The impact of a short-term training program on workers’ sterile processing knowledge and practices in 12 Ethiopian hospitals: A mixed methods study

Abstract

Background The need for increased attention to surgical safety in low- and middle-income countries invited organizations worldwide to support improvements in surgical care. However, little is written about issues in instrument sterilization in low- and middle-income countries including Ethiopia. Objective The study aims to identify the impact of a sterile processing course, with a training-of-trainers component and workplace mentoring on surgical instrument cleaning and sterilization practices at 12 hospitals in Ethiopia. Method A mixed-methods research design that incorporates both qualitative and quantitative research approaches to address issues in sterile processing was used for this study. The quantitative data (test results) were validated by qualitative data (hospital assessments, including observations and participant feedback). Twelve hospitals were involved in the training, including two university teaching hospitals from two regions of Ethiopia. In each of the two regions 30 sterile processing staff were invited to participate in a three-day course including theory and skills training; 12–15 of these individuals were invited to remain for a two-day training of trainers course. The collected quantitative data were analysed using a paired t-test by SPSS software, whereas comparative analysis was employed for the qualitative data. Results Process, structural, and knowledge changes were identified following program implementation. Knowledge test results indicated an increase of greater than 20% in participant sterile processing knowledge. Changes in process included improved flow of instruments from dirty to clean, greater attention to detail during the cleaning and decontamination steps, more focused inspection of instruments and careful packaging, as well as changes to how instruments were stored. Those trained to be trainers had taught over 250 additional staff. Conclusions Increased attention to and knowledge in sterile processing practices and care of instruments with a short, one-week course provides evidence that a small amount of resources applied to a largely under-resourced area of healthcare can result in decreased risks to patients and staff. Providing education in sterile processing and ensuring staff have the ability to disseminate their learnings to other health care providers results in decreasing risks of hospital associated infections in patients.

The impact of a sterile processing program in Northwest Tanzania: a mixed-methods study

“…Findings in this study support evidence of SP practice change from a short training program presented in similar studies in Benin and Ethiopia [9, 10]. While participants showed retention of knowledge 4 months post-training that was attributable to SPECT’s training, knowledge retention was noted to be higher in region A than region B.…”

Sterile processing in low- and middle-income countries: an integrative review

“…Nine papers discussed education, training and mentoring in relation to SP workers’ practice in LMICs. Shortcomings in education were identified as barriers to effective IPC and SP practice (Ayub Khan et al, 2018; Fast et al, 2017; Forrester et al, 2018c) but importantly also serve as opportunities to implement strategies to improve SP through education, training, and mentoring (Fast et al, 2018, 2019b, 2019a; Forrester et al, 2018a). Several authors presented the development and outcomes of SP educational initiatives.…”

“…Several authors discussed unique educational approaches aimed at sustaining practice changes. Fast et al (2019b) discussed incorporating a training of trainers component into an SP training course at 12 Ethiopian hospitals that enabled these trainers to educate an additional 254 workers. Forrester et al (2018a) adapted process mapping, a visual diagramming technique, to surgical workflows at an Ethiopian teaching hospital and observed improvements in adherence to IPC including the use of chemical sterile indicators as well as the WHO SSC, intended to facilitate overall quality improvement and to guide teams toward feasible short-, medium- and long-term achievements (Forrester et al, 2018a).…”

“…Costa et al (2018) noted that policy standards in Brazil required only cleaning, and not necessarily disinfection and sterilisation, before returning loaned instrument sets. During SP training and mentoring programmes in Ethiopian and Tanzanian hospitals, Fast et al (2019aFast et al ( , 2019b found that workers were apprehensive about using enzymatic detergents or soapy water in place of corrosive 0.5% chlorine solutions, a recommendation in alignment with recent changes to WHO (WHO and PAHO, 2016) evidence-based guidelines. In Ethiopia, this stemmed from differences between national guidelines and WHO global guidelines, while in Tanzania, implementing this practice change could have impacted accreditation from government inspectors, not all of whom had received and adopted recently updated guidelines.…”

“…In Ethiopia, this stemmed from differences between national guidelines and WHO global guidelines, while in Tanzania, implementing this practice change could have impacted accreditation from government inspectors, not all of whom had received and adopted recently updated guidelines. To address this gap, an SP educator worked with the Ethiopian government to revise national guidelines to caution against the use of chlorine solutions and clarified the guidelines with hospitals involved in the Safe Surgery 2020 initiative (Fast et al, 2019b). Several papers further discussed how institutions and governments have taken action to address policy-practice gaps.…”