Objectives: Many medical devices and equipment have been reserved in hospital wards and outpatient departments. Among these items, >80% are not often used but are being reserved for emergency situations. We aimed to reduce the number of unnecessarily reserved medical devices and to reduce the cost of unnecessary resterilization of devices and equipment. Methods: The central sterile supply department (CSSD), in coordination with other 13 wards within the Thammasat University Hospital, established a standard action plan for improving the efficiency of medical supply stocking and storage. Medical equipment and/or devices were returned to the CSSD, which acted as the center of management and distribution. The CSSD also tracked and solved problems that occurred and reevaluated practice guidelines. User satisfaction was evaluated and statistic data were collected and analyzed. Results: Wards no longer reserve medical equipment. Thus, no repeated sterilization was needed for unused medical equipment from the participated 13 wards, and sufficient medical equipment was available for various wards when needed. This project helped reduce the cost of purchasing medical equipment, especially for a newly opened ward. The storage of all medical equipment and devices complied with the practice guidelines because the CSSD storage room had a standard temperature and humidity control system. Conclusions: In this project, the CSSD cooperated with the 13 participating wards. As the result of centralizing the supplies, the CSSD has sufficient medical equipment and devices for all other wards, including a newly opened ward. The hospital benefitted from reduced costs of purchasing new medical equipment for a newly opened ward as well as the cost savings of eliminating unnecessary resterilization of unused devices and equipment.

Background: Disinfection and sterilization of medical devices, instruments, and medical supplies are a crucial part of hospital infection control. The significant problems include insufficient cleaning, incorrect registration in the request form, no basic cleaning at the point of use (POS), and incorrect labelling. These problems were analyzed according using the fishbone diagram process. Objectives: We sought to decrease insufficient cleanliness of items after washing, to increase data accuracy in transferring contaminated devices from wards (from end users), to increase the rate of decontamination at the point of use, and to decrease incorrect labelling on instrument packaging. Method: The Community of Practice in Sterilization (CoP Sterile) team revised the disinfection and sterilization system of the Naresuan University Hospital Central Sterile Supply Department (CSSD) using root-cause analysis of subprocess problems and implementing prioritized solutions. A regular monthly meeting was set up to ensure active response, and closed monitoring was performed to ensure the implementation of the revised protocol according to the plan–do–study–act (PDSA) process. Results: From 2019 to 2021, the percentages of annual insufficient cleanliness of items after washing decreased from 4.8% to 3.6% to 3.1% each year. The percentages of incorrect request forms decreased from 14.59% to 2.91% to 1.84% during these same years. The percentages of decontamination ignorance at the point of use decreased from 3.13% to 0.12% to 0.03% from 2019 to 2021. The percentages of incorrect labelling were 0.013%, 0.008%, and 0.013% each year. Conclusions: The CoP Sterile team used quality improvement tools and regular monitoring to achieve reductions in insufficient cleanliness and incorrect request forms and to increase knowledge of decontamination procedures.

Objectives: Public health emergencies caused by airborne infectious agents are a significant concern, re-emphasized by the current COVID-19 pandemic. It is therefore vital to employ a technology that destroys microbes of all phyla and genera. We describe a novel technology called “Zebox” that can extract, trap, and destroy microbes from the air. This technology destroys even microbes that are resistant to known antibiotics. Methods: Airborne microbial load was enumerated using standard microbiological methods in both hospital ICUs and controlled conditions. Significant microbial reductions due to the ZeBox intervention in the ICUs were confirmed by statistical analysis. Results: ZeBox eliminated a broad spectrum of airborne pathogens (ie, viruses, bacteria, and fungi) in laboratory tests and in hospital ICUs, which are characterized by high, stochastic microbial loads. In closed-chamber experiments, ZeBox achieved a >99.999% reduction of airborne microbes. In the hospital ICU, ZeBox achieved a consistent >90% reduction across several months. Some of the airborne pathogens that ZeBox eliminated in the hospital ICU were multidrug resistant. Conclusions: ZeBox is an effective preventive technology against the spread of airborne pathogens and potentially associated infections. ZeBox could be used to reduce healthcare-associated infections in clinics and hospitals, as well as in burns units and immunocompromised patients. Zebox has the potential to be a significant prophylactic device in the global war on antimicrobial resistance.

Background: In the post–COVID-19 era, competency of healthcare workers is very important, and new technology is imperative. The central sterile supply department (CSSD) staff must also improve their response when a patient infection is reported. The sterilization process is more important than ever. Objectives: We sought to simplify surveillance to act faster, to reduce the time to obtain patient data, and to eliminate nonvalue stream mapping in the workflow process in order to prevent patient harm and strengthen our infection prevention and control efforts. Methods: The CSSD staff met with an IT developer to determine requirements for an electronic surveillance program. Before this intervention, we scanned hard copies of patient records and stored them in a folder on a computer on a daily basis. These data were difficult to search, monitor, and display, and this method wasted time in locating patient data. The IT developer designed a program to track patients and instruments. The program collected data regarding the patient’s surgery, instruments used, and monitoring information. With the help of the IT developer, the CSSD staff tested and tweaked the new platform until accuracy and usability were achieved. Staff were trained on the use of the new system before it was implemented. Results: This project yielded simplified surveillance that improved the infection prevention process, reduced potential patient harm, and strengthened the ability of the IPC team to analyze and act on data. Conclusions: A simple surveillance system for tracking patients and instruments used assists both CSSD and IPC teams. This system assures the performance of sterilization procedures. When adverse events occur, patients who used these devices are tracked, and an analysis is performed to identify and implement improvements.

Objectives: Single-use devices are supposed to be used only once, but under some conditions those devices need to be reused. Therefore, we conducted the “Reuse of Single-Use Devices Management” project in our hospital. We evaluated single-use devices that are reused for the following factors: (1) reuse of the single-use device with the same patient; (2) a manufacturer stop production order; (3) lack of devices in inventory; and (4) device value >5,000 Thai baht (US $150). Every unit in the hospital is able to handle and monitor the reuse of single-use devices systematically for patient safety. We performed a quality surveillance project to monitor and prevent patient infection and injury from worn-out reused single-use devices, and we collected data related to the cost of reusing single-use devices. Methods: In a working group that studied single-use devices, responsibilities and roles were assigned and the purposes and scope of work were established. We reviewed the reuse of single-use devices policy. We created a request form for the reuse of single-use devices and a quality record form for use in units that reused single-use devices. We analyzed outcomes, monitored data, and audited the completion of these forms on these units. We assured the completion of single-use device registration. We measured the rate of reuse of single-use devices. We monitored the incidence of surgical wound infections related to reuse of a single-use device. Results: Both of these forms were implemented at 100%, and the number of surgical wound infections was zero. Conclusions: The project focused on single-use device registration and the rate of devices ready to use. The uptake of new procedures was 100%, and the expected number of surgical wound infections in patients was zero.

Background: Avoidable infections in healthcare (healthcare-associated infections or HAIs) occur globally. The causes of HAI are influenced by a complex combination of gaps in policies, infrastructure, organization, knowledge, healthcare worker behavior, and patient-related factors. Through knowledge, best practices, and infrastructure improvement, the infection prevention and control (IPC) team aims to prevent harm to patients and healthcare workers due to HAIs. The most common HAIs are surgical site infections (SSIs) caused by harmful device-reuse practices, inadequate sterilization, and/or inadequate decontamination procedures. Disinfection and sterilization of instruments and medical devices play very important roles in HAI and SSI prevention. World Health Organization (WHO) Collaborating Centre in Quality Improvement Program certification, the first pilot project in Thailand, included the Central Sterilizing Services Association of Thailand and 15 hospital central sterile supply departments (CSSDs). This quality improvement program for sterilization reprocessing aimed to prevent harm to patients and healthcare workers due to HAIs. Objectives: We sought to reduce damage to instruments caused by inadequate reprocessing sterilization to zero incidents. We sought to reduce inadequate packing to ≤3 events per month. We sought to reduce the need to resterilize instruments by >80%. Methods: A root-cause analysis meeting was held by CSSD staff, and an IT vendor was consulted about developing an electronic alert system. The following changes were implemented: Staff packed instruments using a list of pictures for each set. Sticker labels were applied showing the proper number of pieces in the set. Identification O-rings were added to instruments with inventory dates, serial numbers, and instructions for use. Stickers were added to indicate the method of sterilization, such as ethylene oxide gas only or hydrogen peroxide only. Results: Reports of damage due to the sterilization process decreased to zero. No events related to the packing process were reported, and resterilization of instruments decreased by 98.94%. Conclusions: In this project, we implemented a quality improvement process and tracking system, reduced defects, and increased healthcare worker competency to improve patient safety.

Objectives: The central sterile supply department (CSSD) is responsible for sterilization processes, and instruments are then stored in a clean room until use. Environmental controls, such as temperature, and relative humidity, are important in preventing the spread of infection during the sterilization process and during storage of medical devices. Data regarding temperature and relative humidity readings in the operating room, and whether instruments remain covered for the duration of the operation, are difficult to obtain. For easy access to relative temperature and humidity data covering all operational intervals, a rapid and convenient notification system was designed using a software application to send temperature and humidity information to the ThingSpeak website. We identified abnormal values for temperature and relative humidity and submitted revisions for all operating periods to facilitate monitoring of the refrigeration system. Methods: We implemented 3 programs: (1) DHT11 humidity and temperature sensor; (2) NodeMCU ESP8266; and (3) Program Arduino IDE. Results: The ESP8266 board connected using WIFI SUTH Mobile, and the DHT11 displayed temperature and humidity. The temperature and humidity data were sent to the website every 10 minutes. When an alarm occurred, it triggered immediate notification via the software application. Conclusions: We designed a temperature and humidity alert system using DHT11. Environmental control was possible using ESP8266, and alerts were triggered in the software application when an anomaly occurred. Data were uploaded to ThingSpeak every 10 minutes. The triple system actually sends alerts through the application and records data every 10 minutes. This system can measure environmental conditions in real time.

Background: After 3 years, we discovered that a high-value instrument, rigid endoscopes, needed to be used and cleaned properly. If those instruments are damaged from inappropriate handling or reprocessing, they can pose infection risks to patients. Furthermore, the hospital incurs additional repair costs. Objectives: We sought to ensure that specialized instruments are handled and used appropriately in accordance with the manufacturers’ recommendations and that all related units handle and use instruments appropriately. Methods: A meeting was convened to establish the purposes and scope of the work, and related data were collected. As a result, we created registration forms for high-risk instruments as well as a survey list for rigid endoscopes. These forms were distributed to appropriate units. We analyzed outcomes, monitored the indicators, and audited work processes. The operating room registered high-value instruments on a form that included instructions for use. A dealer demonstrated how to handle the rigid endoscopes. The CSSD team visited the operating room to emphasize the importance of handling and reprocessing to ensure compliance. The BEM team inspected all endoscopes after use. We created group communication within the software. Using T-DOC, we analyzed and monitored outcomes. We measured the rate of high-risk instrument registration as well as the completeness of registration. We also measured the rate of damage to rigid endoscopes. Results: We collected data related to rigid endoscopes and educated the staff to handle and reprocess the instruments appropriately, including instructions for use. High-risk instrument registration forms and surveys were created to record information in the T-DOC system. The staff was invited to educational workshops. The rates of registration, registration completeness, and readiness were measured using the plan–do–check–act (PDCA) method. The results of every indicator reached the expected rates of 100%. Conclusions: We achieved our goal of 100% compliance with the new program. All high-value instruments should be registered, and all related staff should be trained to use them appropriately.

Objectives: We aimed to provide sufficient equipment to effectively and efficiently track all equipment. Advanced management procedures are available for the treatment of any patients with infections or immunodeficiency as well as those who need special treatment or isolation from others. This management plan can be beneficial for the hospital by promoting process improvement and achieving cost effectiveness. Methods: The instruments used were surveyed in all departments of Bangkok Hospital and these data were analyzed. We used a plan–do–check–act (PDCA) strategy to improve the management by moving from a manual system to a collaborative innovation project that used 4 technological systems: (1) storage identification and identification codes for equipment; (2) request, return, and delivery using the Nsmart system; (3) transportation, receiving, and delivery; and (4) an HIS system for tracing and NSterile version 4.0 software for reporting. Results: The BHQ isolation cart management system helped the hospital control inventory and prevent infection and helped standardize patient services to improve quality at the hospital. Conclusions: This report confirms earlier findings that sufficient equipment can be made available to patients with no extra cost to management. Our findings can contribute to efforts to prevent the virus from spreading within the hospital.

Objectives: We sought to reduce waiting time for instruments in the operating room, to develop technology for communication between zones, to record data in real time for planning instrument management, and to increase trust and satisfaction of customers. Methods: The central sterile supply department (CSSD) provides sterilization of instruments and medical devices, mostly to the following departments: operating room, dental unit, outpatient otolaryngology, and obstetrics and gynecology. The CSSD processes 557,588 units per month, among which 30.05% are for the operating room. In the normal process when the operating room send instruments for decontamination, the operating room staff places stickers on the item or uses a form to document the request. The normal turnaround time was 3 hours and 9 minutes and urgent turnaround time was 2 hours and 14 minutes. For color control, we used white color for normal requests and pink for urgent requests. We redesigned our record keeping using Google forms and sent data on dashboards with real-time alerts in the CSSD application to notify staff of an urgent request. Results: Staff in the dirty zone placed an urgent tag on the instrument baskets of the auto-washer. After the door was opened in the clean zone, staff noted the urgent tag and marked a validation sheet, then placed a red unilock on the rigid constrainer. Peel pouches were marked “urgent,” advising sterile storage zone staff to separate the basket from normal baskets and to apply the “urgent” paper form and labelling. Conclusions: Turnaround time improved by 15 minutes for urgent instruments. Lead time to export data for analysis increased from 80% to 95.49%. Because of facility design, it was difficult to ensure communication between separate dirty, clean, and sterile storage zones. We redesigned our process using new technology to improve turnaround times, reduce waste, improve communication, and increase productivity.

Objectives: The central sterile services department (CSSD) offers a variety of procedures, including collecting contaminated medical equipment from various agencies through a process of washing, cleaning, packing, and sterilization, followed by storage and distribution to internal and external departments. Plans to expand and open service to the Center of Excellence continue, which will result in a rapid increase in the processing of specialized medical devices. The Center of Excellence is a source of education, learning, teaching, and practice in the cleaning, disposal, and sterile treatment of medical devices. We sought to improve the quality of sterile medical equipment to satisfy international standards of safety. Methods: We implemented a 7-stage process in the CSSD and we developed a checklist with 8 categories of environmental development based on APSIC guidelines. We provided knowledge to CSSD employees, developed their skills, and promoted attitudes in various areas, including sterile work standards, the use of sterilization machines, and infection prevention and control both inside and outside the facility. Results: We established inventory control systems, storage guidelines, and disbursement of medical supplies and equipment in the CSSD. To improve machine use in sterilization treatment or disposal, we educated staff and provided practice of machine skills according to instructions for use. Information technology (IT) was used for the distribution process, medical device identification, recording sterilization, and statistical logging of sterilization and sterile services. Conclusions: Overall, we improved the quality of CSSD services and knowledge and practice of CSSD staff, and we achieved compliance with international standards. These measures ensure the safety of service providers and patients and build trust in the quality of CSSD services and output.

Background: Pattani Hospital in southern Thailand has 540 beds and a network of 22 family clinical practice and community locations and 13 primary-care hospitals. We care for patients and soldiers who have wounds from guns and bombs of varying wound size. The central sterilization services department (CSSD) prepares dressing sets with 1 size dressing procedures. Objectives: We sought to improve the sizing of dressing sets within Pattani Hospital and network, to reduce preparation time to ≤3 minutes per set, and to reduce the cost of dressing sets by 8,000 Thai baht (US $240) per month. Methods: We convened a problem-solving meeting to address the sizes of dressing sets in the hospital. We decided that 3 sizes were needed (small, medium, and large) following the size of the wound. We performed a pilot project and evaluated its progress every 2 months. Results: Unique dressing sets were used in 68.18% of cases before the intervention and 88.5% after the sizing changes. Time to prepare the dressing sets decreased from 3 minutes to 1 minute per set. The intervention reduced the costs related to dressing sets from 39,952.50 Thai baht (US $1,194) per month to 25,641 baht (US $766) per month. Furthermore, infectious waste was reduced from 31.8 kg per day to 7.99 kg per day. Conclusions: Multiple sizes of dressing sets were prepared for use with wounds of varying size. The CSSD prepared the dressing sets using medical supplies such as gauze, cotton, and top gauze. This project reduced waste and improved cost-effectiveness, and this procedure will be extended to other care facilities in our network.