30 October 2006 to 02 November 2006
Black Sea Society of Clinic Microbiology and Infectious Diseases (BSCMID) Kyrgyz State Medical Academy (KSMA) First International Congress of Central Asia Infectious Diseases Bishkek, Kyrgyzstan
[ More information: www.iccaid.org ]
19 August 2006 / 11:00 - 14:00
IDI - Irish Decontamination Institute General IASSM Meeting 19 August 2006 Board Room, Mater Private Hospital, Dublin, Ireland
(All full IASSM members requested to attend)
24 June 2006
IDI - Irish Decontamination Institute General IASSM Meeting 24 June 2006 Castlecommer, Co. Kilkenny, Ireland
(Full and associate IASSM members may attend)
16 June 2006 to 18 June 2006
Hong Kong Infection Control Nurses' Association Hong Kong Society of Endoscopy Nurses Hong Kong Operating Theatre & Sterile Supply Nurses Association HKSSMA - Hong Kong Sterile Services Management Association 2nd International Infection Control Conference "Infection Control: Evidence Vs Reality" Hong Kong Convention & Exhibition Centre, Hong Kong SAR, China
[ Conference Details ] [ More information: http://www.mvdmc.com/icna06/ ]
20 March 2006 to 21 March 2006
in control! - EDANA's Brand New Infection Control Conference The critical role of the nonwoven industry in the prevention of infection Prague, Czech Republic
[ Conference Flyer ] [ Conference Info ] [ More information: www.edana.org ]
It is the time of the year for us to start planning yet once again for the next AGM, Conference and Exhibition - our 11th.
It has always been a source of pleasure for me to extend this invitation to all our members and friends to participate in this event. It is also a great source of satisfaction for me to note your unwavering support for the Association and your enthusiastic participation in its programs year after year and the great speakers that we have for the coming conference.
This year, our theme is "Quality is Priority". This is appropriate for us now as after more than 10 years of ground breaking work in education, under studying, setting standards - we must now look at ourselves with a different perspective.
Being the department entrusted with the task of ensuring sterile supplies for the entire hospital, we must be totally committed to producing a high quality service that we are proud of. We must be totally committed to the managing of a well-run, disciplined, knowledgeable and optimized department where the staff genuinely cares, listens and is committed to doing things the right way.
As sole provider of sterile services in a hospital, it is critically important for us to give quality assurance to the users of our services. It is therefore important to put a major emphasis on process improvement and quality issues to gain optimal efficiency within the department. To be successful, quality initiatives must be strategy driven, process focused and project enabled.
This conference will help us to identify and address some of the quality issues. This is only the beginning of a long arduous journey to learn and practice. However, we believe this is important and must now be undertaken.
Let us now begin to put quality into our lives and make "Quality is Priority".
Thank you,
Wan Muji Wan Ngah
President
Malaysian Sterile Service Association
December 2005
The official language of the congress is Turkish. The scientific speeches which will be made in other languages shall simultaneously be translated to Turkish.
CONGRESS BADGES
In all sessions, social activities and commercial exhibition areas, carrying the congress badges is obligatory. The participants who have made their pre-records, will be able to receive the pre-prepared congress badges together with the other documents without waiting during pre-registration. In on-site recistrations, the participants shall be able to receive their congress badges after completion of the registrations procedures and shall be able to pass to the relevant unit. In our congress, badges with intelligent card "Chip" or Barcode shall be used as congress badges. All activities inside the hotel and within the framework of the congress organization, shall be recorded into the memory of these badges. In entries to the halls in the congress center, congress restaurant(lunches, prolonged cocktail, gala dinner and dinners), in entries to the opening cocktail and gala dinner, it is required for the card reader devices to see the badges. Thus, it will not be possible to circulate inside the hotel and the congress center without congress badges.
Since by the intelligent cards, the services which the members will benefit from are definitely determined, we would like to emphasize again that the congress badges are not an identity data, but at the same time a password card in order to benefit from the congress activities in the congress center and the hotel within the framework of their rights. In the event of loss of congress badges, just for once, a second badge on which the previous passwords and hence the remaining rights are recorded, shall be given.
ACCESS
The Congress Center is reached in 50 minutes by vehicle from the Airport. The distance between the Congress Center Sürmeli Efes Hotel and Kusadasi is 15 minutes. For the shuttle journeys to be made between Airport-city center and the Congress Center and transfer information, please contact the Congress Secretariat.
SMOKING LIMITATION AND DRESSING
No smoking is required in the meeting halls and the commercial exhibition areas during the congress as per code Number 4207.
In participations to the scientific activities (in reports and scientific arguments and the stand areas), it is requested with importance all participants to dress up in conformity with the outward appearance regulations.
CLIMATE
The expected weather condition in Izmir on the dates 2-5 March 2006:
Lowest temperature expected: 4°C
Highest temperature expected: 14°C
OFFICIAL INVITATION, PASSPORT AND VISA
Within the direction of the participants' requests, the official invitation letter may be prepared by the congress organization committee. The foreign participants to come from abroad are required to hold a valid passport. The complete lists of the countries to which Turkey applies visa and the Turkish embassies in all foreign countries may be obtained from the congress center.
TELECOMMUNICATION SERVICES
Throughout the congress, the fax, telephone and electronic mail services shall be active in our congress center.
PAYMENTS AND CHANGE / EXCHANGE
Congress registration fees and accomodation costs and the payments related to the Stand and sponsorship will be made in Euro. In all payments, the transfer costs shall be met by the firm/person making the payment. VAT. Is not inclueded in registration and accomodation fees. In order to benefit from the low prices the payments should be paid into the bank accounts listed below, before 1st February 2006. The payments which are done after this date procecessed as high price even if they were done before pre- reservation date. All the congress payments should be into the accounts and abstract accounts should be faxed until latest 1 st March 2006.
BANK AND ACCOUNTING SERVICES
Throughout the entire congress, in the accounting center to be established in the recistration and information desk, services of collection by foreign currency shall be provided. The record costs related to the congress and the stand, sponsorship and accomodation payments shall be documented with invoice.
TECHNICAL DEVICES AND THE PRESENTATION CONTROL ROOM
In each hall, VHS video and multimedia projector devices shall be held available for use. It is required for the persons who will use slide as presentation materials to transform their slides into digital environment if possible, and if they do not have these opportunities, to apply to the Congress Secretariat in shortest time. The digital presentations are required be preapared in a way presentable in Microsoft Powerpoint® program. The technical equipments to be used in presentation should clearly be indicated on the report forms.
The slide materials should be delivered to slide desk located next to the Congress recistration desk during the recistration procedures. The participants who desire to make slide control are required to be present in the slide room on the appointment time given to themselves. It is requested with importance for the presenters who especially have integrated film files within their presentations to record the codec "Passwords" of their film files and the full files together with their presentations and to try the presentations they have prepared in another computer not belonging to themselves.
MORE INFORMATION
Please feel free to download our conference flyer in A5 PDF format:
In the Stand area which will continue throughout the congress and be realized with the participation of firms, it is aimed to introduce products, equipments and new services in Sterilization and other areas which we predict to enter into the field of interest of our members. The Artemis Saloon wich has connection with the meeting halls in which the scientific meetings will be held shall be arranged for this purpose.
The firms which open stands, have the right to register as many persons as their quota as officials. However, if the number of persons is high, for each official, a registration as participant or stand official should be made.
The firms are obligated to notify the congress secretariat the technical equipments they will need together with their stand demands in shortest time. These demands should be notified in written form at least one week before the starting date of the congress. Staff in sufficient quantity shall be held available at the Artemis Salon in order to provide the services which the firms may need throughout the congress.
REGISTRATION AND STAND AREA DETAILS
The participants who made companion registration may not attend the scientific meetings.
The accomodation fees are at the basis of full board. Accomodation, open buffet breakfast, lunch and dinner are included in the accomodation fees.
In only record fees, collar card, congress briefcase and contents, participation certificate, program book, attendance to the meetings, entrance to the stand area, coffee breaks throughout the congress, gala diner differance and the opening cocktail are included.
For participants who have made record only, the gala dinner costs € 40.
The registration fees of the participants and the firms and the accomodation, stand and sponsorship fees shall be invoiced by our congress organization firm.
Firms wich participate to the congress shall only exhibit their products between 13:30 - 17:00 on 2nd March 2006, and 09:00 - 17:00 in 03 - 04 March 2006.
Participant firms exhibitions will be ended cocerning at 17:00 on 04 March 2006.
Transfer Remittance Account Data
BANK ACCOUNT NUMBER: P.C.O.Turizm ve Tic.A.S. Is Bank Alsancak Branch
Euro Account No: 641997
Swift Code:ISBKTRISXXX
Bank Code: 64
Branch Code: 3401
Exhibitor Info and Registration Form
Companies wishing to exhibit at the conference please use the form included in the following document:
Kusadasi is one of Turkey's most sophisticated holiday centers; a perfect place for vacation with its sandy beaches and glassy water. The contrast of the lively holiday life with the quietness of ancient ruins create the special atmosphere of the city.
Kusadasi, one of Turkey's principle holiday resorts, offers an excellent environment for an unforgettable holiday. Situated on the west coast of Turkey- 90km south of Izmir, Kusadasi, is reputed for one of the most attractive city of the Aegean, as it is close to the important historical sites including Ephesus, Didyma, Priene, Miletos-the principals of ancient times, and ideal for sightseers.
Kusadasi has a typical Mediterranean climate with hot summers and mild winters, providing a long tourism season.The city is bathed in sunshine for 300 days of the year.
Numerous powdery sandy beaches with warm and clear waters, providing a peaceful atmosphere, allow a great variety of water and beach facilities. Windsurfing, water skiing, sailing and beach volley are only a few choice for the lovers of active life.
After sunbathing restfully during the day, the city awaits the superb sunset. As the sun sets, the attractive cafes and restaurants through the palm-lined boulevard, get busier.
It is a great delight to watch the comings and goings of the yachts and ships with accompanience of the panoramic view of the sunset, on a pre-drink before the dinner. The restaurants, serving a variety of fresh seafood &fish and Aegean specialties, offer a delicious meal in Kusadasi. Dancing and entertaining at a lively bar or a disco until dawn, may end an ideal day in Kusadasi.
The Kusadasi Setur Marina is one of the largest and best equipped marinas in Turkey with the capacity of 629 yachts both a float and on shore, visited between 2500-3000 boats each year. The marina is on the latitude of 37 52' 20''N and on the longitude of 27 15' 46''E. Custom, repair service, security are some of the 24 hour services in the marina.
Apart from the great historical beauties around Kusadasi, the city is also preserves excellent examples of Ottoman and Turkish mosques, located in the centum. "The Fortress Mosque", built by the vizier Okuz Mehmet Pasa in the 17th century, is the most impressing and monumental mosque in Kusadasi.
For this year’s 28th National Sterilisation Days relating to the healthcare services, CEFH (French Centre for Hospital Studies and Training) had chosen the scenic city of Tours, which is situated in the Loire and big enough to accommodate the well over 1600 delegates in attendance. For some 30 years now CEFH has been responsible for continuing education and advanced training in the healthcare sector, no mean feat as this entails coordinating the continuing professional development needs of very diverse professional groups with accordingly very different backgrounds. Participating in the congress were engineers, pharmacists as well as doctors, nurses and CSSD workers.
A number of company-sponsored satellite symposia were held in advance of the actual congress on 11th April. These focused on all conceivable subjects ranging from validation of cleaning and disinfection processes through marking instruments for tracking to packaging. The principle topics of the congress, "Tracking - why, how, to what extent?" "Surgical instruments and sterilisation" (focusing primarily on the issue of corrosion) as well as "The air and ambient conditions in the clean zone" dealt with topical issues in the field of sterilisation.
The congress was opened by Christine Chopard from the leading health authority, Hubert Garrigue, hospital director of the Tours University Hospital Centre (CHU Tours) as well as A. Dayan, deputy mayor of Tours.
Tracking - why and how?
This topic was immediately addressed by Claude Evin, President of the French Hospital Federation (FHF), in his opening talk: What is tracking; what rights do patients and personnel have? He explained that tracking was to be equated with localisation of the medical device in terms of time and place. Already back in 1998 French legislation made provision for assuring this standard of safety. Accordingly, guaranteed quality was something to which the patient had a right and those responsible for assuring this had to ensure that a quality management system was in place.
Luc Rozenbaum, hospital pharmacist from Nanterre, took a closer look at this topic by elaborating on the provisions set out by the standard XP 594-467:2006, which stipulates that each instrument must bear an unequivocal and unique identification code. Automatic recording was needed for qualitative and quantitative tracking of instruments in terms of time and place, thus providing for information flow showing the physical movements of the instruments, including identification of the instrument and respective staff member. Rozenbaum emphasised that all other related conditions had to be assured: care of instruments and their delivery to the CSSD as well as implementation of standards. Rozenbaum described the different types of coding systems used, e.g. Barcode and DataMatrix Code, and finished off his talk by explaining why this was needed: a tracking system enabled one to detect malfunctions at an early stage. Staff members could be held to account since whoever was discharging a particular task could be identified. Repairs could be made early on to ensure smooth running of operations.
Aude Coquard, hospital pharmacist from Rouen, showed a short film to demonstrate how her hospital was using a tracking system with Infodot marking (DataMatrix-Code). Her department had more than 5000 instruments in circulation each day. Each instrument was scanned on entering and exiting the packing table, as were the entire trays once again when placed in the steriliser. Overall, the insights gained from such activities were very positive.
Damien Talon, hospital pharmacist from Paris, summarised once again the benefits to be derived from tracking, stating that this enabled one to optimise the composition of the trays and instruments could be made available more quickly. Moreover, all the activities carried out in the CSSD could be recorded: working hours, provision of instruments, which staff members were doing what, where and for how long as well as the circulation time of instruments spanning the entire period elapsing from the time of use until they were reused. This provided not least for optimal scheduling of surgical procedures and warehousing.
Talon gave an analysis of the utilisation frequency of certain instruments. On this basis, instruments that were not being used could be withdrawn, while those that were rarely used could possibly be replaced by single-use devices. Conversely, in the case of those medical devices that were frequently used, such as orthopaedic motors, it might be advisable to purchase extra supplies to minimise the instances where devices had to be decontaminated in short turnaround times. This would also reduce the number of repairs needed, while ultimately enhancing warehousing and decontamination.
François Gougeon, orthopaedic medical director at the Lille University Hospital Centre (CRHU Lille), spoke about various aspects of tracking from the surgeon’s point of view, i.e. that of the "final consumer" of instruments. In his view tracking played a preventive and a curative role. Preventive measures ensured that unsuitable devices were not put to use (contaminated or malfunctioning instruments), while the curative element resided in the fact that a potentially contaminated device could be located and assigned to a particular procedure or patient.
One of the user’s main concerns was being assured of finding an optimally assembled tray, as well as the assurance that decontamination had been carried out in accordance with the manufacturer’s instructions and guidelines. Moreover, being able to relocate an instrument and assign it to a particular patient was a plus point. Looking ahead to the future, Gougeon stated that the use of paper-based documentation would continue to decline, while conversely the trend towards single-use devices and outsourcing was becoming more pronounced. An advantage accruing to the CSSD management was that tracking helped to keep a record of the milestones in an instrument’s service life. Episodes of use and repairs were clearly documented. But a change of mindset was needed before such benefits could be reaped.
Various aspects of this topic were further discussed in a panel discussion, with the views of other European participants also being expressed.
Annette Cubertafond, Limoges, outlined developments over the past decade, stating that already 10 years ago the topic of tracking had been broached - and now it had become reality to a large extent.
Hervé Ney, Geneva, gave an overview of Swiss regulations, stating that the basic issues involved were the same as those in France.
This was also the case for Germany, as portrayed by Andrea Fischer, former German minister of health who explained the regulations in force in Germany. Since 2001 the guideline formulated by the Robert Koch Institute (RKI) has been in force in Germany. This regulation clearly stipulates the hygienic requirements to be met for decontamination. She stated that it was particularly important to document each individual step, something that ultimately had to give rise to a corresponding tracking system. The involvement of the manufacturers was also needed as they were responsible for prescribing decontamination measures for each medical device.
Loic Geffroy from the Association of Private Healthcare Institutes emphasised that it was no longer possible to operate without tracking systems since otherwise it would be impossible to assure an appropriate quality management system. While admittedly costs were incurred for such systems, they were an indispensable prerequisite for meeting present-day requirements.
Marie-Christine Burnier from the French Hospital Association described how such considerations were given prime importance in various branches of industry ranging from the foodstuffs sector to medical device decontamination. The overriding concern was to avoid damage to the client, i.e. the patient, something that called for implementation of the best quality management system possible.
Christine Crespon, SNITEM Paris, outlined the requirements from the manufacturer’s perspective. Once the legal regulations were in place, the manufacturers had to come up with appropriate solutions, while one had to bear in mind that the requirements set by the international market differed in some respects. A higher degree of harmonisation was desirable here.
André Ochmann, vice president of Agence Régionale ARH Centre (entrusted with tasks on a par with those of a regional council) reported how ARH was also involved in decontamination processes, whether in planning and managing departments or outsourcing. ARH approval had to be sought in all cases. He emphasised once again that quality had a price that had to be paid, but pointed out that even at present a price had to be paid, that is to say for "Non-Quality". What was ultimately important was that the patient received the best possible care with a minimal risk.
Brigitte Louvel cited a further advantage conferred by tracking systems: they provided for archival of data together with the patient’s file - this was a tremendous benefit in the light of the increasing importance of documentation.
After this comprehensive portrayal of all aspects, the delegates broke up for lunch and then went on to attend various workshops.
Decontamination of Dental Equipment
Marie-Dominique Lecolier, Reims, Bénédicte Gourieux and Véronique Dasnoy, Strasbourg as well as Stéphane Corvaisier and Aurélie Bonvin, Lyon, dealt with decontamination of dental equipment. One problem encountered here was the manifold nature of the instruments and the applications that often called for a combination of devices. For example the size and design of drilling equipment entailed their own specific requirements, just as did the rotational components and complex design of handpieces and turbines. There was also a plethora of different boxes and containers for accommodating small components, likewise made from the most diverse materials and thus making more exacting demands on cleaning and on other processing steps. In summary it could be concluded that decontamination of dental equipment called for several procedural steps as well as for intensive control measures. In addition, staff had to be given special training.
Corvaisier and Bonvin then went on to elaborate on the special features of dynamic instruments, e.g. rotating handpieces, of which there were also many different types. For example, rotational speeds between < 200 and approx. 180.000 rpm were observed. These devices could be processed in special washer-disinfectors (WDs) or in a WD with special inserts. A further point was that these instruments had also to be lubricated, and various systems were available to that effect. These had been compared in Lyon, permitting the conclusion that the preferred solution was decontamination in a WD in tandem with an automatic lubrication facility.
Gourieux and Dasnoy reported on the setting up of a new dental clinic in Strasbourg, and this had provided an opportunity for reorganisation of the documentation system and sterilisation. In future decontamination would be carried out from a central department in the new clinic. Certain devices were being replaced by single-use instruments; nonetheless, the instrument inventory was to be expanded (inter alia, due to the fact that there were plans to increase the clinic to accommodate 90 dentists’ workstations compared with the present 67). Continuing staff training was essential for documentation and decontamination.
The Role of Ultrasound
The role and validation of ultrasound in decontamination were the subject of another workshop. Alain Ragon presented methods for detection of cavitation, e.g. SonoCheck. Ready-to-use test devices, such as SoilTest or TOSI Lumcheck, could also be used in hollow instruments provided that these instruments could be connected to corresponding ports for flushing.
Christine Denis stressed that cleaning always preceded sterilisation. This entailed a combination of mechanical, thermal and chemical action. Ultrasound was particularly suitable for medical devices that could not be cleaned in conventional WDs, e.g. lumened devices. Ultrasound was contraindicated for devices with adhesive joints and for rigid optics as well as for synthetic materials that absorbed the waves, thus rendering them ineffective. She rounded off her talk by outlining a few specifications: the bath had to be changed after each use, something that caused problems or proved impractical in the case of ultrasonic baths integrated into tunnel washers.
It was then pointed out that a suitable cleaning method should be defined for each instrument; efforts should be made to restrict manual cleaning.
Other workshops dealt with the topics of continuing education for sterilisation personnel, organisation of decontamination workstations, liquid waste resulting from sterilisation, requirements for, and maintenance of, ventilation systems, European standards governing surgical drapes as well as concepts relating to low-temperature sterilisation with liquid sterilants. Thanks to the fact that workshops were repeated, all delegates were able to attend two workshops in the course of the afternoon.
The first congress day ended with a reception at the Town Hall, to which delegates were invited by the City of Tours and where they were able to enjoy wine, stimulating conversation and a view of the beautifully designed banqueting hall.
Corrosion - a Problem in Sterilisation?
The second congress day began with talks on the series of topics "Surgical Instruments and Sterilisation". Following an introduction by Jean-Marie Kaiser, Mathieu Giang from the French standardisation organisation AFNOR spoke about various standards that made references to corrosion of instruments resulting from the material properties (NF EN ISO 13402), disinfectants (NF S94-402-1) as well as the water quality (FD S94-468). The materials employed for manufacturing surgical and dental instruments should render these resistant to sterilisation, corrosion and heat. The French standard NF S94-402-1 elaborates on the corrosive effects of detergents and disinfectants on reusable surgical instruments. The manufacturers had to carry out 2 series of tests with stainless steel: an immersion test and electrochemical testing.
FD S94-468 deals with the water quality and is expected to be published in the coming months. It will help the user evaluate the water quality.
Gérard Vasseur from CETIM (French Industrial and Mechanical Technical Centre) began his talk by summarising the studies published on the topic of resistance of steel to corrosion. Stainless steel is composed of iron and carbon, with other elements such as chromium, nickel, molybdenum, etc. included in addition. The content of these materials also determines the properties of the steel. Vasseur presented various types of stainless steel and the relevant applications. On the basis of electron microscopy images, he spectacularly demonstrated how heat affects the structure of steel. At temperatures above 1250 °C the structure disintegrates, with the steel becoming very brittle and hard.
To finish off, Vasseur presented the results of a corrosion test with peracetic-acid-based products, showing macro- and microscopic images of pitted corrosion and of corrosion of instrument joints.
Ophthalmologic Instruments - A Special Problem Situation
Patrice Rat, Paris, presented cleaning studies of ophthalmologic instruments, stating that the majority of such instruments were sensitive to heat and oxidizing agents and as such could not be autoclaved. American manufacturers have often recommended glutaraldehyde, but this did not take into the account the problems relating to prions. Rat and colleagues investigated various ophthalmologic instruments. After cleaning twice with enzymatic detergents and predisinfection with chlorine-releasing agents, the synthetic polymers were damaged. Peracetic-acid-based finished products with a content < 1000 ppm were more compatible. Using these it was possible to subject the instruments to 450 - 500 processing cycles and peracetic acid was less toxic than glutaraldehyde, stated Rat.
Gas plasma processes were a possibility for sterilisation of sensitive instruments. The Sterrad2 process was validated for the products of the majority of manufactures and provided for sterile instruments as needed for retinal surgery.
Stéphane Corvaisier and Catherine Cunat, hospital pharmacists from Lyon, spoke about assembling trays. One problem encountered here was already that of nomenclature: often, there was only one name for at least two instruments, besides each instrument often had several names that were used synonymously. They stated that DataMatrix coding, as prescribed by the latest tracking systems, did not dispense with the need for optical recognition and assignment of instruments.
At the HC Hospital in Lyon, where 1700 different trays were being assembled with 2500 different instruments, in addition to the generic name, the actual name of each instrument plus a description of its characteristics (e.g. number of teeth) as well as size were recorded. There were photos of entire trays, of individual instruments - in particular of the active parts - as well as of instruments in a dismantled state.
To summarise, Corvaisier stated that each tray was assembled for the patient but also for the surgical staff. This tray had to be safe and reproducible, i.e. for example the instruments had to be arranged such that the instrument nurse could access them easily. Correct nomenclature, as mentioned above, made assembly much easier.
The afternoon was rounded off once again with a panel discussion on this topic. Then the CEFH prizes were awarded, for sterilisation (Dominique Gambaud, Paris), quality in care (Olivier Menier, Sarreguemines) and hygiene/infection control (Françoise Ulmann, Aix-en-Provence).
Taking a Look across the Frontiers
The afternoon was opened with a look across the frontiers. The former German health minister Andrea Fischer reported on sterilisation in the German hospital setting. She portrayed the role of medical devices and their decontamination for the patient as well as the economic and political implications. She went on to speak about the problems relating to CJD, and introduced the guideline formulated by the Robert Koch Institute, which in Germany regulates hygiene requirements for decontamination.
The main tenet of legislation was that decontamination or decontaminated devices should not pose any danger to the patient, the user or to a third party. With a view to the future, she also spoke about the subject of single-use devices, stating that there was no uniform European legislation for decontamination of single-use devices. To date, more than 6 million single-use instruments had been processed without any adverse incidents. In the case of cardiac catheters, which could cost more than 100 Euros, it was thus possible to make savings in the range of several 10,000 to millions of Euros in large centres.
The Air and Ambient Conditions in the Clean Zone
Other lectures were devoted to the topic on the agenda that afternoon: the air and ambient conditions in the clean zone.
Jean-Claude Labadie, infection control officer from Bordeaux queried whether the contamination caused by dispersal of particles from humans posed a risk for decontamination. The human being who, depending on the intensity of movements dictated by the tasks performed, dispersed a large quantity of particles into the environment was to be viewed as "Homo contaminatus". In this way, it was possible to transmit microorganisms and pose a real risk to patients. These could also reproduce and grow on inanimate objects. As such, medical devices could by all means be contaminated and pass on this contamination. One problem in this respect was prolonged exposure to the air within the OR theatre.
Standard ISO 14644 focuses on the particle content in clean rooms, while standard ISO 14698 deals with the maximum concentration of living particles and with microbial loads. Labadie stated that at least the ISO Classification 8 should be observed for decontamination departments.
Jean-Claude Guichard, vice president of the French Society for Prevention and Contamination Research (ASPEC), also spoke about the particle count in various environments, which could amount to approx. 10 million /m3 in hardly industrialised regions, and to 400 million/m3 in industrial areas. Pursuant to ISO 5, a count of 3520/m3 must not be exceeded, and of 352.000/m3 as per ISO 8. Even sedentary persons could give rise to emission and transmission of particles as a result of continuous desquamation of the upper layers of the skin and because of rising air currents resulting from the body heat. The air enclosed between clothing and the body generated a "bellows effect", promoting desquamation and transmission. On the other hand, complete surgical clothing served to considerably reduce particle emission.
Efficacy of Various Substances against Prions
The final lecture of the afternoon was given by Cyril Vadrot, hospital pharmacist from Paris, on the subject of peracetic acid for inactivation of prions compared with other products. Based on French Circular 138 of March 2001, glutaraldehyde was no longer recommended for decontamination of medical devices in the context of prions. Other processes deemed ineffective included radiosterilisation and dry heat sterilisation. Glutaraldehyde is one of the subgroups of fixing substances, but has been classified as being partially effective, whereas peracetic acid has been classified as ineffective. Vadrot presented the results of his own efficacy testing of these substances, where efficacy was investigated in vivo (animal experiments) and in vitro (western blot). Residual infectiousness and even a fixing effect were noted for peracetic acid.
The poster prize was awarded on completion of the round of lectures. The prizewinners were Christophe Paumier and colleagues (evaluation of automated cleaning and disinfection using test soils) and P. Janssens and colleagues (an instrument for analysis of workload in a sterilisation department).
The afternoon was rounded off with a summary of the previous day’s workshops, so delegates had the change once again to recall all topics covered. And this brought to a close an impressive congress that was well organised and, thanks to the interesting topics addressed, it made a worthwhile contribution to the delegates’ continuing professional development, and not least provided an opportunity for exchange of views with colleagues, a particularly valuable aspect of such meetings.
The
Annual EFHSS and NfS Conference 2006 is a specialist congress for healthcare professionals in both hospitals and primary care such as doctor's offices, clinics, dentist, etc. Persons with responsibility for or involvement with preventing and controlling infection in healthcare organisations through decontamination of reusable medical devices.
Dear Colleague,
We are delighted to invite you to Lillehammer in Norway to the Annual
EFHSS Conference 2006 which is organized by the
Norwegian Association of Sterile Supplies (NfS).
Our association has changed its name and it's now possible for anyone with interest in sterile supplies to become a member.
We hope you find our program interesting and we are looking forward to seeing you in Lillehammer!
For information about Lillehammer (sights, activities, pictures, maps/transport info, etc.), please visit the web site of the Lillehammer Tourist Office:
Lillehammer does not have an airport, but Norway's main international aiport, Oslo Airport Gardermoen (OSL), is located only 145 km (90 miles) from Lillehammer. There are frequent train departures from the airport terminal, and you can also rent a car at the airport.
Travelling to the Lillehammer area is easy. The town is located right off the E-6 highway which is the major travel artery from southern to northern Norway. By car, Lillehammer only two hours from Oslo, four hours from Trondheim and five hours from Ålesund. If you are arriving by plane, just take the bus or train from the Oslo International Airport to Lillehammer.
The railway station is located in the basement of the airport terminal - easily accessible by escalator from the arrival hall. There are separate platforms for the Airport Express Trains and other trains. All InterCity trains between Skien in the south and Lillehammer in the north (via Oslo) serve Oslo Airport Gardermoen at intervals of 1 hour during most of the day. Travel distance from from Gardermoen airport to Lillehammer is approximately 1 hour and 45 minutes.
Download (PDF) train time table Oslo-Lillehammer. It takes about 10 minutes with the Taxi from the Lillehammer railway station to the Conference Hotel.
Torp Airport Sandefjord/Oslo (Ryanair, KLM)
Torp Airport (TRF) is located about 10 km from the Sandefjord train station south of Oslo. From Sandefjord to Oslo and on to Lillehammer there are many train departures. Between Torp Airport and Sandefjord train station there are bus/taxi connections and the travel time is about 20 minutes. You can travel from Sandefjord to Lillehammer by train. Please see www.nsb.no for further information. Point-to-point tickets can be purchased on the internet. Download (PDF) train time table from Sandefjord via Oslo to Lillehammer and return.
Conference sessions will focus on providing new science in the sterile supply field, education of CSSD managers and staff, certification of the CSSD, decontamination processes and systems. Proposals for a 15 min. presentation of related topics are invited.
Submission Deadlines:
Deadline for receipt of completed abstracts: February 1st, 2006
Electronic copies only to be submitted.
Articles should be submitted as email attachments to:
A poster competition sponsored by 3M Health Care takes place at the conference.
We encourage you to send your poster and be listed as one of the candidates to the 3M Poster Price of 800 Euro. Only one application is allowed per candidate. The deadline for the registration of posters is April 10th, 2006
18 May 2006 / 13:00 - 14:00
Getinge Lunatronic ApS Getinge T-DOC Symposium The following will be discussed:
"How can you take full advantage of your traceability system when the hospital infrastructure is changing" and
"How can you benefit from an improved collaboration between the Sterilization Department and the Operation Department/Theatres using electronic systems"
Annual EFHSS and NfS Conference 2006 Conference Report
18 May 2006 to 20 May 2006
Lillehammer, Norway
"Sterile with a Smile" - EFHSS Congress in Lillehammer, Norway, 18 - 20 May 2006 Conference Report
by Dr. Gudrun Westermann
Anyone who was lucky enough to travel to the congress already on 17 May had an opportunity to experience Lillehammer festively adorned for Norway’s National Holiday, and above all resplendent in the bright sunshine. As the congress began, so did the rain, but this was confined to the exterior of the conference hotel. Inside, the mood continued to be sunny and thanks to the international composition of the delegates, the Olympian spirit of 1994 was rekindled.
The morning of the first conference day was devoted to various workshops. The firm B. Braun Aesculap organised a seminar on the topic of quality assurance in the CSSD. This dealt with proper management of instruments during decontamination, in particular as regards visual inspection after cleaning, instrument care and functional checks. Various types of residues and functional impairments were demonstrated and the critical aspects of different instrument groups were explained.
The firm ASP Johnson & Johnson sponsored a seminar on low-temperature sterilisation, showing how the costs of instrument repairs could be reduced, especially for rigid optics, by using H2O2 gas plasma sterilisation. In addition, Dr. Clayette, Paris, outlined the current guidelines for prion decontamination. Other lectures dealt with validation and evaluation of the Sterrad technology.
The firm Getinge ran a seminar on the topic of "T-Doc", showing the facilities currently available for instrument management. Special attention was paid to organisational procedures using a case carts. While this is not a precondition for using the T Doc system, it is optimally supported by it. This type of organisational measure has considerable advantages for planning surgical procedures; depending on the size and organisational structures of the hospital, the number of instruments needed could be reduced since a more efficient system of instrument provision is in place.
The congress was officially opened in the afternoon. S.B. Klemetrud, Mayor of Lillehammer, presented the touristic highlight of the region, which since the Olympic Games is having twice as many visitors each year as before.
Wim Renders, EFHSS Chairman, in his opening speech spoke about growing globalisation, something that was now reflected in the new name of this European forum: World Forum for Hospital Sterile Supply (WFHSS) (see p. 184 for extracts of this speech).
Ann M. Berg reported on university studies for CSSD management in Norway. This discipline was planned and implemented in 1994/95 by the Norwegian public health office. The Norwegian Society of Sterile Supply has in the meantime devised and introduced an upgraded curriculum for CSSD managers. The first students had completed this course in 2003, while a further 20 had begun the course in 2006. Berg described how this course was structured, stressing the pivotal role played by training in assuring an efficient quality management system.
Maria Tuulse described the training courses available for CSSD technical assistants and managers in Sweden. In a total of six courses focusing on different topics it was possible to collect points which together with practical work experience determined the total number of points, and as such the qualifying grades.
The first lecture on the next day was given by Marie Banck, likewise from Sweden, who spoke about experiences relating to certification. She began her talk with a few facts about Sweden, where there are a total of 89 CSSDs. Since 1996 quality assurance has been enshrined in legislation. Banck outlined the advantages accruing from a QM system, e.g. greater customer satisfaction and the financial aspect that good quality served to save money since hardly any remedial action had to be taken anymore.
She described the current situation in Sweden, which she had surveyed with the help of a questionnaire. This showed that some departments had initiated the certification process already before 1994, but this was done in the majority of cases at the same time as the corresponding regulations were introduced. This initiative was mainly launched by the CSSD management, and on average it took three years until certification was complete. So far, 7% of CSSDs in Sweden had been certified, but all were aiming in that direction. To finish off, Banck described the positive and negative experiences gleaned from certification. Of course, time and money had to be invested to achieve a corresponding standard; on the plus side this gave rise to better organised working procedures and to enhanced occupational safety. Relationships with customers had also benefited.
Torben A. Pederson described the current situation as regards standards in Denmark. He stated that the Danish standardisation committee had published standard DS 2450 on infection control and infection prevention, which was also valid for the CSSD. Accordingly, in organisational terms the CSSD was also part of a hospital’s infection control system. Pederson described how to address risk factors and define critical control points within the system. Critical limits had to be specified for certain domains. What was important was scrupulous observance of risk factors, also relating to sterilisation within the hospital; continuous improvement should always be the target.
Klaus Roth focused on new cleaning processes in his talk, e.g. the Oxivario system and other multi-step processes. Validation of the Oxivario process had revealed that the addition of H2O2 had potentiated the cleaning performance of certain detergents. The cleaning performance was verified with the OPA as well as the radionuclide method, with the latter proving to be the more sensitive.
Problems were encountered on using the Oxivario process for different materials. For example, titanium screws showed discolorations that receded only after processing them again on 10 further occasions. Admittedly, stated Roth, decontamination of titanium implants was generally not recommended.
The surface of coloured anodised aluminium also underwent a change, but this could be avoided on using the newly developed Orthovario process, which did not adversely affect the colour. What was decisive in all cases was also the water quality; very hard water could cause a sharp decline in the pH value.
Th. Fengler highlighted the role of ultrasound in cleaning. He also outlined the fundamental principles of cleaning, e.g. its important role for preservation of the functional capabilities and inherent value of instruments. Being able to dismantle instruments was vital. Manual cleaning had to be avoided.
The parameters underpinning effective ultrasonic cleaning were the detergent, volume of solution, transducer position and energy distribution within the basin. On the basis of a few interesting graphs, Fengler demonstrated that energy distribution differed greatly within the ultrasound basin. Other important aspects were the tray composition and the water quality. Silicone mats were not suitable as they absorbed the ultrasonic waves. Energy was also lost when trays were overloaded.
Conclusion: While ultrasound cleaning does play a role in cleaning, it is difficult to standardise. Therefore it should be used mainly as an additional measure for precleaning of certain types of instruments.
Anne Jacolot reported on the experiences with various test soils in France. Tests had been carried out with different hollow devices (e.g. endoscopes, hollow dental instruments) which had been cleaned using different methods: once in an ultrasonic basin using sonic irrigation, once in a special cleaning trolley for endoscope accessories, once by flushing and once in an endoscope washer-disinfector. The dental instruments were cleaned in a special stomatology trolley.
Tests conducted with different process challenge devices (PCDs) and test soils (Tosi Lumcheck or Flexicheck) revealed that cleaning endoscope accessories first with ultrasound and in a special trolley produced the best results. Likewise, the best cleaning results for dental instruments were achieved in a trolley specially designed for that purpose. Cleaning once in the endoscope washer-disinfector did not produce satisfactory results for endoscopes; the instruments came out clean only after cleaning once without a detergent followed by cleaning once again with an enzymatic detergent.
Damien Talon continued this topic by elaborating on verification of the cleaning performance of three novel detergents whose performance had also been compared using commercially available test soils, i.e. PCDs incorporating test soils (Tosi) as well as with the Soil Test described in EN ISO 15883, including a microbial contamination (B. subtilis).
To investigate the cleaning performance, the parameters temperature, concentration and cleaning duration were varied such that 20 different combinations were obtained for each detergent. In this way it was possible to define optimal parameters for each detergent, thus in turn assuring an optimal cleaning performance while, at the same time, providing for economical use of the respective detergents.
Heid Garberg Gule spoke about validation of combi loads at Rikshospitalet University Hospital in Oslo. The continuing upsurge in surgical procedures presented a major challenge to the CSSD, which could be countered only by making certain changes to work flow patterns. Improvements had been made in various domains, e.g. ISO certification of the quality management system, checklists for enhanced staff training and the introduction of combi loads. To cite Gule, these conferred various benefits:
There was greater transparency for staff as demonstrated by photos from the CSSD, which soon helped to coin the motto of this congress: "Sterilisation with a smile"
Only one programme had to be run
Fewer mistakes in decontamination and load assembly
More economical
Quicker instrument turnaround times and more rapid instrument delivery to the OR
Validation of these loads was effected using reference loads, reflecting in all cases both worst-case and optimal scenarios. Gule stated that all loads should be revalidated after a period of one year, and any necessary changes made.
Anne Mette Koch reported on experiences with reusable surgical drapes (textiles) at Bergen University Hospital. She briefly outlined the requirements to be met by surgical drapes and stressed that cotton drapes and gowns did not comply with the standards and their use, wherever this was still the case, should be discontinued.
At her hospital tests had been carried out with innovative microfibre fabrics that could be reprocessed. In close cooperation with the laundry and the OR an infection control policy had been compiled explaining how these textiles could be reprocessed. Ensuring appropriate ongoing training staff of CSSD and laundry personnel was of paramount importance so that the relevant processes could be properly validated.
Sverre Fauske, human resources consultant, dealt with another important topic: staff motivation. How could one ensure that staff would turn up for work again every day? That motivation was not exclusively determined by remuneration was something that had to be obvious to everyone. Fauske impressively explained how in his department other factors, which were equally important, came into play, e.g. the chance to engage in continuing personal development, relationships with colleagues, working organisational practices and the organisation’s culture and hierarchy. With the aid of a questionnaire, the mood prevailing in these areas was ascertained and based on a marking scale assigned the colours of the traffic lights: red, amber and green. If the light was "amber", it was already time to take action to improve the level of job satisfaction.
But Fauske stated that one should not concentrate only on the "red side" of the traffic lights; rather, what was equally important was to acknowledge positive aspects in the "green area" and seek to promote these. It was also important that priorities were set by the heads of department, and here their communication skills were of paramount importance. Moreover, in the hospital setting all too often attention was paid only to the activities of the medical and nursing staff, while the equally important "backup departments", including the CSSD, were forgotten.
To finish off, Fauske revealed how the rate of absence because of illness had markedly declined since the introduction of this system, hence the investment in the system in terms of effort and costs had paid off.
In the evening the delegates attended the gala dinner. In addition to the convivial atmosphere created from the outset by the melodious renditions from the musical band, there were some surprises, e.g. the "Sparkling Egg Award" which went to Toni Zanette (see p 183) and the handover of the remaining funds of the International Federation for Sterile Supply (IFSS) by its chairman Gillian Sills to Wim Renders, thus officially highlighting that in future the WFHSS will be taking charge of international tasks going beyond the European borders.
Saturday morning began with the lecture to commemorate Jack van Asten, which has by now become a traditional fixture in the EFHSS programme. On this occasion, the lecture was given by Joost van Doornmalen, who spoke about current standardisation activities. To begin with, van Doornmalen pointed to some inconsistencies in existing standards, e.g. the fact that EN ISO 15883 featured 10 different test soils for verification of the cleaning performance.
He then made a cursory reference to the physical fundamentals of steam sterilisation, while stressing that 100% saturated steam was necessary for sterilisation regardless of the temperature-time combination selected. Van Doornmalen pointed out that in order to select a suitable sterilisation duration for a particular temperature the values specified by the Medical Research Council had been put to the test and had furnished proof of safety, whereas the values calculated in line with the F-value theory deviated from this in some cases and were not able to assure the same level of safety. Furthermore, on the basis of a number of graphs he demonstrated that problems in the sterilisation phase occurred already during the conditioning phase, for example if the pressure had been built up too quickly, thus giving rise to overheating. A longer conditioning phase was safer. After all, successful sterilisation was possible only within narrowly defined limits; hence the pertinent standards were by no means too rigorous.
After this, van Doornmalen went on to address the problems encountered in sterilisation of narrow lumens. Only with great difficult could 100% saturation be achieved at the end of the lumen; there was clear evidence of problems already for lumens measuring more than 50 cm in length. In this context van Doornmalen described tests conducted on ducklings that had been examined with reprocessed angioscopes (Chaufour et al., J Vasc Surg 1999; 30: 277-282.). Here it was revealed that sterilisation without prior cleaning was virtually pointless, since there were many cases of infection just as seen for unprocessed, contaminated angioscopes. Using filmed material, van Doornmalen presented his own tests on endoscopes, showing for example that in some cases better results had not been achieved by cleaning the channels with a brush. Rather what had happened was that any residual soils were redistributed or transferred deeper into the channels.
To finish off, van Doornmalen warned against a false sense of security derived from the existing standards; further investigations and continuous improvement of standards based on results were vital.
Lawrence Dawson spoke about ultrasonic cleaning including continuous irrigation of instruments. He outlined the earlier research conducted in this field using transparent test instruments that simulated the most important characteristics of, for example, MIS instruments. Using the radionuclide method several investigations had been conducted in the meantime, leading to some instruments being designated for single use only. It was also revealed that optimal pressure and flow parameters had to be defined for ultrasonic equipment with sonic irrigation facilities in order to achieve optimal cleaning results. Accordingly, equipment with parameters for flow control was now available (Parametrically Controlled Flow System, PCF).
Diana Bijl from Nijmegen University described the use of radioactively marked protein for verifying cleaning of MIS instruments. Instruments that could be fully dismantled were contaminated with radioactively marked protein and cleaned using the standard methods available in the CSSD. It emerged that on average 2.6% of these fully dismantled instruments were still contaminated after cleaning. Further investigations with new instruments had shown that these soils did not accumulate in the course of clinical use. From these results Bijl concluded that the investigation method based on radioactively marked protein was suitable for monitoring surgical instruments. For the MIS instruments used here it was revealed that they were not adequately cleaned with the standard methods.
Ulrich Kaiser, reported on the properties of Class 5 and 6 chemical indicators. These could replace biological indicators and had the advantage that no incubation time was needed before reading the results. But what was important was that the chemical indicators could provide information only on the conditions prevailing at the respective measuring site; but homogeneous conditions were not to be found throughout the chamber. Therefore it was necessary to position several indicators at appropriate locations.
In respect of non-condensable gases (NCGs) Kaiser stated that chemical indicators were only able to detect accumulated NCGs, and this in turn only if the NCGs occurred at exactly the respective measuring site. Hence the process could still be released even if there were up to 10% NCGs in the steam. It was therefore advisable to use indicator systems that could simulate the correspondingly difficult steam-penetration conditions. These "batch control systems" helped to overcome the limitations inherent in Class 5 and 6 indicators. What was always important was to position the indicator system at the site concerning which information was sought.
Terry McAuley elaborated on the Bowie-Dick test and on the issue of whether it still played a role in modern sterilisation departments. She briefly described the fundamentals of the BD test and summarised the myriad standards dealing with this topic. The test was by all means still relevant today. What was important was that there were different air-removal systems. There were also several different commercially available test packs. Certification of these by an independent body, rather than by the manufacturer, should be advocated.
Cornelia Hugo focused on the topic of loaned instruments and described the system used at Tübingen University Hospital. There had been problems with deliveries earlier, with instruments scheduled for use in the OR on the following morning arriving only in the evening, and that without any decontamination instructions. Another aspect was that the instruments were often packed in plastic containers, giving rise to the problem of wet packs when processed. A working group in Tübingen had dealt with these problems and by now responsibilities had been clearly assigned. Forms were compiled and were now available on the intranet. The instruments had to be delivered four days before their intended use. If the instruments remained in the hospital for a long period of time, they were even integrated into the hospital’s own documentation system.
Even if this approach called for certain administrative investments, to cite Hugo, it had to be borne in mind that by now more than 60% of the instruments used in traumatological surgery were loaned instruments. As such, clearly defined practices were indispensable.
Toni Zanette spoke about cost transparency in the CSSD and described how exact invoices could be produced for the various departments on the basis of cost centres and invoicing departments. Of course, investments would have to be made in advance to assure the technical and staffing requirements. But ultimately this system would provide for fair assignment of costs to the various cost centres, right down to the individual instrument. Furthermore, the level of transparency conferred would grant the user more control over costs. A study carried out in a neurology department had for example revealed that there only 48 - 57% of the instruments in a tray were being actually used. There was a savings potential of some 50,000 Euros to be made in that area. Moreover, it was possible to dispense with budgeting by directly making out an invoice; in reality the resources generated from payment of invoices were used to meet everyday running costs. In the event of a surplus, investments could be made in other projects.
And true to the spontaneously coined motto "Sterilisation with a smile" the congress was brought to a close on a humorous note. Kyrre Saether described the important role of humour in creating a pleasant and productive working atmosphere. While the issues involved were of a serious nature, the playful components of humour served to enrich the working climate by introducing positive emotions - and it was precisely a lot of humour that was in evidence at this congress in Lillehammer.
Next year’s WFHSS congress will be held from 3 - 5 May in Baden near Vienna on the occasion of the Austrian Annual Congress. The announcement of the venue by the Austrian delegation gives us hope that there an equally positive congress atmosphere will prevail - so please make a note of this date in your diaries.
Bioseguridad en Odontología. Doctora Maria del Carmen Manto
Esterilización en Odontología. Farmacéutica Especialista en Esterilización Mabel Urruzola
Instrumental y otros Dispositivos para odontología.
Equipos de Esterilización para el consultorio Odontológico y su Validación. Farmacéutica Especialista en Esterilización Iris Moreno
Central de Esterilización de Odontología.
Controversias en la práctica Odontológica. Farmacéutica Especialista en Esterilización Gladys Quiroga
16:30 Entrega de Certificados
Arancel Viernes: $ 30,00
Viernes y Sábado: $ 60,00
Sábado 9 de Septiembre de 2006
8:00 - 9:00 Acreditación
9:00 - 12:00
Normas reglamentarias para la validación de los equipos de esterilización por vapor ISO17665 y ISO14937
Test de Bowie-Dick Helices.
La validación de los equipos y procesos de esterilización Ingeniero Joost P.C.M. Van Doornmalen - Bureau Veritas HOLANDA Farmacéutica Especialista en Esterilización Helga Sager de Agostini
12:00 - 13:00 Receso
13:00 - 14:00
Garantía de Seguridad en el Procesamiento de Fibroendoscopios.
Procesamiento Manual vs Procesamiento Mecánico.
Desinfección vs Esterilización.
Quien garantiza que? Farmacéutica Damián Ramírez, Técnico en Esterilización Daniel Amante, Técnico en Esterilización Verónica Mancuso
14:00 - 15:30
Tecnología Médica, Disposiciones aplicables para la habilitación de Empresas Fabricantes e Importadoras de Productos Médicos: Disp. 2319/02 , 191/99 y 698/99.
Conceptos de Buenas Prácticas de Fabricación, Calidad, Seguridad y Eficacia y Análisis de Riesgos. Farmacéutica Especialista en Esterilización Rita Metz Farmacéutica Alejandra Staravijosky
15:30 - 16:00 Receso
16:00 - 16:30 Mesa de Discusión: Equipamiento y Costos de la Central de esterilización.
16:30 - 17:00 Reunión Anual de adherentes de FUDESA.
Para realizar su inscripción y abonar en forma anticipada solicite el formulario por e-mail. Recuerde que para que se haga efectiva su reserva deberá abonar el arancel de la jornada. E-mail:
,
A profesionales que directa o indirectamente estén relacionados con garantizar la calidad de la atención sanitaria desde el área de la esterilización hospitalaria e industrial. En especial Farmacéuticos, Técnicos y Auxiliares en Esterilización.
The German Society of Sterile Supply (DGSV) Congress 2006, which was attended by some 360 delegates once again in Potsdam, marked a very special occasion. This became clear already at the members’ general meeting on the eve of the congress when homage was paid to the Society’s founding members, an impressive number of whom are still active today, in order to commemorate in due fashion the DGSV’s 10th anniversary of its foundation. With just under 700 members, the DGSV has grown in a truly impressive manner since its foundation in 1996. But even more impressive are its accomplishments during this 10-year period, in particular in the domain of education and training. It is thanks to the DGSV’s endeavours that today there is a structured training programme, which in the meantime serves as a model for comparative programmes in other countries.
The congress provided many opportunities for reminiscing about the DGSV’s early days and for calling to mind just how many changes had taken place since 1996 in various areas, such as in the domain of quality management.
Reflecting this spirit, the congress was opened on 2 October with a whole series of welcoming speeches. Prof. Mielke from the Robert Koch Institute stated that at the age of ten years the society had reached immunological maturity and that puberty could now be expected. He outlined the issues that had preoccupied us during the past decade, e.g. cleaning also in the light of the risks posed by prions, a topic with which we would have to grapple for the coming decades. Accordingly, efforts were directed at devising better prion-inactivating decontamination processes that would lend themselves to everyday use, also for heat-sensitive instruments as well as at the certification and standardisation of supervisory activities.
Prof. Heeg from Tübingen, likewise a founding member of the DGSV, gave a review of the Society’s first years, concluding that the first phases of storm and stress in this fast-developing society had already been overcome, however, it is only natural that a certain amount of turbulence can still be expected in the future. Now that certified training centres had already been established on a broad scale, a meaningful task would now be to draft and stipulate suitable rules and intervals for supervision and recertification employing external audits.
In the first lecture of the day, Klaus Wiese, Dortmund, spoke about medical device decontamination - yesterday, today and tomorrow. In an interesting historic retrospective he drew the delegates’ attention back to the incipient stages of sterilisation, with the first boilers for alkaline soda solutions and the antiquated types of sterilisation drums. At that time the sterilisation pioneers still had to put up with being reproached with conducting "cleanliness to excessive limits". Wiese also highlighted how sterilisation departments were structured, whether as a central sterilisation department, conducting only sterilisation, or as a CSSD where the entire spectrum of decontamination was conducted. In the present day, the organisational structures and, in particular, the communication structures within the department and with other departments were becoming increasingly more important.
To round off these reflections, Anke Carter, Chairman of the DGSV, and Toni Zanette, Tübingen, reported on the initial stages of specialist training courses in Germany, which had already predated the foundation of the DGSV, first with the Brandenburg Training Institute (Brandenburgisches Bildungswerk) in Potsdam and at Tübingen WIT (Department for Transfer of Knowledge). Already within the first years of its foundation, the DGSV laid the foundation for establishing itself as an autonomous specialist association, rather than, for instance, as a section of the German Society of Hospital Hygiene (DGKH) because, to cite Zanette, the aim was to draft an independent job description for the "Technical Sterilisation Assistant".
Within one year of its foundation, the DGSV had already 150 members and the number of those completing the specialist training courses at all levels continued to rise, too, with several hundred certificates being still handed out each year to successful candidates.
Supervision of medical practitioners’ offices and hospitals by the statutory authorities
The rest of the morning was devoted to the topic of supervision by the statutory authorities.
B. Vogler from the Trade Supervisory Office in Oldenburg reported on experiences as a competent supervisory authority, stating that the supervisor’s qualifications were decisive for effective supervision. Vogler listed the principle four points to be borne in mind for monitoring of effective decontamination: level of staff education and training, premises, organisational structure as well as the processes and equipment. The problems frequently encountered were, for example, a lack of separation of the clean from the unclean area or inadequate restrictions on admittance. In particular in medical practitioners’ offices the Robert Koch Institute (RKI) recommendation was often not observed, nor were processes validated. But the most flagrant examples were shortcomings in the training of staff entrusted with decontamination. Vogler illustrated his experiences with impressive, in some cases shocking, photographic material, making it clear that there was still much to be done here.
Dr. Bauer, Cologne, reported on the findings of inspections conducted in 107 medical practitioners’ offices in North-Rhine Westphalia. Here, too, considerable drawbacks were noted, for example only in 3% of cases was there a really effective infection control policy in force. In the majority of cases, if at all available, the infection control policies were not tailored to the needs of the respective practice. Many practices continued to use very old washer-disinfectors which did not conform to EN 15883.
M. Kremmel, Augsburg, reported on the monitoring of hospitals in Bavaria. To begin with, he spoke about the organisational structures and competences of the different authorities responsible for supervision, and went on to describe how cooperation in this area could be improved through interaction between various working groups. Kremmel also reported on a number of problem areas, for example incomplete validation of processes, which meant that certain load configurations were not validated, something of which the user was often not aware.
But he also emphasised that frequently vital improvements could be made without any major investment. Personnel qualification was of paramount importance here; in the case of good process sequences executed by well-qualified staff decontamination of critical medical devices did not present any problem either; but if this could not guaranteed, it would be better to consider using single-use instruments.
Guideline drafted by DGKH, DGSV and AKI soon to be completed
To round off the morning lectures, representatives of the working group entrusted with the drafting of the DGKH, DGSV and AKI Guideline on EN 15883 reported on current changes in Part 1 as well as on updates in Part 2 and 3 of the Guideline. In the afternoon the members of the working group conducted a comprehensive colloquium in which the participants discussed various aspects of the Guideline and were able to put forward suggestions. The final result of these discussions will be reproduced in the updated and revised version of the Guideline, which is to be published already before the end of this year as a Supplement to Central Service.
Other workshops held during the afternoon dealt with certification of the QM system in various CSSDs. V. Sielhoff from Bad Oeynhausen as well as F. Hornig and I. Mislimi from Schwäbisch Hall reported on procedures in their respective establishments. Personnel qualification as well as the involvement of staff in decision-making and modification processes were portrayed as being very important. In such a case, proposals were made by staff members themselves since they felt a sense of individual responsibility for continually improving quality.
In its workshop, the Quality Task Force focused on decontamination instructions. The solutions put forward here are soon to be published in the article Recommendations by the Quality Task Force which is regularly featured in Central Service.
To gala evening event was also designed to an extent to reflect the spirit of the jubilee. With a series of photos, Ilse Voigt called to mind the founding event and also the "pioneers" of specialist training in Germany. In addition to food and drink as well as an exchange of views, the award of the industrial prizes are a traditional fixture on the agenda. The prize for the most innovative product went this year to the firm Vanguard. The firm Alvi was awarded the prize for best presentation, while the firm Dr. Weigert had the most original stand according to the opinion of the congress delegates. An honorary prize was awarded to the first DGSV chairman, Toni Zanette, who during his tenure of office had, himself, awarded many of these prizes and who, in workshops, up to the present day continues to promote sterile supply issues also at international level.
Evaluation of sterilisation processes
In the first talk of the second day of the congress, C. Witte, Ethicon, described how sterilisation processes were evaluated in the hospital setting. Using a spatial model, he showed how the various sterilisation processes were assigned depending on their suitability for heat-sensitive instruments and for instruments with special decontamination requirements (e.g. hollow instruments) as well as on the basis of the danger they posed.
Only when efficacy, material compatibility and danger potential were clarified could one in addition evaluate the economic feasibility of the processes. In that respect, Witte reported on experiences with H2O2 plasma sterilisation which could lead to considerable savings for various instruments that, in principle, could also be subjected to steam sterilisation. This was because plasma sterilisation meant that the service life of such medical devices was clearly prolonged, e.g. in the case of optics, electrode cables or flow measuring probes. The dry nature of the system reduced corrosion problems; there was also less thermal damage to optics.
Processing by external contractors
C. Meijer, Duisburg, portrayed decontamination from the perspective of the external contractor. In many areas it was no longer possible to distinguish between hospital-based and contractor decontamination since the boundaries were being blurred by the myriad models currently available (in-house decontamination by external contractor; complete spatial and organisational separation; privatisation and reorganisation of internal departments). From an organisational point of view, centralisation of decontamination made economic sense. If this was entrusted to an external contractor, there was initially a considerable need for regulation since structures and information organisational patterns that had accrued over the years could no longer be used. But this meant a greater willingness to introduce and implement changes as well as a markedly greater understanding of, and demand for, quality. Meijer stated that in the future centralisation and increasing involvement of external contractors or reorganisation of internal departments would give rise to increasing competition. This, in turn, held out good prospects for economically successful and quality-oriented units regardless of their organisational form as well as for well-qualified specialists who also had management and motivation skills.
Packaging as a sterile barrier
Dr. S. Manhart, Feuchtwangen, outlined the requirements set out in the new packaging standard 11607. He defined the term "sterile barrier system" used there, specifying the requirements applicable to various parts of a packing system. Within the framework of the QM system material requirements had also to be defined for the packaging material, e.g. demonstrable microbial barrier or compatibility with the intended sterilisation process. Regular checks by means of validated processes furnished proof of conformity with the standard. What was also important was a regular check of finished packaging materials since they were subjected to transportation - or ageing-mediated stress. For validation of the packing process, installation qualification had to be carried out while making an inventory of existing equipment and defining critical processes, in addition to functional qualification including manufacture of packaging at the lower and upper range limits as well as performance qualification during which the process variables and finally the outcome were checked. This increased investment ultimately meant a reduction in consequential costs; Manhart pointed that, however, what was of paramount importance was that the patient e.g. derived benefit from a reduction of the risk of contracting a nosocomial infection.
The post-certification period is also the pre-recertification period
Cornelia Hugo, QM Officer at Tübingen University Hospital, reported on life after certification. While achieving certification brought much satisfaction initially, one should not sit on one’s laurels. Hugo stated that continued efforts were needed to ensure precise documentation and process description as well as continued monitoring to ensure targets were reached. Errors had to be documented and evaluated since not all errors were of an equally critical nature, for example as far as the use of a tray in the surgical department was concerned. Daily routines had to be continually reviewed in internal audits. By enlisting the involvement of staff, their awareness of problems and individual sense of responsibility were increased - something that of course called for commensurate training. Quality management, to cite Hugo, was ultimately a philosophy that had to be put into practice and in this respect the post-certification era was at the same time the pre-recertification era.
Decontamination and the law
Finally, Dr. Schneider, attorney from Pforzheim, spoke about a number of court rulings relating to decontamination. For example, decontamination of critical medical devices could be prohibited if such a decontamination process could not be assured in line with the RKI recommendation. In such cases, it might also be necessary to entrust this task temporarily to an external contractor; after all, one had to assume that such a case posed a general risk that would justify bringing to a temporary standstill all hospital activities, which would be tantamount to closing down the CSSD.
Another court ruling dealt with decontamination of single-use medical devices, something that is not forbidden in Germany. Based on the legal texts of the Federal Government, to cite Schneider, the intended purpose specified by the manufacturer clearly did not refer to the number of decontamination cycles. But single-use products had to be checked for amenability to decontamination. Ultimately, patient safety had to take precedence over cost.
And that brought to an end a congress that once again was able to cast light on the manifold aspects of modern-day medical device decontamination, and which also served as a forum to pay homage in a fitting manner to the DGSV’s early days and 10th jubilee. A date or venue has not yet been decided for DGSV Congress 2007; but you should definitely keep the first week in October free for this. Before that, there will be an opportunity to exchange views with international colleagues in early May 2007 at the
WFHSS congress in Baden, close to Vienna, Austria.
The first congress of the
Asociación Mexicana de Profesionales en Esterilización (AMPE) also was the fourth Pan American congress on sterilization. It was organized in the ‘centro historico’ of Mexico City and was held from 5 to 7 October 2006. Mtra. Enfra. Maria de Lourdes Melendez Sotelo, chairperson of the society, and her team could welcome more then 1200 participants to their maiden event. It was a huge undertaking for a society, which was founded not even one year ago. Nevertheless they did a marvellous job as all the participants from almost all Latin American countries will undoubtedly confirm.
In the plenary sessions a wide range of topics from quality indicators and event related sterility to traceability were explored. In working groups and in parallel sessions amongst others packaging systems and the use of peracetic acid were discussed in depth. It was remarkable that, in contrast to most European congresses, the interest of the participants did not wane. They all stayed till the very end, Saturday afternoon.
Wim Renders, chairman of the WFHSS, was given the honour to close the congress.
He appealed to all the participants to critically evaluate all information which was provided in the different papers.
They have to keep in mind that also in sterilization departments prevention is better than cure and that processes and process controls should not be maximized but optimized.
Very important too for Latin America was the decision taken at the congress to set up a Pan American sterilization association. Patricia Guttierez from Chile was chosen as its first chairperson.
It was also agreed that the next Pan American congress will take place in Brazil in 2008.
