Study Visit Report
On 10 May 2001 the society Vereniging Sterilisatie in het Ziekenhuis (VSZ) paid a visit to the only Belgian instrument manufacturer, Pilling Weck, Simal in Franière. Besides an extensive range of general instruments the Simal plant specialises in the production of titanium and mri-instruments. The latter are used during image creation by means of magnetic resonance just because of their non-magnetic characteristics.
First the visitors were welcomed and a short overview of the history of Simal of its ties to Pilling Weck were given by Olivier Rouvez and Peter Buysse, general managers of Simal and Pilling Weck, respectively. Then for the 70 participants and collaborators the study day proper, which was excellently organised, could start.
The first part consisted of a theoretical discussion illustrated with practical examples. Engineer and technical director Luc Tytgat perfectly managed to combine theory with practice with the result that problems we are confronted with daily got a theoretical underpinning. Problems such as water spots, corrosion, ‘stress fractures’, tight hinges etc. were discussed. Causes, effects and remedies were systematically dealt with. As is always the case prevention is much preferable to cure.
Practical advice, based on years of experience, were given in connection with the treatment of instruments, e.g. do not use silicone oil but biocompatible paraffin oil, do not only pay attention to chlorides (blood, water) but also to jodides (jodine alcohol for example). It was also explained why an instrument which had to be repaired, e.g. a needle machine, had to be completely rehardened, instead of simply replacing the deficient parts, why it is better not to sterilise a closed tampon tweezers with compresses etc..
Thanks to this exposition terms such as interchristaline rupture, austenitic and martinsitic steel, point and stress corrosion, to passivate - now form part of our basic vocabulary.
Finally the most important advantages of titanium (corrosion resistance and spring) and its implementation possibilities were discussed. Everybody received a practical guide with recommendations and tips about this extensive subject.
Then in small groups of 4 to 5 persons we were given a guided tour around the shop floor. We followed the whole production process from stainless steel to a quality instrument. At each workstation we got a thorough explanation of the how and the why of a given manipulation. Didactic panels showed step by step the different production phases of each instrument. It is obvious that numerous manipulations are necessary to arrive at a satisfactory end product and that each step of the process is a necessary one.
This study visit has demonstrated that an instrument maker has to be highly skilled and that the work is still to a large extent based on craftsmanship. It is labour intensive also because the highest possible quality requirements are laid down and optimal functionality is expected. As it is not always clear where the basic materials come from it is absolutely necessary to establish a relationship of trust with the supplier of instruments.
The careful development of instruments sometimes sharply contrasts with the careless way in which they are dealt with in operation theatres and in nursing care. A lack of time and a couldn’t-care-less attitude severely impact on the useful life of an instrument, partially because it is often assumed that stainless steel is indestructible and requires minimum care. We all know which disastrous effects the wrong treatment of an instrument can have.
Not only from the point of view of the patient but also for the sake of the instrument a thorough cleaning and sterilisation is of prime importance to guarantee a good functioning and a long useful life. Only when an instrument is treated with respect (i.e. adequate cleaning, control, packaging, sterilisation and careful storing) will the reparation and replacement costs remain under control. This however requires time, attention and effective arrangements between all the parties concerned.
Finally: a good insight into all problems concerning instruments is imperative for all CSSD collaborators and managers. Indeed some knowledge of chemistry and physiology could prove that not the sterilisation unit but other departments are responsible for sterilisation problems, which might have occurred elsewhere. In cases where the sterilisation was defective the problem can be more easily detected and the necessary countermeasures taken.
It is also the responsibility of the CSSD to inform others about the correct use of instruments in order to facilitate the circular process to which the instruments are subjected.
Ludwig Van de Voorde