Instrument Sterilization and Surgical Site Infections in Low and Middle Income Countries
DOI:
https://doi.org/10.47611/jsrhs.v12i3.4950Keywords:
Sterile Processing, Surgical Instrument Sterilization, Low and Middle Income Country, Developing country, Surgical Site Incision, Surgery, Health inequityAbstract
With the recent surge in oftentimes fatal bacterial resistance, surgical site infections (SSI) are now a prominent topic of scholarly discussion. These infections occur due to unsterile surgical practices infiltrating the operating room, and deadly pathogens with it. The developed world has lowered rates of SSI through scrupulous enforcement of CDC sterilization guidelines while low and middle income countries (LMICs) continue to fall victim to inefficient sterilization. LMICs often don't have the resources to reach these CDC guidelines and as a result endure surgical instrument contamination. Currently, there is a gap in funding and research related to the state of surgical instrument sterilization. This study aims to reveal first hand data regarding the gap in adherence to CDC sterilization guidelines for a variety of LMICs. Data was collected through virtual interviews with surgeons or surgical technologists globally. Interview responses were later scored for adherence to the CDC guidelines and correlated with rates of SSI per country. Results showed that the adequacy of surgical instrument sterilization processes (SP) in hospitals is directly correlated to SSI rates in LMICs. A one tailed test with a flow of SP adherence to SSI prevalence rendered the following strong correlation of R squared=0.772. This relationship demonstrates that investments to improve surgical sterilization processing will likely render lower rates of SSI. Lower SSI rates in LMICs could give rise to an increase in surgical tourism, a decrease in expensive treatments for highly resistant bacteria, and ultimately a decrease in surgical morbidity and mortality.
Downloads
References or Bibliography
Allegranzi, B. (2014, March 12). The burden of surgical site infections worldwide [Slideshow]. 14th IFIC Conference, Malta. https://www.theific.org/wp-content/uploads/2014/10/025.pdf
Anderson, D. J., Podgorny, K., Berríos-Torres, S. I., Bratzler, D. W., Dellinger, E. P., Greene, L., Nyquist, A.-C., Saiman, L., Yokoe, D. S., Maragakis, L. L., & Kaye, K. S. (2014). Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update. Infection Control and Hospital Epidemiology, 35(6), 605–627.https://doi.org/10.1086/676022
Antibiotic Resistant Germs in Hospitals: Information for Patients and their Families. (2019, October 8). Centers for Disease Control and Prevention. Retrieved October 14, 2022, from https://www.cdc.gov/hai/patientsafety/ar-hospitals.html#:~:text=About%20Antibiotic%20Resistance,-What%20You%20Can&text=Additionally%2C%20most%20resistant%20germs%20are,antibiotics%20designed%20to%20kill%20them
Ayala, D., Tolossa, T., Markos, J., & Yilma, M. T. (2021). Magnitude and factors associated with surgical site infection among mothers underwent cesarean delivery in Nekemte town public hospitals, western Ethiopia. PLoS ONE, 16(4), e0250736. https://link.gale.com/apps/doc/A659813064/SCIC?u=va_s_007_0162&sid=bookmark-SCIC&xid=c59e69da
Dencker, E. E., Bonde, A., Troelsen, A., Varadarajan, K. M., & Sillesen, M. (2021). Postoperative complications: an observational study of trends in the United States from 2012 to 2018 - BMC Surgery. BioMed Central. https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-021-01392-z#citeas
Ellingson, K., Haas, J. P., Aiello, A. E., Kusek, L., Maragakis, L. L., Olmsted, R. N., Perencevich, E., Polgreen, P. M., Schweizer, M. L., Trexler, P., VanAmringe, M., & Yokoe, D. S. (2014). Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene. Infection Control and Hospital Epidemiology, 35(8), 937–960. https://doi.org/10.1086/677145
Emerson, C. B., Eyzaguirre, L. M., Albrecht, J. S., Comer, A. C., Harris, A. D., & Furuno, J. P. (2012). Healthcare-Associated Infection and Hospital Readmission. Infection Control and Hospital Epidemiology, 33(6), 539–544. https://doi.org/10.1086/665725
Fast O, Fast C, Fast D, et al. (2017). Limited sterile processing capabilities for safe surgery in low-income and middle-income countries: experience in the Republic of Congo, Madagascar and Benin. BMJ Global Health, 2. https://gh.bmj.com/content/2/Suppl_4/e000428
Fast, O. M., Gebremedhin Teka, H., Alemayehu/Gebreselassie, Mussie, Fast, C. M. D., Fast, D., & Uzoka, F.-M. E. (2019). The impact of a short-term training program on workers' sterile processing knowledge and practices in 12 Ethiopian hospitals: A mixed methods study. PLoS ONE, 14(5), e0215643. https://link.gale.com/apps/doc/A584150121/SCIC?u=va_s_007_0162&sid=bookmark-SCIC&xid=768523df
Gillespie, B. M., Harbeck, E., Rattray, M., Liang, R., Walker, R., Latimer, S., Thalib, L., Erichsen Andersson, A., Griffin, B., Ware, R., & Chaboyer, W. (2021). Worldwide incidence of surgical site infections in general surgical patients: A systematic review and meta-analysis of 488,594 patients. International journal of surgery (London, England), 95, 106136. https://doi.org/10.1016/j.ijsu.2021.106136
GNI per capita, Atlas method (current US$). (n.d.). The World Bank. Retrieved October 28, 2022, from https://data.worldbank.org/indicator/NY.GNP.PCAP.CD
Gross national income per capita (PPP int. $). (n.d.). World Health Organization. Retrieved October 28, 2022, from https://www.who.int/data/gho/indicator-metadata-registry/imr-details/94
McHugh, S. M., Corrigan, M., Dimitrov, B., Cowman, S., Tierney, S., Humphreys, H., & Hill, A. (2010). A Targeted E-Learning Program for Surgical Trainees to Enhance Patient Safety in Preventing Surgical Infection. Journal of Continuing Education in the Health Professions, 30(4), 257–259. https://pubmed.ncbi.nlm.nih.gov/21171032/
Monahan, M., Jowett, S., Pinkney, T., Brocklehurst, P., Morton, D. G., Abdali, Z., & Roberts, T. E. (2020). Surgical site infection and costs in low- and middle-income countries: A systematic review of the economic burden. PloS one, 15(6), e0232960. https://doi.org/10.1371/journal.pone.0232960
Nepogodiev, D., Martin, J., Biccard, B., Makupe, A., Bhangu, A., & National Institute for Health Research Global Health Research Unit on Global Surgery (2019, February 2). The Lancet, 393(10170), 401. https://doi.org/10.1016/S0140-6736(18)33139-8
O'Hara, N. N., Patel, K. R., Caldwell, A., Shone, S., & Bryce, E. A. (2015). Sterile reprocessing of surgical instruments in low- and middle-income countries: A multicenter pilot study. American journal of infection control, 43(11), 1197–1200. https://doi.org/10.1016/j.ajic.2015.06.025
Panta, G., Richardson, A. K., Shaw, I. C., Chambers, S., & Coope, P. A. (2019). Effectiveness of steam sterilization of reusable medical devices in primary and secondary care public hospitals in Nepal and factors associated with ineffective sterilization: A nation-wide cross-sectional study. PLoS ONE, 14(11), e0225595. https://pubmed.ncbi.nlm.nih.gov/31751421/
Robertson, D., et al. (2021). Assessment of laparoscopic instrument reprocessing in rural India: a mixed methods study. Antimicrobial Resistance and Infection Control, Gale Health and Wellness, vol. 10, no. 1. link.gale.com/apps/doc/A672347731/HWRC?u=va_s_007_0162&sid=bookmark-HWRC&xid=cf0ed04a.
Safdar, N., Anderson, D. J., Braun, B. I., Carling, P., Cohen, S., Donskey, C., Drees, M., Harris, A., Henderson, D. K., Huang, S. S., Juthani-Mehta, M., Lautenbach, E., Linkin, D. R., Meddings, J., Miller, L. G., Milstone, A., Morgan, D., Sengupta, S., Varman, M., … on behalf of the Research Committee of the Society for Healthcare Epidemiology of America. (2014). The Evolving Landscape of Healthcare-Associated Infections: Recent Advances in Prevention and a Road Map for Research. Infection Control and Hospital Epidemiology, 35(5), 480–493. https://doi.org/10.1086/675821
Scarborough, J. E., Schumacher, J., Pappas, T. N., McCoy, C. C., Englum, B. R., Agarwal, S. K., Jr, & Greenberg, C. C. (2016). Which Complications Matter Most? Prioritizing Quality Improvement in Emergency General Surgery. Journal of the American College of Surgeons, 222(4), 515–524. https://doi.org/10.1016/j.jamcollsurg.2015.12.038
Sterilization: Monitoring. (2018, March 22). Centers for Disease Control and Prevention. Retrieved November 6, 2022, from https://www.cdc.gov/oralhealth/infectioncontrol/faqs/monitoring.html
Sterilizing Practices. (2016, September 18). Centers for Disease Control and Prevention. Retrieved October 14, 2022, from https://www.cdc.gov/infectioncontrol/guidelines/disinfection/sterilization/sterilizing-practices.html
World Bank Country and Lending Groups. World Bank Country and Lending Groups – World Bank Data Help Desk. (n.d.). Retrieved October 28, 2022, from https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups#:~:text=%EF%BB%BF%EF%BB%BF%20For%20the%20current,those%20with%20a%20GNI%20per
Zanetti, G., Giardina, R., Platt, R., Zanetti, G., Giardina, R., & Platt, R. (2001). Intraoperative redosing of cefazolin and risk for surgical site infection in cardiac surgery. Emerging Infectious Diseases, 7(5), 828–831. https://doi.org/10.3201/eid0705.010509
Published
How to Cite
Issue
Section
Copyright (c) 2023 Marina Cura
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Copyright holder(s) granted JSR a perpetual, non-exclusive license to distriute & display this article.
