Multimodal program lifts sterile processing compliance in Tunisian hospital

In hospitals across low- and middle-income countries, inadequate reprocessing of medical devices remains a major contributor to healthcare-associated infections, and effective sterile processing depends on continuous staff training, standardized protocols and adequate infrastructure. Researchers at Sahloul University Hospital in Sousse, Tunisia, set out to test whether a multimodal quality improvement initiative could strengthen compliance with medical device reprocessing practices in a tertiary care setting. Between 2024 and 2025, the team conducted a quasi-experimental pre–post study, auditing reprocessing standards before and after implementation of the intervention and, as a secondary objective, surveying operating room staff about their satisfaction with sterilization services.

The evaluation relied on structured audits of how devices were handled along the full reprocessing pathway, from the moment they arrived at the sterile processing department to their final release from the autoclave. A total of 770 observations were collected across the two study periods, providing a detailed picture of compliance before and after the multimodal improvement strategy was put in place. Rather than testing a single educational or technical measure, the initiative combined several improvement components, and the audits were designed to capture whether this combined approach changed day-to-day practice.

Following the intervention, a descriptive satisfaction survey on sterilization services was administered to operating room staff to gauge how the people who depend on sterile instruments perceived the service. The audits revealed significant gains in four core steps of the reprocessing pathway. Compliance in medical device reception rose from 92.2 percent before the intervention to 100 percent afterward, manual cleaning of devices increased from 77.6 percent to 91.9 percent, drying and packaging improved from 88.0 percent to 94.0 percent, and autoclave unloading climbed from 85.0 percent to 98.5 percent, with each change statistically significant at p < 0.001.

Not every practice moved in the right direction. At the individual-item level, three practices showed a significant decline in compliance after the intervention: packaging devices within 10 minutes of washing, arranging sterilization pouches vertically with the paper sides facing each other, and avoiding the use of paper or sleeve packaging on containers. Because the study measured compliance only at two time points, the team also emphasizes that the observed improvements reflect an association with the intervention rather than a definitive causal effect.

The satisfaction survey included 120 operating room staff members. Overall, 64.2 percent reported being satisfied with sterilization services, a level the researchers characterized as moderate. Because the survey was administered only after the intervention, the authors caution that it cannot show how perceptions changed over time or attribute satisfaction levels to the initiative itself.

The study concludes that the multimodal quality improvement initiative was associated with significant improvements in compliance with medical device reprocessing practices at the Tunisian tertiary hospital, while overall satisfaction among operating room staff remained moderate. Sustaining these gains over time, the authors argue, requires continuous professional education, regular audits and feedback, appropriate infrastructure and ongoing institutional commitment to infection prevention and control. For low- and middle-income settings where inadequate reprocessing contributes substantially to healthcare-associated infections, the findings offer a practical example of how a combined improvement strategy, paired with measurement, can raise compliance across the sterile processing pathway while highlighting the technical details that demand continued vigilance.

Subject of Research: Infection prevention and control

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

Article References: Balhi, S., Salem, D. B., Rejeb, M. B., Othmen, T. B., Haddad, N., Cheikh, A. B., Ghali, H., Hsairi, M., & Laatiri, H. S. (2026). Medical device reprocessing practices and operating room satisfaction following a multimodal quality improvement initiative in a Tunisian tertiary hospital. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15938-5

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15938-5

Keywords: medical device reprocessing, sterilization, quality improvement, healthcare-associated infections, Tunisia, operating room, infection prevention and control, Medical, device, reprocessing, practices, operating