Reprocessing medical devices in Mongolia

TSAGAAN GANTUMUR

‒ Location: Northern Asia, between China and Russia (landlocked)

‒ Climate: strongly continental

‒ Area: 1,564,116 sq km

‒ Population: 3,2 million , in Ulaanbaatar 1,5 million people

Mongolia

– Culture: nomadic life style

– Religion: Buddhism, Shamanism

– Economy: herding (61 million livestock), agriculture and mining

– GDP 11,16 billions $, ranking 129 of 195 countries

– Health expenditure : 4.7 % of GDP

‒ Healthcare system:

3500 healthcare facilities

70 thousand newborn every year

‒ Emerging infectious diseases:

Tuberculosis

HBV, HCV 10%- 22%

Sexual transmitting disease

‒ Healthcare associated Infections:

5.7% and 19.1%

Some determinants for HAI

‒ Poor knowledge and application of basic infection control measures

‒ Insufficient guide for hygiene procedure

‒ Lack of hygiene products and equipment

‒ Poor hand disinfection in hospitals

‒ Poor recording and response to HAI

‒ International hospital hygiene and IPC projects:

WHO, ADB, Meshhp

Many many trainings on IPC …

Some achievements in reprocessing of medical devices

Reprocessing Old pattern New challenges …

Step 1: Cleaning Washing powder + H2O2

Detergents

Step 2: Disinfection Mixed chemicals Disinfectants listed by the Association for Applied Hygiene (VAH)

Step 3: Inspection Almost never Removing rust, lubricating etc.

Step 4: Packaging Old cotton material Reels, pouch and non woven wrapping materials

Step 5: Sterilization Only steam autoclaves

Steam, H2O2, EO, Formaldehyde

Step 6: Sterilization quality assurance

Only chemical tape indicator

Chemical indicators, Bowie Dick test, biological indicator

Sterilization quality assurance in some hospitals

‒ Used bioindicators: BAG-BioCheck Steam

BAG-BioCheck EO

BAG-BioCheck H2O2

gke Steri-Record FO

G.stearothermophilus‒ Monitored sterilizers:

105 steam 3 EO 1 FO 1 H2O2

‒In study included 77 hospitals of Ulaanbaatar:

44 dental clinics, 26 state and private hospitals3 centers for reprocessing of medical instruments 3 maternity hospitals 1 medical waste disposal facility

Most used models of autoclaves and sterilizers

Steam-SHINVA/China

Plasma-LAOKEN/China

EO-From different Countries

Steam-BK75/Russia

FO-MMM/Germany

In monitoring involved steam autoclaves

Imported from Number (%)

China 46 (43,8%)

Russia 25 (23,8%)

Korea 19 (18,1%)

Germany 5 (4,8%)

Japan 6 (5,7%)

USA 1 (1,0% )

Taiwan 3 (2,9%)

Total 105 (100%)

Commissioning period Number

1980-1990 7

1991-2000 10

2001-2010 46

2011-2016 40

No information 2

Total 105

Steam autoclaves

Bio indicators Number

No growth 101

With growth ‒ 4 (3,8%)

Total 105

Some autoclaves did not sterilize …

EO sterilizer

Bio indicators Number

No growth 1

With growth ‒ 2

Total 3

H2O2 FO

Future challenges ….

More attention on IPC at the governance level

Transfer IPC knowledge

Establishing routine controls for sterilization

Improvement technical service and maintenance for sterilization equipment …

Thank you for your attention and welcome to Mongolia !