What is the risk of poor sterilization at medical facilities?

Whenever a patient goes for a surgical procedure, they have to assume that the equipment being used is clean and sterile. But what if it is not? Between 2015 and 2018, some 67 patients at the Porter Adventist Hospital in Denver, Colorado found out: they developed serious infections because of poor sterilization of surgical equipment . Indeed, one patient died. 

Poor sterilization procedures or even a total lack of sterilization is a problem all over the world. One study found that only 12 percent of medical facility workers in Benin and the Republic of Congo had received any sterilization training. In Madagascar it was zero percent.

Key principles 

Poor sterilization is a slowly ticking time bomb that you do not know when it will explode. But even if medical facilities cannot fund a complete overhaul of their sterilization infrastructure, they can still adapt what they can to make meaningful improvements to the health outcomes of their patients. If there are gaps, these can be filled without a complete rebuild.

A robust sterilization system assumes that several key principles are implemented: 

• Firstly, it is unidirectional, or in other words all instruments go from being dirty, to being cleaned, packaged and sterilized in one way, so that clean and dirty instruments are never in the same place at the same time. 

• It is also zonal with barriers to prevent any infection spreading between the dirty zone, the washing zone, the packaging zone and the sterilization zone. This prevents instrument that have already been cleaned and sterilized from becoming dirty again.

• It is also centralized, with qualified staff dedicated to sterilizing instruments and medical devices for the facility as a whole and not done separately by different departments. 

Common mistakes

We often see medical facilities where sterilizing equipment such as autoclaves are in the wrong places, or which are not the appropriate capacity for the size of the facility. This is a problem of resources. But this is then compounded by poor procedures where the flow is in multiple directions, where clear zoning has not been undertaken and where sterilization has not been centralized. 

There are other common sterilization mistakes we have seen at medical facilities around the world. A failure to timestamp when the sterilization was done and when the sterilized equipment was put into storage can lead to equipment being used that needed to have been re-sterilized. As a result, medical staff use instruments that are already not as safe as they were before the sterilization expired. 

We have also seen storage areas where sterilized and unsterilized instruments and equipment are stored in the same place. We also see some instances of sterilized and clean equipment being carried around hospitals without any preventative packaging, allowing them to become infected by airborne contaminants. We also see that the sterilization unit itself is not fit for the purpose. Either the room itself is cluttered with old furniture or there are cracks in the walls and peeling paint work. These are breeding grounds for germs and mould, which can lead to the contamination of clean instruments that are taken out of the autoclave.

But perhaps the biggest mistake we regularly see is one of underestimating how important sterilization is. Many facilities assume that if they do not have the right equipment then they cannot do anything about it. And then if a patient does develop an infection, then they can just be prescribed antibiotics and they will get better. This is dangerous on several levels, not least as it encourages overuse of antibiotics, which can lead to resistance. 

Solutions

By not taking sterilization seriously, medical facilities are storing up many potential problems for their reputations, their patients’ health, and wider societal problems such as antibiotic resistance. Just one set of dirty, unsterilized medical instruments can infect multiple patients and cause lasting damage to the medical facility. It is not rocket science, but it does require good process design and discipline. Meaningful improvements can be made by adapting existing practices and following new procedures.

This blog has been prepared as part of IFC IQ-Healthcare Advisory activities that helps healthcare service providers around the world improve patient safety, align practices with global quality standards, and build safe health infrastructure.

For more information, please visit www.ifc.org/iqhealth.

IFC Webinar on Sterilization https://vimeo.com/showcase/8381753