MO HINH TRUNG TAM TIET KHUAN HIEN DAI

MODERN STERILE SERVICE CENTER MODEL

Reusing instruments in medical facilities requires a specialized facility suitable for disinfection and sterilization activities, equipped with standard designs, machinery, and equipment appropriate to the hospital's scale of development.

A modern, high-tech disinfection sterilization center is being implemented in many hospitals. Advanced technologies such as endoscopic surgery, cardiovascular intervention, dialysis, and more recently, robotic surgery, have posed challenges for the sterilization center model of medical facilities. According to WHO (2016), a sterilization center must be designed in a linear flow with distinct dirty, clean, and sterile areas, clearly separated, and with specific movement pathways, strictly prohibiting the transport of instruments from dirty to clean areas or cross-movement between areas to prevent the spread of infection.

Equipment and Machinery:

For the cleaning and disinfection area, there should be specialized washing machines, ideally two-door machines that separate dirty and clean areas and save manpower. This includes multifunctional washers (washing and drying) for metal, plastic, and glass instruments; ultrasonic washers for delicate and brittle instruments; and washers for soft and hard endoscopes.

For the sterilization area, there should be sterilizers (ideally two-door machines), sterilizers for heat-resistant instruments, and sterilizers for heat-sensitive instruments (Plasma, ETO). These machines should be in separate rooms. In addition to sterilizers, attention should be given to biological incubators, bag cutting machines, and bag sealing machines.

The maintenance area should be equipped with all necessary maintenance tools for repairs, rust cleaning chemicals, magnifying glasses, and microscopes to detect any malfunctioning instruments invisible to the naked eye.

A quality management system should be established with software and management tools to streamline operations, ensuring the provision of safe, quality instruments for patients and healthcare workers, and preventing instrument loss.

All employees working in the center must receive formal training, be trained as a profession, and regularly updated and assessed annually.

During a seminar on "Updating New Technology: Modern Operating Room Solutions, Sterilization Center Needs of Hospitals in Vietnam" held on October 23 in Hanoi, Deputy Minister of Health Nguyen Viet Tien stated: "Modern operating rooms and sterilization centers play a critical role in medical examination and treatment for patients. These are key areas in the operational structure of hospitals."

On November 24, 2017, the portal of the Department of Health also reported that the Children's Hospital in Ho Chi Minh City had launched a modern central sterilization center with full equipment and a one-way operational process. This ensures that reusable instruments, including hospital beds, meet international standards for disinfection and sterilization, a vital activity to ensure hospital infection control requirements.

Hospital-acquired infections (HAIs) are undesirable medical incidents. The HAI rate varies by hospital type and country, ranging from 5-10%, and is particularly high among immunocompromised patients, those undergoing invasive procedures, surgeries, and especially the elderly and premature newborns. Annually in the US, about 44,000 – 98,000 patients die related to HAIs, costing from 17 – 29 billion USD/year (Kohn, Institute of Medicine, 1999). In Vietnam, cross-sectional studies over many years have shown this rate ranges from 4.5 – 9%, depending on the hospital type.

Disinfection and sterilization of medical instruments and equipment play a crucial role in preventing HAIs, especially for reusable instruments in medical facilities, such as endoscopic instruments, respiratory care instruments, and hemodialysis equipment. Inadequate and improper handling of these reusable instruments has led to outbreaks, not only globally but also in Vietnam.

Reusing instruments in medical facilities requires specialized infrastructure suitable for disinfection and sterilization activities, with standard designs, machinery, and equipment appropriate to the hospital's scale of development. Staff responsible for disinfection and sterilization must receive specialized training in instrument sterilization at educational institutions.

Modern sterilization center models have significantly evolved. Nowadays, many advanced and specialized techniques are being implemented in hospitals, such as endoscopic surgery, cardiovascular interventions, dialysis, and more recently, robotic surgery, posing challenges for the sterilization center model of medical facilities. According to WHO (2016), a sterilization center must be designed in a linear flow with distinct dirty, clean, and sterile areas, clearly separated, and with specific movement pathways, strictly prohibiting the transport of instruments from dirty to clean areas or cross-movement between areas to prevent the spread of infection.

Basic Criteria:

• Entrance and corridors (public area)
• Points for staff to wear personal protective equipment before entering the work area
• Receiving used medical instruments and equipment (dirty area)
• Inspection, assembly, and packaging (clean area)
• Disinfection area (disinfection area)
• Sterile storage (cold temperature and short-term storage)
• Rest areas for administrative staff and other related areas (necessary movement between work areas)
• Storage for equipment, chemicals, and packaging supplies (materials and SSD products)

Equipment and Machinery:

For the cleaning and disinfection area, specialized washing machines are needed, preferably two-door machines to separate dirty and clean areas and save manpower. This includes multifunctional washers (washing and drying) for metal, plastic, and glass instruments; ultrasonic washers for delicate and brittle instruments; and washers for soft and hard endoscopes.

Figures:

• Figure 1: Design and zoning diagram of the sterilization center
• Figure 2: Instrument processing at the sterilization center

For the sterilization area, there should be sterilizers (preferably two-door machines), sterilizers for heat-resistant instruments, and sterilizers for heat-sensitive instruments (Plasma, ETO). These machines should be in separate rooms. In addition to sterilizers, attention should be given to biological incubators, bag cutting machines, and bag sealing machines.

The maintenance area should be equipped with all necessary maintenance tools for repairs, rust cleaning chemicals, magnifying glasses, and microscopes to detect any malfunctioning instruments invisible to the naked eye.

Unit Management:

A quality management system should be built with software and management tools to streamline operations, ensuring the provision of safe, quality instruments for patients and healthcare workers, and preventing instrument loss. Management software for instruments is essential, and instruments need to be coded and managed using barcode scanning software to make instrument management easy, effective, and cost-saving.