Autoclave (steam steriliser)
Many medical devices are reusable and have to be sterilized after use in order to prevent healthcare associated infections. Autoclaves, i.e. sterilizer machines using high-pressure saturated steam, are crucial to achieve effective and safe surgical activities in the field. With surgical activities in MSF requiring increasingly complex surgical instruments – e.g. tubular instruments – the demands on autoclaves continue to grow. Sterilization quality aside, autoclaves should use less water and energy per cycle, be more time-efficient, and be robust and easy to use and maintain in situations where technical support and training is lacking. This innovation project explores a new autoclave concept to complement current autoclaves in field settings where power supply is more reliable.
The project includes multidisciplinary collaboration between several actors, with MSF Sweden Innovation Unit as coordinator and biomedical and infection control referents from the MSF Operational Centre in Brussels as problem owners. Interviews and questionnaires were used to gain insights into the needs of referents, surgeons, nurses, mobile implementation officers, and field workers. Sterilization experts with both field and research backgrounds were consulted to bring in the latest sterilization research findings along with complementary experiences from Ministry of Health (MoH) settings in resource-poor settings. Universities were involved to design new autoclave concepts and explore potential failure modes on existing heater elements. Finally, a manufacturer was brought in to do detail design and prototyping.
The autoclave was installed at the MSF’s training and innovation centre in Brussels, Espace Bruno Corbé (EBC), where initial tests showed that the prototype improves the water efficiency with at least 70% compared to reference autoclaves. Also, average cycle completion time has been reduced with at least 50%. Using an electronic testing system (i.e. 3M ETS) as a complement to Bowie-Dick tests, the sterilization cycle has been redesigned to achieve full steam penetration also in tubular instruments.
Apart from the advantages regarding time and resource efficiency, a significant outcome is the improved understanding of sterilization quality that has evolved. Designing a machine that can promise the highest level of sterilization is obviously important, but the innovation project has also allowed the MSF Operational Centre in Brussels to more thoroughly assess its own protocols when it comes to sterilization.
A thorough needs and requirements analysis has been performed, together with theoretical and experimental analysis to find the reasons behind broken autoclave heater elements.
The MSF Sweden Innovation Unit was responsible for coordinating the development of a concept for a new autoclave to address the above and other requirements. A first prototype was designed, which did then undergo assessment and evaluation at Espace Bruno Corbé (EBC) in Brussels during Q1 2016.
Field tests in Tabarre, Haiti, are ongoing and will be completed during Q3 2017.
MSF Biomedical Working Group (Case referent is the biomedical referent from Operational Centre Brussels, OCB)
MDS (previously Sterimed S.A.), France
MDS, Chambly, France
Delft University of Technology (TU Delft), Delft, The Netherlands
Royal Institute of Technology (KTH), Stockholm, Sweden
Lambda Projects, The Netherlands
HEART Consultancy, Renkum, The Netherlands
3M, The Netherlands & Sweden
Stokman, F. 2014. Water efficient sterilization for humanitarian aid: A redesign of the Robustex 90L (autoclave). Master thesis, Delft University of Technology.
Poster presented at the MSF Scientific Days in London, May 20-21, 2016.