nepal. The mean pH of water used for reprocessing of medical devices varied from 6.48 to 8.05 across the hospitals whereas the mean total hardness of water varied from 5.93 to 402.50 mg/L CaCO3. Although the range of the mean water pH across hospitals fell within the recommended range, many of the hospitals had mean total hardness higher than recommended for cleaning medical devices. None of the hospitals had mean total hardness suitable for using as feed-water for steam generation. Public hospitals in Nepal should have appropriate water treatment systems so that the recommended water quality can be achieved to ensure effective decontamination and reprocessing of medical devices.
Collapse
Affiliation(s)
| | - Ann K Richardson
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | - Ian C Shaw
- School of Physical and Chemical Sciences, University of Canterbury, Christchurch, New Zealand
| |
Collapse
|
6
|
da Fonseca EP, Pereira-Junior EA, Palmier AC, Abreu MHNG. A Description of Infection Control Structure in Primary Dental Health Care, Brazil. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5369133. [PMID: 34373834 PMCID: PMC8349252 DOI: 10.1155/2021/5369133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/13/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study is aimed at describing a score to assess infection control structures in Oral Health Teams (OHT) in Primary Health Care (PHC) in Brazil. METHODS Secondary data from a national external evaluation of PHC conducted in 2017 and 2018 were analyzed. The construction of the score used 14 variables, divided into the following: structural characteristics of the PHC, infection control equipment under conditions of use, and biosafety supplies in sufficient quantity. The questions were mostly dichotomous (yes/no). Descriptive analyses were carried out to characterize the OHT and factor analyses to reduce the number of observed variables to a specific number of factors. RESULTS Among 20,301 health units with OHT, 4,510 (22.2%) units did not have washable floors, ceilings, and walls; 8,406 (41.4%) did not have a sealer; 16,780 (82.7%) did not have taps with noncontact activation, and 4,663 (23.0%) units did not have rubber gloves. Regarding personal protective equipment (PPE), 1,618 (8.0%) units did not have a sufficient quantity of basic PPE. Three factors were defined to explain the 14 evaluated variables. The South region had the best score of infection control, while the North had the worst. CONCLUSIONS Regional inequalities in the failures in infection control structures identified in PHC with OHT were related to the physical structure, equipment, and supplies used for infection control and the absence of PPE for OHT.
Collapse
Affiliation(s)
- Emílio Prado da Fonseca
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Andréa Clemente Palmier
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | |
Collapse
|
7
|
Lv J, Yang J, Xue J, Zhu P, Liu L, Li S. Investigation of potential safety hazards during medical waste disposal in SARS-CoV-2 testing laboratory. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:35822-35829. [PMID: 33677664 PMCID: PMC7936866 DOI: 10.1007/s11356-021-13247-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/28/2021] [Indexed: 04/16/2023]
Abstract
This study aims to investigate the potential safety hazards and provide reference for improving the medical waste disposal procedure in SARS-CoV-2 testing laboratory. Our SARS-CoV-2 testing group detected the RNA residue on the surface of medical waste with Droplet Digital PCR, and held a meeting to discuss the risks in the laboratory medical waste disposal process. After effective autoclaving, SARS-CoV-2 contaminated on the surface of medical waste bags was killed, but the average concentration of viral RNA residues was still 0.85 copies/cm2. It would not pose a health risk, but might contaminate the laboratory and affect the test results. When the sterilized medical waste bags were transferred directly by the operators without hand disinfection, re-contamination would happen, which might cause the virus to leak out of the laboratory. Furthermore, we found that sterilization effect monitoring and cooperation among operators were also very important. In summary, we investigated and analyzed the potential safety hazards during the medical waste disposal process in SARS-CoV-2 testing laboratory, and provided reasonable suggestions to ensure the safety of medical waste disposal.
Collapse
Affiliation(s)
- Jun Lv
- Taihe Hospital, Hubei University of Medicine, Shiyan, 44200 Hubei China
| | - Jin Yang
- Taihe Hospital, Hubei University of Medicine, Shiyan, 44200 Hubei China
| | - Juan Xue
- Taihe Hospital, Hubei University of Medicine, Shiyan, 44200 Hubei China
| | - Ping Zhu
- Taihe Hospital, Hubei University of Medicine, Shiyan, 44200 Hubei China
| | - Lanfang Liu
- Shiyan Center for Disease Control and Prevention, Shiyan, 442000 Hubei China
| | - Shan Li
- Taihe Hospital, Hubei University of Medicine, Shiyan, 44200 Hubei China
- College of Life Science and Technology, Huazhong Agriculture University, Wuhan, 430070 Hubei China
- College of Biomedicine and Health, Huazhong Agricultural University, Wuhan, 430070 Hubei China
| |
Collapse
|
8
|
Sensors in the Autoclave-Modelling and Implementation of the IoT Steam Sterilization Procedure Counter. SENSORS 2021; 21:s21020510. [PMID: 33450855 PMCID: PMC7828345 DOI: 10.3390/s21020510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/09/2021] [Accepted: 01/10/2021] [Indexed: 11/17/2022]
Abstract
Surgical procedures involve major risks, as pathogens can enter the body unhindered. To prevent this, most surgical instruments and implants are sterilized. However, ensuring that this process is carried out safely and according to the normative requirements is not a trivial task. This study aims to develop a sensor system that can automatically detect successful steam sterilization on the basis of the measured temperature profiles. This can be achieved only when the relationship between the temperature on the surface of the tool and the temperature at the measurement point inside the tool is known. To find this relationship, the thermodynamic model of the system has been developed. Simulated results of thermal simulations were compared with the acquired temperature profiles to verify the correctness of the model. Simulated temperature profiles are in accordance with the measured temperature profiles, thus the developed model can be used in the process of further development of the system as well as for the development of algorithms for automated evaluation of the sterilization process. Although the developed sensor system proved that the detection of sterilization cycles can be automated, further studies that address the possibility of optimization of the system in terms of geometrical dimensions, used materials, and processing algorithms will be of significant importance for the potential commercialization of the presented solution.
Collapse
|
9
|
Cuncannon A, Dosani A, Fast O. Sterile processing in low- and middle-income countries: an integrative review. J Infect Prev 2021; 22:28-38. [PMID: 33841559 PMCID: PMC7841710 DOI: 10.1177/1757177420947468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/14/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Worldwide disparities in surgical capacity are a significant contributor to health inequalities. Safe surgery and infection prevention and control depend on effective sterile processing (SP) of surgical instruments; however, little is known about SP in low- and middle-income countries (LMICs), where surgical site infection is a major cause of postoperative morbidity and mortality. AIM To appraise and synthesise available evidence on SP in LMICs. METHODS An integrative review of research literature was conducted on SP in LMICs published between 2010 and 2020. Studies were appraised and synthesised to identify challenges and opportunities in practice and research. RESULTS Eighteen papers met the inclusion criteria for qualitative analysis. Challenges to advancing SP include limited available evidence, resource constraints and policy-practice gaps. Opportunities for advancing SP include tailored education and mentoring initiatives, emerging partnerships and networks that advance implementation guidelines and promote best practices, identifying innovative approaches to resource constraints, and designing and executing quality assurance and surveillance programmes. DISCUSSION Research investigating safe surgery, including SP, in LMICs is increasing. Further research and evidence are needed to confirm the generalisability of study findings and effectiveness of strategies to improve SP practice in LMICs. This review will help researchers and stakeholders identify opportunities to contribute. The burdens of unsafe surgery transcend geopolitical borders, and the global surgery and research communities are called upon to negotiate historical and present-day inequities to achieve safe surgery for all.
Collapse
Affiliation(s)
- Alexander Cuncannon
- School of Nursing and Midwifery, Faculty of Health, Community and Education, Mount Royal University, Calgary, AB, Canada
| | - Aliyah Dosani
- School of Nursing and Midwifery, Faculty of Health, Community and Education, Mount Royal University, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Olive Fast
- School of Nursing and Midwifery, Faculty of Health, Community and Education, Mount Royal University, Calgary, AB, Canada
| |
Collapse
|
10
|
Ahmed YK, Ibitoye MO, Zubair AR, Oladejo JM, Yahaya SA, Abdulsalam SO, Ajibola RO. Low-cost biofuel-powered autoclaving machine for use in rural health care centres. J Med Eng Technol 2020; 44:489-497. [PMID: 33118410 DOI: 10.1080/03091902.2020.1825847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Surgical site infections (SSIs) in developing countries have been linked to inadequate availability of sterilising equipment. Existing autoclaves are mostly unaffordable by rural healthcare practitioners, and when they managed to procure them, the electricity supply to power the autoclaves is epileptic. The solar-powered autoclave alternatives are too bulky with a very high initial cost. Hence, low-cost biofuel-powered autoclave becomes an attractive option, and this study sought to present the design, development and clinical evaluation of the device performance. With the global drive for the adoption of green energy, biofuel will not only reduce greenhouse gas emission but also provide revenue for local producers and reduce biomass associated health complications. The theoretical energy requirement for the sterilisation process was calculated. The standard pressure and temperature needed for sterilisation were tested to be 121 °C and 15 psi. The device was also clinically tested with Staphylococcus aureus bacteria obtained from the Department of Medical Microbiology and Parasitology, University of Ilorin Teaching Hospital using Brain heart Infusion Broth, MacConkey and Blood agar as cultured media. No bacteria growth was observed when the samples containing the bacteria colony were autoclaved by the designed autoclave and incubated at 37 °C for 2 d. Hence, the device met the mechanical and biological validation standards for effective sterilisation.
Collapse
Affiliation(s)
- Yusuf Kola Ahmed
- Department of Biomedical Engineering, Faculty of Engineering and Technology, University of Ilorin, Ilorin, Nigeria
| | - Morufu Olusola Ibitoye
- Department of Biomedical Engineering, Faculty of Engineering and Technology, University of Ilorin, Ilorin, Nigeria
| | - Abdul Rasak Zubair
- Department of Electrical and Electronic Engineering, Faculty of Technology, University of Ibadan, Ibadan, Nigeria
| | - Janet Mosunmola Oladejo
- Department of Medical Microbiology and Parasitology, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Suleiman Abimbola Yahaya
- Department of Biomedical Engineering, Faculty of Engineering and Technology, University of Ilorin, Ilorin, Nigeria
| | - Saheed Olayinka Abdulsalam
- Department of Biomedical Engineering, Faculty of Engineering and Technology, University of Ilorin, Ilorin, Nigeria
| | - Ridwan Oladipupo Ajibola
- Department of Biomedical Engineering, Faculty of Engineering and Technology, University of Ilorin, Ilorin, Nigeria
| |
Collapse
|
11
|
Panta G, Richardson AK, Shaw IC, Coope PA. Compliance of primary and secondary care public hospitals with standard practices for reprocessing and steam sterilization of reusable medical devices in Nepal: findings from nation-wide multicenter clustered audits. BMC Health Serv Res 2020; 20:923. [PMID: 33028325 PMCID: PMC7542764 DOI: 10.1186/s12913-020-05788-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/30/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Reusable medical devices in healthcare facilities are decontaminated and reprocessed following standard practices before each clinical procedure. Reprocessing of critical medical devices (those used for invasive clinical procedures) comprises several processes including sterilization, which provides the highest level of decontamination. Steam sterilization is the most used sterilization procedure across the globe. Noncompliance with standards addressing reprocessing of medical devices may lead to inadequate sterilization and thus increase the risk of person-to-person or environmental transmission of pathogens in healthcare facilities. We conducted nationwide multicenter clustered audits to understand the compliance of primary- and secondary-care public hospitals in Nepal with the standard practices for medical device reprocessing, including steam sterilization. METHODS We developed an audit tool to assess compliance of hospitals with the standard practices for medical device reprocessing including steam sterilization. Altogether, 189 medical device reprocessing cycles which included steam sterilization were assessed in 13 primary and secondary care public hospitals in Nepal using the audit tool. Percentage compliance was calculated for each standard practice. Mean percentage compliances were obtained for overall primary and secondary care hospitals and for each hospital type, specific hospital and process involved. RESULTS For all primary and secondary care hospitals in Nepal, the mean percentage compliance with the standard practices for medical device reprocessing including steam sterilization was 25.9% (95% CI 21.0-30.8%). The lower the level of care provided by the hospitals, the lower was the mean percentage compliance, and the difference in the means across the hospital types was statistically significant (p < 0.01). The mean percentage compliance of individual hospitals ranged from 14.7 to 46.0%. The hospitals had better compliance with the practices for cleaning of used devices and transport and storage of sterilized devices compared with the practices for other processes of the medical device reprocessing cycle. CONCLUSION The primary and secondary care hospitals in Nepal had poor compliance with the standard practices for steam sterilization and reprocessing of medical devices. Interventions to improve compliance of the hospitals are immediately required to minimize the risks of person-to-person or environmental transmission of pathogens through inadequately reprocessed medical devices.
Collapse
Affiliation(s)
| | - Ann K Richardson
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | - Ian C Shaw
- School of Physical and Chemical Sciences, University of Canterbury, Christchurch, New Zealand
| | - Patricia A Coope
- College of Education, Health and Human Development, University of Canterbury, Christchurch, New Zealand
| |
Collapse
|