Sirs,

I would like to know whether any hospital in europe or any part of the world outsource their steriliation activities to any specialised agencies. If they do how effective is it.

Regards,
Lekshmi Nair
TPL, India

Dear,

Indeed an increasing number of hospitals in Europe outsource their sterilization activities. We can distinguish two different concepts:

1. An external contractor collects the used instruments and reprocesses them in a facility outside the hospital. E.g. Combister (Nl), Sterience (Fr) - target: more than 30 % of the French market (source: Sterilization magazine), Ninewells hospital (U.K.). In the U.K. the private sector (subcontractor) has increased their market share from 4 % to 7 % (source: Sterilization magazine). The most important disadvantage, in this case, is a long turn-over time.
2. A "newer" trend is an external company taking over the sterilization department of and in the hospital. We could call it "in"sourcing. E.g. Vanguard (D), B. Braun (D), Air Liquide (Fr, I).

One of these concepts can offer a solution to hospitals that don't want to invest in new equipment and (or) personal, and where the CSSD doesn't meet the essential quality requirements. Of course you have to take the more-cost (10 - 15 % or more?) into account. Sorry, as I don't have any practical experience, I can't tell you anything about the effectivity. I hope our colleagues can.

Kind regards,
Wim Renders

Dear Lekshmi,

Taking the decision to outsource your sterile services can be quite a big step but it has been done here in the U.K. quite successfully and it has been proven that a hospital can function quite well without a sterile services department. Although there are those who would say that a hospital is much better off with their own department there are more and more hospitals moving to the option of outsourcing as increased standards in decontamination and sterilising have meant that hospitals are having to look at building new departments or upgrading their own. These options can be very expensive and need long term commitments

We recently took on the contract to service another acute hospital which is situated approximately 36 miles away and so far it has worked very well. There are a few issues and initial outlays which you need to consider if you are to decide to outsource your sterile services.

Firstly you will have to consider at least tripling your stock of trays and instruments as your turnover time will be considerably increased to as much as 24 - 36 hours. So you should calculate how many trays you will need to keep operations going over this period of time. Of course this can be an initial major investment but it should only be a one off cost.

Secondly you will need to look at where your stock of trays will be stored and where your items will be picked up and delivered. The hospital which we have contracted to still run a Sterile Store where all their items are picked up and delivered. Some of the trays are stored for Theatres and then issued when needed other trays are distributed throughout the hospital.

Thirdly transportation of your items is also a major consideration. If possible they should be transported in a vehicle which is used solely for this purpose and is easily cleaned. Take time to consider what type of container and trolley you are going to put your instruments into. They should be robust and able to protect and contain the instruments during the journeys back and forth.

Lastly get finance involved from the start. Be careful about what kind of contract you go for as a contract for a period of years according to yearly activity may be more constrictive than a contract that just charges a cost per tray. With the latter you will be able to increase or decrease your activity without going back to negotiate. Make sure you also include in your contract the standard of decontamination and sterilisation you expect preferably one which meets all up to date regulations. Also provision for emergencies and compensation for damaged items or failure to meet stipulations of the contract.

Hope this is helpful.

Aisling Bonner
HSDU Manager
Altnagelvin Hospital
Derry City
Northern Ireland.