Author: Jan

Sterilization of medical supplies by Steam. 3rd Edition

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NL-WiesbadenMHPVerlag20100708BookCoverSEnglishVersionEdition3Sterilization of medical supplies by Steam

3rd Edition 2010. Publisher: MHP-Verlag, Germany

ISBN 978-38-8681-102-1

In a hospital or clinic it is necessary that all equipment and materials used for treating patients are absolutely safe for use: the chance for spreading of diseases should be kept as small as possible. Cleaning, decontamination and sterilization are important methods in this battle against this ever present threat. Especially since the fatal disease AIDS became so powerful and spread world wide, the demand for proper procedures for infection control gained momentum enormously. Diseases such as Hepatitis B, known to be transmitted through contaminated surgical instruments, stimulated the need for stricter guidelines for disinfection and sterilization.

This book focuses on the most common and most safe method used for sterilization in the Central Sterile Service Departments in healthcare institutions: sterilization by pressurised high temperature steam.

A first major step to improvement of sterile supply is the training of all personnel involved (technicians, staff and users). Moreover, in the recently published European standards on sterilization, education is required of everybody involved in sterilization, whether it concerns the manufacturer of the sterilizing equipment or the technician maintaining or using it. This series of books provides a foundation needed to fulfil this requirement. Originally intended to educate technical service personnel in remote health institutions, it has grown into a textbook that can be used by anyone interested in sterilization.

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The World Federation for Hospital Sterilization Sciences (WFHSS) is pleased to recommend the book to all their members and all others involved in sterilization practices.

Ordering

You can order this book at MHP Verlag here

Foreword by the author                                         

Good old days in Ghana: 1985. The HES team at the Mary Theresa Hospital in Dodi Papase where we just did install a major electrical supply network.

Good old days in Ghana: 1985. The HES team at the Mary Theresa Hospital in Dodi Papase where we just did install a major electrical supply network.

It already has been almost 28 years since I left for Ghana, West Africa, as a technician, where I would stay for 7 years. I was responsible for the setting-up of a maintenance service for the hospitals within the healthcare system of the Catholic Church. Initially the work was focussing mainly on the actual repairs and maintenance of equipment in all its variety. In the later years the tasks moved to more organisational work and most of all training. I found out that for most equipment a wide range of training and study material was available. However for sterilization the information I could find was limited to often very brief instructions for use of equipment without further background information. After finishing the contract in Ghana I was asked to start preparing training material for hospital technicians. I thus choose sterilization as one of the first subjects to cover. It was in the early nineties, the time that in the Netherlands the world of sterilization was very much in motion. The Netherlands was in the forefront of the developments in this domain. The Guidelines on Sterilisation and Sterility were just formulated and became the basis for the first European Standards for sterilisation. The trade quickly professionalized.

Servicing a good old HA3 Lister power plant at Duayaw Nkwanta Hospital, Ghana. With HES technicians: Sylvester Akparibo, Emmanuel Atubisah and?

Servicing a good old HA3 Lister power plant at Duayaw Nkwanta Hospital, Ghana. 1986. With HES technicians: Sylvester Akparibo, Emmanuel Atubisah and?

I came to realize that I severely underestimated my efforts of writing a book on the topic! In order to be better prepared I attended a training with Mr. Machiel Jan Bot of Medithema, who introduced me with great enthusiasm into the world of micro-organisms, infection prevention and sterilization. For gathering information I got in touch with many sterilization-related companies and among others the RIVM: the Institute for Public Health and the Environment of the Netherlands. At that time the late Mr. Jack van Asten was pushing a scientific approach to sterile supply in hospitals throughout The Netherlands and through his department was enforcing improved quality control and validation of sterilization processes. From the information that was slowly but surely gathered, the first English edition was created which was published in 1996 under auspices of the ESH, the predecessor of the current WFHSS. In 2004 the second updated edition was published. During the past years I had the opportunity to present courses on sterile supplies in many countries, especially in Africa. It is a great experience to see the enthusiasm of all those people who want to make a difference in their own field. The book has been a tool to provide the basic information. With this 3rd edition I hope this contribution to improve sterile supply can continue.

Sterilization is a field where many exiting sciences and technologies meet: from microbiology, medicine, to mechanical and electrical engineering. A profession where life and death meet each other; in which life at micro-level is massively offered in order to protect ours. Through this sterilization almost gets a philosophical/ethical character.

This book wants to be an introduction for all those that get in touch with this fascinating field, which offers an essential contribution to the safe treatment of the many patients, who thus put their lives into our hands.

Jan Huijs enjoying spring time  Jan Huijs, HEART Consultancy, Renkum, The Netherlands, April 2010

 

St. Mary’s Children and Community Hospital Umuowa upgrades its Sterile supply

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St Mary’s Hospital Umuowa upgrades its Sterile supply

Training of users of sterilization equipment

After commissioning of the AJ Costa autoclave, the users are trained by James

In December 2013 the St. Mary’s Children and Community Hospital opened its doors. At the time the CSSD was equipped with an advanced autoclave for the sterilization department: A Matachana LR80-1. At the time it was installed it was anticipated that the machine was not suitable for its setting. Soon indeed it broke down and since 2014 the hospital had to rely on a pressure/cooker type autoclave. A new more basic autoclave was procured and materials for the repair of the Matachana autoclave were ordered and received early in 2015. In October 2015 the Dutch consultant Jan Huijs and his Nigerian colleague James Orsugh could come for a 3 week visit to install the new autoclave, repair the Matachana autoclave, offer advice and perform training for staff. The new autoclave could be installed in the CSSD. In collaboration with the technical team the autoclave was connected to the electricity supply, water supply and drain. Test running resulted in optimizing the pack size for the process. The Matachana autoclave had been worked on by other technicians, however could not be repaired. Wiring was loosened and changed; water level sensors of the steam generator interchanged. The vacuum pump was considered the major problem. During the visit the problems were analysed; the vacuum pump exchanged and issues related to the wiring resolved. Test running could be done again. However the machine allowed only a single reliable cycle at the beginning of the day when the water is still cold. A cycle per day would however remain sufficient production per day. The manufacturer is being contacted on this issue. The small pressure cooker that was in a very poor state: a plastic tube used to close a the connection of a broken down valve was about to burst; the pressure gauge was not working; the electrical connection is extremely poor and dangerous and the trivet for keeping the tray above the heating element was causing corrosion and rust sediments on the chamber, tray and instruments. The autoclave received a full overhaul with new trivet, pressure gauge and adequate closing of the hole of the missing valve. An adequate sterilization cycle has was established. Storage time of goods sterilize in the pressure cooker has been too long resulting in serious growth of fungi in sterile packs. The storage time for these packs was reduced to a maximum of 2 days. Cleaning of instruments revealed short comings: corrosion and serious residues on instruments ready for use were observed. Cleaning practice was improved and new brushes were issued. Packaging of sterile packs caused the need of complicated handling for opening them; thus leading to increase chances of recontamination. Adequate packaging methods were trained on, enabling aseptic opening of the packs. In order to improve the quality and procedures in sterile supply a 5 day training was organized. It included a theoretical part during with principles of infection control were explained. Followed by the basics on physics required to understand the operation of the steam sterilizers. The construction and operation of the sterilizers were explained and followed by hands on practicals on their operation in the sterilization department. The training started with an pre test and was followed by a post test thus enabling evaluation of the performance of the students. The score increased an average of 20%, a considerable improvement. All participants that attended the full training received a certificate of attendance. With and enthusiastic song and lots of happiness outside at the entrance of the hospital the training was closed. The training revealed a desperate need on improving knowledge on basic issues such as quantities and units, principles of physics and calculations! Within the medical field such basic knowledge is crucial and it is strongly recommend to organize more training in order to improve these skills. During the last days still several workshops were held on cleaning packaging and a training session on the Matachana autoclave. In order to improve infection prevention in the OR building a red line was marked in the lobby thus separating the dirty area and clean area of the building. Beyond the red line a strict clothing protocol will be in place. With all lessons learnt, the new equipment and procedures the hospital made another quantum leap in its mission in improving patient care. It was great to be involved in this effort!

Renkum, The Netherlands, 31-12-2015. Jan Huijs

Aftermath of the Ebola Crisis: Liberia Hospitals improving their sterile supply

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2014-12-01: JF Kennedy Medical Centre, Monrovia, Liberia: The Maternity Hospital, supported through the Japanese Government

2014-12-01: JF Kennedy Medical Centre, Monrovia, Liberia: The Maternity Hospital, supported through the Japanese Government

The year 2014, Liberia, West Africa. The country is confronted with the most deadly disease in recent history: Ebola. Public life including the health system have come to a standstill. At the time the German Red Cross assists  the national John F Kennedy Medical Centre in Monrovia with the establishment of a triage unit, where all incoming patients are tested on signs of Ebola. The representing officer of the Red Cross is invited to visit the neighboring Japanese-Liberian Friendship Maternity Hospital, attached the Medical Center. The Maternity Hospital has been established in 1983 with the support of the Japanese International Cooperation Agency JICA.

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Report: Liberia, Monrovia 2015. The Maternity Hospital of of the JF Kennedy Medical Centre upgrades its sterilization department

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In 2011 the Maternity Hospital received a new Matachana S1000 sterilizer. It was supplied in the context of the rehabilitation of the hospital through the Japanese government.

The sterilizer was installed under the responsibility of the Liberian branch of UNOPS. All utilities were connected and test runs took place. However by the time the machine was to be taken to use the compressor broke down. At the time the engineer in charge of the installations fell sick and was repatriated. Since that time the machine has never been used. In 2014, at the height f the Ebola crisis a representative of the German Red Cross visited the Maternity hospital and was also shown the operating theatres with its sterilization department with the broken down autoclave. The delegate offered to have a consultant assessing the status of the machine and possibly recommission it. The assessment visit took place in Dec 2014. He positively advised on the repair, of which the request by the hospital was approved by the German Red Cross. In the months of January-March, preparations took place for the recommissioning: Spare parts were ordered; and a training on the S1000 autoclave was attended at the Matachana headquarters in Barcelona. By the middle of may the consultant came for the actual repair and commissioning. During the visit also the sterilization department of the nearby St. Josephs Catholic hospital was put back to service again by repair of equipment and installing new sterilizers: an activity supported by the German organizations Misereor and the Medical Mission Institute. The activities in both hospitals took place between May 15th and July 17; a month longer then originally planned.

A major problem related to the autoclave in the CSSD of the maternity was the water supply which caused severe sedimentation in the autoclave components. Hardness was within limits. thus a filtering system was installed ensuring sufficient quality water. As the pressure regulator for the compressor was not available in town a new compressor was procured. It was made available through UNOPS. Several technician problems were resolved, such as air leakage to the door seal, date time setting of the processor. All components were thoroughly cleaned. The efforts resulted in  a first success performance test. It made clear that recomissioning was feasible and the new compressor was bought, the water filter installed. With the fluctuating power supply and regular brown and black outs, a UPS was installed, which ensures that during brief black and brownouts, the power on the processor remains available, and upon resumption of power within a limited period of time the interrupted cyle can just continue. It saves enormous efforts and resources. Also the UPS was provided through UNOPS. On xx the first independent performance test was done using the full Bowie and Dick steam penetration test with dataloggers measuring inside the test pack. The Performance proved to be passing the stringent requirements. This made the way free for commissioning the autoclave. On Staff was trained and since then the autoclave is in use again. Although not the main objective of the visit also related activities of the sterilization department were observed and initial recommendations are presented.

Also the CSSD of the main hospital was visited. The only autoclave that was in use was the same model as was procured as a backup sterilizer for the nearby St. Josephs Catholic Hospital. Due to space limitations in that hospital, it was decided to do the practical training in the much more spacious CSSD of JFKMC. Before the training the department was visited and the sterilizer tested. It was found to have several major shortcomings which would actually require the closing down of the department until these were resolved. With essential spares available, the autoclave was repaired on the spot, in collaboration with a technical and CSSD staff. It could be recommissioned again and used during the training. Also the activities of the CSSD of the main hospital were observed and recommendations given for improvement. Note that the main objective of the mission was the recommissioning of the Matachana S1000 sterilizer, which was achieved. The observations are not claiming to be comprehensive nor complete. They however can be an onset for improvement within the departments. It is still recommended to do a thorough evaluation of the full sterile supply cycle of the CSSD in the Maternity Hospital as well as the Main Hospital.

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The situation with the new autoclave not being used during a period of almost 3 years reveals problems of communications and managerial and technical skills. For some reason neither the CSSD, the Hospital management, JICA nor UNOPS signalled the problems or acted effectively on the issue. The same was observed in the CSSD of the main hospital, where the only sterilizer in use was in a state that would have required the department, and thus also the operating theatres to close down until the problems were resolved. The line of communications between departments and relevant organizations needs to be strengthened. Introducing an equipment management system can be an essential tool to monitor and signal the status of equipment and used as source of information for the hospital management, the maintenance department and related organizations in assuring the up time of essential medical equipment, that is crucial for adequate care of our patients. It is however crucial that such a system is updated at a regular basis and that the information will be transparent and analysis will be available all relevant departments such as the maintenance department, the head of the departments and the hospital management. There is much potential of the staff of the maintenance department which is currently seems under utilized. An assessment of the activities and the positioning of the maintenance department within the hospital is recommended.