Sterilization Training, Breaking Down Another Barrier to Safe Surgery

July 19, 2019

"Break down barriers to safe surgery". That was Arbutus Medical's founding mission and continues to guide our everyday strides. The DrillCover technology was designed to tackle the barrier of access to sterile and affordable medical equipment. Arbutus Medical has recognized that many other organizations share this common mission and are tackling related barriers to safe surgery.  

One of these organizations is SPECT, Sterile Processing Education Charitable Trust. This story highlights how SPECT’s sterilization training is bringing safer surgery to healthcare facilities worldwide.

Sterile Processing: Foundational to Safer Surgery

In 2011, Christina Fast visited a healthcare facility in Sierra Leone and discovered broken autoclaves, unclean surgical instruments and a lack of basic knowledge of effective sterile processing practices among healthcare workers. Prompted to act, Fast, a sterile processing professional with a passion for educating healthcare workers, founded Sterile Processing Education Charitable Trust (SPECT) to address this gap. In subsequent years Fast discovered that not one of the 59 facilities SPECT has partnered with in low-income countries was able to adhere to the most basic WHO standards for sterile processing prior to receiving SPECT training.

A holistic approach to training

With innovative and context-specific training, resources and partnerships, SPECT has worked to address the need for safer sterile processing practices through onsite education and training focused on each aspect of the sterilization process.

In 2018 SPECT was invited to Tanzania to train 35 healthcare workers from ten different facilities. SPECT’s initial assessment found significant gaps in formal training; workers stored food in the sterilization room, instruments were immersed in a chlorine solution and washed lightly, leaving them rusted and nonfunctional, and autoclaves were not being run within parameters necessary to kill all microorganisms. These observations revealed a root problem in Tanzania’s ORs, one that Fast had seen as causal across low-resource settings where SPECT was involved. Neither sterile processing staff, nor the healthcare systems they work in, had been aware of the importance of the sterile processing role in making surgery safer.

Maintain the safety of the surgical patient

Through education, hands-on training and mentoring, Fast and her team supported participants not only to learn but to also implement practical and affordable techniques to make the highest quality sterile processing practices a standard at their facility. When SPECT returned for a follow up assessment four months after the training, they found a 45% improvement in adherence to key sterile processing practices - higher cleanliness standards of sterilizer chambers, discontinued use of 0.5% chlorine as a pre-cleaning soaking solution, use of proper cleaning tools (small brushes, soap and water) that left instruments looking new again, and neatly tied instrument packages that were properly stored after sterilization. Staff also now understood how important their job was and how valuable they were to maintain the safety of the surgical patient.

Participant’s view

Theresia Maduka worked with SPECT in Tanzania as a research assistant and helped with the assessment and follow up on the ground. She sums up the noticeable change that the SPECT training ignited: “It was apparent that hospital staff look favourably on their training and were ready and willing to make changes to positively impact the safety of patients, themselves and other staff members.” As one participant noted:“I have seen the difference. We were taught that those instruments that have soil and rust are not clean. I think we used instruments that still had microorganisms. Even when you sterilize them (microorganisms) will still be there. We used (the instruments) on patients just as they were. But I currently see clean instruments used on patients, no microorganisms. Surgical site infections have decreased. I have faith that currently no infections are from instruments.”

Theresia Maduka, SPECT's research assistant, observing participants during the training program in Tanzania.

Impact after eight years

The outcomes measured in Tanzania are not isolated. Similar results have been identified in other countries where SPECT has trained over 500 workers from 154 healthcare facilities on effective sterile processing practices. Through its training of trainers program, participants have gone on to train an additional 500 healthcare workers. On average, partner countries have seen a 40% improvement in sterile processing practices in the facilities where SPECT has been active. By highlighting the role of sterile processing as foundational to safe surgery, SPECT-trained facilities are dramatically improving their ability to adhere to WHO standards, reducing the risk of postoperative infection and mortality for patients.

Certified participants after successful training in 2018.