Improving The Supply Chain Management of Sterile Medical Devices: A Case of Thailand’s Public Hospitals Under Financial Constraints

Abstract

This research aimed at exploring the supply chain management of sterile medical devices in Thailand’s public hospitals and improving sterilization procedures given limited budget allocations. The key informants included three staff members from the sterilization unit and six members from various user departments at one of Thailand’s district hospitals, a 60-bed facility, referred to as “A”. Research instruments included a checklist, interview form, and record forms for reviews and observations. Content analysis was employed for qualitative data analysis. The first phase was conducted from January to May 2016. A clear picture of the device flow was revealed and mapped out, enabling the identification of weaknesses, root causes, and potential solutions. We determined that injury from sharp objects during hand-washing was a key problem. We found that (i) there were no practices for wiping and soaking instruments right after use, (ii) insufficient amounts of enzymatic detergents and washer-decontaminators, and (iii) there was a need to hire additional staff members. The investigation was further conducted into another public hospital, a 120-bed facility located in the same province, Hospital “B”. “B” effectively used a washing machine for the pre-washing of oxygen masks and tubing, which was subsequently recommended for adoption by “A”. Later, from December 2019 to January 2020, we assessed the implementation, improvements, and flaws of the practices at Hospital “A”. Firstly, the hospital allocated a budget for a used washing machine. Next, among the most serious issues found were high injury rates and excessive staff workloads, in which “A” stated that was in the process of purchasing the enzyme mixing tool cleaner and requesting additional staff. Finally the monitoring and support by the director with the supplementation from the Ministry of Public Health (MOPH) was the most crucial aspect. Our study showed the necessity to evaluate and develop the practices of hospitals with limited budgets, and contributed to Thailand’s healthcare system.