There is also the reality that a sealed package is more of a guarantee of sterility than something that should be autoclaved. Even in the US there have been cases of nasties being passed by inadequate cleaning.

And we had a big scandal locally. Were they doing a shoddy job of colonoscopies? Probably. But genetics left no doubt that they were using one needle per jab, but one syringe per patient. And drawing up from multi-use vials. Stick the hep C patient, in pulling back a bit ends up in the syringe. Discard needle, syringe is still infected. New needle, old syringe, draw from the vial again, vial is now infected.