Conference/Seminar Report

Methods and conditions of sterilization process, and how it is monitored are very important subjects in a hospital. Sterilization processes are getting more complex each day, and it is now an undeniable necessity to reorganize the sterilization processes in our country. Each health organization has a different method for dealing with hospital infections which are a major threat to human and hospital health.

Central sterilization units under control of well-trained personnel, have the advantage of providing safe, low cost, of good quality working system. Foundation and organization of such central sterilization units require and increase the responsibilities of units dealing with sterilization. Increase in the number of participants and positive feedbacks encouraged us to arrange this third course and the aim of this course is to describe the organization and procedures in detail and provide the participants a hands-on training.

This year Third Sterilization and Reuse Course was organized by Dokuz Eylul University Central Sterilization Unit and was held on 15-18 May 2003 at Dokuz Eylul University Lecture Hall with many national and international participants.

As. Prof. Arzu Sayiner from Microbiology Department gave the first lecture about "Sterilization and Sterilization in Low Temperatures" on 15th May 2003. In this lecture, the answers to the following questions were discussed:

• What is sterilization-disinfection?
• Which methods can be used for sterilization?
• What are the advantages and disadvantages of these methods?
• Prion activation, a special problem during sterilization.
• Basics concepts of sterilization.
• Disinfection of endoscopes.

Following conclusions were derived from this lecture.

• Surgical instruments must be suitable for pressurized steam sterilization.
• Pressurized steam must be preferred for sterilization.
• If sterilization with low temperature is necessary, either ethylene-oxide, formaldehyde, gas plasma method must be chosen and it is important to pay attention to cost, implants and suitable environment.
• High level disinfection must not be used instead of sterilization.

Hulya Erbil, director of Dokuz Eylul University Hospital Central Sterilization Unit gave a lecture titled "Sterilization Process and Control" and emphasized that a central approach is needed in sterilization process; that a central sterilization is economical, is also beneficial for patient health and safety and reduces the nasocomial infections. In the lecture, she also talked about

• Aim of decontamination, process of decontamination (transportation, clothes, separation, washing)
• Steps to be taken during arrangement and packing,
• Inspection of sterilization (Bowie-Dick tests, chemical indicators, biological indicators), loading and unloading of sterilizators, storage processes and inspection,
• Control of quality.

Toni Zanette, director of Tubingen University Central Sterilization Department, in his lecture titled "Continuous education for safety of quality in sterilization" emphasized the importance of safety and control of quality.

Nergiz Bengu, gave a lecture about management of quality in sterilization units and discussed about quality management system, main components and benefits of quality management. She also presented the work-list, task definition, registration schedule, international standards, education in Dokuz Eylül University Central Sterilization Unit.

She also mentioned the importance and benefits of sharing the knowledge among staff members.

Cornelia Hugo, director of Health Quality in Tubingen University made her presentation about "Education in Quality Management", and advanced education program. This advanced education program is designed by German Medical Committee and European Quality Organization, meaning that this education is already accepted at European level. It was also mentioned that collaboration between different professions is needed. The mentioned education program includes

• Quality management system and self control and supervision in health care,
• Application of quality management system,
• Statistical methods, economics in health,
• Total quality management and improving new methods,
• Real hospital.

Cornelia Hugo indicated that motivation of the staff at every level is the key point, that establishment of a quality management does not require renewal of everything, and that optimization of the documentation and continuing the search for a more efficient application systems in a hospital is very important.

She finished her words by saying "We're the most important staff in the hospital, we're crowded and we know the right thing. Start to do something and show this to others."

Alp Ergor from Public health department in Dokuz Eylul University had a lecture about "Sterilization and risks of working life", and in his lecture he discussed about definition of a health worker, international data about diseases among health workers. He also mentioned about the situation in Turkey. According to him factors effecting the health worker's health are:

• Working environment (physical, biological, chemical, psychosocial)
• Working conditions (total hours of working, salary, education)

Most encountered risks in sterilization units are:

• Ergonomic stresses (sitting, light, repetitive movements, colors)
• Biological risks (HBV,HCV,HIV)
• Chemical risks (Ethylene oxide, latex allergy)
• Accidents (cuts, burns, electric shock)
• Other risks (working in a closed and isolated environment, management problems)

Allowed working limit in Ethylene Oxide is 1 unit (ppm) in 1 billion units of air for an 8 hour working period. (OSHA, USA 1984)

3 main risk conditions are:

• Exceeding the allowed limit (0.5ppm)
• Exceeding the working limit (5ppm for a short period)
• Accidental or uncontrolled leakage.

Effects of Ethylene Oxide on workers health are:

• Carcinogenic effect on humans
• Negative effects on reproduction system
• Strong neurotoxic effect
• Allergenic effect
• Acute effects (irritation of skin and mucosa, depression of central nervous system, head ache, nausea, vomiting, dispnea)

On May 16, 2003, first speaker was Adrie de Bruijn and he gave information about the control of the cleaning of instruments. At the beginning of his presentation, he introduced his department and gave an information of medical technology section. He stressed the importance of the cleaning. Dirt may protect micro-organisms from disinfectant and inhibit the action of disinfectants. It may cause corrosion and may harm the patient also. After the introduction, he gave detailed information of washer disinfector standards, tests for cleaning, requirements and evaluation of cleaning results. His topic was so important for our country and his presentation was very interesting and nice. Dirt is generally macroscopic problem and in some hospitals, microscopic problems like microorganisms are accepted more important than this. At this point, the presentation of Mr Bruijn was very impressive.

The second presentation in the morning session was belong to Wim Renders. He is working as a pharmacist at the Saint John's Hospital in Bruges, Belgium. At the same time, he is the president of the Flemish sterilization society. In his presentation, he sketched the evolution in the thinking about the re-use of single-use medical devices in Belgium during the last years. He began his presentation with the historical perspective to re-use. The most important reason for re-use is control of expenses. Re-use is a more or less flexible way of keeping the budget under control. It allows for a direct cutting of expenditure. However, he stressed that re-use is unacceptable both from technical reasons and lack of insurance cover. Main reasons for his regret were;

1. Public opinion would not accept re-use of disposables if they knew it
2. Re-used disposables can not be sterilized in any other way than with ETO or gas plasma. In the case of re-use, this has to be carefully considered and taken into account.
3. The problem of re-use also has an ethical dimension. To which risk can a patient exposed? Do we have to expose our patients to potentially greater risks? His answer was simple, "He do not think so".

His presentation was so interesting.

On 17th May 2003, Central Sterilization Unit (MSUD) of Dokuz Eylül University Hospital was introduced to the participants. Sterilization processes, equipment, work and nightshift conditions, cleaning, control and records of all things were explained.

The last day of the congress was very impressive as the first day. Dokuz Eylül University is the first university in Turkey which is using active learning methods in medicine. Problem based learning model of active learning was applied by experienced medical school instructors. The instructors were Omer Akcali M.D.(orthopaedic surgeon), Guven Erbil M.D.(histology and embrology), and Yucel Demiral M.D (public health). Pretest was applied for the course participants. A special scenario is designed for sterilization course according to the medical faculty programme. In this scenario there was a history about a sterilization unit with wet bag problem. In the first step, past and the present problems were given to the participations. They discussed about the possible reasons of wet bag and after they proposed the solutions for the problems. The educators did not give any knowledge about the topics, they only act as a guide for solutions. At the last step, solutions for the future were questioned and posttest was applied. The results of pretest and posttest was statistically different.

As a conclusion, these kind courses are the corner stone for sterilization in our country. We did not solve the sterilization problems in Turkey but we put small amount of brick on the wall.