Evaluation of surgical instrument disinfection systems at the emergency department of higher-level hospitals in Santo Domingo, Dominican Republic

Abstract

The evaluation of the surgical instrument disinfection processes is a key element for the elimination of any microbial form and to avoid nosocomial infections. The aims of this study were to evaluate the application of home-based methods of sterilization across five hospitals that offer attention at the emergency department for wounds and other injuries. An observational, descriptive, cross-sectional study was performed before and after disinfection of reusable devices at the emergency department of higher-level hospitals in Santo Domingo, the capital city of Dominican Republic. A total of sixty samples were collected. Sterile transport sampling swabs were used to be cultured, and isolation of any microorganisms. The process was also described per each hospital. Three types of disinfection and sterilization were identified: a) hot air oven, b) 3% glutaraldehyde submersion, in hospital A and B respectively, and c) autoclave in C, D, and E, all after mechanical disinfection. Direct observational evaluation showed that 6 out of 36 (16.7%) sterilized instruments showed residues, and in 17 (47.2%) it was impossible to determine the presence of residues because of rust, while 7 out of 60 (11.7%) instruments showed bacterial growth, all of them before disinfection procedures. In 3 (42.9%) of them moderate colonies (3+) Staphylococcus spp were isolated; 2 (28.6%) Staphylococcus spp with low growth (1+); in one swab collected was isolated (14.3%) Streptococcus spp with abundant growth (4+) and 1 (14.3%) E. coli in abundant growth (4+). Although there are no standard guidelines of disinfection in use in the Dominican Republic; during the period of the study, pathogens were isolated. There is a lack of evidence-based interventions to reduce nosocomial transmission of bacteria, and this will impact the flora of co-infections, leading to multiresistant strains, and other complications. It is recommended the creation of a standardized system of sterilization across the country, and enforcement in the application of international regulations for these departments.