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

Abstract

BackgroundInadequate training of health care workers responsible for the sterilization of surgical instruments in low- and middle-income countries compromises the safety of workers and patients alike.MethodsA mixed methods research study was initiated in the Lake Zone areas of Northwestern Tanzania in the summer of 2018. The goal was to identify the impact of education and training on sterile processing practices at ten hospitals. Quantitative data analyzed included hospital assessments of sterile processing practices prior to and 4 months after training, as well as participant test scores collected at the beginning of training, after 5 days of classes, and 4 months after mentorship was completed. Thematic analysis of interviews with participants 4 months post-training was completed to identify associated impact of training.ResultsImprovement in test scores were found to be directly related to sterile processing training. The greatest sterile processing practice changes identified through hospital assessments involved how instruments were cleaned, both at point of use and during the cleaning process, resulting in rusted and discoloured instruments appearing as new again. Themes identified in participant interviews included: changes in practice, challenges in implementing practice changes, resource constraints, personal and professional growth, and increased motivation, confidence and responsibility.ConclusionsProviding education and follow up support for workers in sterile processing resulted in increased knowledge of best practices, application of knowledge in practice settings, and awareness of issues that need to be overcome to decrease risks for patients and health care workers alike. Further research is needed to identify the impact of mentorship on hospital sterile processing practices in order to provide clear direction for future spending on training courses.

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.…”

“…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.…”

“…After SP education courses at 25 hospitals in Benin, Ethiopia and Tanzania, statistically significant improvements were observed in participants' SP knowledge test scores, and clinically significant and sustained improvements in SP practice were seen in post-training hospital assessments (Fast et al, 2018(Fast et al, , 2019a(Fast et al, , 2019b. These clinical improvements included decreased exposure of instruments to corrosive 0.5% chlorine solutions and workflow reorganisation with the use of a three-step cleaning system (Fast et al, 2018), pre-use instrument inspections and postuse soaking in soap and water (Fast et al, 2019b), and increased cleaning of gross organic material before sterilisation and increased use of chemical sterile indicators to monitor sterilisation (Fast et al, 2019a). At a hospital in Ethiopia, Forrester et al (2018a) worked with hospital leadership and staff to develop workflow process maps relevant to operating room procedures to improve adherence to critical steps of the WHO Surgical Safety Checklist (SSC).…”

“…Several authors presented the work of organisations that provide frontline education and capacity-building initiatives at healthcare facilities in LMICs. In the Republic of Congo, Madagascar, Benin, Ethiopia and Tanzania, collaboration between Sterile Processing Education Charitable Trust (SPECT), Mercy Ships and local researchers enabled the delivery of SP training and mentoring programmes (Fast et al, 2017(Fast et al, , 2018(Fast et al, , 2019a(Fast et al, , 2019b. In Ethiopia, a network of researchers and scientists from Jimma University, Stanford University and the Lifebox Foundation collaborated to develop surgical safety and workflow quality improvement programmes (Forrester et al, 2018a) and SSI surveillance (Forrester et al, 2018b) in hospitals.…”

“…A number of authors underscored the importance that research and practice initiatives fully partner and build capacity with local researchers, professionals and leaders. This approach is recognised as vital to ensure programme feasibility and relevance as well as research capacity building (Fast et al, 2019a(Fast et al, , 2019bForrester et al, 2018aForrester et al, , 2018c.…”