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WFHSS Conference 2009 Opening Ceremony
Welcome Speech

by Wim Renders

WFHSSAnnual WFHSS and GORNA Conference 2009GORNA

October 7th to October 10th, 2009
Creta & Terra Maris Conference Centre, Crete, Greece

Good evening ladies and gentlemen,

It is a real pleasure for me to welcome you in the name of the WFHSS to this congress. In the first place I would of course like to thank our Greek colleagues, and more in particular Aphroditi Faitadzidou, not only for their warm hospitality and the perfect organization but also for the choice of this venue. The exceptional 'antique' setting, Crete, of our congress is indeed unique. Moreover it is very appropriate as for the World Forum too this congress is a historical event as it is our tenth meeting. This is therefore the right time to look back and to reflect on what has happened during the past years.

The European Forum came into being in 1999 after the ESH had decided to transform itself into an international federation. Because we were of the opinion that, in Europe at least, the European Norms formed the basis of sterilization, we came to the conclusion that it was important to continue the activities of the European Society. At that time it did not make any sense to us to start a discussion about global norms, which were not directly applicable. But soon it became apparent that sterilization does not stop at the borders of the old continent.

Not only because in other continents too, serious efforts were and are undertaken to improve the quality of the sterilization departments but also because CEN and ISO started collaborating more intensely in order to achieve a worldwide harmonization of the sterilization norms. Moreover in those days, 10 years ago, the Internet, although still in its infancy, became a catalyst and a vector for an ever faster internationalization process. The World Wide Web made information available just by touching a few keys on a computer keyboard and today even on a mobile phone. Globalization became an irrepressible force in sterilization as well. The EFHSS board recognised this and it adopted the name of the forum, at the occasion of the board meeting in Lillehammer 2006, accordingly to: WFHSS or World Forum for Hospital Sterile Supply.

Especially during the last 2 decades sterilization has undergone cosmetic surgery, to use hospital terminology. The look of a substantial number of departments has drastically changed. At the same time the quality of the delivered product has enormously improved. The almost artisan-like work which characterized sterilization not so long ago - the typical example is the preparation of various simple care sets - has gradually been replaced by an industrial production process in which the focus is on the treatment of surgical instruments.

The CSSD has developed from an annex to the operating theatre into an autonomous department, from an open space in which the different activities were overlapping into a department with a strict separation into zones, from mainly manual cleaning to a cleaning of the instruments by machine, from the unrestrained and uncontrolled re-use of medical devices meant for single use only to a responsible re-use or even to a total prohibition of re-use, from the use of chemical and biological indicators to physical checks and validation of the processes, from the end control of the "sterilization process" to the controlled management of the constituent processes, from unskilled to skilled members of staff. In other words the CSSD has grown from a department with the focus on the sterilization process itself to a department with a holistic approach to "decontamination".

This revolution is not only the consequence of ever more directives, norms and regulations. The increasing number of interventions, complex instruments, the increasing quality requirements and especially the dissemination of information and specific training have resulted in the necessary pressure and knowledge to enable the making of this turnaround at the level of the department. Sterilization has become a discipline in its own right, which due to its multidisciplinary character, is occupying an autonomous position in the hospital. Sterilization can only become better and stronger if it continues to set its own course.

Mainly by bringing together national societies and by stimulating their establishment in countries where they did not yet exist, the World Forum has played its role in this evolution. We consider a national society still to be the ideal vehicle to bring knowledge and information to the departments.

This is essential because without information and knowledge change, innovation and progress are not possible. The fact that we made information available on our website, freely accessible by everyone, and the organization of congresses and workshops has provided the necessary underpinning for this dynamic process of change. We receive 2000 visitors a day on our website and our congresses and workshops are attended by ever more people from different nationalities. This success has exceeded our wildest expectations.

Even at the celebration of our tenth anniversary we should not linger in the past for too long. There is not much time to rest on our laurels and we should not allow our traditions and customs to hold sway over us. Reality lies in the present and also already a little bit in the future. But looking into the future is not easy. The only certainty we have today is that even many more changes will come our way. Environmental factors will exert a big influence on our departments and force us to act with the necessary flexibility.

  • Just think of the technological developments, such as robotic surgery, which have arrived with supersonic speed. The Natural Orifice Transluminal Endoscopic Surgery confronts us with the question as to the validity of the Spaulding classification and the principle of a "sterile" instrument.
  • Just think of the further and general implementation of quality systems and traceability in our departments. Moreover to make quality reproducible and quantifiable is one of the biggest challenges we are faced with. This is the result of the ever mounting pressure on the hospital to become ever more professional. The CSSD cannot escape these trends.
  • Training and permanent schooling will have to take these developments into account and will have to provide an adequate answer to them.

The department will have to fully realize its role as a facilitator with the aim of putting a medical device of the highest quality at the disposal of the medical staff and of the patient and this at the best price.

The limits of what can be done and achieved are continuously explored in the CSSD. The controlling and checking with the help of a microscope of the instruments which were used in micro surgery clearly demonstrates the limits to cleaning and thus of the department. Where will it all end? Should we keep following in the footsteps of Husain Bolt and strive for perfection? The question is whether this can be still realized with natural means in other words does the aim justify the financial means which will be necessary to reach the optimal? The question of the added value will undoubtedly have to be asked and if possible also answered in a scientific manner. In this regard too the limits of what is realistically feasible will be explored in a hospital environment which will have to take into account more and more budgetary constraints amongst others as a result of the present economic crisis.

In order to make the right choices the department will undoubtedly have to professionalize even more. The intuitive approach, still very prevalent today, will have to be replaced by a more rational approach. In other words whether we want to or not, the persons in charge of our departments will all have to become managers. They will be responsible for the operational, financial and scientific management of the CSSD.

At a global level, the World Forum will have to pay much more attention to, as I have already pointed out at numerous occasions in the past, to the harmonization of the sterilization departments. In other words the fact that, wherever in the world, each department will be expected to deliver a minimal quality. Every patient should have the basic right to be treated with a medical device which is of a good quality. This was put forward last year at our congress in Italy and I do fully agree with it. Make this right come true is one of the biggest challenges we are facing.

An unequivocal and uniform "state of art" should make it easier for the departments to realize this. But unfortunately today, we are painfully aware of the big, sometimes too big, differences between countries and continents. Just think of for example the different ways in which the transport of the instruments is carried out, the pre-treatment and the treatment of used instruments, the packaging, the sterilization times, and -tests, the storage etc. It is evident that the WFHSS will have to extend its efforts in this direction too in order to provide more support for the departments.

As an interested party, I can of course not be completely objective, I am convinced that the WFHSS has achieved quite a lot in its peculiar way. This can be criticized and perhaps more could have been achieved by doing things differently. But in my opinion the World forum should stick to its essential tasks and these are and remain the continued support of sterilization societies around the world and the provision of a meeting place, a forum, for them. Moreover it should provide information to everyone. It is obvious that everyone should take his responsibility and be prepared to make a contribution to a better CSSD. Each step, however small, is essential and important to the patient. No matter how many guidelines, recommendations, standard operating procedures and standard level agreements are being written, without their implementation in daily sterilization practice they are useless. This implementation process requires, apart from knowledge, also commitment and courage. Convincing all our members of staff of the philosophy of the CSSD and make them act accordingly is not easy but it is crucial. Ultimately the extent to which the departments succeed in providing a high quality end product will determine to a large degree the success of the sterilization department, the national society and also the World Forum.

The success of the sterilization department is thus the result of the work done on the floor. And this is your achievement. That is why today is, first and foremost, your anniversary and I offer my congratulations to all of you, who successfully work in sterilization departments all around the world!
Not me, not the executive committee, not the board but you are the World Forum.

Finally I would like to thank our industrial partners. Without their support the World Forum would not exist. Without industrial scientific research sterilization would not have made the progress it has made. And despite the fact that our interests are not always concurrent, we are and will remain partners who believe in symbiosis as the best possible form of life.

Together we are stepping into the next decade. We trust that the World Forum will symbolically be Ariadne's thread and show the way. The philosophy which we are following is excellently expressed by Charis Alexiou in her song from "Odos Nefeleis":

Give me road to follow,
Give me a name so that I don't get lost,
Give me a dream I can make into reality,
Give me an ideal to resist...

We are brimming with confidence regarding the future of sterilization and we wish you a successful conference. Thanks very much for your presence!

Lot's of success!
Wim Renders
WFHSS President
Crete, 07 October 2009