On October 26, 120 delegates met in the picturesque region surrounding Kasteel van Brasschaet for a study day organised by the sterilisation association Vereniging Sterilisatie in het Ziekenhuis (V.S.Z). Luc Drieghe, IBA, Griffith Microscience, spoke within the framework of the commercial preliminary programme about "ethylene oxide outside the hospital - an alternative?". Then the V.S.Z chairman, Wim Renders, opened the official programme. In his introduction he stated that a stepwise approach is the most effective method for achieving results. One step which most sterilisation departments have almost completed is abandoning the reuse of medical devices destined for single use. The next step for the CSSD will no doubt - primarily due to the pressure from some leading figures - be the setting up of a quality assurance system, including an associated quality manual.
As first speaker, F. Peys, pharmacist, explained the cost-benefit relationship in the healthcare sector. On the basis of an historic outline he showed the evolution of costs in the healthcare sector from the time of the first oil crisis at the beginning of the seventies up till the present time. Before the first oil crisis there was no problem with finance, and efficiency, safety and quality constituted the three criteria for acceptance of a new medical treatment. In the ensuing period it became necessary to reduce costs due to a poor economic situation. Increasing costs in the healthcare sector led to an imbalance between income and expenditure.
In future increasingly more attention will be paid to the cost-benefit statement as well as to the efficiency of a measure. Demographic and technical developments together with overuse provide for an ongoing escalation in expenditure. The task falling to health economists is to look for the most efficient and effective deployment of the available resources. Dr. Peys explained the 4 types of economic evaluation on the basis of a few examples - altogether a very good and clear analysis of the subject.
Jan Bosch, former technical consultant at RIVM, then spoke about maintenance of steam autoclaves. He began with the thesis that cleaning commences at the time of purchasing the device. If one puts together a good profile of requirements, many disturbances can be precluded from the outset. Bosch elaborated on the steam quality and on the various types of clean steam: filtered steam, clean steam and pure steam. The corrosion-inducing properties of steam call for high-quality materials as well as for precautionary measures when connecting the autoclave, in order to prevent formation of condensate water in the steam connections. Steam should always have 100% saturation. Overheated steam is unacceptable.
Next, he elaborated on the surface roughness. The smoother the surface of the inner walls of the autoclave, the fewer the cleaning measures required. In addition Bosch focused on the problem of appendages, while pondering as to whether a safety lock is necessary, and how pressure differences can be avoided in the compressed air system by using a buffer tank. Bosch gave preference to a door-locking system with compressed air over a steam system.
Mr De Roeck, Marketing Director at Johnson & Johnson, dealt in the next lecture with the problems arising on using malfunctioning Cidex solution. Chemical strips should be put to general use to function as a preventative measure.
After lunch and having visited the industrial exhibition, R. Groeneveld, Branson, spoke about the four steps necessary to ensure the success of cleaning. Aspects playing a role during cleaning include the volume, chemical and mechanical factors as well as time. The correct combination of these parameters should lead to the desired result. Then the various detergents were classified according to their degree of acidity. A closer look was taken at ultrasonic cleaning: the method of functioning was explained as well as physical factors affecting functioning. Of special importance in this context are:
- the temperature
- use of correct chemicals
- the selected frequency
- assignment of the piezoelectric element
Following this, the advantages of ultrasonic cleaning were outlined:
- quick cleaning
- intensive cleaning
- less heat required
- low concentration of the cleaning solution
- cleaning without damage
- cleaning without dismantling
- cleaning in poorly accessible corners
Dolf Linden from Medisch-Technisch Adviesbureau explained ultrasound on the basis of its practical deployment in the CSSD.
Using a chronological overview, E. Goovaerts, who is responsible for central sterilisation at the University Hospital of Antwerp (UZA), explained how the reduction in the number of devices requiring gas sterilisation led to a handing over to another company. The most decisive factors were:
- A central "vision" that made provision for decentralised processing of endoscopes as well as the approval of the endoscopy departments
- Monitoring of the number of such devices in the CSSD by a supporting quality assurance system
By involving the management in the problems relating to treatment of endoscopes and in reprocessing/resterilisation it has been possible to effect restructuring on a global scale.
- Devices have been purchased for dencentralised processing. The system is being supported, inter alia, by regular biological checks (in the CSSD) and by a logbook
- Materials that are suitable for steam sterilisation have been purchased (with a fixed budget), in order to replace devices that were amenable only to gas sterilisation.
Hence within one year the number of devices requiring gas sterilisation was reduced from some 20 ISO trays per week to 1.45 (average value). All measures concomitantly resulted in an increase in quality awareness in the respective departments and in greater transparency in respect of effect as well as vis-à-vis the management.
Under the title "Calculation is Knowledge", Martine Hermes, Kimberley-Clark, explained how one can calculate the price of a sterilised instrument set in the practical setting. Each department within the hospital is required to limit its budget and to reduce costs as much as possible, without adversely affecting quality. In the CSSD, too, the need is being increasingly felt to identify and control costs. On the basis of a cost calculation, the various cost factors become clear, as does the influence they exert on the total price. The four cost factors determining the total price of a sterilised set are: labour (76%), materials (13.4%), adjuncts (4.5%) and deductions (6%). Labour accounts for the greatest portion of costs. This means that a reduction in the labour costs could also considerably reduce the total price.
Recourse can be had to this cost calculation when making decisions affecting the price of a set. A reduction in one of the cost factors could lead to an increase in another and vice versa. It is therefore important to know the interplay between the cost relationships. This type of cost calculation thus provides valuable assistance when it comes to making decisions because one can from the outset estimate the likely consequences arising for the total price.
On conclusion of a successful study afternoon, the minutes were available for the activities of two working groups:
- Architectural standards (P. Cornelissen)
- Procedures (L. Verbist)
Walter Accoe, Gent
Wim Renders, Brugge