Cross sectional study on sterilization in a tertiary cardiac Hospital of Bangladesh

At any time, 1.4 million people suffer from healthcare associated infections. Reports have been published about the risk of infection caused by improper practice of sterilization. So the main objective of this research was to know the awareness, attitude, and practice among the healthcare staffs regarding the sterilization practice of a tertiary cardiac hospital in Bangladesh. 51 healthcare staffs from cardiac OT, cath lab and infection control department were the respondents of this cross sectional descriptive study & data was collected by a questionnaire survey from April 05, 2021 to May 03, 2021. The significant findings of this research are: 23.5% of the staffs had needle injury while working throughout their career. Among them only 3.9% reported to their authority and took treatment for that while the rest overlooked the matter completely and did not take the necessary precaution steps. Another significant finding is 80.4% of the staffs have been vaccinated against Hepatitis B, still 19.60% haven’t take vaccine. This type of study should be done regularly by the hospital authority to find out the lacking of the hospital.


Introduction
In hospital settings, adequate procedures of sterilization is a must to carry out for patient's safety and it is considered as one of the major requisites preventing surgical site infection . Several latest techniques or technology of sterilization have been innovated for reprocessing surgical instruments in hospital settings. "Central Sterile Supply Department", CSSD, is the department of a hospital who is responsible for and overlooks as well as provides sterilized material to all the other departments of the hospital. Receiving, washing or cleaning, packaging, sterilization and finally distribution of sterile equipment, surgical instruments and other materials etc are the activities of this department. So for centralizing the total sterilization procedure of a hospital, CSSD service was established and this service is provided by trained healthcare professionals. CSSD service ensures more effective sterilization process, saves the time of nursing (Kulkarni and Chillarge, 2015). The main purpose of CSSD is to supply all the departments of a hospital with guaranteed sterile instruments, devices or other materials which are ready to use for surgery or other patient care. This service is very much important for preventing the infection.
In all over the world, people up to 1.4 million suffer from healthcare associated infections in any time.  .
After cardiac surgery, infection is considered as the most common non cardiac complication. So proper sterilization practice is very much necessary for any cardiac hospital like the other hospitals to minimize the risk of surgical site infection (Gelijns et al., 2014). To assess the awareness level, attitude, and practice among the healthcare staffs on sterilization procedure of a tertiary cardiac hospital in Bangladesh, this survey based study was administered.

Ethics
Approval was taken from the appropriate authority of the institution.

Study Design
This cross sectional descriptive and exploratory research was administered in a tertiary cardiac hospital in capital of Bangladesh (Dhaka city) from April 05, 2021 to May 03, 2021. Total 51 healthcare staffs from cardiac OT, cath lab and infection control department were the respondents of this study. Purposive sampling technique was employed to collect the samples from the hospital for this research to be carried out. A Questionnaire was administered among the respondents which was covered with few demographic information like working experience, age and details about awareness, attitude and practice on sterilization, disinfection, biomedical waste management, needle injury, vaccination status of the healthcare staffs etc (

Statistical Analysis
The spreadsheets data were imported into IBM SPSS 22 (SPSS inc., Chicago, IL, USA) to perform a descriptive exploratory study.

Fig. 3 Awareness among health-care professionals
All the results were satisfactory in this part. All the healthcare staffs were 100% aware of different sterilization and disinfection methods and their harmful effects, post sterilization management of surgical instruments, temperature for the sterilization in autoclave, aseptic precautions, biomedical waste management, sterilization and infection prevention and control policy of their hospital. Their awareness level on sterilization procedure can be compared to the staffs of any developed foreign hospital.    . 5 Practice of health care professionals There were few dissatisfactory results in this part. 23.5% healthcare staffs had needle injury, it can happen but the important thing was only 3.9% of them reported it to the authority and took treatment for it. Rest of the (96.1%) staffs remained silent in this regards which was very much threatening both for the healthcare staffs as well as for the patients.

Discussion
The most significant findings of this research was, 23.5% staffs had needle injury while working throughout their career, among them only 3.9% reported to the authority and took treatment for that which is already mentioned in the above result part. There are six devices which are mainly responsible for majority of the sharp and needle stick injuries identified by United States National Surveillance System (NaSH). The devices are suture needles, scalpel blades, winged steel needles (butterfly), hypodermic needles, phlebotomy needles and IV catheter stylets (CDC 2004). Needle stick or other sharp injuries can transmit dangerous blood borne pathogens to the healthcare providers, including hepatitis C virus, hepatitis B virus and HIV or human immunodeficiency virus (HIV). In United States, each year as a result of sharps injuries, more than 35 health care staffs contract with HIV, 400 contract with hepatitis B and 2,000 contract with hepatitis C (Shelton and Rosenthal, 2004). The frequency of needle stick injuries is the highest in developing countries. In Africa, the health care professionals suffer 2-4 needle stick injuries on average per year and over 50% of the hospitalized patients are HIV positive (Wilburn, 2004). So sharp injury is dangerous for both healthcare staffs as well as the patients. If all the needle or sharp injured healthcare professionals reported the information of their injury in time to their authority and took treatment, then the result of this study would be satisfactory .
Another dissatisfactory findings of this study is, 80.4% of the total healthcare staffs were vaccinated against Hepatitis B, rest of the (19.6%) staffs were not. Risk of Hepatitis B Viral infection by a contaminated needle stick injury is 2 -40%, according to CDC, 1998a(CDC 1998a. So the healthcare staffs must have to be vaccinated against Hepatitis B which is also recommended in the study of Sifat Uz Zaman M et al, 2021 . But the practice among the healthcare staffs of washing hands with antiseptic, using personal protective measures, using disposable needles and intravenous sets, training on sterilization & disinfection procedure for surgical instruments were 100% satisfactory.

Conclusion
The healthcare staffs must have to be immunized by vaccine before performing duty which have to be ensured by IPC team of the hospital. Vaccination center need to be established for healthcare staffs. The staffs must have to report to the infection prevention and control committee of the hospital if any needle injury is occurred while working. Continuous training program should have to be arranged for the healthcare staffs for raising awareness in this regard. This type of study should be done regularly by the hospital authority to find out the lacking of the hospital. Due to time constraints, the healthcare staffs of only one cardiac hospital was selected to conduct this research. To understand the overall situation of Bangladesh, large sample size need to be taken for further research.