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Sterile reprocessing of surgical instruments in low- and middle-income countries: A multicenter pilot study
Nathan N O'Hara1, Kushal R Patel2, Amber Caldwell2
1Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada.
Background:
Surgical site infections increase the morbidity, mortality, and costs associated with surgical care. An estimated 96.2 million surgical procedures are performed in low- and middle-income countries (LMICs) each year. This pilot study assessed the steam sterilization aspect of the surgical instrument reprocessing practice in LMIC hospitals.
Methods:
Surgeons representing 26 hospitals in 9 different LMICs were consented to test the single most frequently used autoclave in their respective surgical departments. Participants conducted 10 chemical integrator tests and recorded the total cycle time, exposure temperature, and pressure on each test. Data were analyzed with descriptive statistics and reviewed by medical reprocessing experts.
Results:
Nine of the 26 (35%) study sites representing 7 countries returned their autoclave data and test strips (n = 90). Of the sites, 78% obtained acceptable readings on all 10 tests. When the data were compared against the recommended parameters for sterility, the results were less favorable. All 90 tests had at least 1 variable not within the target exposure time, temperature, or pressure.
Conclusion:
This pilot study presents concerns in regard to the effectiveness of steam autoclaves used in LMIC hospitals and the subsequent risks this presents to surgical patients. We acknowledge the resource limitations in many LMIC hospitals. However, the international medical community must ensure that basic sterile practice guidelines are adhered to despite these constraints.
Insights
Steam sterilization in low- and middle-income countries (LMICs) shows concerning results. Many hospitals struggle to meet recommended autoclave parameters, potentially risking patient safety during surgical procedures.
Area of Science:
- Medical reprocessing
- Sterilization technologies
- Global health
Background:
- Surgical site infections (SSIs) are a significant global health concern, increasing patient morbidity, mortality, and healthcare costs.
- Low- and middle-income countries (LMICs) perform a substantial number of surgical procedures annually, highlighting the importance of safe surgical practices.
- This study specifically investigates the critical step of steam sterilization in surgical instrument reprocessing within LMIC hospital settings.
Purpose of the Study:
- To assess the effectiveness of steam sterilization practices in LMIC hospitals.
- To evaluate the performance of autoclaves used for surgical instrument reprocessing in these settings.
- To identify potential risks to patient safety arising from sterilization deficiencies.
Main Methods:
- A pilot study involved surgeons from 26 hospitals across 9 LMICs.
- Participants used chemical integrators to test their most frequently used autoclave over 10 cycles.
- Key parameters including cycle time, temperature, and pressure were recorded and analyzed.
Main Results:
- Data from 9 hospitals in 7 countries (90 tests) were analyzed.
- While 78% of tests showed acceptable integrator readings, 100% of tests had at least one parameter outside recommended sterilization ranges.
- This indicates a discrepancy between perceived and actual sterilization effectiveness.
Conclusions:
- The study raises significant concerns about the efficacy of steam autoclaves in LMIC hospitals.
- Suboptimal sterilization practices pose a direct risk to surgical patient safety.
- Adherence to basic sterile practice guidelines is crucial, even amidst resource limitations.
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