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

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.

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

“…Their level of education ranges from illiteracy to a maximum of year 10 (class 10) of school education. Interestingly, we previously reported that they were involved in 97.0% (CI 95 : 87.5% - 99.3%) of the steam sterilization cycles [ 8 ] and 71.0% (CI 95 : 46.8% - 87.2%) of these cycles failed to sterilize medical devices when tested with biological indicators [ 7 ]. In addition, compliance with standard practices for medical device reprocessing and steam sterilization was very poor in these hospitals [ 8 ].…”

“…Interestingly, we previously reported that they were involved in 97.0% (CI 95 : 87.5% - 99.3%) of the steam sterilization cycles [ 8 ] and 71.0% (CI 95 : 46.8% - 87.2%) of these cycles failed to sterilize medical devices when tested with biological indicators [ 7 ]. In addition, compliance with standard practices for medical device reprocessing and steam sterilization was very poor in these hospitals [ 8 ]. One of the key reasons behind such poor compliance might be the low education level of staff responsible for medical device reprocessing.…”

“…This provides some information on medical device reprocessing and sterilization for healthcare workers; however, the training time allocated to this is only three hours [ 39 ]. We previously reported poor compliance in primary and secondary public hospitals in Nepal with the standard practices for medical device reprocessing and sterilization [ 8 ]; such poor compliance might be because of inadequate staff training. Medical device reprocessing and sterilization is a specialized area comprising several scientific processes, and specific training on this topic can be useful for providing adequate knowledge and skills for healthcare workers.…”

“…The studies have indicated that inadequate reprocessing and sterilization of reusable medical devices could be one of the factors contributing to the higher rates of SSIs. We previously reported a high proportion of steam sterilization failures in primary and secondary care public hospitals in Nepal and poor compliance with the recommended practices for medical device reprocessing and sterilization [ 7 , 8 ].…”

Assessment of Laparoscopic Instrument Reprocessing in Rural India: A Mixed Methods Study

“…Numerous authors have assessed the sterile processing of surgical instruments in LMIC hospitals by carrying out a checklist survey (13)(14)(15). However, no studies exist that document the current laparoscopic reprocessing methods in LMICs.…”