Conference Report
Introduction

On the occasion of the celebration of the 30^th birthday of the Dutch Central Sterilization Club (CSC), a joint two-day congress was organised with the Flemish society for Sterilization in Hospitals (V.S.Z). The congress took place in Papendal on 27 and 28 September 1999. 350 participants took part in this jubilee congress.

Conference Report
Day 1

The first day focused on the quality of management.

Ms Le Grand congratulated the CSC on behalf of the NVZ (the Dutch Society of Hospitals) with its multidisciplinary approach as a result of which pigeonholing is eliminated. She caused some controversy by critically questioning the request from the CSC to increase the level of training CSSD operatives get.

The NVZ is clearly not happy with this request. It fears that a higher standard of training will deter both prospective employees and employers. This discussion will definitely be continued.

Next Mr de Kanter indicated which steps still have to be taken before recognised training for sterilisation assistants can be started up.

Mr van de Vaart applied the concept of integral quality management to the public pharmacy. It has according to him a number of intersections with CSSD.

Quality management should not only provide a guarantee of product quality but also of service quality. The starting off point are the reachability of norms, standards and guidelines indicating the required levels.

To reach this level the pharmacist has to dispose of a quality system. This can be partially laid down in documentation. Complementary to the process of documentation is the capacity of the employees to act situationally i.e. to meet individual needs of customers.

Ms van Gennip then described the objectives of the Dutch Institute for Accreditation of Hospitals (NIAZ).

The last paper of the morning session was given by engineer Vinkenburg who gave an excellent talk on external quality auditing.

He made a plea for taking into account apart from measurable parameters also subjective elements such as the emotions and the sensibilities (satisfaction) of the employers and the customers in order to as he expressed it: "to allow everybody his/her value system". These aspects, which are very often neglected, can be made tangible through self-criticism and self-reflection.

In the afternoon a number of parallel sessions were organised. An arbitrary selection:

1. New developments in micro-instruments
2. Internal quality auditing
3. Gasplasm sterilization and working conditions
4. Leading through motivating
5. Procedure tray
6. Instrument order system and the AOC code
7. Monitoring of steamsterilizers: a new approach.

After the afternoon sessions the old saying "mens sana in corpore sano" was put into practice. In other words it was time for sports. These culminated in a mini Netherlands - Belgium soccer game and a hard-fought Dutch victory.

Conference Report
Day 2

Ms Meers was the first speaker of the second day.

She discussed the increased responsibility of the head of the CSSD. She always has to take into account a large number of norms and guidelines and a shortage of personnel. Automation can, according to Ms Meers, be a solution if the choice of programme is geared to the knowledge level of the personnel. Because automatic data input is more mistake proof than human processes barcoding could be useful.

Mr Vis, chairman of the CSC, next gave an honest account of how at the Academic Hospital of the Free University of Amsterdam sterile medical devices are handled. The core of his paper was formed by the training story for all managers in how to deal with these tools and the positive results of this training. Very interesting and innovative was the use of the videocamera to record abuses.

The videotakes are later used for educational purposes. He proposed the following measures for improvement:

1. working out of procedures
2. training of personnel
3. internal auditing.

Rene pointed out that purchases had to be centralised in order to allow for standardisation and that permanent training is a must in order to improve the quality of the distribution.

Prof. Luscuere talked about bacterial control through contamination control in operating theatres

The technology used to protect the patient with open wounds in the operating room is comparable to the industrial cleanroom flow systems. However, the quantities of air used are far lower. Since health care workers are primarly concerned with 'live matter' (bacteria) they traditionally use bacteria samples (in the air or through deposition) to monitor the level of cleanliness of operating rooms. These bacteria, which are generated by the presence of people in the operating room, do present a risk to the patient being operated on, and have in practice lead to several percentage of infections which have in turn caused extra costs, morbidity and even mortality. The use of the bacteria sampler method has one major drawback, and that is the time needed to breed bacteria (minimum hours) in order to obtain quantitative measurement. This creates a "dead time" between the measurement and the result. The source of the bacteria however is the presence of people and their activities (time scale seconds), which release them into the operating room. Using this kind of monitoring technique we will never be able to accurately link measurements to sources or spreads or gain insight in how to prevent infections. Bacteria transport in operating rooms takes place through direct contact - to which substantial attention is already being devoted in health care - or through the air, attached to particles. This latter observation links the two fields of application: microelectronics and the health care. Using particle measurement techniques, we can measure the real quality of the environmental air in the operating rooms at relatively low cost. Given the size of the particles, we can identify which ones are big enough to be classified as potential carriers of bacteria. Research into activities, contaminants and spread allows us to match measurements to sources and to identify potentially harmful contamination spreads that can in turn be eliminated.

Research based on this philosophy has been carried out over a three-year period in the Netherlands in the Sociey of Integral Contamination Control, financed by commercial participants subsidised by the Dutch government and carried out by TNO Building and Construction Research. This allows a cost-effective contribution to be made to progress in health care, based on technological developments from industry, but also applicable to the pharmaceutical and food industry.

Mr Varekamp defined the concept communication and drew attention to the different sides of it. New developments influencing communication between OR and CSSD were set out. An important finding was that the dependence of OR in relation to CSSD is increasing. The specific function of CSSD in a hospital is nowadays accepted but a lot still remains to be clarified. This clarification should take place on the basis of objective information.

Finally a number of parallel sessions were held. The congress ended with a one-man-show by Mart Smeets.

More Information

For more information about the lectures of the congress please contact the secretariat of the Dutch Central Sterilization Club through the CSC Website.