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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 14  |  Issue : 1  |  Page : 18-20

Sterility preservation of surgical dressing packs wrapped in gumstick lining material


1 Department of Nursing Science, Bayero University, Kano, Nigeria
2 Department of Medical Microbiology, Aminu Kano Teaching Hospital, Kano, Nigeria
3 Department of Nursing, Central Sterile Supply Unit, Aminu Kano Teaching Hospital, Kano, Nigeria

Date of Web Publication7-Apr-2017

Correspondence Address:
Salisu Abubakar
Department of Nursing Science, Bayero University, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0331-8540.204077

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  Abstract 

Background: Post-sterilisation contamination is the ability of the organisms to penetrate through the wrapping material and settle on the enclosed instruments. Safeguarding the sterility of sterile dressing packs during transportation and storage is an important requirement of a sterile supply packaging system. We evaluated the use of locally available and affordable tailoring lining material popularly known as gumstick. The objective of this study was to ascertain the efficacy of gumstick lining material in safeguarding the sterility of wrapped surgical dressing instrument. Materials and Methods: The post-sterilisation sterility was confirmed by culturing the sterile packs and then exposed to contaminants by leaving the packs on a microbiology working bench. The wrapped packs were then contaminated with suspensions of control strains of some selected bacteria, then swabbed and cultured. The surgical packs were also exposed to environmental contaminants, swabbed and cultured. Results: All cultures yielded no growth proving that the wrapped surgical instruments are bacteriologically sterile and gumstick provides the needed protection against contamination of surgical packs. Conclusion: Gumstick lining material is therefore recommended as packaging material for surgical instrument particularly in resource-constrained settings.

Keywords: Gumstick lining material, sterility, surgical instrument


How to cite this article:
Abubakar S, Sadiq NM, Jibrin Y, Usman BM, Adetokun AB. Sterility preservation of surgical dressing packs wrapped in gumstick lining material. Niger J Basic Clin Sci 2017;14:18-20

How to cite this URL:
Abubakar S, Sadiq NM, Jibrin Y, Usman BM, Adetokun AB. Sterility preservation of surgical dressing packs wrapped in gumstick lining material. Niger J Basic Clin Sci [serial online] 2017 [cited 2017 Jun 25];14:18-20. Available from: http://www.njbcs.net/text.asp?2017/14/1/18/204077


  Introduction Top


Healthcare-associated infections remained an important cause of patient morbidity and mortality.[1],[2],[3] The WHO reported post-operative wound infection as the most occurring healthcare associated infection in resource-constrained settings.[3] Post-operative wound infection, therefore, increases health care costs and affects patient experience negatively.[4],[5] Safeguarding the sterility of sterile surgical and dressing packs during transportation and storage is an important requirement of a sterile supply packaging system. This requirement is essential in preventing contamination of the sterilised surgical instruments during handling, transportation and/or storage prior utilization.

Post-sterilisation contamination is the ability of the organisms to penetrate through the wrapping material and settle on the enclosed instrument. Contamination of surgical dressing instrument has been found to increase the risk of post-operative surgical wound infection.[5] An array of studies has reported the effectiveness of certain sterile packaging materials in preventing microbial contamination of enclosed items [6],[7], while others established a testing method to determine the passage of microorganisms through sterile packaging material.[8] In settings with limited resources, the recommended sterile packaging material is not readily available and Central Sterile Department may be lacking. Where sterile packaging material is available locally, the sterile departments may not be able to afford. Consequently, other alternatives such as ordinary clothing materials are used to package sterile instruments meant for surgical procedures and dressings. We proposed the use of locally available and affordable tailoring lining material popularly known as gumstick to help improve sterility of processed surgical dressing instrument, prevent infection and improve safety of the surgical patient. The study was conducted in Aminu Kano Teaching Hospital's Central Sterile Supply Unit and Medical Microbiology Department to ascertain the efficacy of gumstick lining material in safeguarding the sterility of wrapped surgical dressing instrument. Contrary to approaches used by others to determine the efficacy of sterile packs, we adopted a different approach in which common hospital isolates were introduced as source of contaminants.[9] It is assumed that direct introduction of pathogens on the packs can expose the wrapped surgical instrument to higher amount of contaminants. This can help to determine the true efficacy or otherwise of the lining material in preventing post-sterilisation contamination.


  Materials and Methods Top


The instrument was washed, dried, packed in a kidney dish and then wrapped with gumstick lining material. Each pack contains surgical forceps, gauze and swabs. The packs wrapped in gumstick lining material were then sterilised using steam under pressure (autoclave) at 121°C for 50 min. Sterility of the packed instrument was confirmed using an autoclave tape and were labelled A and B. Packs were then transported to Microbiology Laboratory for the investigation. The outer wrapping material was first swabbed and the packs were aseptically opened and the instrument swabbed using swap sticks wet in sterile normal saline. The swabs were inoculated unto Chocolate and MacConkey agar plates, respectively. The labelled plates were incubated aerobically at 37°C for 24 h.

The packs were aseptically closed and then allowed to stand on a bacteriology working bench. American Type Culture Collection (ATCC) strains of Staphylococcus aureus (ATCC no 25923) and Escherichia coli (ATCC no 25922) were inoculated on similar plates using a sterile wire loop as control of the media used. Suspensions of the control organisms were made using sterile normal saline to obtain a turbidity which were compared with standard 0.5 MacFarland's suspension. They were inoculated unto labelled Chocolate and MacConkey agar plates respectively and incubated at 37°C for 24 h. The MacConkey plates were incubated aerobically while the Chocolate plates were incubated in 10% CO2.

With the aid of sterile Pasteur pipettes, the outer surface of the wrapped surgical dressing packs were exposed to the organisms by sprinkling the suspension of the control organisms as a form of contamination. The wrapped packs were then allowed to stand on the bench for 1 h to allow the wrapped material soak and to further expose the wrapped instruments to contamination.

After an hour, the packs were aseptically opened and the surgical dressing instruments were swabbed using sterile swab sticks and inoculated unto labelled Chocolate and MacConkey agar plates, respectively. The plates were incubated at 37°C for 24 h. The procedure was repeated 4 times at an hourly interval. For fungal study, the swabs were further sub-cultured unto Sabouraud dextrose agar for 7 days at 25°C.


  Results Top


The control organisms (S. aureus and E. coli) were found to be viable on both Chocolate and MacConkey agar plates incubated at the same condition as described in the methods [Table 1]. The enclosed surgical dressing instrument wrapped in a single layer of gumstick lining material shows absolute sterility on the media plates after an hour of exposure to contaminants. Similarly, sterility of the instrument did not change after 2, 3 and 4 h of exposure with viable microorganisms [Table 2]. Thus, the surgical dressing packs were found to be microbiologically sterile as no contamination was found on the covering of the packs at baseline following transportation from the Central Sterile Unit to Medical Microbiology Laboratory. More so, no organism was isolated from the enclosed instrument after maximum incubation period despite exposure of the outer packs to heavy contaminants at 1, 2, 3 and 4 h, respectively [Table 1]. In addition, all the wrapped packs show no fungal spores after 7 days of mycology study using Sabouraud dextrose agar [Table 3].
Table 1: Baseline testing of sterile packs and viability of the organisms

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Table 2: Culture results at different hours of exposure

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Table 3: Mycology study of the surgical packs

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  Discussion Top


Several wrapping materials are available for packaging sterile surgical dressing materials. Often, these standard wrapping materials are not readily available and affordable in settings with limited resources particularly Sub-Saharan Africa. This study established the barrier efficacy of locally available wrapping material popularly called gumstick. Despite prolonged exposure to viable pathogens, the material provided the needed protection against heavy contamination.

Unlike in earlier studies that determine the effectiveness of sterile pack wrapping materials [7],[8],[10] this study directly exposed the wrapped sterile surgical dressing instrument to viable E. coli and s. aureus. The assumption was that post-sterilisation contamination of surgical dressing packs occurred during handling, transportation and/or storage prior utilization. Thus, direct exposure with high dose of pathogens can demonstrate its ability to prevent microbial penetration. The study by Dunkelberg and Wedekind [8] evaluated the quality of single and double sterile packaging materials exposed to ambient air established that double packing has higher barrier efficacy than single. Conversely, this study revealed full barrier efficacy of single layer packaging with gumstick material which is cost friendly, locally accessible and affordable. However, due to resource constraints, the study was unable to examine sterility of the instrument after days of storage. Nevertheless, the investigators assumed that the intentional heavy contamination of the outer pack was sufficient to demonstrate the possible and potential long-term effect of the material. More studies to examine the effect of the sticky gum material on the surgical and dressing instrument are required.


  Conclusion Top


Conclusively, the study found that the material is effective in the following ways:

  1. Gumstick lining material can withstand the autoclaving temperature (121°C) for the required period of sterilisation without significant change in its nature
  2. Gumstick lining provides the needed protection against bacterial contamination of surgical dressing instrument after sterilisation and despite exposure to pathogens on a working bench of bacteriological laboratory
  3. The lining material was able to prevent contamination of the sterilised instrument after been deliberately exposed to viable bacteria capable of contaminating the package
  4. Safeguard against environmental fungal contamination in spite of many days of exposure at room temperature of a bacteriology laboratory.


The study, therefore, established that sterilised surgical instrument wrapped in gumstick lining material can remain free from microbial contamination for a long period.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Allegranzi B, Bagheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, et al. Burden of endemic health-care-associated infection in developing countries: Systematic review and meta-analysis. Lancet 2011;377:228-41.  Back to cited text no. 1
    
2.
Lambert ML, Suetens C, Savey A, Palomar M, Hiesmayr M, Morales I, et al. Clinical outcomes of health-care-associated infections and antimicrobial resistance in patients admitted to European intensive-care units: A cohort study. Lancet Infect Dis 2011;11:30-8.  Back to cited text no. 2
    
3.
World Health Organization. Report on the Endemic Burden of Healthcare Associated Infection. Worldwide; 2011. Available from: http://www.apps.who.int/iris/bitstream/10665/80135/1/9789241501507_eng.pdf. [Last accessed on 2016 Apr 20].  Back to cited text no. 3
    
4.
Brandt C, Sohr D, Behnke M, Daschner F, Rüden H, Gastmeier P. Reduction of surgical site infection rates associated with active surveillance. Infect Control Hosp Epidemiol 2006;27:1347-51.  Back to cited text no. 4
    
5.
Dancer SJ, Stewart M, Coulombe C, Gregori A, Virdi M. Surgical site infections linked to contaminated surgical instruments. J Hosp Infect 2012;81:231-8.  Back to cited text no. 5
    
6.
Dunkelberg H, Schmelz U. Determination of the efficacy of sterile barrier systems against microbial challenges during transport and storage. Infect Control Hosp Epidemiol 2009;30:179-83.  Back to cited text no. 6
    
7.
Webster J, Radke E, George N, Faoagali J, Harris M. Barrier properties and cost implications of a single versus a double wrap for storing sterile instrument packs. Am J Infect Control 2005;33:348-52.  Back to cited text no. 7
    
8.
Dunkelberg H, Wedekind S. Preliminary results for a new final package test to assess the quality of sterile package systems. Infect Control Hosp Epidemiol 2004;25:26-9.  Back to cited text no. 8
    
9.
Ayliffe GA, Babb JR, Quoraishi AH. A test for 'hygienic' hand disinfection. J Clin Pathol 1978;31:923-8.  Back to cited text no. 9
    
10.
Standard PG, Mackel DC, Mallison GF. Microbial penetration of muslin- and paper-wrapped sterile packs stored on open shelves and in closed cabinets. Appl Microbiol 1971;22:432-7.  Back to cited text no. 10
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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