Objectives: Bacterial coinfection occurred in 3.5% of COVID-19 patients, and secondary bacterial infection occurred in 14.3% of patients. In Indonesia, one of the guidelines for COVID-19 therapy is to administer azithromycin 500 mg per 24 hours for mild and moderate cases and azithromycin 500 mg per 24 hours and levofloxacin 750 g per 24 hours for severe cases with suspected secondary bacterial infection. At the beginning of the pandemic, many antibiotics were used, even without proven or suspected bacterial infection. We sought to determine changes in the resistance of “ESKAPE” bacteria (ie, Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp) to the antibiotics levofloxacin and azithromycin prior to and during the COVID-19 pandemic. Methods: The study was conducted retrospectively by examining the culture and sensitivity test results of “ESKAPE” bacteria to levofloxacin and azithromycin antibiotics in 2019 (before the pandemic) and April 2020–April 2021 (during the pandemic) in 4 hospitals in Yogyakarta. The number of samples represents all cultures completed within the specified period to detect antibiotic sensitivity patterns. Results: In a top referral hospital, resistance to levofloxacin and azithromycin increased significantly for E. faecium and P. aeruginosa, but at a private hospital, an increase in resistance to azithromycin and levofloxacin occurred for A. baumannii and for Enterobacter spp and resistance to levofloxacin increased significantly. At an academic hospital, there was a considerable decrease in S. aureus and E. faecium resistance to levofloxacin and azithromycin. At the government hospital, S. aureus, K. pneumoniae, P. aeruginosa, Acinetobacter baumannii, and Enterobacter spp developed resistance to levofloxacin. Conclusions: Resistance to azithromycin and levofloxacin by different ESKAPE bacteria increased on average during the COVID-19 pandemic.

Objectives: We estimated the change to health-service costs and health benefits resulting from a decision to adopt temporary isolation rooms, which are effective at isolating the patient within a general ward environment. We assessed the cost-effectiveness of the decision to adopt temporary isolation rooms in a Singapore hospital. Methods: Existing data were used to update a model of the impact of adopting temporary isolation rooms on healthcare-associated infections. We predicted the expected change to health service costs and health benefits, measured in life years gained. Uncertainty was addressed using probabilistic sensitivity analysis, and the findings were tested with plausible scenarios to determine the effectiveness of the intervention. Results: We predicted 478 fewer HAIs per 100,000 occupied bed days resulting from a decision to adopt temporary isolation rooms. This decreased would result in cost savings of SGD$329,432 (US $247,302) and 1,754 life years gained. When the effectiveness of the intervention was set at 1% of cases of HAI prevented, the incremental cost per life year saved was SGD$16,519 (US $12,400), indicating that this would be a cost-effective measure in Singapore. Conclusions: We have provided evidence that adoption of a temporary isolation room would be cost-effective for Singapore acute-care hospitals. Using temporary isolation rooms may be a positive decision for other countries in the region with fewer resources for infection prevention and control.

Objectives: Streptococcus mitis is a gram-positive coccus and is a common commensal found in the throat, nasopharynx, and mouth. In an immunocompromised host, S. mitis opportunistically multiplies and can translocate to other sites. At baseline, the prevalence of S. mitis remained stable among hematological patients, averaging ~1 case monthly. However, in August–September 2020, 5 S. mitis cases were documented in a hematology ward and included overlapping inpatient stays. In this descriptive cluster report, we sought to identify the reasons for the increased prevalence of S. mitis in our institution. Methods: A literature review was undertaken to gain a better understanding of the bacteriology of S. mitis. Subsequently, geographical mapping was performed to identify epidemiological links. Further culture and sensitivity testing was requested. Hand hygiene compliance, environmental audit, and handling of central lines within the ward were examined for any lapses in practice. Results: Based on geographical mapping, no epidemiological linkages were established between patients; they were admitted to different rooms and did not share any equipment. Moreover, based on the antibiogram, different bacteria sensitivities were recorded across the isolates from these patients. A hand hygiene and environmental audit result showed 100% compliance. Nurses performed care of central lines in accordance with guidelines. However, an investigation of changes in practice revealed that the use of a toothbrush had only recently been permitted as part of streamlining oral care for hematology patients. Because toothbrushes were not provided by the hospital, patients were utilizing their personal toothbrushes with no direct supervision of their oral care regimen. Conclusions: The prevalence of S. mitis in hematological patients was likely due to the neutropenic condition of patients. This report provides valuable information supporting the optimization of oral hygiene in immunocompromised patients while minimizing the risk of opportunistic infections.

Objectives: Control of Clostridioides difficile infections (CDIs) in healthcare facilities presents significant challenges to infectious disease physicians, infection prevention and control practitioners, and environmental services staff. CDI is a common cause of infectious diarrhea and is associated with significant morbidity, mortality, and healthcare cost. A high infection rate was documented in our institution in 2017, higher than the national infection rate. Strategies to reduce hospital-onset CDI were implemented after review of international guidelines and relevant literature. The impact on hospital-onset CDI was assessed. Methods: The following strategies were implemented beginning early in 2018: (1) contact precautions for patients with diarrhea; (2) early recognition and diagnosis of C. difficile infection; (3) prompt isolation of C. difficile patients; (4) emphasis on hand hygiene and contact precautions; (5) enhanced environmental cleaning with chlorine-based disinfectant and use of UV-C and ionized hydrogen peroxide for equipment disinfection; (6) enhanced cleaning and disinfection using sporicidal wipes for shared high-risk equipment; (7) audit and feedback regarding compliance with practices and environmental cleaning; and (8) collaboration with antibiotics stewardship program (ASP) to reduce inappropriate antibiotic use. Hospital-onset CDI cases were tracked by infection prevention and control nurses using definitions from the Singapore Ministry of Health. Results: In total, 135 hospital-onset C. difficile infection cases occurred in 2017, a rate of 4.2 per 10,000 patient days. This rate gradually decreased to 3.0 in 2018 and to 2.3 in 2020, with an average of 87 infections per year. This rate further decreased to 1.8 infections per 10,000 patient days in 2021, with 61 clinical infections. Conclusions: Using multimodal strategies, CGH achieved a gradual and steady reduction in hospital-onset CDI over several years. These strategies require close collaboration among various departments to achieve the desired outcome.

Objectives: Surgical-site infections (SSIs) cause significant increases in mortality, morbidity, and prolonged hospitalization after cesarean deliveries. We assessed the effectiveness of the implementation of an SSI bundle in reducing postoperative infections in cesarean deliveries in a tertiary-care teaching hospital in Malaysia. Method: We conducted a quality-improvement study on all women who underwent labor and scheduled cesarean sections at the University Malaya Medical Center (UMMC) between May and December 2020. The preintervention period was May–June 2020 and the postintervention period was September–December 2020. Patients were followed for 90 days after their operation. Before the intervention, SSI rates and compliance with prevention practices were documented. A multidisciplinary team was formed, and education regarding the elements of the SSI prevention bundle was conducted before they were implemented. The care bundle focused on monitoring compliance with preoperative bathing, contact time for skin preparation, hair management, and antibiotics prophylaxis given within 60 minutes prior to incision, as well as patient education. Result: With the implementation of the SSI bundle, we observed a significant reduction in the SSI rate by 50%, from 7 per 100 procedures to 2 per 100 procedures. Compared with the preintervention period, overall compliance with bundle elements improved greatly for preoperative bathing (0 vs 95.7%) and contact time for skin preparation (0 vs 98.8%). In the postintervention period, the method of hair removal was documented, compared to no documentation during the preintervention period. The administration of prophylactic antibiotics within 60 minutes prior incision decreased from 99% to 92.3%. Conclusion: Implementation of an SSI prevention bundle successfully reduced the rate of SSI after cesarean section. The SSI prevention bundle together with improvements by multidisciplinary teams and a good patient-safety culture helped reduce SSI rates. Patient education on pre- and postoperative infection prevention also played an important role in reducing this infection rate.

Objectives: In Australia, the prevalence of SSI is 3.6%, with a particularly high burden in colorectal procedures of 8.7%. ChloraPrep (2% chlorhexidine gluconate (CHG)–70% isopropyl alcohol formulation) is a preoperative sterile alcoholic CHG solution prefilled in a ready-to-use applicator. We compared the costs and SSI outcomes of adopting ChloraPrep versus a bulk aqueous povidone iodine (PVI) solution for colorectal procedures in a public hospital setting. Methods: We used a budget-impact tool to evaluate the clinical and economic impacts of skin preparation methods. The PVI SSI rate was assumed to be the baseline rate observed in Australia (8.7%). The ChloraPrep SSI rate was derived by applying the demonstrated ChloraPrep SSI reduction versus PVI (41%) to the PVI SSI rate. The cost of ChloraPrep was AU$8 (US $5.50) and the cost of PVI solution was AU$3 (US $2). The PVI equipment cost AU$2.13 (US $1.47). Additional average length of stay was 9.4 days, and the daily average cost was AU$2,347 (US $1,618). The average skin preparation time was 3.5 minutes using ChloraPrep and 8.5 minutes using PVI. The hospital-acquired complication (HAC) penalty for SSI was calculated using the national efficient price (AU $5,797 or US $3,996), national weighted activity unit (4.6261), and adjustment rate for patient complexity levels (high, 4.8%; moderate, 5.9%; and low, 7.9%). Results: The model estimated SSI rates were 5.1% using ChloraPrep and 8.7% for PVI. For every 1,000 patients, skin preparation cost was estimated to be AU$8,100 (US $5.583) using ChloraPrep and AU$5,200 (US $3.585) using PVI. SSI treatment cost was estimated to be AU$449,900 (US $310,127) for ChloraPrep and AU$762,500 (US $525,610) for PVI. In addition, 330 bed days could be avoided and at least 80 operating room hours could be saved with 35 SSIs avoided. With 35 SSIs avoided, a potential reduction of AU$26,500 (US $18,267) in HAC penalty could be expected. This intervention could yield an overall cost savings of AU$336,300 (US $231,820). Conclusions: Using ChloraPrep for skin preparation prior to colorectal procedures could result in lower SSI rates and cost savings from treating fewer SSIs. Operational efficiency might also be improved.

Objectives: Surgical site infection (SSI) is the most common healthcare-associated infection (HAI) in our gynecology and obstetrics hospital. SSI among patients following gynecological and obstetrical surgery not only results in increased morbidity but also has far-reaching implications. Thus, this study was conducted to determine the incidence, risk factors, and bacterial pathogens related to SSI. Methods: We conducted this retrospective study based on medical records from January 2019 to December 2020 at Hung Vuong Hospital. Results: Of 51,466 patients undergoing surgery, 581 patients (1.34%) developed an SSI after cesarean section and 145 patients (1.77%) developed an SSI after gynecological surgery. A multivariate logistic regression analysis identified the following risk factors among patients who underwent cesarean section: age (OR, 1.02; 95% CI, 1.01–1.04), emergency cesarean section (OR, 1.62; 95% CI, 1.36–1.93), operation time >60 minutes (OR, 2.04; 95% CI, 1.48–2.80), surgery during the night shift (OR, 1.29; 95% CI, 1.08–1.54), and prolonged hospital stay ≥2 days (OR, 1.51; 95% CI, 1.21–1.89). SSI risk factors for patients following gynecological surgery included age (OR, 1.03; 95% CI, 1.02–1.05), contaminated wound (OR, 3.44; 95% CI, 1.56–7.57), dirty wound (OR, 3.61; 95% CI, 1.44–9.05), vertical abdominal incision (OR, 2.49; 95% CI, 1.65–3.77), and duration of surgery >180 minutes (OR, 2.02; 95% CI, 1.24–3.29). Staphylococcus aureus was the most commonly identified SSI pathogen following cesarean section (49.56%), and Escherichia coli was isolated in 44.93% of SSIs among patients undergoing gynecological surgery. Conclusions: SSI interventions should target this high-risk group. Based on microbiology culture and susceptibility results isolated from SSI cases, novel antibiotic therapies are needed to treat SSIs.

Objectives: We aimed to reduce surgical site infections in Camarines Norte Provincial Hospital, Philippines, (1) by establishing SSI surveillance in the surgical departments, (2) by implementing quality improvement processes, and (3) by developing and implementing an SSI prevention care bundle. Methods: In partnership with Americares, SSI surveillance based on CDC criteria was instituted for all surgeries, excluding orthopedic surgeries. Staff were trained in applying quality-improvement methodology, infection prevention and control, and SSI prevention. A care bundle based on the WHO evidence-based interventions for SSI prevention was designed. Interventions included preoperative bathing, surgical hand preparation, intraoperative surgical-site preparation using 2% chlorhexidine isopropanol solution, and postoperative wound management. The model for improvement methodology was used to implement these changes for 12 months from May 2020 to May 2021. Results: In total, 718 surgeries were followed for SSI surveillance, with an average of 58 surgical patients per month in 2020, which increased to 90 patients per month in 2021. In 2020, the SSI incidence rate was 1.76%, and this rate increased 38.64% to 2.44% in 2021. A statistically significant increase in knowledge of 5.29 points (95% CI, 4.91–5.67) among 150 participants undergoing SSI training between pretest (+6.46) and posttest (+ 11.76) was achieved. SSI care-bundle checklists were used for 80% of eligible surgical patients by 2021. Compliance with the SSI care-bundle checklist increased from 0 to 87.69% (n = 718) by October 2021, subsequently decreasing by 2.75% by December 2021. Conclusions: A quality-improvement process embedded in routine surgical care can be a building block for reducing SSIs. However, we did not achieve an overall decrease in SSIs, likely due to increased reporting of SSIs through improved SSI surveillance. However, important gains were achieved in improved healthcare worker knowledge and practice through the implementation of an SSI care bundle. Fluctuations in checklist compliance reflected COVID-19 surges.

Objectives: We aimed to reduce the overall surgical-site infection (SSI) rate to 0.2%. Methods: A new checklist protocol was developed based on the APSIC guidelines. The bundle for preoperative preparation was implemented: adequate preoperative bathing, proper time of hand-forearm washing, and sufficient contact time of antiseptic application. The compliance rate was monitored with a weekly control chart from December 2019 to November 2020. Results: In total, 9,995 cases were operated at Narasuan University Hospital (NUH) in 2020, classified by surgical wound type as follows: clean wound, 62.6%; clean-contaminated wound, 32.1%; contaminated wound, 0.8%; and dirty wound, 4.5%. According to surgical wound type, the mean compliance with preoperative bathing was 68.22% for clean wounds, 68.33% for clean-contaminated wounds, and 34.82% for contaminated wounds. Hand hygiene preparation compliance was higher for clean wound surgeries (mean, 94.01%) and clean-contaminated wound surgeries (mean, 95.05%) than for contaminated wound surgeries (mean, 88.30%). A high percentage was achieved by the 3 groups. The rate of skin antiseptic preparation compliance was higher in the clean wound group (mean, 89.05%) and the clean-contaminated wound group (mean, 90.70%) than the contaminated wound group (mean, 68.12%). The lower rate might be due to time constraints in contaminated wound operations. Only 0.18% of clean-wound operations had SSIs, and the clean-contaminated wound group had 0.19% SSIs, whereas no SSIs occurred in the contaminated and dirty wound groups. The overall SSI rate was 0.17%; thus, we achieved our goal. Conclusions: A bundle of preoperative infection-prevention preparations reduced the rate of SSI. Furthermore, the bundle had a highly tangible positive impact for both internal and external stakeholders, and it was effective in ensuring good practice regarding preoperative preparation.

Objectives: Based on Sardjito Hospital surveillance data in 2020, the incidence of SSI in orthopedic implant surgery was 46 cases (4.7%), mostly in the outpatient clinic. We evaluated some of the potential risks and proposed redesign of infection prevention and control measures in April 2021 to improve the overall clean care at the orthopedic outpatient clinic. Methods: We conducted an operational study to redesign various components of clean care using a before-and-after evaluation of infection risk. The study was led by an IPC nurse and was supported by all levels of stakeholders at Sardjito Hospital, a referral and academic hospital in Yogyakarta, Indonesia, during May–September 2021. Results: The redesigned components covered continuing professional development (CPD) through a workshop on clean care and wound care for doctors and nurses. The workshop also encouraged high-level management to make several important changes: (1) to redistribute medical staff schedules, (2) to start online patient registration to better distribute and decrease patient loads, (3) to set up the waiting room as well as the dressing room with strictly separate between dirty and clean areas, (4) to schedule daily general disinfection at noon during service hours, and (5) to perform routine air disinfection after daily clinic services as well as placing an additional portable HEPA filter for continuous air disinfection. After the these changes, during 2021, 7 SSIs occurred among postoperative orthopedic implant patients, a decrease of 85%. We observed more clean and neat rooms without patient overcrowding as well as easy and comfortable flow of patients and staff. Environmental pathogen germ counts decreased significantly. Conclusions: A redesign project at the orthopedic outpatient clinic reduced the incidence of postoperative SSIs and reduced the number of environmental pathogens. Overall clean care is a basic strategy in IPC for improving patient safety.

Objectives: Improper reprocessing of endoscopes may result in healthcare-associated infections. Regular microbiological surveillance is an important means of evaluating the quality of endoscope reprocessing. We evaluated the effectiveness of reprocessing endoscopes (including the protocols on steps to be taken in the event of any positive microbiological results) in a sterile supply unit (SSU) and an endoscopy unit in a Singapore tertiary-care academic hospital. Methods: Singapore General Hospital (SGH) is a 1,750-bed, tertiary-care, academic medical center in Singapore with 2 main SSUs: 1 inpatient endoscopy unit and 1 outpatient endoscopy unit. We reviewed microbiological surveillance results from endoscopes following reprocessing from January 2018 to December 2021. In total, 160 endoscopes (27 bronchoscopes, 58 gastroscopes, 52 colonoscopes, 6 duodenoscopes, 5 echoscopes, 5 cystoscopes, 5 rhinolaryngoscopes, and 5 enteroscopes) and 15 automated endoscope reprocessors (AERs) were evaluated for the presence of microorganisms. Samples were obtained by swabbing the tip of the scope and the biopsy channel. Fluid was flushed from the biopsy channel after reprocessing, and this water from the AERs was sampled after waterline disinfection. Results: Of the 15,783 samples collected, 15,667 (99.3%) yielded no growth; 36 (0.2%) were positive for gut and environmental flora; and 80 (0.5%) were positive for low-concern organisms such as skin flora. Conclusions: Microbiological surveillance yielded a high percentage of negative results confirming the effectiveness of endoscope reprocessing. This quality-assurance process is necessary and beneficial in achieving patient safety.

Objectives: We evaluated the resterilization rate, user satisfaction, and cost of resterilization after rearranging and packing of reusable instrument sets. Methods: For 1 month in July 2018, we conducted an observational prospective study in 39 service departments for which sterilization and instrument packing was done by the central sterile supply department (CSSD). Common sterile instrument sets (eg, intercostal drainage (ICD) sets, bone-marrow aspiration sets, or suture sets) were analyzed to set up basic surgical instruments for common procedures and specific instruments for each procedure. Sets for common procedures were then packed and rearranged for use universally in various procedures separately from specific instruments. A questionnaire survey was delivered to all 39 service departments to evaluate user satisfaction. The resterilization rates and cost analyses before and after the rearranging and packing were compared for their effectiveness. The data were analyzed using descriptive statistics for percentage, mean, standard deviation, and inferential statistics. Categorical data were analyzed using the χ2 test and continuous data were analyzed using a t test with significance level of 0.05. Results: The resterilization rate decreased significantly from 7.1% to 0.1%. The cost of resterilization decreased from 76,500 Thai baht (US $2,287) to 4,800 Thai baht (US $143) within 1 month. Overall, user satisfaction regarding this intervention was 85.2%. Conclusions: This study highlights the need for the evaluation of process and customer demand to improve user satisfaction and reduce hospital cost by customizing the sterilization packaging and rearranging process.

Objectives: Dental instruments are contaminated by blood and saliva during dental procedures. To prevent cross infection, all contaminants should be removed from the surfaces of instruments. Inadequate cleaning can hinder disinfection and sterilization process. To compare the cleaning efficacy of an automated washer–disinfector versus an ultrasonic machine on dental instruments, adenosine triphosphate (ATP) measurements were compared. Methods: From National University Polyclinic Bukit Panjang Dental Services, we collected 2 loads of 40 dental instruments previously used in dental treatments: extraction forceps, high-volume suction tips, Coupland elevators, matrix band holders, and ultrasonic scaler tips. At the point of use, gross soil was wiped from instrument surfaces with water. Each instrument was swabbed after cleaning either using a washer–disinfector or an ultrasonic machine. The relative light units (RLU) on the luminometer indicated the amount of ATP contaminants and residue bioburden present on the instruments. Results: The mean RLU values across all instruments in the washer–disinfector group was 2.5 times lower than the mean value of the instruments in the ultrasonic group (35.4 vs 89.9 RLU). This difference was statistically significant for all instrument groups except for the high-volume suction tips. The Mann-Whitney U test indicated that the RLU in the ultrasonic group was higher than the RLU for the washer–disinfector group for extraction forceps (P < .001), ultrasonic scaler tips (P < .023), and matrix bands (P < .006). A t test indicated the same relationship for Coupland elevators (P < .005). Conclusions: The mean RLU values for both cleaning methods were lower than the manufacturer’s benchmark (RLU ≤ 150), suggesting that both methods can achieve effective cleaning. However, cleaning using an automated washer–disinfector is significantly more effective than an ultrasonic machine for nonlumen instruments. The effectiveness of cleaning using ultrasonic machine varied greatly among different types of instruments with different design complexities.

Objectives: Sterilization failure is one of the main causes of surgical-site infections. We assessed the effectiveness of the sterilization process of surgical instruments to determine the reasons for sterilization failure. Methods: In total, 100 sterilization cycles were observed from February 4, 2022, to September 5, 2022, in hospitals in Dhaka City. We used sterilization quality assurance monitoring tools (ie, biological indicators) for rapid steam and ethylene oxide sterilization methods. Tests were performed using an automatic reading machine, chemical indicator strips, and indicator tape for both steam and ethylene oxide methods. For laboratory testing and data collection, APSIC guidelines were followed. All samples were incubated for 48 hours to cross check the accuracy of the auto-reader result. Results: All ethylene oxide sterilization cycles were 100% successful, as shown by the rapid biological indicator (auto-reader), chemical indicator strips, and indicator tape. However, 22% sterilization failure occurred with steam sterilization, which was confirmed by the auto-reader, chemical indicator strips, and indicator tape. All biological samples showed no growth after 48 hours of incubation, except the sample from steam sterilization, which did show growth after 48 hours of incubation. Conclusions: We detected 22% steam sterilization failure, and serious harm to patients could occur if these surgical instruments were used for surgery. Process recall would not have been not possible if rapid biological indicator tests had not been performed and other chemical monitoring tools had not been used. The regular use of monitoring tools according to guidelines can be a reliable solution to reduce surgical site infections caused by inappropriate sterilization of surgical instruments.

Objectives: We noted moisture in Thompson retractor sets after steam sterilization in our hospital. Moisture can cause severe problems leading to potentially contaminated instruments that carry infection risk to patients and cause procedure delays, wasted time and effort, greater workload, and higher costs. We sought to reduce the number of retractor sets with moisture to zero. Methods: The central sterile supply (CSS) team discussed the cause of the problem. We hypothesized that temperature difference between the sterilizer chamber and inside the container might create condensation and thus moisture in the final surgical set. We collected and analyzed data and proposed an experiment to improve the sterilization process. We performed a trial of sterilization process improvements pertaining to proper loading technique and the packaging process. We also evaluated the appropriate drying time for rigid containers. We then rearranged the process and adjusted the cooling time from 30 to 60 minutes after steaming. Results: Moisture in Thompson retractor packs occurred because of thicker, rigid containers. We removed the previous type of lining material to separately steam the rigid surgical instrument, and we extended the cooling time to 60 minutes. We updated standard operation procedures and continued to monitor and re-evaluate the process. Conclusions: We identified the primary cause of moisture in Thompson retractor sets after steam sterilization. We illustrated that avoiding sterilizer overload, avoiding contact with fabric wrapping materials, and proper cooling time kept the pack moisture free. Occurrences of moisture in surgical packs after sterilization should be reported and handled efficiently by CSS personnel to preserve quality and avoid waste.

Objectives: The central sterile supply department (CSSD) provides sterile perineal care sets (SPC sets) for use with patients. However, the SPC sets exceed the standard, and the sterilization process incurs high cost. Therefore, a CSSD nursing team set out to find ways to save costs by providing clean perineal care sets (CPC sets) instead of sterile sets. We examined the rate of catheter-associated urinary tract infection (CAUTI) after using CPC sets, measured the satisfaction of the nursing staff who use the CPC sets, evaluated the decrease in the cost to the hospital. Methods: The CSSD nursing team presented some evidence of the benefits of using the CPC sets to the infection control subcommittee and asked for their approval to use CPC sets instead of SPC sets. After approval by the subcommittee, the CSSD nursing staff began to use CPC sets for patients. The incidence of CAUTI was monitored, and a satisfaction survey of the nurses who used the CPC sets was performed. We compared the costs between the SPC set and the CPC set to determine the cost savings. Results: The CAUTI rate did not change after using CPC sets. The nurses who used the CPC sets indicated no difference in satisfaction between the SPC and CPC sets, and the cost of the CPC set was cheaper than the SPC set (27 Baht per set). Conclusions: In a quality improvement effort, using the CPC set was safe for patients. The users were satisfied with the CPC set and trusted the safety of the instruments. Moreover, using the less expensive CPC sets saved the hospital >700,000 Baht per year.

Objectives: Since 2018, the workload in the central sterilization services department (CSSD) has intensified as surgeries have increased. The extended operative time among complicated surgical cases has also led to shortages of resterilized surgical instruments. One factor influencing these shortages was inadequate CSSD staff during high workload periods. We developed a strategy to improve the availability of resterilized instruments. We sought to reduce wasted time and improve effectiveness of surgical instrument preparation by adopting a shift-work arrangement. We additionally sought to minimize unorganized instrumentation and surgical equipment loss. Methods: Team members investigated workload disproportion shift by shift. We devised a practical arrangement of staff for each work shift by dividing manpower in ratios based on workload. Results: The period from 10:00 a.m. to 7:00 p.m. was the period of most intense workload in the CSSD. However, 3 staff worked the morning shift and 2 staff worked the evening shift (4:00 p.m.– 2.00 a.m.). We reassigned 1 person to work from 8.00 a.m. to 4.00 p.m. and 2 persons for an extra shift from 10:30 a.m. to 6:30 p.m. After the manpower readjustment, surgical equipment damage and loss decreased from 57 to 26 losses per year from 2018 to 2021. In addition, work productivity increased from 85% to 115%. Worker satisfaction improved >70%. Conclusions: Internal inconsistency concerning instrumental preparation and improper instrument arrangement can affect surgery time. By addressing workload and shift distribution of labor, productivity notably improved, with higher satisfaction and a dramatic decrease in surgical equipment loss.

Objectives: We evaluated the BHQ instrument management strategies at Bangkok Hospital as well as the general instrument and surgical instrument inventories to develop effective management of general and surgical instruments. Methods: A survey of instruments that had been used and were ready for use was conducted in all departments of Bangkok Hospital. Data were collected and analyzed using statistical methods to adapt the “refill and reduce” strategy. We determined usage rates from each department to determine inventory needs based on the principles that patients are safest with sufficient instruments available and that the central sterilization supply department (CSSD) can provide the best inventory management. Results: Our evaluation revealed that BHQ instrument management strategies can assist the hospital in reducing the cost of resterilizing instruments and thus can lower the workload and reduce tracking conflicts related to overdue instruments. Conclusions: This report confirmed earlier findings that Bangkok Hospital can have more instruments ready to use and can reduce costs without buying replacement instruments by using a strategy of “filling missing parts and cutting the excess.”

Objectives: Single-use medical supplies are usually expensive, resulting in excess costs for hospitals and patients. Reusing single-use medical devices by resterilization or reprocessing has thus been enacted. We compared the cost of resterilizing single-use medical supplies with the cost of new purchases to reduce the unnecessary resterilization of medical supplies. Methods: The central sterile supply department (CSSD) listed single-use medical supplies that were sent for resterilization. Policies and guidelines for reusing or resterilizing single-use medical supplies were established following the standards for disinfection and sterilization. The costs of the resterilizing process for single-use medical supplies were compared with the expenses of new purchases of those medical supplies. Results: In 2019, many medical supplies were resterilized, and the resterilization of single-use devices cost up to 2,352,270 Thai baht (US $68,340). Since this project was implemented in fiscal year 2020 (October 1, 2019–September 30, 2020), the resterilization of medical supplies has decreased, and the cost of resterilization has decreased to 1,356,280 Thai baht (US $40,557), leading to a saving of 995,990 Thai baht (US $29,783, or 42% of the resterilization cost in 2019). The CSSD proposed a resterilization policy in which resterilization for reuse must be done for medical supplies and/or devices that cost ≥1,000 Thai baht (US $30). Conclusions: Although this project did not reach the target outcome of 100% reduction, the outcome was consistent with the aims of the project. The cost of resterilization of single-use medical supplies can be reduced, and a resterilization system can be developed that assures safety and effectiveness to both service providers and patients.

Objectives: We examined the washing evaluation method of the flusher disinfector installed in the medical site by visual evaluation using an ISO test soil and adenosine triphosphate (ATP) measurement. Methods: The test soil shown in ISO15883-5 was applied to the bedpan using 2 methods (N = 10) and was then visually evaluated using a 4-step scale. The ATP value on the surface of the bedpan corresponding to each scale was measured, and the correlation with the visual scale was confirmed. In addition, a visual evaluation was performed using a different flusher disinfector and bedpan (N = 3). Results: In the visual evaluation, when the test soil was applied to the entire surface of the bedpan, it remained in the parts where the water flow was hard to hit. When the test soil was applied to the surface of the bedpan except the lid, no soil remained. The 4-step visual evaluation scale and the logarithm of ATP value showed a positive correlation. In visual evaluations with different flusher disinfector and bedpan combinations, the residual soil patterns tended to be different. Some bedpans showed washing failure related to improper design. Conclusions: Poor cleaning of flusher disinfectors may occur when the amount of water used is insufficient or when the bedpan is significantly contaminated. It is important to carry out flusher disinfector washing evaluation at medical sites to evaluate the function of flusher disinfectors. An appropriate program must be utilized for staff education and appropriate management. Because flusher disinfectors and bedpans differ, flusher disinfector cleaning evaluations should be carried out at all facilities.