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

Reuse of Orthopaedic Equipment: Barriers and Opportunities

» Reuse of orthopaedic equipment is one of many potential ways to minimize the negative impact of used equipment on the environment, rising healthcare costs and disparities in access to surgical care.» Barriers to widespread adoption of reuse include concerns for patient safety, exposure to unknown liability risks, negative public perceptions, and logistical barriers such as limited availability of infrastructure and quality control metrics.» Some low- and middle-income countries have existing models of equipment reuse that can be adapted through reverse innovation to high-income countries such as the United States.» Further research should be conducted to examine the safety and efficacy of reusing various orthopaedic equipment, so that standardized guidelines for reuse can be established.

Knowledge about methods of disinfection of dental impression among dentists from Ecuador post SARS-COV-2 pandemic

Purpose

The aim of this study is to evaluate the understanding of the management of methods and practices of disinfection of dental impressions applied by general dentists and specialists in oral rehabilitation, post SARS-COV-2 pandemic.

Introduction

The oral cavity has a favorable environment for the growth and multiplication of bacteria and viruses, serving as the gateway to viruses such as SARS CoV-2 virus. Given that patients may be hosts of this infectious disease, stricter biosecurity measures in dental offices and a better understanding of the disinfection processes of dental impressions should be considered in addition to avoiding cross-infections, which are very common in our work environment.

Materials and methods

Descriptive, analytical, survey with the topic "Methods and practices of disinfection of dental impressions" that was composed of 14 questions based in OHPD (Oral Health Preventive Dentistry), n = 452 respondents who met the following inclusion criteria: general practice dentists from Ecuador who actively take dental impressions, specialists in oral rehabilitation with 5 years of experience, surveys with information of complete items, n = 270 professionals; n = 192 general dentists, dental hygienist and n = 78 oral rehabilitation specialists.

Results

n = 270 professionals evaluated, with a mean of p = 0.0. At 426 responses with a p value of <0.05, 30.4 % of responses indicated ignorance in the management of dental impressions, with a standard deviation of 2.744, with significant differences between professions (p = 0.035) and higher average knowledge of sample management within specialist dentists, (Chi p = 0.410 p > 0.05).

Conclusion

The understanding of the management of dental impressions among general dentists and specialists in oral rehabilitation is limited.

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

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.

Impact of a training intervention on knowledge and practices of health-care workers about reprocessing reusable medical devices in a South-Tunisian University Hospital

INTRODUCTION

Reprocessing of reusable medical devices (RMD) play an important role in the prevention of health-care associated infections. In this perspective, this study aimed to evaluate the impact of a training program intervention on health-care workers' (HCWs) knowledge and hospital practices about the reprocessing of RMD as a main strategic axis of infection control.

METHOD

We led a pre-post quasi-experimental study to evaluate knowledge of HCWs and to assess hospital practices in reprocessing RMD before and after a training intervention from May to November 2020 in Hedi Chaker University Hospital. A self-administrated questionnaire was distributed for each participant to assess knowledge. To evaluate practical skills, an audit grid was used.

RESULTS

Overall, 30 participants were included. All HCWs had a fair level of knowledge before training. The knowledge score(KS) has significantly risen from pre to post-training (64/100 vs 80/100; p<0.001). When stratified by RMD type, a significant increase was noted on post intervention in KS about thermo-sensitive RMD reprocessing(p=0.044) and sterilization of thermo-resistant RMD (p=0.004). As for practice assessment, 5(62.5%) departments had a fair level of practice. The conformity score(CS) did not significantly change from baseline to post-follow-up(53.5 vs 56.2; p=0.06). According to the audit sections, we did not find a significant change in the pre- and post-intervention CS in sterilization process(70 vs 80; p=0.06) and in the cleaning and decontamination steps(66.7 vs 67 ; p=0.18).

CONCLUSION

As opposed to practical skills, positive impact of the training intervention on HCWs knowledge was noted, which underlined the gap between theory and practice.

Assessment of laparoscopic instrument reprocessing in rural India: a mixed methods study

Background

Laparoscopy is a minimally-invasive surgical procedure that uses long slender instruments that require much smaller incisions than conventional surgery. This leads to faster recovery times, fewer post-surgical wound infections and shorter hospital stays. For these reasons, laparoscopy could be particularly advantageous to patients in low to middle income countries (LMICs). Unfortunately, sterile processing departments in LMIC hospitals are faced with limited access to equipment and trained staff which poses an obstacle to safe surgical care. The reprocessing of laparoscopic devices requires specialised equipment and training. Therefore, when LMIC hospitals invest in laparoscopy, an update of the standard operating procedure in sterile processing is required. Currently, it is unclear whether LMIC hospitals, that already perform laparoscopy, have managed to introduce updated reprocessing methods that minimally invasive equipment requires. The aim of this study was to identify the laparoscopic sterile reprocessing procedures in rural India and to test the effectiveness of the sterilisation equipment.

Methods

We assessed laparoscopic instrument sterilisation capacity in four rural hospitals in different states in India using a mixed-methods approach. As the main form of data collection, we developed a standardised observational checklist based on reprocessing guidelines from several sources. Steam autoclave performance was measured by monitoring the autoclave cycles in two hospitals. Finally, the findings from the checklist data was supported by an interview survey with surgeons and nurses.

Results

The checklist data revealed the reprocessing methods the hospitals used in the reprocessing of laparoscopic instruments. It showed that the standard operating procedures had not been updated since the introduction of laparoscopy and the same reprocessing methods for regular surgical instruments were still applied. The interviews confirmed that staff had not received additional training and that they were unaware of the hazardous effects of reprocessing detergents and disinfectants.

Conclusion

As laparoscopy is becoming more prevalent in LMICs, updated policy is needed to incorporate minimally invasive instrument reprocessing in medical practitioner and staff training programmes. While reprocessing standards improve, it is essential to develop instruments and reprocessing equipment that is more suitable for resource-constrained rural surgical environments.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13756-021-00976-x.