The design and development of a context-specific medical washer for laparoscopic instruments for rural Indian hospitals

Abstract

Rural India faces many challenges in providing adequate health care for all. Health awareness among the Indian population is low due to poor functional literacy and low emphasis on education within the health sector.

Minimally Invasive Surgery (MIS), such as laparoscopy, offers many advantages, including smaller incisions, less tissue damage and faster recovery for patients compared to traditional open surgery. The use of laparoscopy in low- and middle-income countries (LMICs) is particularly influential because it can minimise the morbidity associated with laparotomies and provide benefits such as fewer postoperative infections and faster return to work. The laparoscopic instruments must be carefully cleaned and sterilised after each use to prevent infection. In any surgery, there is a risk of infection. Postoperative wound infections (POWIs) occur after surgery on the part of the body being operated on. Globally, the rate of POWIs varies between 0.5 and 15 per cent, while in India, rates between 23 and 38 per cent are consistently measured (Arora et al., 2018). These complications lead to revision surgery, delayed wound healing, increased use of antibiotics and longer hospital stay, all of which have a significant impact on patients and healthcare costs. Antimicrobial resistance (AMR) is one of the greatest threats to human health we face worldwide. (World Health Organisation, 2012a, 2012b).

This project focuses on making minimally invasive surgery such as laparoscopy safely applicable in low- and middle-income countries through a medical washer. It aims to find a research-based solution to improve the reprocessing of laparoscopic instruments to reduce POWIs and the need for antibiotics. The current method of reprocessing in hospitals in rural India does not result in sterile laparoscopic instruments and is harmful to patient, nurse and all other staff present in the OR. Instruments are also damaged during the cleaning process. These problems mainly stem from lack of training of nurses, time pressure and due to lack of cleaning equipment.

The project approach was implemented using the Double Diamond Design Model. In the final phase, a prototype was built and this prototype was evaluated in the context of rural India. The aim of this study was to investigate the medical washer loading system for laparoscopic instruments in rural hospitals and to understand how the loading system is used by nurses without any prior explanation. We also investigated how the concept of the medical washing machine is perceived by the end user.

The medical washer for laparoscopic instruments for the context of rural India has been developed can improve current reprocessing practices. By automating the cleaning process, the medical washer reduces the risk of human error and ensures that instruments are thoroughly cleaned. The inclusion of a loading system that can be used without extensive training ensures that the system can be used safely and correctly by all healthcare workers. With the combination of these systems in an integrated design, the medical washer can additionally provide value by reducing cleaning time and allowing nurses to take rest breaks or do other tasks.