Sterilization Of Instruments Research Articles

Opening Sterile Surgical Instrument Containers

Welcome to our Basic Skills for the OR Series! Complete series includes: Scalpels Surgical Sutures Surgical Staplers Opening Sterile Surgical Packs Opening Sterile Surgical Instrument Containers Laparoscopic Instruments

Opening Sterile Surgical Packs

Welcome to our Basic Skills for the OR Series! Complete series includes: Scalpels Surgical Sutures Surgical Staplers Opening Sterile Surgical Packs Opening Sterile Surgical Instrument Containers Laparoscopic Instruments

Situation analysis of the quality of primary health care services in Pakistan.

Primary health care services to promote the mental and physical health of communities include preventive, promotive, curative, general hygiene, and nutritional elements. To assess the quality of service delivery at primary healthcare settings in Punjab, Pakistan. Quantitative surveys were conducted at 106 health facilities: 92 basic health units (BHUs) and 14 rural health centres (RHCs) across Punjab in 2020. Data from the survey were supplemented with information from observations by the researchers and all data were analysed using SPSS version 25. All the 7 district health authorities surveyed had monthly targets for number of normal deliveries and the outpatient department. Systems for safe transportation and storage of medicines were deficient except in 2 districts. Anti-venom and anti-rabies vaccines were either limited or not available at most of the health units visited. Some 14% of clinical equipment examined at the BHUs and RHCs were non-functional, and no BHU had ultrasonic machines to improve the quality of antenatal care. Sterilization of surgical instruments was unsatisfactory at most health units. Several key positions at BHU and RHC were vacant. Most health units did not have fence and their main buildings were in poor condition. Several gaps were identified at the primary healthcare level in Punjab that need to be addressed to improve the quality of service delivery.

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.

Routine sterile glove and instrument change at the time of abdominal wound closure to prevent surgical site infection (ChEETAh): a model-based cost-effectiveness analysis of a pragmatic, cluster-randomised trial in seven low-income and middle-income countries

Surgical site infection (SSI) is a major burden on patients and health systems. This study assessed the cost-effectiveness of routine change of sterile gloves and instruments before abdominal wall closure to prevent SSI. A decision-analytic model was built to estimate average costs and outcomes of changing gloves and instruments before abdominal wall closure compared with current practice. Clinical data were obtained from the ChEETAh trial, a multicentre, cluster-randomised trial in seven low-income and middle-income countries (LMICs), and costs were obtained from a study (KIWI) that assessed costs associated with SSIs in LMICs. Outcomes were measured as the percentage of surgeries resulting in SSIs. Costs were measured from a health-care provider perspective and were reported in 2021 US$. The economic analysis used a partially split single-country costing approach, with pooled outcomes data from all seven countries in the ChEETAh trial, and data for resource use and unit costs from India (KIWI); secondary analyses used resource use and costs from Mexico and Ghana (KIWI). In the base case, the average cost of the intervention was $259∙92 compared with $261∙10 for current practice (cost difference -$1∙18, 95% CI -4∙08 to 1∙33). In the intervention group, an estimated 17∙6% of patients had an SSI compared with 19∙7% of patients in the current practice group (absolute risk reduction 2∙10%, 95% CI 2∙07-2∙84). At all cost-effectiveness thresholds assumed ($0 to $14 000), the intervention had a higher likelihood of being cost-effective compared with current practice, indicating that the intervention was cost-effective. Similar results were obtained when the analysis using data from India was repeated using resource use and unit cost data from Mexico and Ghana. Routine sterile glove and instrument change before abdominal wall closure is effective and the costs are similar to those for current practice. Routine change of gloves and instruments before abdominal wall closure should be rolled out in LMICs. National Institute for Health and Care Research (NIHR) Clinician Scientist Award, NIHR Global Health Research Unit Grant, and Mölnlycke Healthcare.

A robust LP-based approach for a dynamic surgical case scheduling problem with sterilisation constraints

The purpose of this article is to investigate a practical scheduling problem in which a group of elective surgical cases are scheduled over time, while considering their unpredictable durations and potential delays in the sterilisation of surgical instruments. The primary objectives were to schedule the maximum number of surgeries and decrease overtime for the surgical staff, as well as limit the number of instruments requiring emergency sterilisation. The study was conducted in collaboration with the University Hospital of Angers in France, which also contributed historical data for the experiments. We propose two robust mixed integer linear programming models, which are then solved iteratively through a rolling horizon approach, in which the objective functions are taken into account in lexicographic order. Experiments on randomly generated instances indicated which of the two approaches had better performance. Comparison of the results for a real-world scenario involving actual planning at the hospital indicated a greater than 69% decrease in overtime, and a minimum of 92% fewer stressful situations in the sterilising unit.

Standardism Performance of Dental Workers and Infection Control Status of Corrective Patient Instruments

Objective: This study aims to understand the performance of standardism through the performance of orthodontic workers and the infection control of orthodontic patients, and to contribute to the improvement of oral health of orthodontic patients and provide it as academic basic data. Methods: A study was conducted on 111 dental workers working at dental clinics in Gwangju Metropolitan City and Gyeonggi-do from March 1, 2023. The number of students participating in the study was calculated as the G. power 3.1 program, with an effect size of 0.3, a significant level of 0.05, and a power of 0.95. Participants in the survey understood the purpose of the study and agreed to participate in the study, and a self-written survey was conducted. The questionnaire was measured on a Likert 5-point scale, and 5 points were given to "very important" on the Likert 5-point scale and 1 point to "not important" so the higher the score, the higher the degree of practice. Results: Number of sterilizations of braces * In cross-analysis of clinical experience, sterilization was most common once a week, followed by sterilization once every two weeks. It can be said that there is no significant difference in the number of times and clinical experience. Conclusion: Clinical experience and regression analysis of instrument sterilization showed minimal levels of clinical experience, contaminated instrument management, hand hygiene, personal protective equipment, respiratory etiquette, and instrument sterilization methods.

Post circumcision Fournier’s gangrene in an infant: A case report

Fournier’s gangrene is a rare life-threatening condition that is characterized by rapid necrotizing spread from the scrotum and perineal area along facial planes to the abdominal wall, the flanks and the upper thighs. We present a case report of post-circumcision Fournier’s gangrene in an infant that was associated with spontaneous rupture of the lower pole of the left scrotum. This report highlights the need for practitioners of circumcision to be skillful in the procedure, use sterile instruments for it and adhere to standard infection prevention and control measures in health facilities.

Sterile Instrument Storage in an Austere Environment: Are Sterile Peel Packaging and Cellulose Wrapping Equivalent?

Recommendations for optimal temperature and humidity for sterile instrument storage vary according to different sources. Furthermore, there are limited data comparing methods of packing smaller, lightweight, low-profile instruments. The purpose of this study was to compare sterile peel packaging and sterile cellulose wrapping for sterile instrument storage in an austere environment characterized by elevated temperature and humidity. Stainless steel screws were sterilized and stored in either sterile peel packaging, sterile cellulose wrapping, or no packaging. Four groups were evaluated. Group 1 consisted of four screws in a sterile peelpack envelope and served as a time-zero control. Group 2 consisted of two groups of five screws, each packaged with blue sterilization cellulose wrap. Group 3 consisted of two groups of five screws, each packaged in sterile peel-pack envelopes. Group 4 consisted of 10 non-sterile unpackaged screws, which served as controls. Screws from groups 2, 3, and 4 were then cultured for 6 and 12 weeks. Temperature and humidity values were recorded in the instrument storage area. Average temperature was 21.3°C (SD 1.2°C; range 18.9°C-27.2°C) and average humidity was 51.7% (SD 3.9%; range 39%- 70%). Groups 1 (time-zero control) and 2 (sterile cellulose wrapping) demonstrated no growth. After 6 and 12 weeks, groups 3 (sterile peel packaging) and 4 (control) demonstrated bacterial growth. The most common culture isolates were gram-positive rods and two common nosocomial Staphylococcius species. Sterile peel packaging was not found to be equivalent to sterile cellulose wrapping in austere environmental conditions.

Enhancing microsurgical skills in neurosurgery residents of low-income countries: A comprehensive guide

Background: The main objectives of this paper are to outline the essential tools, instruments, and equipment needed to set up a functional microsurgery laboratory that is affordable for low-income hospitals and to identify cost-effective alternatives for acquiring microsurgical equipment, such as refurbished or donated instruments, collaborating with medical device manufacturers for discounted rates, or exploring local suppliers. Methods: Step-by-step instructions were provided on setting up the microsurgery laboratory, including recommendations for the layout, ergonomic considerations, lighting, and sterilization processes while ensuring cost-effectiveness, as well as comprehensive training protocols and a curriculum specifically tailored to enhance microsurgical skills in neurosurgery residents. Results: We explored cost-effective options for obtaining microsurgery simulators and utilizing open-source or low-cost virtual training platforms. We also included guidelines for regular equipment maintenance, instrument sterilization, and establishing protocols for infection control to ensure a safe and hygienic learning environment. To foster collaboration between low-income hospitals and external organizations or institutions that can provide support, resources, or mentorship, this paper shows strategies for networking, knowledge exchange, and establishing partnerships to enhance microsurgical training opportunities further. We evaluated the impact and effectiveness of the low-cost microsurgery laboratory by assessing the impact and effectiveness of the established microsurgery laboratory in improving the microsurgical skills of neurosurgery residents. About microsutures and microanastomosis, after three weeks of training, residents showed improvement in “surgical time” for ten separate simple stitches (30.06 vs. 8.65 min) and ten continuous single stitches (19.84 vs. 6.51 min). Similarly, there was an increase in the “good quality” of the stitches and the suture pattern from 36.36% to 63.63%. Conclusion: By achieving these objectives, this guide aims to empower low-income hospitals and neurosurgery residents with the necessary resources and knowledge to establish and operate an affordable microsurgery laboratory, ultimately enhancing the quality of microsurgical training and patient care in low-income countries.

Analysis of the Effect of Quality Control Circle on the Central Sterile Supply Department

Objective: To analyze the effect of quality control circle on the central sterile supply department (CSSD). Methods: The control group and the observation group each consisted of 180 instruments received by the sterilization supply center from January to March 2023 and 11 CSSD staff. The control group underwent routine management while quality control circle was implemented in the observation group. The quality of work, disinfection and sterilization qualification rates, disinfection and sterilization of various instruments, cleaning indicators, and management satisfaction of both groups were compared. Results: The observation group scored higher in terms of work quality, the qualification rate of disinfection and sterilization in each link, the disinfection and sterilization of instruments, and cleaning indicators compared to the control group. Besides, the management satisfaction of the observation group was higher than that of the control group (P < 0.05). Conclusion: A quality control circle ensures the quality of work, improves the cleaning, disinfection, and sterilization of instruments of the CSSD, and improves the management satisfaction of the CSSD staff.

A unique case of laproscopic port site tuberculosis.

We report a case of 27 years old lady who presented after 04 weeks of laproscopic cholecystectomy, with purulent discharge from 03 port sites most likely due to improper sterilization of re-usable laproscopic instruments. Patient was initially managed conservatively by repeated incision and drainage and multiple antibiotics including second line drugs against atypical mycobacterium were prescribed but infection did not settle. Her routine bacterial cultures and acid fast bacillus (AFB) stains were negative. After 07 months patient started developing abscesses in surrounding primary port sites and it was finally decided to excise the discharging sinus tracks and sent for histopathology. Histopathology confirmed tuberculosis as it showed epithelioid granulomas. Patient was started with standard first line anti tuberculous treatment (ATT) to eradicate the disease and she became alright after 06 months of ATT.

The Surgical Instrument Sterilization Process: What Every Surgeon Should Know.

» The phases of the sterilization process for surgical equipment are cleaning, disinfection, and sterilization.» Following manufacturer and regulatory guidelines will minimize contamination throughout the sterilization process.» Immediate use steam sterilization, when used appropriately, is a reasonably safe option to be used at the discretion of the operating surgeon.

The Public Perceptions on Wet Cupping Therapy (Hijama) in Saudi Arabia.

: Wet cupping (Hijama), a form of alternative medicine, is widely practiced in Middle Eastern countries, especially Saudi Arabia. Although considerable effort has been put into increasing public awareness about the safe and proper practice of wet cupping, studies on the attitudes, knowledge, and awareness levels of the Saudi Arabian public are lacking. : This study evaluated public attitudes toward the effectiveness, safety, and expected standards of practicing wet cupping. : This cross-sectional study was conducted using an online questionnaire and involved 909 complete responses. The respondents were Saudi adults with a mean age of 30.43 ± 11.4 years (males: 42.1%, females: 57.9%). : The study revealed that most participants believed that although wet cupping is a beneficial (84.6%), well-known form of alternative medicine (82.4%) without harmful side effects (63.9%), it is not suitable for treating all diseases (72.3%) or everyone (66.8%). Most participants prefer wet cupping to be done at specialized centers (84.6%) by practitioners with confirmed qualifications (88.6%) using valid and sterile instruments (88.9%). The main demographic factor influencing participant responses was age, which was associated with more positive perceptions. Female, single, college-educated, and middle-aged respondents had more cautious attitudes. : Our results indicate that Saudis support the use of wet cupping as an alternative medicine for select diseases and that individuals have adequate awareness of the practice's safety standards to avoid potential risks.

A Prospective Evaluation of Cost and Space Utilization Following Implementation of an Intelligent Delivery Platform for Forefoot Single-use Implants and Instrumentation in the ASC Setting

Category: Midfoot/Forefoot; Other Introduction/Purpose: The transition of the US healthcare system from a fee-for-service model to a value-based care model calls for a deeper evaluation of patient care in order to uphold quality and efficiency. Sterile-packed single-use instruments have been introduced as a tool to help facilities streamline operating room logistics and reduce sterilization needs and requirements thus reducing cost, time, and valuable shelf space. With the added intelligent delivery platform, procedure mapping (physician specific stocking of implants) and automatic restocking is now possible1-3. The purpose of this study was to examine the efficiencies of cost savings and reduction of shelf space required for storage of an intelligent delivery platform (Pulse Intelligent Delivery Platform, Stryker, Memphis, TN) with single-use surgery-ready forefoot implants. Methods: A total of 19 cases were performed during a 3-month period (August to November 2022) at a single ambulatory surgery center. Instrument tray reduction was tabulated and compared to the number of trays typically utilized using reusable instruments. Tray management time was evaluated clinically by direct observation. A cost analysis of reprocessed instrumentation trays was then performed looking at sterilization, surgical delay, and instrumentation costs per tray and then compared to pricing for the sterile instrument kits. The instrument, sterilization, and case delay costs/tray at the facility were calculated2. A comparison of space utilization was also performed between the two groups (reprocessed trays versus sterile kits). Results: There was a substantial decrease in the need for reusable instrument trays by 80%. 70% of cases did not require even one tray of reusable instruments to be opened. The delivery platform was shown to lower instrument tray cost per case by 74.25%. Space was also evaluated, and the sterile kits were found to have an 85.9% reduction in space when compared to the reprocessed trays2,3. Conclusion: A forefoot single-use surgery ready intelligent delivery platform has been shown to effectively lower overall instrument tray cost per case by 74.25% in a highly efficient ASC. In addition, an 85.9% reduction in shelf space per tray was also seen comparing reprocessed instrumentation to sterile instrument kits. Pricing is variable per facility, and sterilization and usage processes vary1-6. However, we believe that sterile kits can be more cost effective than reprocessed sets. In addition, space can be saved with the use of sterile instrument kits adding to the established benefits of the delivery platform of procedure mapping and automatic restocking1-3.

Patients’ perception of infection control in dentistry

Background: Dentistry is a high-risk profession for infections due to exposure to contaminated materials like blood, saliva, and instruments. Both dental staff and patients can contract diseases via person-to-person contact or contaminated objects. Objectives: To assess patient perception of infection control practices in dentistry which will help in planning effective public health care delivery. Methods: A descriptive cross-sectional study was carried out in 170 patients visiting Kathmandu Medical College Teaching Hospital (KMCTH) over the period of three months (2022 June to 2022 August) for any form of dental treatment. Ethical approval was granted by Institutional Review Committee of KMCTH on 8th June 2021. Data obtained were entered and analysed using SPSS v.21. Results: Majority of the participants believed dentists should wear gloves (164, 96.7%), face masks (159, 93.8%), and eye goggles (105, 61.9%) while treating patients, and 152 (89.6%) of participants agreed that dentist should change gloves between patients. However, nearly half of the participants were not hesitant to receive treatment from the dentist not wearing gloves (82, 48.3%) and mask (86, 50.7%). In total, 119 (70.2%) agreed that it was possible to catch an infection during dental treatment and 121 (71.3%) did take interest in sterilisation of instruments but only 21 (12.3%) always asked their dentist about the method of sterilisation. Conclusion: Patients possess a strong awareness of the importance for infection control in dental practice, however, this study underscores the importance of implementing effective infection control measures in dental settings to ensure the safety and well-being of patients.

Routine Sterile Glove and Instrument Change at the Time of Abdominal Wound Closure to Prevent Surgical Site Infection: Reviewing the ChEETAh Trial.

"Evidence-Based Reviews in Surgery" (EBRS) was developed to foster critical appraisal skills in practicing surgeons and trainees in order that they may evaluate surgical literature and practice Evidence-based Based Surgery. EBRS virtually connects experts in clinical surgery and evidence-based methodology to collaboratively assess the strengths and weaknesses of current practice compared to the risks and benefits of new approaches to care. Since the inception of EBRS, summaries of each review have been published. The present article is a comprehensive review of the ChEETAh trial, investigating the effectiveness of routine glove and instrument change before abdominal wound closure to prevent surgical site infection (SSI). The trial was conducted in low- and middle-income countries (LMICs) and employed a cluster-randomized design. The results indicate a statistically significant reduction in SSI rates. Although the ChEETAh trial has strengths, caution is advised before implementing the intervention globally. The study's clinical relevance and cost-effectiveness need to be considered, and targeted implementation in specific patient clusters and hospitals with the necessary resources is recommended. Institutions should not only assess their unique circumstances (resources, baseline SSI rates, and use of other effective preventive measures) before implementing glove and instrument changes in their setting but also monitor their outcomes and costs should they choose in favor of implementation. Further research, including long-term effects, is suggested to refine the understanding of the intervention's implications in diverse settings.

Instrument Sterilization and Surgical Site Infections in Low and Middle Income Countries

With the recent surge in oftentimes fatal bacterial resistance, surgical site infections (SSI) are now a prominent topic of scholarly discussion. These infections occur due to unsterile surgical practices infiltrating the operating room, and deadly pathogens with it. The developed world has lowered rates of SSI through scrupulous enforcement of CDC sterilization guidelines while low and middle income countries (LMICs) continue to fall victim to inefficient sterilization. LMICs often don't have the resources to reach these CDC guidelines and as a result endure surgical instrument contamination. Currently, there is a gap in funding and research related to the state of surgical instrument sterilization. This study aims to reveal first hand data regarding the gap in adherence to CDC sterilization guidelines for a variety of LMICs. Data was collected through virtual interviews with surgeons or surgical technologists globally. Interview responses were later scored for adherence to the CDC guidelines and correlated with rates of SSI per country. Results showed that the adequacy of surgical instrument sterilization processes (SP) in hospitals is directly correlated to SSI rates in LMICs. A one tailed test with a flow of SP adherence to SSI prevalence rendered the following strong correlation of R squared=0.772. This relationship demonstrates that investments to improve surgical sterilization processing will likely render lower rates of SSI. Lower SSI rates in LMICs could give rise to an increase in surgical tourism, a decrease in expensive treatments for highly resistant bacteria, and ultimately a decrease in surgical morbidity and mortality.

Six Sigma can significantly reduce costs of poor quality of the surgical instruments sterilization process and improve surgeon and operating room personnel satisfaction

Operating room (OR) management is a complex multidimensional activity combining clinical and managerial aspects. This longitudinal observational study aimed to assess the impact of Six-Sigma methodology to optimize surgical instrument sterilization processes. The project was conducted at the operating theatre of our tertiary regional hospital during the period from July 2021 to December 2022. The project was based on the surgical instrument supply chain analysis. We applied the Six Sigma lean methodology by conducting workshops and practical exercises and by improving the surgical instrument process chain, as well as checking stakeholders’ satisfaction. The primary outcome was the analysis of Sigma improvement. Through this supply chain passed 314,552 instruments in 2022 and 22 OR processes were regularly assessed. The initial Sigma value was 4.79 ± 1.02σ, and the final one was 5.04 ± 0.85σ (SMD 0.60, 95%CI 0.16–1.04, p = 0.010). The observed improvement was estimated in approximately $19,729 of cost savings. Regarding personnel satisfaction, 150 questionnaires were answered, and the overall score improved from 6.6 ± 2.2 pts to 7.0 ± 1.9 pts (p = 0.013). In our experience the application of the Lean Six Sigma methodology to the process of handling the surgical instruments from/to the OR was cost-effective, significantly decreased the costs of poor quality and increased internal stakeholder satisfaction.

Gloves Contamination During Revision Surgery for Periprosthetic Joint Infection

BackgroundThe use of double gloving has become a standard practice for joint replacement surgeons. However, since there are limited data on how gloves are contaminated during both primary and revision arthroplasty, no precise protocol exists to direct surgeons on when, or if, to change their gloves. The goals of this preliminary study were to evaluate the contamination of gloves during total joint arthroplasties (TJAs). MethodsWe included 25 infected cases and 10 primaries, which were performed at the same institution using the same surgical protocol from 3 fellowship trained surgeons. Samples were taken every 20 minutes from the start of the surgery until the joint was irrigated. Procedural steps were noted. To evaluate cross-contamination during infected cases, we sampled gloves using blood agar plates. In primary cases, culture swabs of anterior chamfer cuts and sterile instruments on the back table were used as negative controls. Next-generation sequencing (NGS) was used as an adjunct to identify low virulence bacteria. ResultsIn the primary cases, all samples were found culture negative but 3 (8.1%) of the 37 samples were found to have a low, unidentifiable bacterial mass via NGS testing. In the infected cases, 41 (59.4%) of the 69 samples yielded positive microbial results. The positivity rate was higher in the samples collected after the arthrotomy was performed (70%) compared to samples collected before the arthrotomy was performed (40%), and the surgeon was only dissecting superficial layers (P = .502). ConclusionGloves seem to be a common source of cross-contamination in the intraoperative field during revision TJA. Due to the higher percent of positive samples following the opening of the joint, we hypothesize that the arthrotomy allows for the spread of bacteria across the operative site. While further investigation is necessary to formulate a precise protocol for the changing of gloves during TJA, it may be beneficial to perform a thorough irrigation of the joint and change of the gloves immediately following arthrotomy.