A Shipping Container-Based Sterile Processing Unit for Low Resources Settings

Abstract

Deficiencies in the sterile processing of medical instruments contribute to poor outcomes for patients, such as surgical site infections, longer hospital stays, and deaths. In low resources settings, such as some rural and semi-rural areas and secondary and tertiary cities of developing countries, deficiencies in sterile processing are accentuated due to the lack of access to sterilization equipment, improperly maintained and malfunctioning equipment, lack of power to operate equipment, poor protocols, and inadequate quality control over inventory. Inspired by our sterile processing fieldwork at a district hospital in Sierra Leone in 2013, we built an autonomous, shipping-container-based sterile processing unit to address these deficiencies. The sterile processing unit, dubbed “the sterile box,” is a full suite capable of handling instruments from the moment they leave the operating room to the point they are sterile and ready to be reused for the next surgery. The sterile processing unit is self-sufficient in power and water and features an intake for contaminated instruments, decontamination, sterilization via non-electric steam sterilizers, and secure inventory storage. To validate efficacy, we ran tests of decontamination and sterilization performance. Results of 61 trials validate convincingly that our sterile processing unit achieves satisfactory outcomes for decontamination and sterilization and as such holds promise to support healthcare facilities in low resources settings.

Limited sterile processing capabilities for safe surgery in low-income and middle-income countries: experience in the Republic of Congo, Madagascar and Benin

“…The provision of good-quality surgical instruments is a current area of focus for improving surgical safety in LMICs. 17 Our assessments show that if new instruments were donated to the hospitals in our study, instrument quality would deteriorate rapidly due to lack of proper care. All three countries in our study were following outdated guidelines now known to damage surgical instruments.…”

Sterile processing in low- and middle-income countries: an integrative review

“…All papers discussed circumstances or implications of resource constraints in LMICs. Although IPC principles are universally applicable (Oosthuysen et al, 2014), limitations in infrastructure, equipment, finances and human resources are widely recognised as hindering IPC and SP practice in LMICs (Ayub Khan et al, 2018; Boubour et al, 2016; Fast et al, 2017; Forrester et al, 2018c).…”

“…Two authors presented unique approaches to infrastructure and practice. Boubour et al (2016) reported on a pilot study of a self-contained SP unit repurposed from a shipping container that simulated contamination, and after steam sterilisation, verification of effective sterilisation with chemical and biological sterile indicators across 61 trials. Devadiga et al (2015) conducted a secondary analysis of local data to analyse resource constraints affecting SP at a facility in India and found that the facility change to packaging sterilised instruments in non-woven fabrics reduced the proportion of re-sterilisation.…”

Is TAVR Ready for the Global Aging Population?

“…In hospitals with autoclave sterilizers, it can be difficult to maintain or repair the vital equipment, and this increases the risk associated with infections and undermines entire surgical programs [56]. Indeed, the occurrence of infections is 9Â greater in low-resource settings [57]. The above-mentioned barriers to achieving safe and efficacious surgery in the global setting are increasing post-discharge complications [58].…”