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EFHSS Conference 2006
Lectures and Presentations
Opening Speech

by Wim Renders
Lillehammer 18 May 2006

Good afternoon mister mayor, ladies and gentlemen,

It is my pleasure to welcome you in the name of the EFHSS to the European Conference for sterilization. First of all I would like to thank the Norwegian society for the invitation addressed to us and for the excellent work Kari and the organizing committee have done. Together with you, I am looking forward to the presentations and all the other activities during the following congress days.

Secondly I would like to briefly provide some information about the European Forum for Hospital Sterile Supply for the benefit of those, just a few I trust, who don't know the Forum. The Forum, as the name implies, is the meeting place of national and regional societies that are active in the area of sterilization in the hospital. At the moment we have 35 members. The objective of the Forum is to disseminate knowledge about sterilization. The most important means we employ to achieve this purpose are our website and the annual European Congress. However, as the financial threshold for participating in these congresses is often too high to allow everybody to attend, and as we also want to reach the numerous anonymous collaborators we go on regional visits and organize regional workshops as well. Apart from these initiatives the workgroup "Education" worked out a training proposal on the basis of the model, which was developed by the ESH. The training model consists of 3 modules: technician, teamleader and manager. It is also available on our website. We trust the training model can be a source of inspiration for those societies who have not yet set up their own training programmes. Training provides the necessary foundation on which a quality approach is built.

But not only in Europe also in other continents serious efforts are undertaken to improve the quality of the sterilization departments. The worldwide interest and the international participation here prove that globalization has become an irrepressible force in sterilization as well. The EFHSS board recognised this and I am happy to tell you, in primeur, that it adopted the name accordingly to: WFHSS or World Forum for Hospital Sterile Supply.

In the outside world globalization is not always greeted with applause, and rightly so. The other-globalizers are strongly opposed to the growing power of the multinationals and their monopolization of society. As a result the drive for financial gains of some individuals and companies, takes precedence over the quality of life and in extreme cases over the survival of many. Moreover, as a result of the loss of authenticity and identity, the whole world is becoming more westernized and thus less diversified. The other-globalizers fear that the preservation of a common world heritage: water, air and land, is coming under more and more pressure. Economic interests seem to prevail everywhere.

The sterilization world as well has to be wary of some harmful side-effects of globalization. One is the blurring of norms. The norms, which are being drawn up in the ISO-CEN workgroups should not be a diluted version of the original ones and much less the result of a compromise between interest groups. Norms should map the way ahead but at the same time have to be realistic and attainable. In the workgroups also the sterilization department should as a matter of urgency have much more say because the norms will determine the organization, the work load and the future output of the sterilization departments. But the high expenses necessary to attend the meetings form an obstacle to directly participate in the debate. In order to make this possible, albeit indirectly, we have started a page on the EFHSS website. Thereon we will provide up-to-date information about standardization. We invite you to provide there your comments on the norms so that they can be shared by your colleagues. By sending your remarks to your own national institute for normalization you can give the sterilization sector a voice in the discussion. We can and should make a constructive contribution to the establishing of the norms. Therefore I count on your cooperation.

Another problem is the provision of information, which is not always objective to put it mildly. Sometimes the information issued by companies has a strong marketing slant: it is an element in the sales strategy. This obviously does not serve the best interests of the consumer. Sometimes the ignorance of the buyer is exploited in order to sell old-fashioned technologies or outdated products, which are not effective. For example there is these days quite a lot of uncertainty about the use of formaldehyde and certain forms of ethylene-oxide sterilization. And unfortunately not everyone has the expertise to make an informed choice. It is therefore very important that companies adopt an ethical attitude. The sterilization departments wherever in the world need objective information, which provides the desired clarity and confidence but without falling into the trap of overshooting.

A third consequence of globalization is the trend towards the outsourcing of the sterilization departments and the setting up of super-centres. A lack of financial means for the hospital, the ever rising operating costs of the sterilization department, a lack of space and indeed, I have to admit, the fact that a number of departments cannot produce the desired quality combined with the fact that it would be too expensive to upgrade these departments, has fuelled the discussion about outsourcing which is taking place all over Western Europe nowadays. This trend is supported by a number of decision makers inside the hospital who are of the opinion that sterilization activities are not a core business of the hospital and thus can be outsourced.

At the level of the department this is in the first place - and rightly so - an employment issue. At the macro level the question arises whether there still is a future for sterilization within the hospital? Will sterilization departments face the same fate as the hospital laundries, the technical services, the cleaning and the catering?

The hospital sector too will be forced, much more than has been the case up to now, to adopt economic management models. An ostrich approach in the CSSD, in other words simply carrying on as if nothing were the matter, is definitely not the right response. We should have the courage to ask ourselves awkward questions, to make an objective analysis of the way in which our department is functioning and to dissect our weaknesses. Only a rational approach will enable us to take the appropriate measures and to make the necessary improvements. Only in this way can a higher quality standard be reached and a preventative strategy implemented. In the long run the survival of the CSSD depends on the quality of the end product. If we cannot provide the necessary quality guarantees co-operation with an external partner should be a better option than providing bad quality.

We should of course make the most use of the trumps cards we hold in our hands namely our intimate knowledge of the product, our flexibility and our commitment. When we play our cards right, there will certainly be a future for the sterilization department in the hospital.

The environment too has to be a concern for the CSSD. In the hospital environmental concerns always take second place to patient care. That is the reason why they have not been given a high priority listing. But this cannot continue to be the case. As a big user of energy, water, packaging materials etc. the CSSD can make a substantial contribution to the protection of natural resources by for example promoting lean energy and water use, by reducing emissions of EO and formaldehyde. Generally speaking, procedures have to be assessed from an environmental perspective and adapted to make sure they are environmentally friendly. The environment must become a debatable topic and should be a criterion in the purchasing and production process. We too should make a contribution to defuse the timebomb, which is ticking underneath our globe, and to make man's footprint on the planet as light as possible.

Sterilization departments aren't islands. They cannot isolate themselves from the general trend and from economic dictates. Globalization is a fact and fighting windmills as useless as in Don Quichote's time. However, we should see to it that these developments are exploited to the advantage of all sterilization departments and that we do it in our own way. This would be possible, according to me, by opting for a soft form of globalization, a special kind of other-globalization, namely a globalization based on solidarity. For us this solidarity has to take the form of the dissemination of knowledge, in other words the willingness to put the expertise and knowledge we have acquired at the disposal of others. This can be done at a local, regional, national, international, European and even global level. Especially at a bilateral level many more opportunities should be created to work together than has been the case up to now. Within the same region it cannot be too difficult for example to stimulate the participation in each other's congresses. Situating one's own department within a broader reference framework could provide a strong stimulus for a critical analysis of one's own practices. Learning from each other provides a shortcut to quality improvements. We have experienced this ourselves in Flanders. The steep learning curve, the substantial quality improvements we have managed to achieve only came about after we started comparing our practices with those in our neighbouring countries and to learn from them. As a result new initiatives were taken and new approaches and processes introduced. The quality changes brought about as a result of this process of sharing expertise and knowledge were astounding.

This form of solidarity empowers everyone, does away with paternalism and avoids the pitfall of the knowledge economy. In the latter everyone guards his or her own comfort zone, with the result that the fault lines between the poor and the rich, the east and the west, the north and the south become even more sharply etched. By sharing knowledge and expertise, through permanent co-operation and the building of partnerships the gap between the haves and the have-nots can be bridged. Fortunately a lot is happening in this respect. Just take a look at the question and answer pages on our website. But things can and should get even better. There still is too much reluctance, also in industry, to share knowledge, probably out of fear that others could profit from your work of simply through lack of interest or time. If we just could shelve our fears and become more open, sterilization worldwide could get a big boost.

In this way solidarity could increase mutual coherence, have a big impact on quality and contribute to a gradual worldwide harmonization of the sterilization departments. With this I envisage that each department, wherever it is located, meets for itself maximal quality criteria. Of course the available means always have to be taken into account because one can only work with the means put at one's disposal. But one should get the maximum out of the available means. I am convinced that this kind of harmonization is not a pipedream but a statement of fact through which we indicate that we want to continue building the road to the future in the interest of the collaborator, the care provider and the patient. I told this already in London too but I like to repeat it now: one for all and all for one is the way in which we should build the future of the CSSD in order to be in a position which allows us to successfully meet the big challenges we are facing. Thank you for attending the congress. Enjoy it.

Wim Renders
Lillehammer, 18 May 2006