Safe Surgery

My Reflections Working with SPECT


When I started working with SPECT as a research assistant in Tanzania, I was given the opportunity to challenge myself and expand my knowledge into many new areas. Professionally and personally my experience is with environmental issues, as I have my Bachelor of Environmental Studies, so it was interesting for me to learn more about the healthcare sector. Since my time with SPECT I have become increasingly interested in healthcare, particularly because I had such a wonderful learning experience. Over the course of the summer, my primary duties were to help with translating between English and Swahili and assist SPECT facilitators with training activities for both the Fundamentals of Sterile Processing course and the Training of Trainers course.

During our time in Tanzania, SPECT has made a significant impact on the ten hospitals that we worked with in the Mara and Kagera Regions. One nurse told me: “Staff members are happy with the visible results and changes that have been made since the training”.

As I was visiting the hospitals, prior to assisting with training sessions, I observed many sterile processing practices that I learnt were putting staff at risk of causing infections to patients and themselves. A few of the situations and stories I found most interesting, which I’d like to share with you are as follows:

  • Often, staff would store food and sometimes take tea in the sterilization room. Most rooms were not well organized since sterilization staff did not have the training to know that poor organization increased the risk of infection. I also found sterilization staff did not realize how important their positions were in the hospital.

  • Big brushes that would be used to clean floors, walls or clothes were used to clean instruments.

  • Clothes used to wrap instruments had lint and holes in them. The lint would stick on the instruments during sterilization and the holes allowed microbes to contaminate the sterilized instruments before use. Gauze was also used to tie wrappers, increasing the potential of contaminating the instruments.

  • Instruments looked clean on the outside but had rust on the box locks and serrations. There were also many instruments that were not functioning. 

  • There was no one way flow of instruments, increasing risk of cross contamination and infection.

  • The sterilizer chambers and the rooms (walls and floors) were seldom cleaned.

After assisting SPECT with their sterile processing training, I visited the hospitals again for follow up assessments. I was impressed by the changes that had been made by staff.  One nurse told me “Instruments appeared clean, shiny and attractive compared to the previous; even the doctors and other staff members are impressed”. Other changes that I’m pleased to share include:

  • Some hospitals had stopped using Chlorine to wash instruments and were using just water and soap and had also trained other staff working in the operating theater.

  • Sterilization staff were using smaller brushes (like toothbrushes) to wash instruments and big brushes were now used to wash clothes, walls and floors.

  • Instrument packages were neatly tied for sterilization and storage.

  • Sterilization staff were now following processes learned in SPECT training, cleaning decontaminating, sterilizing and storing instruments in an organized fashion.

Theresia's Group Photo.jpg

During my time with SPECT, I was able to witness significant changes this training program had on hospital staff. Firstly, the training reminded staff that their jobs are important. The course emphasized the importance of sterile processing and this helped to communicate the importance of the staff’s role in this process. Secondly, it renewed their sense of fulfillment in their positions. I noticed staff worked hard to initiate these changes during our follow up assessments and were proud of what they accomplished. Lastly, I was able to recognize a shift in mindset focused on keeping patients and staff safe. It was apparent that hospital staff looked favorably on their training and were ready and willing to make changes to positively impact the safety of patients, themselves and other staff members.

Theresia Maduka, SPECT Research Assistant

Lifebox and the Sterile Processing Education Charitable Trust (SPECT) Launch Partnership to Improve Surgical Instrument Sterilization Globally


Calgary/New York/London, November 29, 2018 – This week, Lifebox and Sterile Processing Education Charitable Trust (SPECT) launched a partnership to improve surgical safety in low-resource countries through training in appropriate cleaning and maintenance of surgical instruments. Lifebox, the international non-profit dedicated to improving the safety of surgery and anesthesia around the world and SPECT, the Canadian-based non-profit established to improve instrument decontamination and sterilization processes in resource-constrained countries, are piloting the training course in Ethiopia and Central America.

Founded in 2011 by four leading global health organizations and chaired by Dr. Atul Gawande, Lifebox utilizes tools, training, and partnerships to help improve the delivery of safe surgery and anesthesia globally. Lifebox developed “Clean Cut” -- a team-based approach for reducing surgical site infections -- with the support of the GE Foundation and Assist International through the Safe Surgery 2020 initiative in Ethiopia. The Clean Cut program in Ethiopia has seen significant results, including a 78 percent improvement in the confirmation of sterile instruments and a 35 percent improvement in proper timing of prophylactic antibiotic administration -- both known measures for reducing surgical site infections.

Founded in 2013, SPECT is a charitable organization that provides education, training, and mentoring on instrument decontamination and sterilization techniques for health care workers in hospitals and clinics in resource constrained countries. With the support of the GE Foundation and Assist International, SPECT, to date, has trained over 530 individuals in 8 countries, including 110 individuals in Ethiopia, with an aim to decrease the risks of unsafe surgery and bring sterile processing practices closer to international standards worldwide.

“Lifebox and SPECT are natural partners,” stated Dr. Thomas Weiser, surgeon and Lifebox clinical advisor. “We met in Ethiopia working side by side with operating room teams to address the causes of deadly surgical infections through practical techniques and effective teamwork. By working together, we enhance our capacity to improve the outcomes of life-saving surgery around the world.”


Lifebox and SPECT are currently piloting a joint training module in Ethiopia that combines the two organizations’ expertise in sterile processing, instrument maintenance, and surgical teamwork. With support from the IZUMI Foundation, the SPECT-Lifebox training module will next be implemented in Central America in partnership with the regional anesthesia society group Federación de Sociedades de Anestesiología de Centroamérica y Caribe (FESACAC).

"SPECT is thrilled to be partnering with Lifebox to expand our combined global impact and increase surgical safety in resource constrained countries,” said SPECT’s Chair Dr. Olive Fast. “Together we can make a bigger impact.”

For more information contact: Marco Carraro (Communications Officer), phone (+ 44 (0)203 286 0402)

Our work on instrument sterilization processing has been contributed to by -- Mr Mahmood Bhutta,Tom Brophy, Lauren Anders Brown, Christina Fast, Mr Ed Fitzgerald, Jared Forrester M.D. , Nichole Starr M.D. , Tom Weiser M.D. , Dr Iain Wilson.