Medical device reprocessing practices and operating room satisfaction following a multimodal quality improvement initiative in a Tunisian tertiary hospital

Abstract

Inadequate medical device (MD) reprocessing is a major contributor to healthcare-associated infections in low- and middle-income countries. Effective sterile processing relies on continuous staff training, standardized protocols, and adequate infrastructure. This study aimed to evaluate changes in compliance with MDs reprocessing practices following implementation of a multimodal quality improvement intervention. As a secondary objective, OR staff satisfaction with sterilization services was assessed through an internal survey. A quasi-experimental pre–post study was conducted at Sahloul University Hospital, Sousse, Tunisia, between 2024 and 2025. Compliance with MD reprocessing standards was assessed through audits conducted before and after the implementation of a multimodal improvement strategy. Following the intervention, a descriptive satisfaction survey on sterilization services was administered to OR staff. A total of 770 observations were collected over the two study periods. Significant improvements were observed in MD reception (92.2% vs. 100%, p < 0.001), manual cleaning of MDs (77.6% vs. 91.9%, p < 0.001), drying and packaging (88.0% vs. 94.0%, p < 0.001), and autoclave unloading (85.0% vs. 98.5%, p < 0.001). At the individual-item level, three practices showed a significant decline in compliance after the intervention: packaging MDs within 10 min of washing, correct vertical arrangement of sterilization pouches with the paper sides facing each other, and avoiding the use of paper or sleeve packaging on containers. Overall, 120 OR staff participated in the satisfaction survey. The majority (64.2%) reported being satisfied with sterilization services. Technical conformity and instrument traceability received the highest satisfaction scores (> 79%). This multimodal intervention was associated with significant improvements in compliance with MDs reprocessing practices. Overall satisfaction among OR staff was moderate, although it was assessed only after the intervention. Sustaining these improvements over time require continuous professional education, regular audits and feedback, appropriate infrastructure, and ongoing institutional commitment to infection prevention and control.

The authors' abstract, as published at the source. BMC Health Services Research, 2026 · DOI ↗