| Summary: | A research dissertation submitted to the
Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
fulfilment of the requirements for the degree
of
Master of Science in Nursing
Johannesburg, 2015 === Patients undergo surgical and medical procedures daily in hospitals and clinics in South Africa to treat various health problems. Medical devices are used to perform these procedures. It is possible that dirty medical devices could transmit healthcare associated infections, so it is critical that medical devices are cleaned, disinfected or sterilized according to validated procedures. Medical devices should be visually inspected to verify that they are indeed clean. Not all patient soils are visible to the naked eye so cleaning should be verified using additional methods. One such method is to test the device for protein residues.
The aim of this study was to establish if selected hospitals in Gauteng (South Africa) have standard operating procedures for cleaning medical devices, if their cleaning procedures are based on international validated procedures and to investigate if selected medical devices have protein residuals left on them after undergoing routine cleaning procedures. The results of this study could be used to help establish South African medical device cleaning guidelines.
A descriptive, multiple case study design was utilised in order to understand the phenomenon of medical device cleaning within its real life context in 5 hospitals in Gauteng (South Africa). The researcher established if the hospitals had medical device cleaning standard operating procedures at a unit level. The researcher observed and documented how specific medical devices were routinely cleaned (namely; flexible gastroscope, Yankhauer suction nozzle, needle holder, diathermy forceps, laryngoscope blades and vaginal speculum). Those devices were then visually inspected for soil and photographed. A marked (traceable) Crile’s forceps provided by the researcher was soiled with Browne’s soil test (artificial test soil). The Crile forceps and the aforementioned
medical devices were then be swabbed with a sterile swab and that swab was tested for protein residues with a ninhydrin protein residual test.
Results
Only 3% percent of the staff at unit level was aware of medical device cleaning SOP’s.
Not all medical devices were cleaned in accordance with internationally validated cleaning procedures. The percentage of medical devices that tested positive for proteins varied per device and per hospital. Overall 16% percent of medical devices tested positive for residual proteins post routine cleaning. Only 12% of the medical devices that were kept moist tested positive for residual proteins, whereas 19% of the medical devices that were not kept moist tested positive for residual proteins. The commercially available Ninhydrin test kit (Browne Ltd, UK) was able to effectively detect residual proteins on medical devices in this research to a similar degree found in previous research. The findings in this research however suggest that the ninhydrin test method may not be ideal for testing gastroscopes for residual protein (a more sensitive test may be more effective), and that medical devices should be tested regularly for residual proteins as visually inspecting them for soils is simply unreliable.
Conclusion
Medical devices should be decontaminated according to hospital SOP’s that are based on validated cleaning procedures and MIFU in order for them to be cleaned effectively. Cleaning of medical devices should be verified using residual protein tests as visual inspection alone is not effective enough. South African guideline should be established for cleaning of medical devices that are in line with internationally validated procedures, MIFU and that advocate the use of protein residual tests to verify cleaning efficacy.
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