What is medical staff knowledge about decontamination?

Introduction

Decontamination is a complex process that can involve many aspects of the healthcare organization. The primary goal of this process is to remove and destroy microorganisms or other contaminants from surgical equipment and instruments. Reusable surgical instruments, which can be a potential route of transmission for pathogenic microorganisms, must be properly disinfected to eliminate health risks to patients and healthcare workers (1).

One of the most serious consequences of failure to comply with all procedures and standards relating to care and treatment is nosocomial infections, including surgical site infections (SSIs), which, despite advances in medicine and increasing knowledge of their causes and methods of elimination, continue to pose a major challenge to healthcare professionals and healthcare facility managers (2,3). The incidence of SSI is estimated to be 2–11% of all surgical procedures, and risk factors directly related to the patient include: age, nutritional status, diabetes, nicotine dependence, obesity, coexisting infections and immune system disorders. and length of hospital stay prior to the procedure or surgery. Healthcare-associated infections (HAIs) cause approximately 40,000 deaths per year, resulting in a nosocomial infection incidence of 25% in developing countries and 5–15% in developed countries (4,5). Nosocomial infections can prolong the patient’s stay in hospital, increase costs to the healthcare system, cause financial problems for the patient and their family (e.g., due to the patient’s inability to work or long-term disability), and even lead to the patient’s death. In Europe, the financial loss due to nosocomial infections amounts to approximately €7 billion per year (6). Surgical instruments and medical devices, both disposable and reusable, are a very important part of any surgical procedure performed. For this reason, the decontamination process, including disinfection and/or sterilisation, used to safely release reusable equipment or tools for further use, plays a fundamental role in limiting the transmission of pathogenic microorganisms and thus has a positive impact on the decreasing number of nosocomial infections (7,8).

The aim of this study was therefore to assess healthcare workers’ awareness of the importance of carrying out the decontamination process. We present this article in accordance with the SURGE reporting checklist (available at https://jphe.amegroups.com/article/view/10.21037/jphe-24-10/rc).

Methods

Selection of study participants

The study group consisted of 101 healthcare workers. The healthcare workers were employed in a hospital in the Silesian Voivodeship. The study was conducted from December 2022 to February 2023, after obtaining written consent from the hospital management. Participation in the study was voluntary for all respondents. No patients were involved in this study and approval from the Ethics Committee was not necessary, and implied consent was assumed by voluntary response. The study used an original questionnaire consisting of the birth certificate and 17 closed, single-choice questions. The data section includes questions on gender, age, position, length of service, education and place of residence. To assess healthcare workers’ awareness of the importance of carrying out the decontamination process, questions were included on, among other things, knowledge of terms such as decontamination and the risks of a poorly carried out decontamination process. Respondents were also asked to give a subjective assessment of their knowledge in the field of decontamination of medical devices and equipment.

Statistical analysis

The results of the survey questionnaire were prepared in Microsoft Office Excel 2019 and presented in the form of tables and figures. The relationship between the work experience of the respondents and the answers to the questions was examined using Spearman’s rank correlation using the Statistica 13 programme. Statistical significance was set at P<0.05.

Results

Ninety women (89.11%) and 11 men (10.89%) participated in the study. Higher education was reported by 63 respondents (62.38%), while 38 people (37.62%) reported secondary education. None of the respondents indicated their level of education as primary or vocational. A city with a population of more than 100,000 was reported by 53.47% of respondents (n=54), while 39.6% of respondents (n=40) reported a city with a population of up to 100,000 as their place of residence. Only 7 people (6.93%) said they lived in a village. The largest group of all respondents were people aged 47–54 years (35.64%) and the smallest group were people aged 23–30 years (5.94%). Most respondents had been working in their profession for 22–32 years (n=31; 30.69%). The majority of respondents were nurses (n=60; 59.41%) and midwives (n=18; 17.82%). The age, work experience and profession of the respondents are shown in Table 1.

The vast majority of respondents (n=89; 88.12%) stated that decontamination is the process of destroying biological pathogens by washing, disinfecting and sterilising (P=0.36; R=0.09). Most respondents (n=73; 72.28%) correctly answered that new medical devices should undergo a full decontamination process (P=0.51; R=−0.06). Respondents were asked about the purpose of disinfection. The distribution of answers to this question was almost equal (n=51; 50.50%) of respondents answered that the aim of this process is to destroy all microorganisms, and 49.50% of respondents (n=50) indicated the destruction of vegetative forms of microorganisms, which was the correct answer (P=0.41; R=−0.08). According to the vast majority of respondents (n=69; 68.32%), high-level disinfection can destroy most viruses, including human immunodeficiency virus (HIV) and hepatitis B virus (HBV). However, this can already be achieved with medium level disinfection—this answer was given by 16 respondents (15.84%) (P=0.58 R=0.05). The majority of healthcare workers (n=65; 64.36%) reported that hepatitis C transmission through blood via unwashed and unsterilised surgical instruments or other medical devices can occur after 6 to 8 weeks (P=0.98; R=−0.02). When asked “How long do you think the initial disinfection should be carried out after the use of surgical instruments”, respondents (n=56; 55.45%) answered up to 3 hours, 38.61% of respondents (n=39) up to 6 hours and 5.94% of respondents (n=6) up to 24 hours after the use of surgical instruments. A statistically significant relationship was found (P=0.04; R=−0.20). The majority of respondents (n=71; 70.30%) identified surgical and gynaecological instruments as being at high risk of transmitting infections in the hospital environment. A statistically significant association was also found for this question (P=0.04; R=0.20) (Table 2).

Discussion

Adequate preparation of the patient before surgery and compliance with hygiene rules are of great importance in protecting hospitalised patients and medical staff from the adverse effects of hospitalisation (9).

It should be noted that in our study most of the participants were nurses and midwives, and only two doctors took part in the study. To carry out similar research in the future, the study group should be better selected. It should be emphasised that although only 10.89% of the healthcare workers in our study rated their knowledge of medical device decontamination as very good and answered very detailed questions, this knowledge was not necessary for them to perform their job. Knowledge in this area should primarily be provided by Central Sterile Services (CSS) and sterile equipment should be made available (10). Considering the above and analysing the results of our study, not all healthcare workers were aware that moderate disinfection can destroy most viruses, including HIV and HBV (11); 55.45% of respondents were aware that initial disinfection after use of surgical instruments should take place within a maximum of 3 hours (12). Not all healthcare workers in this study were aware of how long it takes to become infected with hepatitis C after blood contamination with unwashed and unsterilised surgical instruments or other medical devices.

Citing the results of the 2018 The Supreme Chamber of Control (NIK) on infections in healthcare settings, the main causes of their occurrence include: failure to follow procedures and standards; and non-sterile medical and non-medical equipment (13).

An educated public plays a fundamental role in infection prevention, as does an aware medical staff who responsibly follow the rules for the correct handling of medical instruments and equipment (14). The study by Sztark et al. asked how new instruments should be handled before their first use. The vast majority of respondents, i.e., 98% of people (n=49), answered that they should be subjected to a complete cycle of decontamination activities (15). In our own study, a similar question was asked: “How do you think new tools and medical equipment should be treated before first use?”, as many as 72.28% of people responded that they should be subjected to a full decontamination process (n=73). In the Sahiledengle study, respondents were asked when they wet/soak contaminated instruments after surgical procedures; 70.7% of respondents (n=193) replied that they did so within 30 minutes, 17.9% (n=49) immediately and 11.4% (n=31) within 1 hour (16).

In our own study, a similar question was asked about how long the initial disinfection should be carried out after the use of surgical instruments—55.45% of respondents (n=56) said up to 3 hours. Sifat Uz Zaman et al. asked respondents whether it was necessary to provide regular training for medical staff in sterilisation and disinfection procedures—100% of respondents answered in the affirmative (n=73) (17). In our study, medical staff were asked to respond to the question: “Would you like to participate in systematic training, courses or conferences on the decontamination process?”, 76.24% of respondents (n=77) expressed their willingness to continue to acquire knowledge and training in this area.

Due to the increase in medical procedures performed—including surgical ones, attention is paid to preventive measures aimed at reducing the occurrence of, among others SSIs. Some of the health risk factors in the hospital environment can be modified—especially those that concern medical staff and hospital organizational units. Medical staff should remember about hand hygiene, which is considered one of the most effective methods of preventing infections. Patient education—including compliance with hygiene rules—is another measure that effectively limits the negative effects of infection. The operating theatre staff play an important role in the whole process of hospitalisation and surgery, as they must demonstrate knowledge and compliance with all procedures and protocols under time pressure. However, cooperation with the central sterilisation department and the implementation of proper cleaning, disinfection and sterilisation procedures play a key role in infection prevention. We should not ignore HAI control systems, the implementation of which can reduce the risk of infection by up to 70% (18).

Knowing that the human factor plays a significant role in the prevention of nosocomial infections, and taking into account the results of our own research and their comparison with those of other authors, it seems necessary to continuously educate health care workers in order to minimise the health risk of patients and medical staff (18,19).

Conclusions

Healthcare workers’ awareness of the importance of carrying out the decontamination process is at an average level. Most of the respondents were unable to correctly answer questions about the purpose and associated processes of disinfection and to correctly define sterilisation. It is recommended to implement educational activities aimed at improving the awareness of health care workers regarding the decontamination process in order to minimise the health risk to patients and medical staff.

Acknowledgments

Funding: None.

Footnote

Reporting Checklist: The authors have completed the SURGE reporting checklist. Available at https://jphe.amegroups.com/article/view/10.21037/jphe-24-10/rc

Data Sharing Statement: Available at https://jphe.amegroups.com/article/view/10.21037/jphe-24-10/dss

Peer Review File: Available at https://jphe.amegroups.com/article/view/10.21037/jphe-24-10/prf

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://jphe.amegroups.com/article/view/10.21037/jphe-24-10/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. No patients were involved in this study and approval from the Ethics Committee was not necessary, and implied consent was assumed by voluntary response.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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