Sterilization Services Research Articles

Evaluation of Momentum Male Sterilization Service Effectiveness as an Attempt to Reach MURI Record

Family Planning (FP) program achievement in North Sumatera Province is less encouraging. Total fertility rate in North Sumatera (3.0) is higher than the national (2.6) and contraceptive prevalence (55.9%) is lower than the national (61.4%). As one strategy to increase FP participation, momentum sterilization service was feared not to meet the medical care standard because related to Indonesian Record Museum. This evaluation aimed to explain service quality and satisfaction among male sterilization acceptors. Both qualitative and quantitative evaluation were done cross sectionally against FP officers, prospectives and acceptors who received medical procedure during momentum service performed in 13 health facilities in Medan City, North Sumatera on October 23 to 24, 2012. Qualitative data were obtained through in-depth interview towards subdistrict and village FP managers. Quantitative data regarding prospective acceptors and a structured questionnaire to subsample of male sterilization acceptors were collected by the provider at the service location. Results showed the relatively smooth preparation, mobilization, Information, Education and Communication, male sterilization services and its reporting records. Implementation of male sterilization service had served 1379 of 2001 prospective acceptors targetted, so the national record was achieved. Almost all respondents were satisfied with the services provided both by FP and medical officers. Abstrak Pencapaian Program KB di Sumatera Utara kurang menggembirakan. Total Fertility Rate Sumatera Utara (3,0) lebih tinggi dibandingkan nasional (2,6); dan prevalensi kontrasepsi (55,9 %) lebih rendah dibandingkan nasional (61,9%). Sebagai salah satu strategi peningkatan kesertaan KB, pelayanan momentum sterilisasi pria dikhawatirkan tidak memenuhi standar pelayanan karena dikaitkan dengan rekor MURI. Evaluasi ini bertujuan untuk menjelaskan kualitas pelaksanaan pelayanan dan kepuasan akseptor sterilisasi pria. Evaluasi bersifat kualitatif dan kuantitatif dilakukan secara potong lintang terhadap petugas KB, calon akseptor dan akseptor yang mendapat tindakan sterilisasi pada pelayanan momentum di 13 fasilitas kesehatan di Kota Medan, Sumatera Utara pada 23-24 Oktober 2012. Data kualitatif diperoleh melalui wawancara mendalam terhadap pengelola KB kecamatan dan desa. Data kuantitatif dikumpulkan provider di tempat pelayanan dengan menggunakan angket mengenai calon akseptor, dan kuesioner berstruktur terhadap sub sampel akseptor sterilisasi pria. Hasil menunjukkan relatif lancar persiapan, penggerakan, KIE, pelayanan sterilisasi pria dan pencatatan pelaporannya. Pelaksanaan pelayanan sterilisasi pria berhasil melayanai 1379 dari target 2001 target calon akseptor, sehingga mendapatkan REKOR MURI. Hampir semua peserta sterilisasi pria merasa puas terhadap pelayanan dari petugas medis dan petugas KB.

Quality Assessment of Family Planning Sterilization Services at Health Care Facilities: Case Record Audit.

Quality of sterilization services is a matter of concern in India because population control is a necessity. Family Planning Sterilization (FPS) services provided at public health care facilities need to be as per Standard Operating Procedures. To assess the quality of FPS services by audit of case records at selected health care facilities. This cross-sectional study was conducted for two and a half year duration at selected public health care facilities of central India by simple random sampling where FPS services were provided. As per the standards of Government of India, case records were audited and compliance was calculated to assess the quality of services. Results of record audit were satisfactory but important criteria like previous contraceptive history and postoperative counselling were found to be deviated from standards. At Primary Health Centres (PHCs) only 89.5% and at Community Health Centres (CHCs) 58.7% of records were having details of previous contraceptive history. Other criteria like mental illness (only 70% at CHCs) assessment were also inadequate. Although informed consent was found to be having 100% compliance in all records. Quality of care in FPS services is the matter of concern in present scenario for better quality of services. This study may enlighten the policy makers regarding improvements needed for providing quality care.

Perception and satisfactory level of beneficiaries regarding female sterilization services through client exit interview at various facilities of Rajkot district

Perception and satisfactory level of beneficiaries regarding female sterilization services through client exit interview at various facilities of Rajkot district

Qualidade da água: fatos e mitos!

Objetivo: Discorrer sobre a importância da água no Centro de Material e Esterilização, as principais evidências de risco, normas, legislação relacionada e orientações para a definição de um sistema de tratamento de água para enxágue de produtos. Método: Revisão narrativa buscando fatos, mitos e descrevendo aspectos relacionados à necessidade de controle da qualidade de água utilizada no processamento de produtos para saúde. Resultados: Relatos de efeitos tóxicos locais e reações pirogênicas em pacientes demandam a padronização e controle de qualidade da água para enxágue de produtos e geração de vapor nas autoclaves. Conclusão: O tratamento e monitoramento da qualidade da água devem ser incorporados pelos serviços de saúde.

Commentary: A Central Sterile Services Perspective on the Servicing of Medical Devices.

Commentary: A Central Sterile Services Perspective on the Servicing of Medical Devices.

Control of an outbreak of postoperative bone mucormycosis: An intervention study of contiguous cohorts

An outbreak of postoperative bone mucormycosis following arthroscopic anterior cruciate ligament reconstruction in a tertiary referral center in Paraná, Argentina, could have been transmitted through an arthroscopic anterior cruciate ligament reconstruction-exclusive contaminated item. The outbreak was controlled after changing from a system of direct delivery of implants and instruments to the operating room without proper verification, to a controlled and centralized process; specifically, the institution's pharmacy verified the quality and traceability of implants, and instruments were processed only by the institution's central sterile services department.

Biossegurança no centro de materiais e esterilização: dúvidas dos profissionais*

Objetivos: Conhecer as dúvidas dos profissionais da saúde sobre biossegurança no Centro de Materiais e Esterilização (CME) e refletir sobre as respostas emitidas. Método: Estudo exploratório descritivo qualitativo. O cenário da pesquisa foi um site nacional reconhecido que dispõe uma lista de discussão por e-mail. O corpus foram 2.260 mensagens enviadas à lista de discussão em 2014; a amostra foi composta por 109 mensagens com conteúdo relacionado à biossegurança no CME. Utilizou-se para interpretação dos dados a Análise de Conteúdo de Bardin. Resultados: Na análise emergiram quatro categorias temáticas das dúvidas mais frequentes denominadas: soluções; equipamentos e materiais; Legislação; e validação do processo. Evidenciou-se forte relação entre CME e Controle de Infecção Hospitalar (CIH), tanto nos questionamentos quanto nas respostas. Conclusão: A maioria dos profissionais que encaminharam dúvidas foram enfermeiros. As dúvidas mais frequentes sobre biossegurança relacionavam-se a soluções usadas, equipamentos e materiais. As respostas foram fundamentadas na legislação vigente e emitidas por profissionais com experiência. Palavras-chave: Segurança de equipamentos médicos. Enfermagem. Material.

Select Public Health Policies in Iran: Recommendations for Action

For a decade, the Iranian population growth rate has remained constant at around 1.3 percent. To address this issue, the Iranian government has terminated the national family planning program and removed all of the information about birth control methods from school education, media, and government websites. Moreover, the Iranian Ministry of Health and Medical Education (MOHME) has implemented a program, entitled “Reproductive Health,” with the aim of increasing the fertility rate to at least 2.1 percent. Accordingly, women of reproductive age with fewer than three children are found and encouraged to deliver at least three children. MOHME has also restricted providing permanent sterilization services to the community by new regulations, and banned advertisement of family planning in health clinics. These policies potentially have significant negative consequences on public health in Iran. Therefore, we provide a set of recommendations from health policy and public health points of view. This includes improving maternal and child health, prevention of non-communicable diseases, traffic injury prevention, and strengthening elderly health care.

Analytical and subjective interpretation of thermal comfort in hospitals: A case study in two sterilization services

ABSTRACTHospital facilities are normally very complex, which combined with patient requirements promote conditions for potential development of uncomfortable working conditions. Thermal discomfort is one such example. This study aimed to determine levels of thermal comfort, sensations, and preferences, from a field investigation conducted in two sterilization services (SS) of two hospitals from Porto and Aveiro, Portugal. The analytical determination and interpretation of thermal comfort was based upon assumptions of ISO 7726:1998 and ISO 7730:2005. The predicted mean vote (PMV) and predicted percentage of dissatisfaction (PPD) indices were obtained by measurement and estimation of environmental and personal variables, respectively, and calculated according to ISO 7730 equations. The subjective variables were obtained from thermal sensation (subjective PMV) and affective assessment (subjective PPD), reported by a questionnaire based upon ISO 10551:1995. Both approaches confirmed thermal discomfort in both SS (codified as SS1 and SS2). For all areas, PMV and PPD exceeded in all periods of the day the recommended range of –0.5 to +0.5 and <10%, respectively. No significant differences were found between day periods. The questionnaire results showed that SS2 workers reported a higher level of thermal discomfort. There were no significant differences between PMV and thermal sensations, as well as between PPD and affective assessment. The PMV/PPD model was found suitable to predict thermal sensations of occupants in hospital SS located in areas with a mild climate in Portugal.

Preventing Healthcare-Associated Infections by Monitoring the Cleanliness of Medical Devices and Other Critical Points in a Sterilization Service.

It is well known that the common goal of all central sterile supply departments (CSSDs) is to prevent healthcare-associated infections. Such infections entail high costs to society, not only economic but also social. Therefore, delivering safe medical devices and guaranteeing a positive contribution to the control of healthcare-associated infections form the main responsibilities of a CSSD. The monitoring of the effectiveness of medical device cleaning processes is highly recommended. However, ensuring a flawless environment for the preparation, assembly, and packaging of medical devices and clean handling of sterilized items is crucial to achieving the goal of safe medical devices. This study analyzed not only the cleanliness of surgical instruments but also two critical aspects of the surrounding environment: the cleanliness of work surfaces and the cleanliness of workers' hands. To evaluate the cleanliness of surgical instruments, two methods were used: the adenosine triphosphate (ATP) detection method and a residual protein test. It was not the intention of this work to make an exhaustive comparison of these methods. The ATP bioluminescence method was also used for monitoring the cleanliness of work surfaces and workers' hands. The aims of this study were to establish the most suitable method of evaluating the cleanliness of reusable medical devices in the CSSD and to assess the quality of the environment. Assessing the surgical instruments, work surfaces, and staff hands for cleanliness allowed the identification of possible contamination sources and to correct them by improving cleaning/disinfection protocols. Furthermore, the use of ATP monitoring tests of workers' hands highlighted the importance of staff compliance with good practice guidelines. Thus, these results have a positive impact on the CSSD quality system and, consequently, on patient safety.

Reflecting on the Development of the Decontamination Services: Pondering the Past, Presenting the Future

This paper explores the historical developments of the UK decontamination services workforce over the past century. It will look back at how the services originated and look forward towards what the future could hold. This evolving workforce has progressed from traditional in-house training programmes towards accredited education, aiming to pave the way towards becoming a new profession--the healthcare scientist. The paper also explores some of the main drivers behind how previous healthcare professions have developed, and how these may impact on evolving professions such as decontamination services. The paper concludes by highlighting the importance of ensuring that staff are educated to national standards and keep abreast of current healthcare advances, in order to develop and retain the sterile services leaders of the future.

Insulation failure in electrosurgery instrumentation: a prospective evaluation.

The use of electrosurgery has expanded to a wide variety of surgical specialities, but it has also been accompanied by its share of complications, including thermal injuries to nontargeted tissues, caused by a break or defect in the insulation of the instrument's coat. The purpose of this study was to determine the prevalence and the location of insulation failures (IFs) in electrosurgical instruments, then to assess the necessity of routine IF testing. Electrosurgical instruments were visually inspected and checked for IF using a high-voltage detector. Two different detectors were used during two testing sessions: DTU-6 (Petel company) and DIATEG (Morgate company). Laparoscopic and non-laparoscopic instruments were determined to have IF if current crossed the instrument's insulation, signaled by an alarm sound. A total of 489 instruments were tested. The overall prevalence of IFs was 24.1% with only visual inspection and 37.2% with the IF detector. Among the 489 instruments, 13.1% were visually intact, but had an electric test failure. DTU-6 and DIATEG detectors showed comparable efficiency in detection of overall IFs and for laparoscopic and non-laparoscopic instruments. The median location of IFs was more pronounced for laparoscopic instruments (50.4%) and the distal location for non-laparoscopic instruments (40.4%). Accidental burns are a hidden problem and can lead to patient complications. In Central Sterilization Service Department, prevention currently includes only visual control of electrosurgery instrumentation, but testing campaigns are now necessary in order to identify maximum instruments' defects.

An analytic hierarchy process-based framework to support outsourcing decisions on hospital sterilisation

The study investigates the opportunity to outsource, partially or totally, the sterilisation service of a hospital. It proposes a framework, based on the analytic hierarchy process (AHP), to support the choice of the most effective configuration of the service when multiple criteria are considered. First, the sterilisation process was subdivided into stages that could be managed by the hospital (insourced) or outsourced. The feasible configurations obtained by combining insourced and outsourced stages were then evaluated by means of an AHP model that was validated by the participants to the decision process. The framework can be used in different settings, but the criteria must be validated in the each specific case. Further applications to real cases are needed to test it in different contexts, especially if characterised by different organisation structures.

Factors associated with induced abortion among women attending Marie Stopes Clinics in Kathmandu Valley

INTRODUCTION: Though abortion has been legalized in Nepal from September 2002 but it is still a highly stigmatized issue with lots of prevailing misconceptions in the community. In this scenario also each year one lakh abortion are done in Nepal and the number of women seeking abortion services is in increasing trend. Therefore, it is very important to know the reasons behind seeking abortion services by Nepalese women. The overall objective of this study was to assess the factors associated with induced abortion among women attending at Marie Stopes Clinics of Kathmandu Valley.&#x0D; MATERIAL AND METHODS: A descriptive cross-sectional study was carried out over a period of two weeks in the Marie Stopes's clinics of Gongabu and Kupondole sites of Kathmandu among 85 purposively selected women. Face-to-face interview was done by using the semi-structured questionnaire. The collected data was analyzed by using simple descriptive statistics like percentage, frequency, mean and standard deviations and presented in the forms of tables and narratives.&#x0D; RESULTS: The mean age of the respondents with standard deviation was 25.5±5.571 years. Around 88 % of the respondents were literate. Majority (91.8%) were married. Around 75 % of the respondents cited, having enough children and wanting no more child now as the main reason behind having abortion. The decision of undergoing abortion was taken by both partners in 89.4% of the respondents. Exactly 62.4% of the respondents were not aware about the possible effects of abortion. Almost 32% of the respondents had the history of previous abortion. Almost 90 % of the respondents had desired to use contraceptive after abortion. Condoms, pills and Depo-Provera were preferred by 41.3%, 22.7% and 13.3% of the respondents for use after undergoing abortion respectively.&#x0D; CONCLUSION: It can be concluded from the study that the major reasons behind undergoing abortion were to limit the number of children and desire to postpone the children. About one-third of women have the history of previous abortion and similar proportion has done abortion two to three times. Therefore, this study suggests that long acting FP methods and sterilization services should be made accessible to women so that they could prevent unwanted pregnancy. Also there is need of strengthening counseling services for contraceptive use to women coming for abortion repeatedly.

Performance improvement project in the sterile processing department at a university hospital in Egypt - Redesign to centralize the process

Reprocessing of medical instruments is a complex process requiring several steps. In the last few years, many reports were delivered to our infection control unit about defects in the sterilization service. This study aims to describe improvements in the performance of the Sterile Processing Department (SPD), thus improving safety for patients and healthcare professionals. The FOCUS-PDCA strategy and root cause analysis were used to define the problem, investigate the underlying causes and develop a quality improvement plan. Defects in the service provided were detected, including inadequate procedures and training, breaches in reprocessing, and suboptimal workplace ergonomics and design. We developed an institutional policy and standard operating procedures for the SPD, implemented a training program for SPD staff, and improved the workplace layout to improve separation of clean and soiled equipment.

Decontamination of breast pump milk collection kits and related items at home and in hospital: guidance from a Joint Working Group of the Healthcare Infection Society & Infection Prevention Society.

A variety of methods are in use for decontaminating breast pump milk collection kits and related items associated with infant feeding. This paper aims to provide best practice guidance for decontamination of this equipment at home and in hospital. It has been compiled by a joint Working Group of the Healthcare Infection Society and the Infection Prevention Society. The guidance has been informed by a search of the literature in Medline, the British Nursing Index, the Cumulative Index to Nursing & Allied Health Literature, Midwifery & Infant Care and the results of two surveys of UK neonatal units in 2002/3 and 2006, and of members of the Infection Prevention Society in 2014. Since limited good quality evidence was available from these sources much of the guidance represents good practice based on the consensus view of the Working Group. Breast pump milk collection kits should not be reused by different mothers unless they have been sterilized in a Sterile Services Department between these different users.When used by the same mother, a detergent wash followed by thorough rinsing and drying after each use gives acceptable decontamination for most circumstances, as long as it is performed correctly.Additional decontamination precautions to washing, rinsing and drying may be used if indicated by local risk assessments and on advice from the departmental clinicians and Infection Prevention and Control Teams. The microbiological quality of the rinse water is an important consideration, particularly for infants on neonatal units.If bottle brushes or breast/nipple shields are used, they should be for use by one mother only. Decontamination should be by the processes used for breast pump milk collection kits.Dummies (soothers, pacifiers or comforters) needed for non-nutritive sucking by infants on neonatal units, should be for single infant use. Manufacturers should provide these dummies ready-to-use and individually packaged. They must be discarded at least every 24 hours or immediately if soiled with anything other than the baby's saliva. No attempt should be made to decontaminate the dummies, either before or during use. This guidance provides practical recommendations to support the safe decontamination of breast pump milk collection kits for healthcare professionals to use and communicate to other groups such as parents and carers.

Dog and cat management through sterilization: Implications for population dynamics and veterinary public policies

The present study aimed to compare different sterilization scenarios allowing the adoption of the most adequate strategy to control owned dog and cat population sizes as the official veterinary public policy for animal control in an urban area of Campinas municipality, Brazil.To achieve this goal, the vital parameters of the owned pet population were measured in a neighborhood of Campinas called Jardim Vila Olimpia through questionnaires used in two census studies performed in February 2012 and June 2013.Different hypothetical sterilization scenarios were compared with the scenario of a single sterilization campaign performed in the study area between the census studies. Using a deterministic mathematical model, population dynamics were simulated for these different scenarios. We have observed that for both owned dogs and cats, the impact on the population size achieved by a single sterilization campaign would be diluted over the years, equating to the impact achieved by the usual sterilization rate practiced before the sterilization campaign yearly. Moreover, using local and global sensitivity analyses, we assessed the relative influence on animal population evolution of each vital parameter used in the mathematical models. The more influential parameters for both species were the carrying capacity of the environment and sterilization rates of males and females (for both species).We observed that even with sterilizing 100% of the intact animals annually, it would not be possible to obtain proportions greater than 86% and 88% of sterilized dogs and cats, respectively, after 20 years due to the high introduction of new intact animals. There is no public dog and cat sterilization service in place in the city, and sporadic and local sterilization campaigns are performed with a prior communication to the owners to bring their animals to be sterilized in a selected veterinary facility. If a sterilization campaign was performed annually in the study area, it would have the most favorable cost effectiveness ratio after 20 years compared to the scenarios of 50% and 100% sterilization of intact animals annually.These results allowed the veterinary public policy stakeholders to make decisions based on scientific evidence to implement adequate control of dog and cat populations in urban areas, aiming to reduce zoonosis transmission to humans and other problems associated with uncontrolled animal populations.

Structure for prevention of health care–associated infections in Brazilian hospitals: A countrywide study

Minimal structure is required for effective prevention of health care-associated infection (HAI). The objective of this study was to evaluate the structure for prevention of HAI in a sample of Brazilian hospitals. This was a cross-sectional study from hospitals in 5 Brazilian regions (n = 153; total beds: 13,983) classified according to the number of beds; 11 university hospitals were used as reference for comparison. Trained nurses carried out the evaluation by using structured forms previously validated. The evaluation of conformity index (CI) included elements of structure of the Health Care-Associated Prevention and Control Committee (HAIPCC), hand hygiene, sterilization, and laboratory of microbiology. The median CI for the HAIPCC varied from 0.55-0.94 among hospital categories. Hospitals with >200 beds had the worst ratio of beds to sinks (3.9; P < .001). Regarding alcoholic product for handrubbing, the worst ratio of beds to dispensers was found in hospitals with <50 beds (6.4) compared with reference hospitals (3.3; P < .001). The CI for sterilization services showed huge variation ranging from 0.0-1.00. Reference hospitals were more likely to have their own laboratory of microbiology than other hospitals. This study highlights the need for public health strategies aiming to improve the structure for HAI prevention in Brazilian hospitals.

Exploring the perceptions of sterile services staff: a qualitative constructivist study.

With innovations in medicine and science, the extended roles for practitioners continue to evolve and merge, often crossing interprofessional boundaries. This paper presents a qualitative study which explored sterile services staff experiences of current practices and how they perceive the prospect of professionalisation.

Economic Benefits of Using Sterile Insect Technique and Mating Disruption to Control Codling Moth

In the Okanagan/Similkameen region, the tree fruit industry value chain forms a significant part of the Agricultural Products Cluster. In 2011, 8677 acres of apples comprised 38% of the total horticulture land base. The remaining acreage was planted primarily to sweet cherries (3500 acres) and wine grapes (8100 acres). However, the tree fruit industry value chain is undergoing significant transformational change as the apple acreage has declined from 13 430 acres in 2001, a loss of 4753 acres. This change in the primary production base has had profound processing and marketing implications for the apple sector, and for the government programs such as the Okanagan Kootenay Sterile Insect Release Program (OKSIR) that provide services to the sector. A social benefit-cost analysis (B/C) was used to evaluate the OKSIR. This analysis measures both the benefits, in the form of cost savings and Sterile Insect Release services that accrue to the commercial apple and pear producers, and the benefits that non-agricultural residents receive, the consumer surplus. The study compares the Benefit/Cost ratios for both the existing Sterile Insect Technique (SIT) to control Codling moth and the use of a mating disruption (MD) technique. The net benefit for MD ($281.47/acre) is higher than for SIT ($258.65/acre). This is also reflected in the higher NPV for MD. The break-even point for SIT is 6238 acres and 1264 acres for MD. The lower acreage requirement for MD reflects the lower costs associated with MD, and supports the idea that MD is a viable method for controlling Codling moth in areas with relatively small acreages.