Sterilization Of Surgical Instruments Research Articles

Numerical prediction of the chemical indicator response used in steam sterilisers

Steam sterilisation is a commonly used method in the sterilisation of surgical instruments. To ensure the sterility of the sterilised goods an evaluation of the sterilisation process is required. This might be achieved either through physical measurements or indicators. Optimal sterilisation results are achieved by removing the air from the sterilisation chamber. In this paper a new computational fluid dynamics (CFD) based approach is presented, which allows to calculate the steam distribution within a sterilisation chamber with focusing on hollow loads. Additional measurements were performed using a self-developed measurement chamber to validate the CFD model. A modified process challenge device (PCD) with different tube lengths in combination with a chemical indicator (CI) was tested, to identify the volumetric influence of the lumen on the resulting air-steam mixture therein. A numerically efficient model was developed to determine a steam volume fraction threshold leading to a response of the CI. This study aims to predict the volumetric amount of steam which is necessary in order to pass a PCD test fitted with a CI. Both the CFD model and the measurements showed that often an insufficient steam penetration is indicated by PCDs which can lead to an insufficient sterilisation of hollow loads.

Covering surgical instruments with single- or double-layer drape pending surgery: an experimental study in a perioperative setting.

Background:Surgical site infections (SSI) constitute a severe threat to surgery patients. The surgical environment must be as free of contaminating microorganisms as possible. Using sterile surgical instruments while performing surgery is an absolute necessity for ensuring quality of care in perioperative settings.Aim:To compare bacterial contamination of agar plates after 15 h on set surgical instrument tables covered with a single- or double-layer drape.Methods:An experimental design was used consisting of set instrument tables with six agar plates on each table: four instrument tables were covered with a single-layer drape and four instrument tables were covered with a double-layer drape. This set-up was repeated on nine occasions during the period of data collection, making 76 set instrument tables in total. As a control, one instrument table was uncovered on four of those occasions.Results:The double-layer drape cover showed a significantly (P = 0.03) lower number of colony forming units (CFU) per agar plate than the single-layer drape covering. As expected, the uncovered instrument tables were highly contaminated.Discussion:Our results indicate that it is good practice to cover instruments properly with at least a single-layer drape before a surgical procedure. If there is difficulty achieving optimal conditions while setting the instrument tables (e.g. positioning the patient for general anaesthesia), it is a better option to set the instrument tables earlier and cover them with a double-layer drape. These precautions will help protect the patient from harm and unnecessary SSI by lowering microbiological burden, a key factor in developing SSI.

Use of six sigma methodology to reduce surgical site infections in a surgical day care centre in North India

Background: The Aim of the study is to help hospitals reduce their surgical site infection (SSI) by use of six sigma methodology. The study conducted in a Day care surgical centre in North India with an SSI rate of 4.4% was done to ascertain the significant parameters leading to SSI and further rectification of these factors in order to reduce SSI. Methods and materials: A total of 45 surgical cases including 2SSI operated in the centre were followed up. Cases were followed up for cleaning of OT, humidity maintenance, temperature maintenance, OT Traffic, OT door opening frequency during surgery, H/o smoking, H/o diabetes, preoperative showering, surgical Instrument sterilization /disinfection, storage of Instruments, hand washing, skin preparation, hair removal, antibiotic prophylaxis. Fish bone analysis was done followed by pareto analysis which indicated 5 main causes for surgical site infection.1.High Frequency of door opening during surgery.2.High OT traffic.3.Inadequate hand Washing.4.Inadequate humidity maintenance.5.Inadequate sterilization/disinfection of surgical instruments. Hypothesis testing was done to identify the root causes among these 5 parameters and null hypothesis was defined. The statistics were carried on Minitab. For parameters related to high frequency of door opening during surgery and high OT traffic, P-value was 1 and 0.5091 respectively and this association was considered not significant statistically. For inadequate hand washing, P value was 0.0283 and was considered significant. P value for inadequate sterilization/disinfection of instruments was 0. 0455 and was considered significant. P value for inadequate OT humidity maintenance was 0.1919 and was considered not significant. Results: Two parameters comprising of inadequate hand washing and inadequate sterilization/disinfection of instruments were considered statistically significant in our study as causative factor for SSI. Conclusion: Several parameters can be responsible for causing Surgical Site Infection. Six sigma studies can help in defining most crucial parameters as causes for SSI .In our study we were able to define two most important factors responsible for SSI .Special emphasis was laid on strict hand hygiene and proper sterilization/disinfection of surgical instruments to reduce SSI rates .Strict monitoring of these parameters helped us to reduce SSI rates to 0%.

Using huddles to improve communication and teamwork in an instrument-processing department.

Instrument-processing staff work in a fast-paced, high-risk environment and errors in any of their processes can have a significant effect on patient safety. Effective communication is essential to the maintenance of complex processes such as the cleaning, disinfection and sterilisation of surgical instruments. This article details a service improvement project that aimed to evaluate staff members' perceptions of teamwork and communication before and after the implementation of team huddles in an instrument-processing department. A questionnaire was used to survey staff perceptions of teamwork and communication before and after the implementation of team huddles. The huddles included the use of a huddle board to standardise their content. While the survey did not identify any significant differences in staff perceptions before and after the implementation of the huddles, the department leaders noted significant improvements in the attitudes and engagement of staff members. The service improvement project demonstrated that structured team huddles can improve morale and efficiencies within departments through enhanced collaboration and communication.

Particle removal from air by face masks made from Sterilization Wraps: Effectiveness and Reusability.

Wearing face masks is highly recommended to prevent SARS-CoV-2 transmission in health care workers and for the general public. The demand for high quality face masks has seen an upsurge in the recent times, leading to exploration of alternative economic and easily available options, without compromising on the quality. Particle removal from air in terms of capture efficiency of the filter media or the face mask is a crucial parameter for testing and quality assurance. Short-term reusability of the face masks is also an important aspect as the demand for masks will potentially outstrip the supply in future. Sterilization Wraps, which are used to wrap sterile surgical instruments, have shown a promising performance in terms of removal of particles from air. In this study, we evaluate the particle filtration characteristics of face masks made of 2 different metric weights [45 and 60 gram per square metre (GSM)] respectively, using locally available Sterilization Wraps. The aerosol filtration characteristics were also studied after sterilisation by different techniques such as heat with 50% humidity (thermal treatment), ethylene oxide (ETO), steam and radiation dose of 30kGy. We found that 60 GSM face mask had particle capture efficiency of 94% for total particles greater than 0.3 microns and this capture efficiency was maintained even after sterilisation with ETO and thermal treatment. The cost of producing these masks was 30 US cents/mask at our institute. Our study suggests that sterilization wrap material made of non-woven polypropylene spunbond-meltblown-spunbond (SMS) fibres could be an appropriate readily available inexpensive material for making face masks or N95 respirators.

The Effect of Strengthening Quality Control in Improving the Quality of Cleaning, Disinfection and Sterilization of Surgical Instruments

The Effect of Strengthening Quality Control in Improving the Quality of Cleaning, Disinfection and Sterilization of Surgical Instruments

Chronic osteomyelitis as a complication from mycobacteriosis after breast implant

Introduction: Infection is one of the most feared complications in surgeries with the inclusion of breast implants, associated with the need for new procedures and aesthetic compromise. The agents that are most associated with this conditions are the ones that colonize the skin, such as Staphylococcus aureus and Coagulase-negative staphylococci. Case Report: We described the case of a 25-year old patient, who came to our service after an augmentation mammoplasty performed about 60 days before in a hospital in the countryside. She reported bilateral seroma and extrusion of the right breast implant on the 14th postoperative day, being submitted to antibiotic therapy and a new procedure for site review, with the placement of new implants, bilaterally. When she came to our service, on the 45th day after the exchange of implants, she presented with pain, fever, hyperemia and drainage of the purulent secretion in the operative wounds with extrusion of the implants. In the transoperative period, after the changes were identified, on the 3rd, 4th and 5th costal arches to the right, suggestive of osteomyelitis, associated with partial necrosis of the intercostal muscles and pectoralis minor. The bacteriological test of the periprosthetic secretion was bilaterally positive for mycobacteruim abscessus, and the anatomopathological study of the right costal arch biopsy was compatible with chronic osteomyelitis. The patient presented favorable clinical evolution after the removal of the implants and antibiotic therapy. Discussion: Mycobacteria are opportunistic organisms, which hardly cause diseases in human beings. Despite being uncommon, the infection of breast implants by mycobacteria can be associated with the contamination of surgical instruments and immunosuppression of the host. The infection can be similar to those caused by more common agents. In many cases, it presents with the later onset of symptoms. Prophylaxis and antisepsis, including special care regarding the protocols of sterilization of surgical instruments, are still the main factors associated with the impact of this type of complication in surgeries with breast implants.

Dermatosurgery Practice and Implications of COVID-19 Pandemic: Recommendations by IADVL SIG Dermatosurgery (IADVL Academy).

Dermatosurgery Practice and Implications of COVID-19 Pandemic: Recommendations by IADVL SIG Dermatosurgery (IADVL Academy).

The impact of a\xa0sterile processing program\xa0in Northwest Tanzania: a mixed-methods study

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.

Time-dependent surgical instrument contamination begins earlier in the uncovered table than in the covered table.

Time-dependent surgical instrument contamination and the effect of covering during arthroplasty have not been investigated. This study aimed to evaluate time-dependent contamination of surgical instruments and the effect of covering on contamination as well as to perform bacterial typing of contaminated samples. The hypothesis was that covering the surgical instruments would decrease contamination rates. Sixty patients who underwent total knee arthroplasty were randomized and divided into two groups: surgical instruments covered with a sterile towel or surgical instruments left uncovered. K-wires were used to extract microbiological samples. The K-wires were placed in a liquid culture medium at 0, 15, 30, 60, 90, and 120min. After 24-h incubation period, samples from liquid cultures were cultured on blood agar using swabs. Samples with growth after 48h were considered contaminated. Microscopic, staining, and biochemical properties were used for bacterial typing. Bacterial growth started after 30 and 60min in the uncovered and covered groups, respectively. An increase in the number of K-wires contaminated with time was detected. At least 10,000CFU/mL bacterial load was observed in the culture samples. Contamination was more significant in the uncovered group. A statistically significant difference in contamination was found between the uncovered and covered groups at 30-, 60-, 90-, and 120min (p = 0.035, p = 0.012, p = 0.024, and p = 0.037, respectively). The most common bacteria on the contaminated instruments were coagulase-negative Staphylococci (60.4%), Staphylococcus aureus (22.9%), and Streptococcus agalactia (16.7%), respectively. The risk of contamination increases with time. However, it may decrease if surgical instruments are covered. In the clinical practice, empiric antibiotic regimens based on the type of identified microorganisms in this study may be developed for postoperative periprosthetic joint infection prophylaxis. Prognostic, Level II.

A Tale of Two Departments: How Collaboration Between Infection Prevention and Sterile Processing Departments Can Improve Patient Safety

BACKGROUND Sterile Processing Departments (SPD) play a critical role in patient safety by proper sterilization of surgical instruments. Infection Preventionists (IPs) are often responsible for overseeing Infection Control (IC) standards for SPD, but frequently lack training in sterile processing that can create challenges. In 2015 we developed a quality improvement project improving IP knowledge of SPD processes and compliance with IC measures. METHODS An audit tool was created utilizing observations, staff responses to IC questions and documentation review. To gain familiarity with SPD processes and improve audits, IPs attended weekly SPD meetings, Skills Fairs, APIC webinars and professional conferences . Audits were developed from nationally recommended practices, done bimonthly by IC personnel and reviewed quarterly with SPD leadership. IPs provided education for staff when gaps were identified. Implementation of SPD audits occurred concurrently with other OR quality improvement projects to facilitate improved instrument reprocessing RESULTS Average overall audit scores increased in the first year from 67% in 2015 to 84% in 2016 (p CONCLUSIONS By attending SPD conferences, staff meetings, and skills fairs, IPs developed an audit tool to improve SPD oversight. Frequent auditing and education improved audit scores and correlated with an improvement in SPD function, as measured by decreased bioburden events. This project demonstrates how collaboration between the IP and SPD departments can lead to improved compliance and patient safety.

Implementing a perioperative efficiency initiative for orthopedic surgery instrumentation at an academic center: A comparative before-and-after study.

Optimizing surgical instrumentation may contribute to value-based care, particularly in commonly performed procedures. We report our experience in implementing a perioperative efficiency program in 2 types of orthopedic surgery (primary total-knee arthroplasty, TKA, and total-hip arthroplasty, THA).A comparative before-and-after study with 2 participating surgeons, each performing both THA and TKA, was conducted. Our objective was to evaluate the effect of surgical tray optimization on operating and processing time, cost, and waste associated with preparation, delivery, and staging of sterile surgical instruments. The study was designed as a prospective quality improvement initiative with pre- and postimplementation operational measures and a provider satisfaction survey.A total of 96 procedures (38 preimplementation and 58 postimplementation) were assessed using time-stamped performance endpoints. The number and weight of trays and instruments processed were reduced substantially after the optimization intervention, particularly for TKA. Setup time was reduced by 23% (6 minutes, P = .01) for TKA procedures but did not differ for THA. The number of survey respondents was small, but satisfaction was high overall among personnel involved in implementation.Optimizing instrumentation trays for orthopedic procedures yielded reduction in processing time and cost. Future research should evaluate patient outcomes and incremental/additive impact on institutional quality measures.

Disinfection and sterilization of surgical instruments

Disinfection and sterilization of surgical instruments

Spotlight on … infection in obstetrics and gynaecology

Spotlight on … infection in obstetrics and gynaecology

Experimental Investigation of Mechanical Performance and Printability of Gamma-Irradiated Additively Manufactured ABS

The work presented in this paper investigates the effects of gamma radiation on ABS in forms of irradiated 3D-printed parts, and irradiated filament used to later 3D-printed parts, using a cobalt-60 gamma irradiator. Tensile and flexural test samples were fabricated using off-the-shelf FDM 3D printers and irradiated at different dosages. Mechanical properties including elastic and flexure moduli, ultimate and flexural strength, % elongation at break, and surface hardness were evaluated, and results were compared to a control group. Evidence of cross-linking and chain scission and signs of possible oxidation of polymer caused by irradiation were found in both test groups which led to changes in mechanical properties. Moreover, it was found that ABS filament retains its printability after absorbing 15 kGy of gamma radiation and that its mechanical performance is very similar to those of irradiated samples at the same dose. Obtained results show promise for using ABS to fabricate sterile surgical instruments.

ADS-57 - What are the Gaps in Reprocessing and Sterilization Practices in Illinois Healthcare Settings? A Summary of Observations in 56 Illinois Settings, 2016-2017

Background: Improper sterilization of surgical instruments is a growing patient safety concern. Routine auditing using standardized audit tools is an organized approach to identify opportunities for healthcare organizations to improve performance. In this study, healthcare facilities participated in a free, non-regulatory on-site assessment of infection prevention and control practices. A standardized audit tool and a supplemental sterilization audit tool guided the onsite assessments and observations of facility infection control practices, instrument reprocessing, and sterilization practices.

Developing Process Maps as a Tool for a Surgical Infection Prevention Quality Improvement Initiative in Resource-Constrained Settings

Surgical infections cause substantial morbidity and mortality in low-and middle-income countries (LMICs). To improve adherence to critical perioperative infection prevention standards, we developed Clean Cut, a checklist-based quality improvement program to improve compliance with best practices. We hypothesized that process mapping infection prevention activities can help clinicians identify strategies for improving surgical safety. We introduced Clean Cut at a tertiary hospital in Ethiopia. Infection prevention standards included skin antisepsis, ensuring a sterile field, instrument decontamination/sterilization, prophylactic antibiotic administration, routine swab/gauze counting, and use of a surgical safety checklist. Processes were mapped by a visiting surgical fellow and local operating theater staff to facilitate the development of contextually relevant solutions; processes were reassessed for improvements. Process mapping helped identify barriers to using alcohol-based hand solution due to skin irritation, inconsistent administration of prophylactic antibiotics due to variable delivery outside of the operating theater, inefficiencies in assuring sterility of surgical instruments through lack of confirmatory measures, and occurrences of retained surgical items through inappropriate guidelines, staffing, and training in proper routine gauze counting. Compliance with most processes improved significantly following organizational changes to align tasks with specific process goals. Enumerating the steps involved in surgical infection prevention using a process mapping technique helped identify opportunities for improving adherence and plotting contextually relevant solutions, resulting in superior compliance with antiseptic standards. Simplifying these process maps into an adaptable tool could be a powerful strategy for improving safe surgery delivery in LMICs.

Segregation for reduction of regulated medical waste in the operating room: a case report.

One-third of all hospital-regulated medical waste (RMW) comes from the operating room (OR), and it considerably consists of disposable packaging and wrapping materials for the sterilization of surgical instruments. This study sought to identify the amount and type of waste produced by ORs in order to reduce the RMW so as to achieve environmentally-friendly waste management in the OR. We performed an initial waste segregation of 4 total knee replacement arthroplasties (TKRAs) and 1 total hip replacement arthroplasty, and later of 1 extra TKRA, 1 laparoscopic anterior resection of the colon, and 1 pelviscopy (with radical vaginal hysterectomy), performed at our OR. The total mass of non-regulated medical waste (non-RMW) and blue wrap amounted to 30.5 kg (24.9%), and that of RMW to 92.1 kg (75.1%). In the course of the study, we noted that the non-RMW included recyclables, such as papers, plastics, cardboards, and various wrapping materials. The study showed that a reduction in RMW generation can be achieved through the systematic segregation of OR waste.

Study of Application of Mobile DR Detector for Hospital Acquired Infection

Objectives: Generally, hospitals have a special condition easily causing environment pollution, cross infection, contact infection and droplet infection the patients, for it is the place for hospitalized patients who are strongly susceptible to disease and there is a high possibility of that diagnostic tools, hygienic materials in a hospital is infected by disease causing germs. Methods/Statistical Analysis: This study obtained a chest image with using medical radial rays by the thickness of disposable plastic packing paper, surgical instrument sterilization wraps for the prevention of hospital acquired infection from repetitive use of portable digital x radiation generator detector and compared and evaluated the definition of the images. Findings: According to qualitative analysis result analyzing the images by each types of disposable plastic, disposable plastic with air layer, sterilization sheet, 0.2 mm and 10 mm cotton materials, there was no statistical difference in the group, which did not use an infection prevention protecting product, in terms of contrast, occlusion detection rate and clarity of the boundary. Improvements/Applications: The study result suggests that it needs to actively use the materials for certain conditions to obtain optimal medical images and prevent hospital acquired image and to work on developing various protecting products for infection management.

Bar Code–Based Management to Enhance Efficiency of a Sterile Supply Unit in Singapore

Sterile surgical instruments are essential for successful surgical outcomes. The Singapore General Hospital’s Theatre Sterile Supplies Unit (TSSU) has faced many challenges, including increasing demand for instruments and the need to maintain instruments of greater complexity. To address these challenges, stakeholders from key departments at Singapore General Hospital formed a multidisciplinary team to transform operations in the TSSU. The team adopted and implemented the TSSU Instrument Management System (TIMS) in three phases over five years. The project included standardizing instrument-naming conventions, implementing electronic integration of instrument tracking in the unit, extending traceability of instruments to the major ORs, initiating integrated web-based instrument ordering, and extending the system management of instruments at ambulatory surgery and specialized OR facilities. The implementation of TIMS has improved inventory, supply, and quality management; reduced instrument repairs; and led to savings through increased productivity and lower expenses.