ASSESSMENT OF DIFFERENT METHODS OF STERILIZATION OF HSG EQUIPMENT IN RADIOLOGY DEPARTMENTS IN ENUGU URBAN

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• Name: ASSESSMENT OF DIFFERENT METHODS OF STERILIZATION OF HSG EQUIPMENT IN RADIOLOGY DEPARTMENTS IN ENUGU URBAN
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ABSTRACT

This study, Assessment of different methods of sterilization of HSG equipment in Radiology Department in Enugu Urban, was done using questionnaire and interviews methods of data collection. The main purpose of the study was to determine different methods of sterilizing equipment used during HSG procedures in our locality, to assess if attention is given to monitoring of methods used for sterilization of HSG equipment in our locality and to compare the different methods of sterilizing HSG equipment in Radiology departments with a view to recommending the best option available. Eight standard Radiology centers in Enugu Urban were used for this research and a total number of 70 questionnaires were used for the study. The results showed that three major methods of sterilizing HSG equipment are available in the locality of study, which includes high pressure steam (autoclave), Dry heat (oven), and chemicals. 47.84% of the centers make use of chemical,32.47% and 24.21% centers make use of high pressure stem (Autoclave) and dry heat (oven) respectively. The attention given to monitoring of HSG equipment is commendable as 97.57% of the centers monitor the procedure routinely. The result showed that most Radiology centers in Enugu Urban use chemical method of sterilization in preference to high pressure steam (Autoclave) which is a better method of sterilizing HSG equipment. The result simply showed that most Radiology centers in our locality are not in tone with current trend of sterilization as chemicals method of sterilization is hazardous to both patients and staff.

TABLE OF CONTENTS

Title page –       –       –       –       –       –       –       –               i

Approval page  –       –       –       –       –       –       –               ii

Certification-    –       –       –       –       –       –       –               iii

Dedication –     –       –       –       –       –       –       –               iv

Acknowledgement-  –       –       –       –       –       –               v

List of Tables-  –       –       –       –       –       –       –               vii

Abstract   –       –       –       –       –       –       –       –               ix

Table of Contents-   –       –       –       –       –       –               x

CHAPTER ONE: BACKGROUND OF THE STUDY

1.0.  Introduction                                                             1

1.1.  Statement of Problem                                              4

1.2.  Objectives of Study                                                  5

1.3.  Significance of Study                                                       5

1.4.  Scope of Study                                                         5

1.5.  Review of Related Literature                                     6

CHAPTER TWO: BACKGROUND OF THE STUDY

2.0.  Introduction                                                             14

2.1.  Basic Trolley Setting, During HSG Procedures                 15

2.1.1. Radiation Sterilization                                           15

2.1.2. Methods of Heat Sterilization                                 17

2.1.3. Sterilization by Steam                                            19

2.1.4. Sterilization by Dry Heat                                                21

2.1.5. Chemical Sterilization                                            24

2.2.  Monitoring Sterilization Procedures                         29

2.3.  Storage of Sterile HSG Equipment                           31

2.4.  Shelf Life of Sterilized HSG Equipment                    32

2.5.  Other Sterilization Methods                                     34

2.5.1. Gas Sterilization                                                    34

2.5.2. Other Chemical Sterilant                                               35

CHAPTER THREE: RESEARCH METHODOLOGY

3.1.  Research Design                                                      37

3.2.  Target Population                                                    37

3.3.  Selection Criteria                                                     38

3.4.  Source of Data                                                                 38

3.4.1 Primary Source Data                                               39

3.4.2 Secondary Source Data                                           39

3.5   Method of Data Collection                                               39

CHAPTER FOUR

Data Presentation And Analysis                                       47

CHAPTER FIVE: DISCUSSION, SUMMARY, RECOMMENDATION AND CONCLUSION

5.1   Discussion                                                       60

• Summary 65
• Recommendation 66
• Conclusions 68
• Area of Further Studies 69
• Limitations of The Study 69

APPENDIX

REFERENCES

CHAPTER ONE

BACKGROUND OF THE STUDY

1.0.  Introduction

Hysterosalpingographgy (HSG) is a radiological contrast examination used to outline the uterus and the fallopian tubes. It is employed to diagnose a suspected intrauterine tumour, congenital malformation, or suspected fallopian tubes blockage¹.  HSG entails the injection of a radio-opaque  contrast agent into the cervical canals under fluoroscopy with image intensification.  A normal result shows the filling of the uterine cavity and bilateral filling of the fallopian tube with the contrast agent. HSG could be done with either oil contrast agent or water soluble contrast agent.  Oil-based media remained popular until the 1960s.  Their popularity was based on their ability to demonstrate a good delayed film when image-intensified fluoroscopy was not universally available.   Because most HSG is now performed by image intensified fluoroscopy, many experts concluded that oil based media should no longer be used, due to the availability of what are perceived to be safer water soluble peparations².

This examination is usually done on outpatient basis.  It should be performed in the proliferative phase of the cycle to reduce the possibility of radiation exposure of an early embryo³.  In addition, it obviates the unlikely possibility of inducing an ectopic pregnancy by performing the procedure after fertilization and altering embryo transport through the fallopian tube.  The procedure should not be carried out during the active stage of any pelvic infection⁴.

        During HSG procedures, HSG equipment such as vulsellum forceps, vagina speculum, uterine sound, uterine cannula, tissue forceps, the couch and some of the devices that are essential to producing successful quality result are usually sterilized to enhance aseptic conditions. 

However, because they are typically designed for a reuse, they also transmit pathogen if any of the processes involved in their decontamination is compromised.  This gives rise to the introduction of pathogenic micro-organisms into the patient’s body and initiate an infection process, owing to the fact that patients in hospitals often have low immunity to infection⁶.This leads to iatrogenic or nosocomial infections in the patients. Iatrogenic infection is synonymous to nosocomial infections and they are infections which are as a result of treatment or health care service unit, but secondary to the patient original condition⁶.

Sterilization of equipment used in HSG procedure can be achieved if any of the steps involved in reprocessing, cleaning, disinfection or sterilization are adquate¹⁰.  Sterilization techniques include all the means used to completely eliminate or destroy all micro-organisms on  objects, including tools used to diagnose or treat patients.     To be effective, sterilization requires time, contact, temperature and with steam, sterilization high pressure.

In radiology departments today, there are different method of sterilizing HSG equipment which ranges from radiation form of sterilization, which includes electron beams, x-rays, gamma rays and subatomic particles.  Other methods include, high pressure saturated steam using an autoclave, or dry heat using an oven.  These methods are the most common and readily available methods of heat sterilization¹⁰.  An alternative to high pressure steam or dry heat sterilization is chemical sterilization (often called, “cold sterilization”).Monitoring sterilization procedures is another important aspect of sterilization to ensure effective sterilization and sterilization can be monitored routinely using a combination of biological, chemical and mechanical indicators as parameters.

This study is aimed at evaluating the different sterilization methods employed on HSG equipment and disposable HSG kits.

1.1.  Statement of Problem

1. Different methods of sterilizing HSG equipment have not been documented in our locality.
2. It has been observed that enough attention has not been paid to the methods employed in HSG equipment sterilization in our locality.

3  Most Radiographers do not know the methods of sterilization of HSG equipment.

1.2.  Objectives of Study

1. To determine different methods of sterilizing equipment used during HSG procedures in our locality.
2. To assess if attention is given to monitoring of methods used for sterilization of HSG equipment in our locality.
3. To compare the different methods of sterilizing HSG equipment in Radiology department with a view to recommending the best options.

1.3.  Significance of Study

This research work,

1. Will document different methods of sterilizing HSG equipment in radiology department in our locality
2. Will define the level of attention exhibited during sterilization methods employed on HSG sterilization.
3. Will suggest the best option of sterilization methods in our locality based on the available local capacity.

1.4.  Scope of Study

This study will be restricted to X-ray or radiology departments in Enugu Urban.