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The SPECT Perspective

Highlights of our work in 2016

  • We now have a US presence! SPECT US was established in February 2016, as a sister organization to SPECT Canada. We are thrilled to have partners in the US who share the same vision. We are also excited to be able to provide tax receipts for donations made by US donors! Thank you to Wendy Thiessen (President), Scott Carpenter (Treasurer), Catherine Fulmer (Secretary), Olive Fast (Vice-President), and Al Enns (Board member), for donating their time and energy to this important work.
  • To date in 2016, SPECT volunteers spent a combined total of 11 weeks working in Madagascar and 4 weeks in Benin. A fall trip is planned that will add another 13 weeks in Benin.
  • During the two Africa Mercy visits to Madagascar in 2014-2016, Mercy Ships (MS) funded a major upgrade to the main hospital in Toamasina, the port city. SPECT’s input was requested on the design of the sterilization areas and the flow of medical devices. In February, as the upgrades were completed, SPECT had the opportunity to work alongside MS Operating Room (OR) Nurse Educator, Jen Peterschmidt, to organize and re-orient OR staff at this hospital. This collaboration was beneficial in providing extra support and debriefing opportunities for SPECT plus it assisted in bridging communications between the Sterilizing and OR staff at the hospital.
  • In Jan-Feb 2016, SPECT’s Program Coordinator spent 3 weeks coordinating the distribution of 27 sterilization systems to 3 urban hospitals and 23 rural health clinics in and around Antananarivo and Antsirabe, Madagascar. The recipients of these units understood the importance of sterilization and expressed deep appreciation and confidence that now they would actually have a method of steam sterilizing their instruments.
  • In February, Global News Calgary sent the husband and wife team of Jamie and Tommy Mentzelopoulos, to join our volunteers, Christina and Dan in Madagascar to film SPECT’s work. In May, Global News Calgary ran a 3 night series on the work of SPECT, Mercy Ships, and a Calgary project to save endangered lemurs in Madagascar. Here’s the link to SPECT’s work: http://globalnews.ca/news/2716954/calgary-woman-brings-infection-prevention-to-madagascar-hospitals/

Sterilization Packages

For the benefit of those who are hearing about SPECT for the first time with this newsletter, in April 2013, SPECT was selected to receive a grant from Grand Challenges Canada to promote an “innovate idea” in health care. Our idea was to see if we could use a simple pressure cooker fitted with a specialized basket that could suspend surgical instruments and then be heated using a non-electrical source. The objective was to provide hospitals and clinics with a low cost, simple, and effective method of sterilizing surgical instruments.  We are delighted to say that this project was successful; we were able to find a local medical supplier who imported the large pressure cookers, we hired a local welder to weld the stainless steel baskets, and we found a Swiss/Madagascar NGO that produced charcoal stoves that worked well as heating sources for these units. In December 2015 and January 2016 we were able to distribute 27 sterilization systems to clinics and urban hospitals that had no means of steam sterilizing their instruments. We were also able to train all of the recipients on safe operation and maintenance of the units.


Providing a pressure cooker sterilizer to a rural clinic in Madagascar. The unit is being used by a doctor, midwife, nurses and a dentist to sterilize their instruments.

Providing a pressure cooker sterilizer to a rural clinic in Madagascar. The unit is being used by a doctor, midwife, nurses and a dentist to sterilize their instruments.

Training a group of medical workers on the safe operation and maintenance of the pressure cooker sterilizer, watching as the pressure builds up.

Training a group of medical workers on the safe operation and maintenance of the pressure cooker sterilizer, watching as the pressure builds up.


Training 

February/March 2016SPECT’s Educator reinforced previous training and provided further hands on mentoring with the staff at the main hospital in Toamasina, Madagascar. She provided instruction on instrument flow and the use of new equipment following the completion of the OR renovations. This work included cleaning and disinfecting the operating block in preparation for use, putting together and creating new surgical instrument sets, and education on how to use and maintain the new sterilization equipment. Our Educator also took photos of the sets and created procedural write-ups and instructions for assembly by the staff. Complete processing procedures were developed, including proper disposal of biohazards and contaminated linens, one-way flow of contaminated instruments from point of use to sterile storage, and appropriate documentation of sterilized instrument packages. Furthermore, 10 hours were spent mentoring two MS staff in sterile technique; they work with another MS program called the Ponseti Clinic which provides surgical treatment for people with clubfoot.

Demonstrating how to properly wrap surgical instruments prior to sterilization.

Demonstrating how to properly wrap surgical instruments prior to sterilization.

Instrument packages after sterilization, note indicator tape strips that have turned from white to black = sterilization temperatures were attained.

Instrument packages after sterilization, note indicator tape strips that have turned from white to black = sterilization temperatures were attained.


Evaluation of Teaching

In the fall of 2015 SPECT’s Educator had provided pre-and post-course tests to training participants to assess the impact and retention of course materials and to evaluate the improvement in participants’ knowledge and skills.  When SPECT’s Educator visited these participants again in February 2016, she was pleased to note that they were implementing the knowledge gained from the training and had followed recommendations, including mounting restricted access and instructional posters on the walls.
 
At the outset of training at the main Toamasina hospital, staff initially expressed resistance to education and change. However, when our Educator returned in February 2016, she observed one of the staff, who had attended the training, explaining proper sterilization procedures to a group of nurses and nursing students - train the trainer model in action! Excerpts from an interview with one sterilizer staff member are included to give you a feel for the work we do.
 
Q. What have you learned over the past year?
A. Firstly, I’ve learned how to clean the walls and sweep the floors on a regular basis. Secondly, how to clean the instruments and materials. Thirdly, that we have to clean every corner of the instruments. Fourthly, how to sterilize the instruments and what temperature they need to be sterilized at. I’ve also learned how to wrap instruments and how to check the autoclave before running it and why that’s important.
 
Q. How has the training you’ve received from SPECT and Mercy Ships impacted the patients that come into the OR?
A. The good thing that the training has provided has been that everything is clean and there are no harmful bacteria that can impact the patient’s surgery. The staff stopped worrying about the patient’s outcome because the instruments are now clean.
 
Q. Were the staff worried about the patient’s outcome before the training?
A. Yes, there were many infections before the training.
 
Q. Has there been a decrease in infections since Mercy Ships and SPECT started providing the training?
A. We cannot tell the percentage of decreased infection, but the doctors stopped telling the sterilizers that they were doing a bad job because the patient would come back with an infection. Even after the training during Madagascar I, the doctors stopped complaining about infection. Now we have new instruments so there should be no excuse for the patient to get sick from surgery.
 
Q. How has this training changed your life personally?
A. Before we didn’t know how to do the job, but now we understand the principles behind the work and we’re trying to do the right thing.

 
Joseph, a Sterile Processing Technician, filling up the Big Bertha steam sterilizer with water before putting it into service. Photo compliments of Mercy Ships.

Joseph, a Sterile Processing Technician, filling up the Big Bertha steam sterilizer with water before putting it into service. Photo compliments of Mercy Ships.

 

Hospital Sterilization Equipment Testing

As mentioned in a previous newsletter, one of the services SPECT offers is testing sterilization equipment in hospitals and clinics, to see if it is working effectively. Often these hospitals have received older donated equipment without adequate operating instructions or means to calibrate or test the equipment. When dials and gauges no longer function, staff simply insert medical devices into the sterilizing equipment with the hopes that the devices will be sterile when removed. Our indicator tests are simple yet highly effective. For dry heat sterilizers, a chemical indicator will reveal whether adequate temperatures and times were reached to sterilize. For steam sterilizers, a biological indicator test will reveal whether all microorganisms were killed; it is the best test to verify sterilization. When we find failures, we recommend changes and then re-test until consistent passes are attained or recommend that equipment be replaced. Sometimes even a simple suggestion can result in a very significant change. For example, one department supervisor in a hospital in Benin was attempting to sterilize instruments in a sealed box that was put into an autoclave (steam sterilizer). When the test failed, we pointed out that steam was unable to penetrate the sealed box. After some searching, she was able to find a perforated container. Instruments were placed in the container and re-tested, and it readily passed. The supervisor was thrilled to discover that this simple change produced sterilized instruments. Imagine the impact this small step will have on decreasing patient infection rates!


Funding

While we were hopeful to receive on-going funding from Grand Challenges Canada for our projects, we have been notified that they have chosen not to do so at this time. We are in discussion with several agencies interested in partnering with us. However, while these agencies are interested in supporting program costs, they do not cover all staffing costs. Therefore, SPECT is looking for people who believe in what we do and are willing to help fund our workers. We have relied heavily on the good will of volunteers to date, but know this is not sustainable. If you want to see our work go forward we ask that you consider making either a monthly commitment to donate to SPECT or a one time donation that would go towards our administrative costs. To date, Christina, our Educator/Consultant, is the only one receiving a consulting fee while working internationally. Our goal is to be able to hire two people full-time and one part-time person for SPECT.
 
As a charity we continue to rely on and appreciate your donations and support. If you wish to make a tax-free donation, please go to the donation page on our website at www.spectrust.org

For Canadian donors:

  • ATB Cares contributes an additional 15% to SPECT for every donation made through our website.

For US donors:

o   If you shop on Amazon you can designate SPECT-US as your preferred charity on smile.amazon.com and Amazon will donate 0.5% of your purchase to SPECT-US. This costs you nothing, however if you are a frequent Amazon customer and want to see SPECT-US supported this is one way to show your support.


What's Next

The Africa Mercy Ship will be in Cotonou, Benin from August 2016 to June 2017. SPECT will again be partnering with Mercy Ships to provide education and training to staff members at 4-6 hospitals as well as several clinics. Our Educator will be conducting classroom sessions for up to 60 people over a 3-week period in October. This will be a challenge for her and prayers for sustained energy and on-going health are needed.

Mount Royal University, in collaboration with Mercy Ships International, is funding a research project led by Dr. Olive Fast, SPECT’s Canadian Chairperson and Dan Fast, SPECT’s Program Coordinator. The research aims to identify the impact SPECT’s education and mentoring program has on improving sterilization practices in Benin. Olive and Dan will be traveling to Benin for five weeks in September/October to recruit participants, continue hospital assessments, and set up education sessions in preparation for the October classroom training. We very much appreciate the support received for this research project from Michelle Bullington (Mercy Ships International), Dr. Michelle White (Africa Mercy Ship), and the Ministry of Health in Benin, who have provided consent for this research project to move forward.

SPECT has been invited to present at an international conference in Thailand in February 2017. The conference is organized by Pan African Academy of Christian Surgeons (PAACS) http://www.paacs.net/ and attended by hundreds of surgeons and other medical staff who work throughout Africa and Asia