Abstract
International guidelines stipulate that autoclavation is necessary to sterilize surgical equipment. World Health Organization (WHO) guidelines for decontamination of medical devices require four levels of decontamination: cleaning, low- and high-level disinfection, as well as sterilization. Following disasters, there is a substantial need for wound care surgery. This requires prompt availability of a significant volume of instruments that are adequately decontaminated. Ideally, they should be sterilized using an autoclave, but due to the resource-limited field context, this may be impossible. The aim of this study was therefore to identify whether there are portable and less resource-demanding techniques to decontaminate surgical instruments for safe wound care surgery in disasters. A scoping review was chosen, and searches were performed in three scientific databases, grey literature, and included data from organizations and journals. Articles were scanned for decontamination techniques feasible for use in the resource-scarce disaster setting given that: they achieved at least high-level disinfected instruments, were portable, and did not require electricity. A total of 401 articles were reviewed, yielding 13 articles for inclusion. The study identified three techniques: pressure cooking, boiling, and liquid chemical immersion, all achieving either sterilized or high-level disinfected instruments. It was concluded that besides autoclaves, there are less resource-demanding decontamination techniques available for safe wound surgery in disasters. This study provides systematic information to guide optimal standard setting for sterilization of surgical material in resource-limited disaster settings.
Highlights
Disasters are events that kill, maim, and create needs that exceed available health care capacities
This study provides systematic information to guide optimal standard setting for sterilization of surgical material in resource-limited disaster settings
Minor wound surgery was defined as surgical management of already open and contaminated minor wounds that can be managed at a primary health service level such as Emergency Medical Team PRISMA (EMT) Type 1
Summary
Disasters are events that kill, maim, and create needs that exceed available health care capacities. Natural disasters such as typhoon and flooding cause a significant burden of minor injuries requiring surgical wound care.[1,2,3] This requires surgical instruments that must be decontaminated to avoid transmission of pathogens.[4,5] There are different degrees of decontamination: clean, disinfected, and sterile.[5,6] Disinfected means that microorganisms have been destroyed or removed but does not necessarily include destruction of bacterial spores. It remains unclear to what extent this has clinical value in the disaster setting where wounds already are contaminated
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