Integrating Quality Tools and Methods to Analyze and Improve a Hospital Sterilization Process

Healthcare facilities are facing major issues and challenges. Hospitals continuously search approaches to improve operations quality, optimize performance, and minimize costs. Specifically, an efficient hospital sterilization process (HSP) allows reusable medical devices (RMDs) to be more quickly available for healthcare activities. In this context, this paper describes an integrated approach developed to analyze HSP and to identify the most critical improvement actions. This proposed approach integrates four quality tools and techniques. Firstly, a structured analysis and design technique (SADT) methodology is applied to describe HSP as a hierarchy of activities and functions. Secondly, the failure modes and effects analysis (FMEA) method is used as a risk assessment step to determine which activity processes need careful attention. Thirdly, a cause–effect analysis technique is used as a tool to help identify all the possible improvement actions. Finally, priority improvement actions are proposed using the quality function deployment (QFD) method. To validate the proposed approach, a real sterilization process used at the maternity services of Hedi-Cheker Hospital in the governorate of Sfax, Tunisia, was fully studied. For this specific HSP, the proposed approach results showed that the two most critical activities were (1) improving the coordination between the sterilization service and the surgery block and (2) minimizing the average duration of the sterilization process to ensure the availability of RMDs in time.

Bio contamination of surfaces and medical devices in controlled environment areas at a hospital in Morocco

The hospital environment, especially medical devices and surfaces, represents a secondary reservoir for pathogens. This work aims to evaluate the microbiological quality of surfaces and medical equipment of controlled environment services (burn unit, operating room, and sterilization service) at a hospital in Meknes (center of Morocco). This study was carried out for three months (September-December of 2017). A total of 63 samples were taken by swabbing technique from different surfaces and medical equipment after bio-cleaning. Identification was performed according to conventional bacteriological methods and by microscopic observation for fungi. The study showed that 68% of the surface was contaminated. The operating room recorded a rate of 93% of contamination (p-value <0.01), 83% for sterilization service, and 47% for burn unit. A percentage of 67% of the isolates were identified as Gram-positive bacteria against 32% Gram-negative bacteria (p-value <0.05). Bacterial identification showed Coagulase-negative Staphylococci (45%), Enterobacter cloacae (14%), Micrococcus sp (10%), Klebsiella pneumoniae, peptostreptococcus sp and Pseudomonas fluorescens (7% for each one), Escherichia coli, and Methicillin-resistant Staphylococcus aureus (5% for each one). These results require corrective action represented by rigorous cleaning and disinfection procedures.

Evaluation of risk and quality management in a Casablanca operating theatre

Risks at the level of the operating room are permanent and different from one surgical intervention to another. They have diverse sources, hence the importance of risk management concept for a good functioning of the operating room in order to enhance care quality.The recurrent absence of surgical instruments (surgery forceps and other instruments) in their box is still a major problem within the operating room. It often happens during the surgical interventions, whether are major or minor, that the surgical team uses many boxes to fill these lacks.The objective of this study is to help the clinic to establish an ongoing improvement dynamic of processes within the operating room. It is consisted of tracing the steps of management of the patient to be operated, from their first contact with the process staff to their exit from the operating room to the functional unit. With the help of cartography, the connections between the operating room process and the processes of support, the liaison between activities, fluxes and resources are easily understood.The analysis and the prioritization of dominant problems are done according to (SMART) indicators and QQQQCC methodology. The absence of surgical instruments (surgery forceps and other instruments) in their storing boxes was chosen as a dominant problem within this process in complicity with key persons of the operating room and the clinic managers through many meetings.Through the analysis of the causes effects or ishikawa diagram, the weak organizational culture, the competences insufficiency, unsuitable workforce, and the under motivation of staff sterilization service have been recognized as causes of the origin of the problem because it is at the equipment packaging step where the instruments are intertwined.In conclusion, an arsenal of solutions and actions are set up to overcome this problem and as the staff enhancement responsible for sorting and packaging boxes of sterilization (currently only the major is dedicated to these tasks, continuous staff training, a team in charge of monitoring and evaluation of risks and quality within the operating…

Infectious Risk of the Hospital Environment in the Center of Morocco: A Case of Care Unit Surfaces

Background. Equipment and hospital surfaces constitute a microbial reservoir that can contaminate hospital users and thus create an infectious risk. The aim of this work, which was carried out for the first time at a hospital in Meknes (regional hospital in the center of Morocco), is to evaluate the microbiological quality of surfaces and equipment in three potential risk areas (burn unit, operating room, and sterilization service). Methods. This study was carried out over a period of 4 months (February–May 2017). A total of 60 samples were taken by swabbing according to the standard (ISO/DIS 14698-1 (2004)) in an environment of dry area and equipment after biocleaning. Isolation and identification were performed according to conventional bacteriological methods and by microscopic observation for fungi. Results. The study showed that 40% of surface samples were contaminated after biocleaning. The burn unit recorded a percentage of 70% contamination (p value <0.001), 13% for the sterilization service, and 7% for the operating room. 89% of the isolates were identified as Gram-positive bacteria against 11% for fungi (p value <0.001). Bacterial identification showed coagulase-negative staphylococci (32%), Bacillus spp. (16%), Corynebacterium (8%), and oxidase-negative Gram-positive bacillus (40%) while fungal identification showed Aspergillus niger (n = 2) and Aspergillus nidulans (n = 1). Conclusion. To control the infectious risk related to equipment and hospital surfaces, it would be necessary to evaluate the disinfection protocol applied in these units.

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.

Free-living amoebae isolated from a hospital water system in South Africa: a potential source of nosocomial and occupational infection

This study investigated the occurrence of free-living amoebae (FLA) in a public hospital in South Africa. A total of 97 water and biofilm samples from the municipal water inlet of the hospital, theatres, theatre sterilization service unit, central sterilization service unit, endoscopy/gastroscopy unit, intensive care unit and the renal unit were collected and examined for the presence of FLA using an amoebal co-culture and molecular techniques. Of the 97 samples, 77 (79.4%), 40 (52%) water and 37 (48.1%) biofilm, contained FLA. The genera Acanthamoeba, Vermamoeba (formerly Hartmanella) and Naegleria were detected by morphology, 18S rRNA PCR (polymerase chain reaction) and sequence analyses. Further sequence analysis of the five Acanthamoeba-positive isolates revealed a close resemblance with the potentially pathogenic T20 genotype. These results show a potential health risk to immuno-compromised patients and health care workers as some of the species detected are pathogenic and may harbor potential intracellular bacteria responsible for nosocomial infections. To date, this is the first report on the detection of potentially pathogenic amoebae from South African hospital water systems.