Identifying sterilization practice gaps at five early implementation hospitals in Cambodia: An observational study

Effective sterilization of devices used for medical procedures is essential for reducing the risk of healthcare-associated infections. Limited data are available from lower-middle-income countries on the quality of sterilization processing practices or strategies for improving quality. This study developed an approach to collecting and using data on sterilization processing practices as part of the first phase of improving sterilization quality in Cambodia.

Five early implementation national, provincial, and district hospitals were selected. Evidence-based data collection tools and methods that assessed the proportion of sterilization practice standards met were adapted for local use. Multistakeholder hospital teams assessed environments and practices in sterilization processing areas, calculated indicators, interpreted data, identified gaps and barriers, and developed action plans. Team-based problem-solving was used to guide bottom-up engagement, communication, and staff motivation to implement change.

Across 5 hospitals, practice gaps were identified for instrument washing (0/24 [0%] cold water pre-rinse, 18/64 [28%] manual washing, 7/32 [22%] manual rinsing, and 0/24 [0%] drying standards met); inspection and packing (11/39 [28%] inspection and function testing, 21/71 [30%] packing, 21/30 [70%] wrapping, and 7/35 [20%] labeling standards met); sterilization (10/59 [17%] sterilizer loading, 10/28 [36%] sterilizer unloading, and 7/63 [11%] recording standards met); and sterile storage (71/130 [55%] sterile storage and 21/62 [34%] sterile-stock management standards met). Environments had limited one-way workflow, separation from patient care, and availability of handwashing resources. Hospital teams used data to develop short-term action plans to improve sterilization practice quality using local experience and resources.

New evidence-based tools and indicators proved practical and effective for assessing sterilization processing practices in hospitals. Collection and use of local data enabled multistakeholder hospital teams to prioritize problems and work on solutions to problems tailored to the local context. This approach has potential applicability to other hospitals in Cambodia and elsewhere as the foundation of an approach to improve the quality of sterilization practices.