Good morning, ladies and gentlemen,
It is a great honour to welcome you in the name of the WFHSS to our 9th combined conference. Firstly, I would of course like to thank AIOS, the Italian sterilization society for their willingness to organize the World Congress and for their warm hospitality. It is a pleasure to be here in Milan.
The World Forum dedicates itself, as our mission statement expresses "to the promotion of the worldwide harmonization of sterilization departments and of decontamination practices especially by providing:
- a meeting place for national and regional sterilization societies, thus stimulating co-operation and the exchange of information, and by providing
- information via its website.
In this way we hope to make a contribution to ensuring that the quality of reprocessing is of the highest possible level across the globe. The average number of 2500 daily visitors to our website and the growing number of participants in our congresses from ever more countries undoubtedly greatly contributes to the realisation of these objectives.
Co-operation between sterilization societies and between sterilization departments is of the utmost importance because it is the catalyst for progress and innovation. I am convinced that this congress will also make a big contribution to this aim and that after it is finished it will keep on reverberating and provide continuous motivation and inspiration.
At the opening session yesterday I talked about the three pillars on which a good CSSD is founded: sufficient means, people and know how. These foundations are synergistic and prerequisites in order to deliver an end product of the highest possible quality.
Quality, in other words meeting the needs of the customer, was, in earlier, more innocent times just an ethical requirement because the patient had a right to it. But all of that has changed nowadays. The competition with third parties forces the sterilization department to be vigilant also for reasons of economy and economics.
This is the most striking shift which has occurred in recent years. I am of the opinion that this shift will turn out to be almost as historically important as the move towards the centralisation of the sterilization activities in the hospital. This latest trend was started in the U.S.A. some seventy years ago and has been the most important driving force towards good practice.
Today we are entering a new era. The following years will be crucial in determining the future outlook of sterilization.
Fundamental choices will have to be made. From the answers we and others will provide, our future will depend. Today there is just one certainty: nothing will remain as it is.
The most important question and the item at the top of the agenda both of hospital management and of public health authorities is what kind of sterilization we want? In other words do we keep control over the CSSD or not? Inside or outside the hospital?
As far as I am concerned and this should be clear to everyone, I am in favour of sterilization in the hospital in a department run and supervised by the hospital itself. This to me is the most logical model because not only does one remain in control of one's own department, independent from others, but one also retains knowledge and know how. The loss of knowledge is most of the time irreversible. This route makes it possible to react flexibly in a fast developing environment to the ever changing questions of the customer.
Conditions which have to be met are sufficient size and the willingness by management to make the necessary investments and to keep on making them in order to keep the department up to date. The CSSD will only be able to defend its position if it has sufficient means put at its disposal. It is unacceptable to me, as I also made clear yesterday, that hospital management allows things to slip out of control and afterwards uses the lack of quality as an argument in favour of in- or outsourcing. Nevertheless, this is what is happening in a number of countries. I am not convinced that the takeover of the CSSD in the hospital by a third party provides surplus value. Maybe my doubts are not fully justified, but until the contrary is proven I remain a sceptical realist.
Another choice is the outsourcing or external centralisation. This model is based on a radical rationalisation of the scarce financial means in the health sector, the ever increasing demands being made as a result of e.g. the implementation of international norms and of personnel problems. Nothing is new under the sun because the same arguments were used in earlier days to make a case for the centralisation of sterilization in the hospital. These arguments were a striving towards better quality, cost reduction through standardization and a more efficient use of people and means. These arguments are used once again but now to justify centralisation outside the hospital. As you are fully well aware, it is always useful to take a brief look at the past in order to be informed about the future.
In this case sterilization will become an industrial sterilization business. The French experiments in which hospitals are collaborating in the setting up of external, central departments are very interesting to keep track of. I am convinced that if they succeed they will be copied. Other examples of outsourcing which at the moment seem to be less successful are the so called supercentres in the UK. One month ago they made the BBC news bulletins which reported on the bad service and the poor quality of some centres and of some end products. For now the further expansion of the supercentres has been put on hold, I've heard.
Despite the fact that the sterilization department does not have the final say in this debate, sometimes the discussion even takes place and the decisions are made without the involvement of the Sterilization Department, it has its fate more or less in its own hands. It will, like the supercentres, be judged on the basis of the quality of its end product and of the service it provides. Thus it simply has to make sure that it produces quality. If this is below standard, then co-operation with an outside partner, in whatever form, is to me the preferred option. It is not acceptable that a medical device of inferior quality is put at the disposal of the provider of care and of the patient.
This is one of the challenging choices sterilization departments are faced with today. Its future, our future will very much depend on the answer we shall give to it.
Apart from this almost tragic, existential question there are other also fundamental choices which should be considered.
A second, interesting but rather academic question is whether in the future we will stick to the old dogmas or whether we will opt for a more "evidence based practice"? Indeed even today daily practice is still too much based on tradition and rule-of-thumb. As a result of a lack of real proof we are inclined to cling to old tenets which perhaps have lost their validity or we are all too keen to accept as truths whatever is said by who-ever. These kind of practices are obstacles to open communication and prevent the coming into being of a global "state of the art" because everybody is clinging to "his" or "her" almost individual truth. That is why more opportunities for co-operation should be created in order to allow us to compare our practices and gradually eliminate the differences between countries. Also independent research, research with a small character, to analyse and test products, techniques, machines, programmes and procedures could help us to arrive at an evidence-based evaluation.
On this road there is one thing you never should do. This is to deviate from routine practice without sufficient proof that the new technique is an improvement on the old one. A typical case in this regard is the discussion about the relevance of the Bowie Dick or helix test which is currently taking place.
Of course it is not easy to implement a correct evidence based practice. To deal with scientific information rigidly does not only require the courage to apply it in practice but also knowledge. To acquire knowledge is not easy; without a determined effort it is not possible. Fortunately this efforts are compensated by an important side-effect of knowledge acquisition namely the gaining of self-confidence.
But self-confidence enables the CSSD to develop into an autonomous department with its own competencies and responsibilities. The appointment of a person who is ultimately responsible for the department can only speed up this evolution. This person should be someone with academic training and a scientific background. As the departments are managed by specialists they are more easily recognized and accepted as full, competent discussion partners. This is not unimportant as an independent CSSD is much better able to defend the interests of the patients when these are threatened e.g. when shortcuts in procedures are taken as a result of a lack of instruments or bad planning.
All these questions are burning issues today and deserve a structured response. From the reply the survival of the department will depend.
I trust that together we will be able to work out an answer to the problems we are facing and that together we can move towards a better future.
Lot's of success in the CSSD, your private lives and enjoy the conference!