Sterile Department Research Articles

Molecular investigation of Staphylococcus aureus isolated from inanimate surfaces in Jordanian hospitals.

Staphylococcus aureus is a ubiquitous nosocomial bacterium, which confers hospital-associated infections ranging from moderate to life-threatening disorders. The pathogenicity of the microorganism is attributed to various camouflage mechanisms harbored in its genome. Methicillin-resistant Staphylococcus aureus strains have become significant pathogens in nosocomial and community settings. In the current study, we aimed to determine the prevalence of S. aureus, and more specifically, MRSA at different departments in four major hospitals in Jordan. A total of 500 inanimate surfaces located in the intensive care unit ICU, kidney department, surgery department, internal department, sterilization ‎department, burn department, and operation department were swabbed.‎ All isolates were identified by using routine bacterial culture, Gram staining, and a panel of biochemical tests such as; catalase, coagulase, DNase, urease, oxidase, and hemolysin production were performed. In terms of PCR, three main genes were screened, the 16S rRNA gene targeting Staphylococcus spp as a housekeeping gene, the coA gene was used as a specific gene to detect S. aureus, and the mecA gene used to identify MRSA isolates. Results revealed the prevalence of Staphylococcus spp was 212 (42.4%), ‎S. aureus ‎prevalence by coA gene 198 (39.6%), and MRSA by mecA gene in 81 samples ‎‎ (16.2%)‎. There was a strong positive connection (P < 0.01) found between department site and bacterial contamination.‎ It was concluded that inanimate hospital environments contain a relatively high number of S. aureus and MRSA. Proper sterilization techniques, infection prevention, and control management strategies should be implemented.

THE RELEVANCE OF NURSE TRAINING FOR PERFORMANCE IN THE CENTRAL SUPPLY AND STERILIZATION DEPARTMENT: A narrative review

The present study aimed to highlight the importance of nurse training to ensure the good performance of the team in the Central Supply and Sterilization Department (CSSD). A narrative theoretical review was conducted, with searches in the BVS (Virtual Health Library) and Scielo (Scientific Electronic Library Online) databases. In addition to articles published in the last ten years, current documents and publications from national health organizations that guide the procedures for sterilizing medical-hospital materials were also considered. The flow of health product processing was described; subsequently, the responsibilities and expected skills of the nurse in the department were specified; finally, important aspects of the professional nurse's training for the role in the CSSD were discussed. The consulted works confirmed the relevance of training and continuous education for nurses as a means of ensuring the effectiveness of health product processing and, consequently, patient safety.

Requirement analysis for an AI-based AR assistance system for surgical tools in the operating room: stakeholder requirements and technical perspectives

PurposeWe aim to investigate the integration of augmented reality (AR) within the context of increasingly complex surgical procedures and instrument handling toward the transition to smart operating rooms (OR). In contrast to cumbersome paper-based surgical instrument manuals still used in the OR, we wish to provide surgical staff with an AR head-mounted display that provides in-situ visualization and guidance throughout the assembly process of surgical instruments. Our requirement analysis supports the development and provides guidelines for its transfer into surgical practice.MethodsA three-phase user-centered design approach was applied with online interviews, an observational study, and a workshop with two focus groups with scrub nurses, circulating nurses, surgeons, manufacturers, clinic IT staff, and members of the sterilization department. The requirement analysis was based on key criteria for usability. The data were analyzed via structured content analysis.ResultsWe identified twelve main problems with the current use of paper manuals. Major issues included sterile users’ inability to directly handle non-sterile manuals, missing details, and excessive text information, potentially delaying procedure performance. Major requirements for AR-driven guidance fall into the categories of design, practicability, control, and integration into the current workflow. Additionally, further recommendations for technical development could be obtained.ConclusionIn conclusion, our insights have outlined a comprehensive spectrum of requirements that are essential for the successful implementation of an AI- and AR-driven guidance for assembling surgical instruments. The consistently appreciative evaluation by stakeholders underscores the profound potential of AR and AI technology as valuable assistance and guidance.

Особенности организации центрального стерилизационного отделения для лечения пациентов гнойно-хирургического профиля

The article was prepared on the basis of a report made at the scientific and practical conference «Organization of deratization measures in modern conditions, topical issues of disinfection activities in the conditions of medical organizations of various profiles,» held May 15-16, 2024 in St. Petersburg. Purulent-septic infections cause damage to the health and life of patients, as well as cause social and economic damage. Disinfection and sterilization measures are one of the most important measures in the system of anti-epidemic measures aimed at breaking the mechanism of transmission of infectious agents, which leads to the cessation of the development of the epidemiological process and the spread of ISMP. Keywords: hospital, purulent-septic infections, central sterilization department, diabetes mellitus, preventive measures, anti-epidemic measures, infections associated with the provision of medical care, nosocomial infections.

Практические аспекты сохранения стандартов качества обработки изделий медицинского назначения в условиях импортозамещения. Экономическая целесообразность

The article was prepared on the basis of a report made at the scientific and practical conference «Organization of deratization measures in modern conditions, topical issues of disinfection activities in the conditions of medical organizations of various profiles,» held May 15-16, 2024 in St. Petersburg. Despite the wide range of products for PSOs manufactured by foreign industry, at present, special attention is paid to the development of import substitutes and high-quality pre-sterilization cleaning. The experience of using new domestic means «Neodezin F» and «Neodezin N» for carrying out PSO by mechanized method in the disinfection-washing machine Miele PG 8536 is presented. Keywords: dental clinic, dental care for the population, non-specific prevention of infections associated with the provision of medical care, central sterilization department, import substitution, disinfection and washing machine, testing of Neodesin F and Neodesin N products for PSO, quality control of pre-sterilization treatment.

Smart Sterilization Container Technology: Blue Wrap Innovation

Steam sterilization is the basis of modern surgical instrument sterilization. It is a highly effective, safe, cost-effective heat transfer method that is closely monitored and regulated. The autoclave time is typically 1 hour for sterilization and requires direct steam contact with surgical tray contents. A porous barrier, typically blue polypropylene wrap or filter, is required around or on the walls of the sterilized tray to allow steam to enter and escape. This barrier can require up to 2 hours of cooling without touching after autoclave sterilization to prevent moisture condensation and bacterial wicking. The porous barrier is fragile and can tear or develop holes which can lead to OR challenges. It is also moisture sensitive and may be an underappreciated source of surgical site infections. Porous barrier technologies create inherent inefficiencies in sterile processing and OR turnover. Electronic container technology may possibly forego the porous barrier limitations and inefficiencies by capturing a sterile vacuum seal in the autoclave. A verifiable vacuum sealed container may eliminate limited handling while cooling and may increase sterile department efficiency and reduce operating room turnover. If the technology is reliable and consistent, it may offer a safer and more durable, transportable, monitorable, sustainable sterile processing alternative than current porous barrier technologies.

WORK ORGANIZATION OF A CENTRAL STERILIZATION DEPARTMENT IN A PEDIATRIC EMERGENCY MEDICAL INSTITUTION (Part 1)

Background. Sterilization of medical devices is one of the most important measures of non-specific prophylaxis aimed at preventing infections associated with the provision of medical care. Sterilization of medical devices is one of the main measures to ensure the safe provision of medical care, an important stage in the system of infection control and epidemiological safety, in accordance with the requirements of which the work on the prevention of nosocomial infection is carried out.. There have been numerous cases of nosocomial infections transmitted through medical devices. Strict observance of all norms and rules of sterilization measures, especially in a pediatric emergency medical organization, is of great importance in the nonspecific prevention of infection associated with the provision of medical care. Strict implementation of the rules for organisation of the central sterilization department in a pediatric emergency medical institution plays an important role in the prevention of infections associated with the provision of medical care to children and makes it possible to fully avoid nosocomial infections in both patients and staff of a medical organization. To carry out measures to properly organise the work of the central sterilization department, a number of administrative, organizational and anti-epidemic measures are required in a medical organization. Aim. To determine the work organisation features of the central sterilization department in a medical institution of the pediatric emergency care proRle. Materials and Methods. The materials presented in the publication were obtained by analyzing the work of the central sterilization department of the Research Institute of Emergency Pediatric Surgery and Traumatology. Results. It has been established that the personnel of the central sterilization department of the Research Institute of Emergency Pediatric Surgery and Traumatology, its material resources and technical equipment comply with the requirements of sanitary rules SP 2.1.3678-20 "Sanitary and epidemiological requirements for the operation of premises, buildings, structures, equipment and transport, as well as the conditions of activity of business entities selling goods, performing work or providing services" and other regulatory and legal documents regulating the work of the central sterilization department in a medical organization. Conclusions. The organization of medical devices sterilization in the central sterilization department of the Research Institute of Emergency Pediatric Surgery and Traumatology allows to perform sanitary and hygienic (prophylactic) and anti-epidemic measures in order to prevent infections associated with the provision of quality medical care a to patients.

Optimum Sterilization Department Design in Low-Medium Healthcare Facilities

Optimum Sterilization Department Design in Low-Medium Healthcare Facilities

Improving perioperative management of surgical sets for trauma surgeries: the 4S approach

BackgroundThe perioperative management of the surgical instruments and implants that comprise sets for trauma surgeries has been identified as a complex and resource-intensive activity due to non-standardized inventories, redundant surgical instruments and unnecessary sterilization cycles. The 4S Intelligent Trauma Care program aims to improve perioperative management and thereby reduce environmental impact by utilizing standardized inventories, a sterile implant portfolio, a barcode that enables a digital safety certification, and a digitized restocking service.ObjectiveThe objective of this study was to investigate the impact of the introduction of the 4S program for the management of surgical sets in open reduction internal fixation (ORIF) trauma surgeries.MethodsThis was a single-center, quality improvement study of ORIF trauma surgeries, comparing the current practice (30 procedures) to the procedure following the introduction of the 4S program (30 procedures). The primary outcome was the proportion of procedures requiring only one sterilization cycle. Secondary outcomes were the number of sterilization cycles per procedure, set processing time across departments, total set processing costs, number of missing or damaged implants, number of cleaning cycles per procedure, time taken to assemble containers for sterilization, number of containers entering the autoclave per procedure, environmental impact, number of baskets entering the cleaning machine per procedure, and staff satisfaction.ResultsIntroduction of the 4S program resulted in a reduction in the mean number of sterilization cycles required from 2.1 to 1.0 (p < 0.001). In the current practice, only 30.0% of procedure sets were sterilized within one cycle, compared to 100.0% following introduction of the 4S program (p < 0.001). A reduction in the mean set processing time of 24.1% in the OR and 35.3% in the sterilization department was observed. Mean set processing costs for the current practice were €81.23, compared to €50.30 following introduction of the 4S program. Furthermore, following the introduction of the 4S program, procedures were associated with significant reductions in water and electricity usage, and increased staff satisfaction.ConclusionsThis quality improvement study demonstrates the substantial time and cost savings, positive environmental impact and staff satisfaction that could be achieved by streamlining surgical set management through the 4S program. To our knowledge, this is the first study of this type and our findings may be instructive to other hospitals and surgical specialties.

Pre-sterilization cleaning of medical devices in central sterilization department of multidisciplinary hospital

The reprocessing of multiple-use medical devices (MD) is an integral part of anti-epidemic (preventive) measures aimed at interrupting the transmission routes of infectious diseases in the sterilization departments of medical organizations. One of the key issues in the treatment of medical devices is their pre-sterilization cleaning, carried out manually or mechanized. A number of factors affect the operation of washer disinfection machines (WD), related both to the WD itself and to the process of placing MD in them for processing. Disinfection of MD in WD in all cases, from the point of view of ISO standards, is preferable to chemical disinfection. Ultrasonic cleaning of simple medical products makes it possible to clean them effectively.

Surgical waste reprocessing: Injection molding using recycled blue wrapping paper from the operating room

IntroductionHospitals in the Netherlands generate approximately 1.3 million kg of waste from the polypropylene (PP) wrapping paper (WP) used to wrap surgical instruments each year. The aim of this study was to develop a method to recycle WP waste into new medical devices. MethodsWP was recovered from Maasstad Hospital, Netherlands. The WP was melted into bars, granulated, and mixed with virgin material at different ratios and temperatures. Dog bones were injection-molded from volume (v.%) virgin, mixed (%R), and recycled (100%R) granulate, and a tensile testing machine was used to compare the material properties before and after ten disinfection cycles at the sterilization department. Then, 25 instrument openers were made from the 50%R material and circulated for four weeks. ResultsThe data indicated no significant differences in the mechanical properties at different melting temperatures. For dog bones made from the 100%R, 50%R, and virgin granulate, the Young's moduli were 1021 (SD13), 879 (SD13), and 795 (SD14) MPa, and the strains were 8%, 12%, and 14%. Ten disinfection cycles did not significantly change the material properties. After one month, the openers did not show any deterioration or damage other than surface scratches. DiscussionThe results indicated that the initial WP melting temperature did not influence the mechanical properties. Although devices could be produced directly from the recycled WP granulate, increasing the recycled granulate in the mix ratio increased the strength and brittleness. ConclusionsIt is feasible to recycle WP waste into a high-quality raw material for the injection molding of medical devices without using additives. This would allow hospitals to become more compliant with the circular economy enabling economically viable and circular processes that positively contribute to cleaner technical processes, sustainable products, and the reduction of medical waste.

Design Opportunities to Reduce Waste in Operating Rooms

While taking care of the population’s health, hospitals generate mountains of waste, which in turn causes a hazard to the environment of the population. The operating room is responsible for a disproportionately big amount of hospital waste. This research aims to investigate waste creation in the operating room in order to identify design opportunities to support waste reduction according to the circular economy. Eight observations and five expert interviews were conducted in a large sized hospital. The hospital’s waste infrastructure, management, and sterilization department were mapped out. Findings are that washable towels and operation instruments are reused; paper, cardboard, and specific fabric are being recycled; and (non-)hazardous medical waste is being incinerated. Observation results and literature findings are largely comparable, stating that covering sheets of the operation bed, sterile clothing, sterile packaging, and department-specific products are as well the most used and discarded. The research also identified two waste hotspots: the logistical packaging (tertiary, secondary, and primary) of products and incorrect sorting between hazardous and non-hazardous medical waste. Design opportunities include optimization of recycling and increased use of reusables. Reuse is the preferred method, more specifically by exploring the possibilities of reuse of textiles, consumables, and packaging.

REORGANIZATION OF THE CENTRAL SUPPLY STERILE DEPARTMENT: NURSING STAFF’S CONTRIBUTIONS

ABSTRACT Objective: to analyze the strategies used by nurses for organization and planning in the centralization process of the Central Supply Sterile Department at a General Hospital. Method: this is a qualitative study of the history of the present time, carried out through an interview with 8 nursing professionals, such as nurses and nursing technicians at a hospital in the city of Petrópolis, state of Rio de Janeiro, Brazil. Data collection took place between September 2017 and August 2018. For analysis and interpretation of the documentary corpus, pertinence, sufficiency, completeness, representativeness, homogeneity and organization of documents in chronological order of the events during the investigated period were considered. The historical context was triangulated, with social structures and the symbolic universe resulting from interviews and documentary analysis. Thus, the categories of analysis emerged. Results: the strategies used by nurses occurred through organization and new work practices, enhancement of the Central Supply Sterile Department, hiring new nursing technicians, staff training and insertion of new technologies before, during and after centralization from the Central Supply Sterile Department. Conclusion: material sterilization at Hospital Santa Teresa continued with fractional nursing care among surgical patients and material processing. The strategies to centralize the sterilization unit contributed to a correct sterilization of hospital materials, resulting in expressive gains for nursing, Hospital Santa Teresa, society and control of Infections Related to Health Care.

A comparison of the costs of bronchodilator delivery methods in children with asthma exacerbations treated in hospital. The first Polish study in children.

IntroductionRecommended methods of administering bronchodilator drugs in children with asthma exacerbations in a hospital include the pressurized metered-dose inhaler (pMDI) and nebulization (NEB). These methods differ in clinical effectiveness, safety and, as some studies indicate, the cost of their use in a child.AimTo calculate the direct costs of hospital therapy conducted with the use of short-acting β2-agonist (SABA) or its combination with short-acting muscarinic antagonist (SAMA) administered via pMDI with valved holding chamber (VHC) versus the same drugs in NEB in children with asthma exacerbation.Material and methodsA retrospective analysis of the costs of SABA (salbutamol) and SABA + SAMA (fenoterol + ipratropium bromide) inhalation therapy was performed. Based on the data obtained from the financial department, the pharmacy, and the sterilization department of the university hospital, the direct unit cost of the inhalation therapy in the child was calculated.ResultsThe results of the analysis indicate that in a hospital setting the cost of one-time SABA or SABA + SAMA administration via pMDI+VHC is 1.5–2.4 times lower compared to NEB. The payer incurred the lowest costs during anti-obstructive treatment using SABA with pMDI + VHC (PLN 9.39 for one inhalation procedure). The working time of medical staff during the inhalation treatment is the component generating the highest cost for the hospital (up to 40% of direct costs).ConclusionsIn hospital conditions, the supply of SABA or SABA + SAMA with the use of pMDI + VHC in a child with asthma exacerbation is more beneficial financially than the supply of the same drugs in NEB.

Application of standard operational procedures in sterilization and supply departments

Objective To explore the effect of standard operational procedures (SOPs) when used in the quality management system of sterilization and supply departments, and to provide a theoretical basis for ensuring sterilization quality. Methods At first, a standard procedure template was prepared, then each department member was assigned to customize their SOPs based on their own circumstances, and finally the SOPs were reviewed one by one by the departments before the members were trained and began to use the SOPs; totally 2 000 surgical instruments from January to December 2014 (before SOPs) and from January to December 2015 (after SOPs) were selected by random sampling, and the percentage of their cleaning quality failure, packing failure, needlestick injury, and the average of clean-up time were measured and compared. Results The possibilities of disqualified cleaning, packing, needlestick injury and lost stitches and average clean-up time decreased compared with those before the SOPs were introduced (χ2=132.37, 91.85, 9.98, 9.20, 32.85; P<0.05) . Conclusions The introduction of SOPs maintains the work of sterilization and supply departments orderly and improve its quality, and therefore, SOPs should be introduced into the quality management system of sterilization and supply departments. Key words: Quality management; Standard operational procedures; Sterilization and supply department

Barriers to Adopting FDA Guidance in Central Sterile Departments

Barriers to Adopting FDA Guidance in Central Sterile Departments

ATP Measurement in the Last Rinse Water of Automated Washer-Disinfectors: The Added Value of Every Load Monitoring

Objective: To assess whether monitoring every loads of automated washer-disinfectors (AWDs) by testing the last rinse water with Adenosine Triphosphate (ATP) would have an added value to document effective and reproducible AWD processes. Methods: Every load monitoring (ELM) of the last rinse water with ATP was performed on three AWDs at the sterilization department of a 329 acute-bed hospital in Italy. No change were made in the routine procedures, except the last rinse water of a process was collected with a water sampler and tested on ATP. Data from negative controls and empty cycles were also obtained for comparison. ATP values were analysed according to AWD, load, and process characteristics. Results: A total of 435 ATP tests were performed, including 74 negative, 74 empty runs and 287 regular load tests. ATP values from regular loads ranged between 2 and 452 RLUs and 1.3%, 0.7%, 0.3% out of the 287 measurements was above 200, 300, and 400 RLUs, respectively. ATP values from negative tests and empty runs differed significantly (p<0.001) from the regular loads with a median value [I quartile; III quartile] of 4[2;5], 5[3;7], and 12[7;22] RLU, respectively. Analysis of ATP values from regular loads grouped by load pre-treatment, AWD washing program, load material or load amount showed significant differences between groups. No significant differences in ATP data were found among AWDs. Conclusion: The measurement of ATP in the last rinse water of AWDs showed that characteristics and quantities of the load relate to the ATP readings. The test is advised as an informative additional test to visual inspection for monitoring every load of an AWD.

Evaluation of the ScopeControl endoscope test system in six hospitals in The Netherlands

As rigid endoscopes are re-used after minimal invasive surgery, they degrade over time. To guarantee the optical quality of a rigid endoscope, the ScopeControl has been developed to measure key optical parameters such as, light transmission (LT), color correctness (CC), focus (FC), fiber transmission (FT), viewing angle (VA) and field of view (FV). To evaluate the performance of the ScopeControl, five ScopeControls SV (study version) have been tested in six hospitals in the Netherlands. Aspects such as robustness, precision, usability of the measured data, acceptation criteria and ergonomic aspects have been assessed. The ScopeControl maintains its stability over time and can measure LT, CC and FC with 5% precision, VA and FV with 2% accuracy and FT with 10% precision. The final thresholds above which an endoscope could still be considered to be in good condition, appeared to be: VA at 75%, CC, FC and FV at 70%, LT at 65% and FT at 35% of that of the best endoscope of that type ever found. The ScopeControl SV fits the workflow of the sterilization department as it is easy to use and can easily be cleaned. The time to perform a measurement is 2–3 min (one minute is spent to select the correct endoscope). The ScopeControl PV (launched in November 2013), has been used clinically from April to November 2014. It proves to be more stable, well accepted by personnel from the sterilization department and be of large value of preventing defect endoscopes on the surgery table.

P391: Audit of the processing of medical devices in reusable surgical services of the university hospital Yalgado Ouedraogo (Chu-Yo)

In surgical services, reusable equipment must follow a strict process with several stages (pre-disinfecting, cleaning, rinsing, drying, packaging and sterilization). Following the steps of this process is essential for the prevention of infections associated with surgery and poses a problem at CHU-YO since it does not have central sterilization department as recommended.

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