The EcoClave An innovative solution to the sterilisation challenges faced in the developing world

Transcription

1 The EcoClave An innovative solution to the sterilisation challenges faced in the developing world

2 Sterilisation: Rarely talked about and very rarely done properly Donors often supply pressure cooker autoclaves but do not realise they will almost certainly not be used due to lack of fuel (wood or kerosene) and a lack of understanding. Note the soot marks on a newly supplied EcoClave pressure cooker autoclave, above left. Compare this with the unused model, right, that has been there for several years. No soot or signs of use.

3 Points to Consider Incomplete sterilisation is unacceptable. There is a much higher chance of cross infection due to contaminated instruments. It is the view of the team at Medical Aid International based on many years experience, observations, correspondence and conversations that complete sterilisation virtually never happens outside of any major town or city in the developing world. It should be noted that the process of ensuring properly sterilised instruments, linen and any other items contributes significantly to good discipline and clinical practice.

4 Common Situations Often Little Sister (and similar) autoclaves are donated to help with the sterilisation problem However they do not travel well and are often broken on arrival. They also require a lot of maintenance. The developing world is littered with broken ones. They are small litres. They require a lot of power, larger autoclaves need three phase electricity. Our BioMedical Engineer trying to repair a broken Little Sister in Malawi. Sadly, in this situation it was not repairable.

5 Back to basics: What is needed to sterilise? Of all the methods available for sterilization, moist heat in the form of saturated steam under pressure is the most widely used and the most dependable. Steam sterilization is nontoxic, inexpensive 826, rapidly microbicidal, sporicidal, and rapidly heats and penetrates fabrics. erilization.html A set of instruments sterilised in an EcoClave. The Bowie Dick tape has changed indicating sterilisation has taken place. This was through two layers of reusable theatre linin.

6 Back to basics: What is needed to sterilise? There are four parameters of steam sterilization: steam, pressure, temperature and time. Pressure serves as a means to obtain the high temperatures necessary to quickly kill microorganisms. Recognized minimum exposure periods for sterilization of wrapped healthcare supplies are 30 minutes at 121 o C (250 o F).

7 In a major surgical unit in Africa this cooker was steaming instruments for eye surgery for 5 minutes (a bit like cooking food). They were then used on the next procedure - this did not sterilise them.

8 Why does sterilisation not take place? Inadequate understanding of what it means. Clean instruments / boiling them does not sterilise the instruments. Very inadequate and unreliable supply of electricity. Electricitical autoclaves need a lot of electricity and have, with few exceptions, reliability issues. A lack of understanding of how to use pressure cooker autoclaves. If using wood, a very significant amount will be needed to run one cycle. It is difficult to maintain the heat level and very impractical. If using a kerosene stove, lack of fuel due largely to cost.

9 To use a traditional pressure cooker autoclave on an open fire is very difficult due to the need to control the heat once it obtains sterilisation pressure. This cooking fire, above right, gives an idea of what it would be like. A lot of wood, time and skill is required to control the heat. Open fires are very dangerous, right.

10 Results from a questionnaire regarding sterilisation at a Primary Trauma Care Course in Africa Answers in red relate to power supply issues

11 What problems, if any, do you have with sterilising equipment? On and off power problem. Electrical power blackouts. Power supply. Often breaks down and shortage of power service - it's run on electricity. Frequent breakdowns, irregular power for running. Lack of skills. Repairs are delayed due to inadequate skills. Most good autoclaves need electricity to run. This makes the cost quite high for the hospital to afford. Facility does not have an autoclave. We use a boiler. Sometimes stops working. I work in the national referral hospital. It has a central sterilising unit which is cumbersome for my unit to keep carrying items for sterilisation. The autoclave in A&E and surgical side here broke down and needs repair/replacement.

12 What problems, if any, do you have with sterilising equipment? Leakage of steam. Power source. There are very few in the hospital. The equipment is too old and faulty. Irregular power supply, few sterilisers/autoclaves Sometimes no power. How to operate. Leakage of pressure. Irregular mains electricity supply. Lack of prompt repairs in case of damage. Lack of power. Inadequate electricity. Power not stable. Power failure. Failure to function sometimes. Running the same autoclave over and over again. Unreliable power (electricity). Power irregularity and small size. None, other than too small for our ward size.

13 What is the capacity of your autoclave? Up to 10 Litres 38% (10 ) Up to 20 Litres 35% (9) Up to 40 Litres 15% (4) Up to 80 Litres 8% (2 ) Over 80 Litres 4% (1) An EcoClave is 39.5 Lts and holds three instruments sets, right

14 What power do you use for your autoclave / sterilizer? Electricity 63% (17) Gas 4% (1) Fire 15% (4) Other 19% (generators) (5)

15 Using a pressure cooker autoclave is straight forward. The basic sequence is below: 1. Clean instruments / linen 2. Put just under 1 inch of water in the bottom 3. Place instruments inside and replace top 4. Heat until steam is permanently coming of out pressure release valve. Close valve. The pressure gauge will start to climb. 5. Once the gauge needle is in the green (sterilisation) zone, maintain heat so pressure / temperature is maintained 6. Wait 30 minutes and then release steam by opening valve 7. Remove top

16 The EcoClave - The Solution A simple way of heating the autoclave was needed to ensure: Safety Effective use of fuel Simplicity of operation Reliable and maintenance free Reasonable cost to purchase

17 The EcoClave - The Solution An aluminium frame securely and safely holds the pressure cooker autoclave. It allows the heat to cover the base and go up the sides of the autoclave. A controllable draw through wood fuelled heating system. A fully insulated, fireproof lining to maximise the effect of the heat. It uses approximately three shoeboxes of wood (less after the first cycle).

18 See our YouTube site for film of an EcoClave being used: youtube.com/user/medaidintl For further information contact: Tel +44 (0) Mobile +44 (0) Fax +44 (0) Unit 3, Firs Farm Stagsden Bedfordshire MK43 8TB

19 Thank you