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

Gopal Panta; Ann K Richardson; Ian C Shaw; Stephen Chambers; Patricia A Coope

doi:10.1371/journal.pone.0225595

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. 2019 Nov 21;14(11):e0225595. doi: 10.1371/journal.pone.0225595. eCollection 2019.

Authors

Gopal Panta¹, Ann K Richardson¹, Ian C Shaw², Stephen Chambers³, Patricia A Coope⁴

Affiliations

¹ School of Health Sciences, University of Canterbury, Christchurch, New Zealand.
² School of Physical and Chemical Sciences, University of Canterbury, Christchurch, New Zealand.
³ Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand.
⁴ College of Education, Health and Human Development, University of Canterbury, Christchurch, New Zealand.

Abstract

Background: Inadequate sterilization of reusable medical devices can lead to healthcare associated infections (HAIs) through person-to-person or environmental transmission of pathogens. Autoclaving (steam sterilization) is most commonly used for sterilizing medical devices in healthcare facilities. We conducted a nation-wide cross-sectional study to evaluate the effectiveness of steam sterilization practices in primary and secondary care public hospitals in Nepal and to identify factors associated with ineffective sterilization.

Methods: Using a stratified clustered random sampling, 13 primary- and secondary-care public hospitals in Nepal were selected. 189 steam sterilization cycles from these hospitals were evaluated for their effectiveness using self-contained biological indicators, class-5 chemical indicators, autoclave indicator tape and physical parameters. Information about the hospitals and the types of autoclaves being used was also collected. Data were analysed to estimate the proportion of ineffective steam sterilization cycles. Logistic regression was used to identify factors associated with ineffective sterilization.

Findings: In primary and secondary care public hospitals in Nepal, 71.0% (95% CI 46.8% - 87.2%) of the autoclave cycles were ineffective (i.e. showed positive results) when tested with biological indicators and 69.8% (95% CI 44.4% - 87.0%) showed 'reject' results with class 5 chemical indicators. There was no statistically significant difference in proportions showing positive or reject results by hospital types for either biological (p = 0.51) or class 5 chemical (p = 0.87) indicators. Autoclave type and pressure achieved during sterilization were statistically significantly associated with steam sterilization failures, adjusted for holding period, evenness of pressure and barrier system used.

Conclusion: Primary and secondary care hospitals in Nepal have a high proportion of steam sterilization failure, indicating a risk of person-to-person transmission of pathogens through reusable medical devices. There is an urgent need to improve steam sterilization processes in these hospitals.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
Equipment Contamination / prevention & control*
Equipment and Supplies
Hospitals, Public
Humans
Logistic Models
Nepal
Secondary Care Centers
Sterilization / methods*

Grants and funding

This study was partially funded School of Health Sciences and School of Physical and Chemical Sciences, University of Canterbury. Financial supports provided by the schools were in the forms of tuition fee waiver and costs for purchasing equipment and supplies required by the study. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.