Study Visit Report
On 20 June 2002 the society Vereniging Sterilisatie in het Ziekenhuis (VSZ) visited the Virga Jesse Hospital in Hasselt. The hospital has about 600 beds of which 160 are surgical. The main activities focus on orthopedic, cardiac, neuro and vascular surgery.
In his introduction our chairman Wim Renders sketched the slowly evolving evolutions within our domain of expertise. Quality management has found its way into the CSA. Most departments are planning or carrying out architectonic and organisational improvements. The training of sterilisation assistants and managers too is thoroughly revised and adapted. The next training course for assistants starts on 26 September in the Katho in Roeselare.
Our chairman pointed to the necessity of there being written procedures in the CSA. The ministry is increasingly checking whether this is the case. The quality handbook has to be the repository of the credentials of the central sterilisation department and has to form the basis of a well structured department.
After this introduction we were welcomed by the people in charge of the CSA of Virga Jesse Hasselt: Armand Busselen and Inge Cleeren. The evolution and the eventual establishment of the CSA in Virga Jesse were discussed. The software management package (T-doc) was introduced. It was pointed out that the CSA has a very personnel friendly character which is expressed in amongst others the work schedule, the attention for ergonomics, the infrastructure (shower, airconditioning, ...)
Then mr. Heinze Sikkema, head of the CSA of the medical centre Noorderbreedte in Leeuwarden talked about the steps approach one has to apply when setting up a new or reorganised CSA. This requires careful and systematic planning.
Apart from determining the present position (where are we and what are our objectives) which involves an evaluation of working methods, distribution, production, bottlenecks etc. in a first orientation phase the main lines have to be drawn.
Important are the latest developments in the sterilisation area, new wishes of the personnel and of the customers of the CSA, visits to colleagues and to their departments.
This is followed by the preparatory phase. A project team which consists amongst others of the purchasing, technical and informatics departments, CSA personnel, pharmacy. Quotations are requested and discussed, capacity calculations made, logistics and routing analysed, ergonomics and space requirements are calculated, equipment compared etc. During the decision making process this multitude of facets finds a definite place within the whole.
This talk illustrated that renovation within the CSA is something which has to be done after careful preparation and in consultation with different departments. Speed will never have the desired endresult. When one neglects through haste certain important aspects this will have detrimental consequences for the organisation. Moreover it will be extremely difficult to correct the mistakes afterwards, just think of architectural designs. Think before starting should be the watchword.
The last talk was given by Patrick Cornelissen staff member of medical-technical services of the Jan Portael hospital in Vilvoorde. He talked in depth about the disinfecting and sterilising of critical medical materials. The long used classification into low and high level disinfecting still exists but is not specific enough anymore e.g. an endoscope and a vaginal speculum both need a high level of disinfection but a thorough disinfection of an endoscope is much more difficult than of a speculum. Re-usables are not necessarily easier to clean: laparoscopic tongs of an older generation which cannot be disassembled, Kerrisons...
The creation of subgroups with their own specific points of attention is called for. With his long experience as head of the CSA he once more pointed out that cleaning is the most important step in the disinfection and sterilisation process. It is a pre-condition for an adequate follow-up procedure. But it is also the first phase in which corners are cut when the CSA comes under time pressure.
Finally he sketched a slightly pessimistic vision of the future. There is a growing discrepancy between the cost price of the materials used during operations and the related revenues for the hospital. It is unfortunate when in times of cost controls savings have to be made in cost centres which should in actual fact be upgraded. The minimal procedures which sometimes have to be followed for medical devices do not allow any further cost cutting. There is no step back beyond 'rudimentary'.
This study day was a very successful one. Our thanks go to the organisers who once again have given the participants a lot of food for thought.
Ludwig Van de Voorde
Head of CSSD
AZ Maria Middelares