The impact of a sterile processing program in Northwest Tanzania: a mixed-methods study.

Background: Inadequate 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. Methods: A 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. Results: Improvement 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. Conclusions: Providing 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.

The impact of a short-term training program on workers' sterile processing knowledge and practices in 12 Ethiopian hospitals: A mixed methods study.

BACKGROUND: The need for increased attention to surgical safety in low- and middle-income countries invited organizations worldwide to support improvements in surgical care. However, little is written about issues in instrument sterilization in low- and middle-income countries including Ethiopia. OBJECTIVE: The study aims to identify the impact of a sterile processing course, with a training-of-trainers component and workplace mentoring on surgical instrument cleaning and sterilization practices at 12 hospitals in Ethiopia. METHOD: A mixed-methods research design that incorporates both qualitative and quantitative research approaches to address issues in sterile processing was used for this study. The quantitative data (test results) were validated by qualitative data (hospital assessments, including observations and participant feedback). Twelve hospitals were involved in the training, including two university teaching hospitals from two regions of Ethiopia. In each of the two regions 30 sterile processing staff were invited to participate in a three-day course including theory and skills training; 12-15 of these individuals were invited to remain for a two-day training of trainers course. The collected quantitative data were analysed using a paired t-test by SPSS software, whereas comparative analysis was employed for the qualitative data. RESULTS: Process, structural, and knowledge changes were identified following program implementation. Knowledge test results indicated an increase of greater than 20% in participant sterile processing knowledge. Changes in process included improved flow of instruments from dirty to clean, greater attention to detail during the cleaning and decontamination steps, more focused inspection of instruments and careful packaging, as well as changes to how instruments were stored. Those trained to be trainers had taught over 250 additional staff. CONCLUSIONS: Increased attention to and knowledge in sterile processing practices and care of instruments with a short, one-week course provides evidence that a small amount of resources applied to a largely under-resourced area of healthcare can result in decreased risks to patients and staff. Providing education in sterile processing and ensuring staff have the ability to disseminate their learnings to other health care providers results in decreasing risks of hospital associated infections in patients.

Mixed methods evaluation of the impact of a short term training program on sterile processing knowledge, practice, and attitude in three hospitals in Benin.

Background: Proper sterile processing is fundamental to safe surgical practice and optimal patient outcomes. Sterile processing practices in low and middle-income countries often fall short of recommended standards. The impact of education and training on sterile processing practices in low and middle-income countries is unknown. We designed a sterile processing education course, including mentoring, and aimed to evaluate the impact on participants' personal knowledge, skills, and practices. We also aimed to identify institutional changes in sterile processing practices at participants' work places. Methods: A mixed methods design study was conducted using a Hospital Sterile Processing Assessment Tool, knowledge tests, and open-ended interviews. Results: Education and mentoring improved how workers understood and approached their work and to what they paid attention. Sterile processing workers were also better able to identify resources available to do their work and showed improved understanding of the impact of their work on patient safety. Conclusions: Health care organizations seeking to improve surgical outcomes can find easy wins requiring minimal cost expenditures by paying attention to sterile processing practices. Investing in education and low-cost resources, such as cleaning detergents and brushes, must be part of any quality improvement initiative aimed at providing safe surgery in low and middle-income countries.

Limited sterile processing capabilities for safe surgery in low-income and middle-income countries: experience in the Republic of Congo, Madagascar and Benin.

It is highly difficult to perform safe surgery without sterile instruments, yet the capacity to adequately clean, disinfect and sterilise surgical instruments in low-income and middle-income countries is largely unknown. Sterile Processing Education Charitable Trust developed an assessment tool and, in partnership with Mercy Ships, evaluated the sterile processing capacity in 59 facilities in Madagascar, Benin and the Republic of Congo. This data-driven analysis paper illustrates how lack of sterile processing capacity acts as a barrier to safe surgical care. Our tool identified widespread lack of knowledge of techniques and resources needed for sterile processing. Only 12% of workers in Republic of Congo and Benin had sterile processing training and none in Madagascar. None of the hospitals surveyed met basic standards for cleaning, disinfection and sterilisation as defined by the WHO/Pan American Health Organization. Examples of poor practice included lack of cleaning supplies (basic brushes and detergents), incorrect drying and storage of surgical instruments, and inattention to workflow causing cross-contamination. Bleach (sodium hypochlorite) solutions, damaging to instruments, were used universally. In our experience, using an assessment tool allowed identification of specific gaps in sterile processing capacity. Many of the gaps are amenable to simple solutions requiring minimal resources and achievable by most hospitals. We recommend that stakeholders seeking to strengthen surgical health systems in low-resource settings incorporate sterile processing capacity assessments and training into their programmes.