24th DGSV Congress, 4 to 5 October 2021, Fulda
While the 24th Congress of the German Society of Sterile Supply (DGSV) was held this year in Fulda, only the members of the board of directors and the speakers attended in person. Unfortunately, because of the pandemic, the audience had to stay away from the venue and tune in remotely to the lectures taking place at this hybrid event.
Following an introduction by Klaus Wiese, DGSV chairman, Kathrin Mann gave the first talk on the topic of “Costs of reprocessing medical devices in the outpatient operating room (OR)”. She explained that the operator was responsible for proper conduct of medical device reprocessing. However, in the case of Germany, the remuneration structures had for many years now failed to keep abreast of the rising demands. Did it pay off for an institution to take charge of its own reprocessing activities or could the economic operator outsource these services or even switch to single-use devices? These issues could only be resolved through detailed analysis.
Citing by way of example at outpatient surgical centre in the Upper Palatinate region of Germany, Mann explained how the costs of reprocessing a single sterilization unit (1 StU) were calculated. She gave an overview of the surgical centre and its various areas, explaining in detail the items that had to be included in the economic analysis. She pointed out that such topics were unfamiliar territory for the majority of the clinicians involved. These costs were not confined to personnel, others items such as e.g. consumables, equipment rental charges as well as water and electricity consumption had to be included in the calculation. In the specific case cited, it thus led to total reprocessing costs of at least 36,000 EUR/year. The reprocessing costs for a varicose vein set, for example, amounted to around 20 EUR and around 118 EUR for one StU.
These calculations helped the economic operator exactly estimate whether in-house reprocessing continued to make economic sense or whether outsourcing of reprocessing or switching to single-use devices were an alternative.
Can robots reduce the workload in the RUMED?
As part of the SteriRob project sponsored by the German Federal Ministry of Education and Research (BMBF), the deployment of cooperative robotics to underpin instrument reprocessing is being investigated. Such a system could enhance personnel protection in that the handling of contaminated instruments would be entrusted to robots. It was important to identify at which juncture of the reprocessing process this would be beneficial. Jan Heibeyn from RWTH Aachen reported on identification of performance factors in instrument reprocessing for targeted workflow support.
The approaches used hitherto for process analysis of reprocessing activities focused on monetary factors. However, Heibeyn stated that these did not suffice for comprehensive evaluation and optimization of the process. He explained that the action required would have to be determined in cooperation with personnel in the Reprocessing Unit for Medical Devices (RUMED) to identify current weak points. That involved issues such as e.g. the incidence of injuries and the levels of physical stress.
An online questionnaire was used to carry out a survey among RUMED personnel. For managerial staff, the questions revolved around process management and performance factors, while for the remainder of the staff members the focus was on the practical implementation of the processes and accordingly on the action required in practice.
40% of respondents believed that the process steps that needed to be optimized included handling the incoming unclean trays and loading the washer-disinfectors (WDs), as well as instrument precleaning. 30% hoped for improvements in storage, including the management of repairs, servicing and returns. 20% of respondents called for improvements in sorting the cleaned trays and instruments as well as in packing and caring for trays.
The physical stress associated with unpacking wire trays was rated high, and manual cleaning of instruments was deemed by 24% to be “very strenuous” to “quite strenuous”.
Based on these findings, the greatest need for action was in the unclean area of reprocessing. Based on the performance factors given highest priority, the possibilities for reducing stress when unloading trays as well as during manual cleaning by cooperative robotic systems should be investigated.
Spotlight on the RUMED workflow – poll results
Anke Carter reported on the findings of polls carried out on behalf of the DGSV. Of particular interest was a comparison of two flash polls on the situation in Reprocessing Units for Medical Devices (RUMEDs). The DGSV e.V. board of directors conducted the first poll in 2019 to get an insight into various aspects of the workflow of RUMED personnel. A second poll was carried in the summer of 2021 to ask once again how the RUMED workflow was evaluated, what qualifications staff working in the domain of “medical device reprocessing” had acquired and how the situation was assessed in the workplaces.
The questions had barely changed and both polls produced almost the same number of respondents. More than half of respondents came from RUMED managerial level. There was a sharp decline in the number of respondents with completed professional/vocational training. Carter stressed that, in that regard, completed professional training was an important factor in enhancing employee status – hence, completion of training as a Medical Device Reprocessing Specialist was highly recommended.
Other findings were somewhat surprising: e.g. questions about weekend work revealed that the majority of respondents worked from Monday to Friday. The entire findings would soon be available on the DGSV website.
Cleaning – factors for quality assurance
Winfried Michels spoke about routine quality control of cleaning. Cleaning of surgical instruments had to be carried out with validated processes. Michels said that the scope of validation of cleaning in a WD process was absolutely inadequate. In particular, too few instruments harbouring soils from real-life use and with different constructional features were used for verification of cleaning.
Special attention should be paid to the cleaning mechanical action: this was not homogeneous across the cleaning levels and instrument positioning as well as the orientation of the instrument gap regions, e.g. of jointed instruments, played a major role. Since it was difficult to gain insights into the essence of the cleaning technology, routine quality assurance checks of the cleaning of real-life instruments were needed, said Michels. He described the procedure used for sampling. The instruments to be sampled had to be withdrawn from the WD prior to thermal disinfection. Intensive washing was needed for elution to determine the amount of residual proteins.
With regard to cleaning indicators, Michels said that in some of the tests performed by him indicators did not show whether the enzyme activity was still adequate. Nor was a concentration fluctuation of the detergent of e.g. over 10% displayed. Even obstructed spray arm rotation did not necessarily mean that the indicator signalled this at the end of the process. There definitely was a certain risk if users relied on the indicators and used them as a basis for batch release.
The guideline compiled by the German Society of Hospital Hygiene (DGKH), German Society of Sterile Supply (DGSV) and the Working Group Instrument Preparation (AKI) for validation and routine monitoring of automated cleaning and thermal disinfection processes did not recommend indicators since there was no normative basis to that effect. In his conclusion, Michels stated that in the RUMED too there should be a test area to perform periodic quality checks of the cleaning of instruments with real-life soils in order to ensure the pertinent requirements were met.
Paula Lorek from the University of Anhalt in Köthen focused on the impact of the duration of the waiting time until surgical instruments were cleaned after use. She explained that for the past four decades dry transportation of the medical devices after use had been recommended and that a waiting time of up to six hours was not thought to be a problem for automated cleaning. This 6-hour rule had also been recommended by the Working Group Instrument Preparation (AKI) in its Red Brochure.
In her bachelor thesis, Lorek examined the impact of different dry transportation times until automated cleaning of surgical instruments harbouring real-life soils after use. In the RUMED of the hospital BG Klinikum Bergmannstrost in Halle, the results of automated cleaning were investigated two, six and 14 hours after dry transportation. For each of these waiting times 30 similarly-sized instruments with and without a joint and with the same contamination load were selected and marked. After expiry of the specified waiting time, the instruments were cleaned in a conventional WD and withdrawn from the WD before thermal disinfection.
The results demonstrated that a longer dry transportation waiting time led to higher amounts of residual protein after cleaning. Lorek stressed that in particular waiting times of more than 14 h led to essentially poorer cleaning results. Although all instruments had less than 100 µg residual protein, this increased significantly with prolongation of the waiting time.
Hence, it was not possible to infer a 6-hour rule from these findings. Rather, the dry transportation time after which cleaning results that always met the pertinent specifications were assured depended more on the respective WD process.
Long waiting/storage times, especially at the weekend, were thus a problem. Lorek concluded by pointing out that how this could be resolved in everyday life should be considered.
Matthias Tschoerner, Chemische Fabrik Dr. Weigert, spoke about the inactivation and removal of prion proteins in cleaning processes.
For a long time now it had been known that various types of transmissible spongiform encephalopathies could be transmitted through direct tissue transfer during surgical procedures and via contaminated instruments. The high stability of prion proteins required specific reprocessing steps to reduce any such prion protein load, inactivate the residual infectiousness and thus prevent iatrogenic transmission.
Different approaches were taken in different countries. In France, a cleaning process with demonstrated prionicidal activity was needed for instruments that may have come into contact with risk tissues, while in Germany these instruments should be reprocessed with at least two partially prionicidal processes.
Tschoerner presented the results of tests aimed at in vitro and in vivo removal and inactivation of various prions. He said that the results revealed that good cleaning in an alkaline medium was able to remove prion protein from surfaces by > 2 to > 4 log levels. On routinely using the prophylactic method recommended by the Robert Koch Institute (RKI) – inter alia, precleaning and cleaning with a mildly alkaline detergent, it was possible to achieve a reduction of at least 2.5 log levels.
However, Tschoerner stressed that this in itself did not constitute a prionicidal process: suspension tests had demonstrated that while this was able to neutralize the infectiousness of instruments, it did not inactivate prions. Through complete inactivation with prionicidal formulations, it was possible to reduce and inactivate prion proteins by > 5–6 log levels.
Standards and guidelines – what’s new?
The new DIN “Requirements for the validation of cleaning and disinfection processes” (DIN 58341) was published in July 2020. The purpose of this document is also to set out in detail the implementation of the content of existing standards (DIN EN ISO 15883, Part 1, 2, 4, 5). The corresponding DGSV guideline will also be amended and the annex “Requirements for validation officers” is to be published beforehand.
Robert Eibl spoke about the essential contents of the standard, including the requirements for conduct of validation (necessary knowledge) and actual validation of cleaning and disinfection processes with various subsections, including the validation plan, information on installation, operational and performance qualification.
A special feature was normative Annex A “Requirements for, and contents of, validation reports”, making it finally possible to harmonize the validation folders of different companies.
Gerald Göllner summarized new information and amendments to DIN EN ISO 17665 “Sterilization of health care products – moist heat”. The new version had still the status of an internal paper, and numerous commentaries had still to be processed. Publication of the draft was planned for the end of the year.
An important goal of revision was to take account of the different ways the requirements were implemented across the various areas of the healthcare sector (e.g. hospitals and medical/dental practitioner offices). New annexes were intended as a means of permitting a differentiated approach.
For example, the old annexes B, C and D were summarized as a new Annex B, dealing with microbiological methods for evaluation of sterilization safety. This gave a detailed account of three methods (bioburden-based, bioburden/bioindicator-based and overkill), underpinned with examples, intended to facilitate the selection and evaluation of biological indicators and test results.
“How do I optimize my RUMED?”, asked Franziska Meindl from Freising. She reported on the increasingly more stringent regulatory requirements, resulting from revision of the standard 13485 “Medical Devices – Quality management systems – Requirements for regulatory purposes” and the coming into force of the European Medical Device Regulation (EU 2017/745 on medical devices). Meindl went on to say that it was not just the manufacturers who were affected by these amendments, but also the hospitals as users and, in particular, the RUMED. The requirements called for a process-oriented approach to quality, underpinned by extensive medical/technical knowledge – this was a challenge that was difficult to meet in the majority of healthcare establishments.
For her bachelor thesis Meindl developed a practical method to help the responsible parties in the Reprocessing Units for Medical Devices transparently present and, at the same time, evaluate their quality management system in accordance with EN ISO 13485:2016. This Quality Management System Evaluation Matrix contributed to a continuing improvement process, thus helping to identify weak points and making even Germany-wide comparisons conceivable, in order to assure nationwide a good supply of reprocessable medical devices.
The method had already been successfully used in the RUMED of the hospital Nordoberpfalz AG in preparation for an external audit. This made it possible to detect weak links already before the audit and take timely remedial measures.
Heike Martiny dealt with definitions: “Can you still get to grips with this?” She explained that uncommon designations had appeared in the new version of DIN EN ISO 15883-4 or in DIN 58341. That was because of new definitions which would also be used in future in other parts of DIN EN ISO 15883 being currently revised and in the guidelines for validation of cleaning and disinfection processes.
Since 2019 there was the international standard DIN EN ISO 11139 with the title “Sterilization of health care products – vocabulary of terms used in sterilization and related equipment and process standards (ISO 11139:2018)”. This meant that many familiar terms had changed, said Martiny. The entire matter was made more complicated by the “Definition of terms” in the EU Regulation which had been in force since 26 May 2021.
For the practical application standards will be translated into guidelines. Monika Schick-Leisten presented the new version of the guideline for the validation of packaging processes from 2020. What has changed? On the one hand, the specifications: the new Medical Device Regulation (MDR) was published in 2017, and the standards had been accordingly updated. Packaging processes for reprocessing would continue to be set out in the Medical Device Operator Regulation (MPBetreibV) of 2018. That also gave rise to the legal requirement for validation of the packaging process.
The already mentioned revision of the vocabulary in standard ISO 11139 gave rise to further amendment of the definitions which would be applied in future also to packaging processes.
As one example of an important amendment Schick-Leisten cited the terms process variable, process parameter and process specification. On the other hand, the term “Critical process parameters” has completed disappeared.
Smart sterilization – how it becomes possible
Marc Andres, from the firm Getinge, looked at work processes in the RUMED. Medical device reprocessing comprised certain workflow patterns. Suitable premises, appropriate equipment technology, logistics tailored to the workflow patterns, an IT infrastructure for recording and documentation of the workflow patterns and, of course, personnel too were needed.
Various optimization measures could be taken to achieve more efficient work processes, reduce instrument turnaround times and effectively reprocess the instruments. First of all, the aforementioned prerequisites – from the premises through the equipment technology to the IT infrastructure – had to be properly combined. Automation could also play a role here.
Andres stressed that solutions should always support staff members and avoid making excessive demands on them. Optimization of fittings/furnishings and efficiency ultimately enhanced patient and personnel safety.
Ultrasound and occupational safety and health
Johanna Klümper, St.-Johannes-Hospital, Dortmund, described the hazards faced by operators of ultrasonic baths. Often, the noise pollution caused by ultrasonic baths and the associated, and possibly damaging, effects on personnel were often overlooked and only very rarely taken into account during hazard assessment.
Klümper described in detail the physiological background. Ultrasonic components were not perceived by human hearing and hence their potential dangers were underestimated. Investigations into the possible damage to human hearing by high frequency sound had been carried out, in particular, in dentistry, where ultrasonic devices were also used. The findings on auditory threshold shifts were not unequivocal, but high sound pressure levels in the high frequency range did indisputably have subjective effects, such as e.g. headache, nausea and vertigo. However, no data was available on dose-response relationships.
Klümper went on to describe how the sound impact could be measured more effectively and what had to be noted when doing so. There were also effective protective measures that could be taken, e.g. the enclosure of the ultrasonic bath with a solid aluminium or woodchip plate. It should be noted that this led to increased temperatures in the bath and could possibly impact the cleaning results.
To finish off, Klümper pointed out that hearing protection should be offered to staff as a general measure only after other protective measures had proved inadequate and did not produce satisfactory results.
Endoscopes: how is the reprocessing quality?
Dirk Diedrich gave an update on the HYGEA study. This study which was published in 2001 revealed that there were still high complaint rates with regard to reprocessed flexible endoscopes of 49% (1st phase) and 39 % (2nd phase). Since then several regulatory measures had been taken to improve the reprocessing quality of flexible endoscopes.
On comparing the findings of the HYGEA study with up-to-date data collected by a hygiene/infection control department on the routine microbiology test results for flexible endoscopes, it was revealed that there was no change in the percentage usage of automated reprocessing in hospitals – 92% of hospitals reprocessed their endoscopes in an automated washer-disinfector. By contrast in the medical/dental practitioner offices a sharp rise was observed in automated reprocessing from 17% to 60%.
The complaint rates in 2018 were only 8%. A conspicuous finding, said Diedrich, was that the rate of duodenoscopes attracting complaints remained unchanged at 9%. He pointed out in the interval between the two studies the microbiological limit value set for the cleaning solution was reduced from 10 cfu/ml to 1 cfu/ml. If this limit value was applied, it would result in an unchanging contamination rate of around 13%, and complaint rates of > 10% were certainly not in the interest of patient safety, said Diedrich.
Causal research highlighted two factors: first, the use of manual steps, which were still required in endoscope reprocessing and were more prone to failure than automated processes. Second, reprocessing was subjected to pressures caused by a severe lack of time because the endoscopes were used so frequently due to the high number of endoscopic examinations. That generated pressure to continually expedite the AER (automated endoscope reprocessor) processes – in some cases drying was omitted because of a lack of time.
Besides, there were questions about the way in which process validation was currently performed in AERs – was it really able to evaluate automated reprocessing of flexible endoscopes? Despite validation, the reasons for unsatisfactory results were often not identified.
Diedrich elaborated further on the various sampling approaches as per the DGKH or RKI specifications. Sampling as per the DGKH gave rise to a higher rate of unsatisfactory results.
Ulrike Beilenhoff, chairperson of the German Society of Endoscopy Nurses and Associates (DEGEA) from Ulm, gave a talk on damage to endoscopes. Heat-sensitive, flexible endoscopes were susceptible to damage because of the mixed materials of which they were composed, their complex design and delicate optical systems. Damage was generally caused by one of four factors:
Mechanical effects resulted, in particular, from careless handling and led e.g. to kinking. Inappropriate handling of ancillary instruments, such as needles or biopsy forceps, could damage the channel system.
Endoscopes could also be damaged through exposure to heat. Beilenhoff explained that AERs were equipped with safety mechanisms to prevent this; thermal effects resulting from selecting the wrong reprocessing programme were thus prevented by scanning the endoscopes. But the use of laser or APC (argon plasma coagulation) could by all means damage the distal end.
Process chemicals could cause swelling and damage to the endoscope sheath material, valves and control panels. Interactions between process chemicals could also form deposits in the AERs and on the inner and outer endoscope surfaces. Water with very high lime content could also cause deposits.
As regards infections associated with endoscopic procedures, the endoscope or ancillary instruments will have served as a vehicle for pathogenic or facultative pathogenic microorganisms originating from previously examined patients or the environment.
In the case of outbreaks with multi-drug resistant bacteria, microlesions were detected increasingly at the distal ends of the endoscopes and had served as portals of entry for the bacteria.
How could one prevent such damage? Appropriate structural and process quality was the most important prerequisite. This included having sufficiently spacious and well-equipped endoscopy suites and RUMEDs, proper organization that helped to avoid mistakes in the workflow, in addition to the right number of qualified personnel.
Process quality included the professional and expert deployment of endoscopes during endoscopy, reprocessing with all manual and automated work steps, transport and storage of the endoscopes. Expertise, knowledge of the specific endoscopes as well as experience were decisive, stressed Beilenhoff. That was why the special endoscopy training courses were so important. Quality checks also helped to detect any damage early on.
MDR – what (still) applies?
Christian Jäkel, Lübben, spoke about the new Medical Device Regulation (MDR) and its implications for reprocessing. The new Medical Device Regulation applied to both European and German legal regulations.Jäkel explained thatthe Medical Device Regulation (MDR) was immediately applicable law in every Member State of the EU as well as in the other EEA States (Island, Norway, Liechtenstein). It therefore did not have to be transposed into national law first. Switzerland would be seen in future as a third country.
Implementing acts (four so far) set out detailed rules on MDR, e.g. on common specifications for reprocessing single-use devices. These legal regulations too became immediately applicable law.
Because of the predictable problems expected when placing medical devices belonging to a higher class on the market, an amendment was made to MDR, whereby now e.g. also reusable surgical instruments were granted a transitional period for placement on the market.
Jäkel went on to say that reusable surgical Instruments had been assigned from class I to a new, higher class Ir. Therefore, a Notified Body had to now be involved in the conformity assessment procedure with regard to aspects related to reuse, in particular cleaning, disinfection, sterilization, maintenance and functional testing as well as associated instructions for use. The transition period ran until 26 May 2024.
In German law, the Medical Devices Act (MPG) was replaced by the Medical Device Law Implementation Act (MPDG) on 26 May, 2021. This contained only supplements and detailed regulations because the MDR was directly applicable law.
The Medical Devices Operator Regulation (MPBetreibV) continued to be applicable, and also the KRINKO/BfArM Recommendation*, BAnz AT 12.10.2012 B1) continued to be the key recommendation for reprocessing medical devices.
Jäkel next spoke about the Medical Devices User Notification and Information Ordinance (MPAMIV), regulating, among other things, notification procedures and information exchange between the competent authorities, and set out the rules enshrined in MDR on implants.
KRINKO/BfArM Recommendation*: Recommendation for hygienic processing practices for medical devices, jointly compiled by the Commission for Hospital Hygiene and Infection Prevention at the Robert Koch Institute (RKI) and the Federal Institute for Drugs and Medical Devices (BfArM)
Ultrasonic probes – wiping is not enough
Jalel Ben Mesmia, University Hospital Schleswig-Holstein, Kiel, spoke about reprocessing ultrasonic probes, including gamma probes which were classified as critical as per the KRINKO/BfArM Recommedation. These were used intraoperatively. Most of the other ultrasonic probes were classified as semi-critical medical devices and were often reprocessed manually in everyday practice using ready-to-use wipes for final disinfection.
Ben Mesmia drew attention to the DGKH Memorandum on reprocessing selected semi-critical medical devices, which advocated the safest method, and hence as a general rule the use of automated reprocessing in a washer-disinfector. A validated process had to be used in all cases.
Validation of manual wipe disinfection processes was very onerous and difficult, and in the meantime there were automated and validatable high-level disinfection processes. The Robert Koch Institute answered the question about the validatability of final disinfection of semi-critical medical devices with wipes by stating that at present validatability was not assured. The guideline for the validation of manual cleaning and manual chemical disinfection of medical devices did not mention wipe disinfection processes either. Hence, an automated disinfection process was used predominantly and was currently the only process that could be validated.
Ben Mesmia emphasized that the reprocessing process consisted of a number of subprocesses, which all had to be taken into account and validated in accordance with the pertinent guidelines or standards. He clarified this by presenting the applicable standards and guidelines for each of the subprocesses. For gamma probes classified as critical, a third validation phase had to be performed for the "sterilization" subprocess (plasma sterilization) in addition to the validation of the cleaning and disinfection steps.
Karlheinz Zacherl focused on the topic of communication between the RUMED, OR and clinician and first of all described error management and relationship work.
Fear of making mistakes could act as a brake block. The task of a responsible management was to devise an error management policy, so that those concerned could be freed from such brake pads.
Instead, a productive approach to dealing with mistakes, which entailed learning from mistakes, was beneficial.
Zacherl went on to say that the well-known quality tools (e.g. error analysis) were not always suitable. Efforts had to be invested in the relationship. For example, the parties involved should consciously try to question their behaviour toward the other person and, if necessary, to change it in the interest of shaping the relationship positively. Hence, the aim should be to achieve better cooperation and open exchange. Zacherl highlighted the importance of having the right mindset. The mindset determined in a short span of time how a situation was reacted to and communicated.
Citing a few examples, he explained how the goal of integrative communication could be achieved, helping to overcome in a professional manner obstacles to communication (communication gaps, slowness, anxieties, orientation), so that in the end a common goal could be reached through mutually agreed actions.
Disabled persons in a RUMED – Risks, opportunities, implementation
Stefan Titt from Bonn Community Hospital dealt with the topic of disabled employees in a RUMED. He pointed out that inclusion was possible only if the corresponding requirements were met already at the time of planning new buildings or conversions.
Citing a few examples, he highlighted that disability could present in many different forms and the degree of disability alone said nothing about the extent to which someone could be employed in a RUMED.
Titt said that what was more important was to focus on the human being and together discuss their individual supports needs in their workplace. Indeed, many adaptations would benefit not just disabled employees – just think of height-adjustable packing tables.
This was a topic that was of practical relevance, which the DGSV Committee for Hygiene, Construction and Technology should also address, said Rainer Stens (DGSV) at the end of the talk and called for staff members with a disability to forward their experiences on this issue to the email address firstname.lastname@example.org.
Sterile supply logistics – what helps?
Gerhard Kirmse, from the firm Aesculap, made clear in his talk that logistics in hospitals was lagging behind modern industrial systems by decades. Analysis of logistics processes in hospitals often revealed that even simple basic data were lacking for logistics processes. Whereas inventory data were normally available (instrument inventory), the production capacity of the RUMED and the instrument turnaround time were unknown in many cases. The same was true for the needs of the operating room (OR).
Kirmse explained the difference between Push and Pull Systems. The RUMED usually operated in accordance with the “push” principle, i.e. incoming medical devices were “pushed” as quickly as possible through the production process. By contrast, a key element of modern logistics was production based on customer needs (“pull system”; the consumer “pulls” products out of production). That meant the provision of supplies tailored to the OR schedule. The advantages were obvious:
- The goods (supplies) needed were reliably produced (demand-driven).
- No unused stock was generated.
- Unnecessary overtime was avoided, and a more uniform personnel and resource requirement was achieved. Kirmse demonstrated that this could even help to dispense with night shifts.
However, certain prerequisites had to be met, e.g. a clearly known need per surgical operation e.g. with case cart systems. It should be possible to assign priorities to the incoming sets in the RUMED.
But it should also be possible to react to short-term changes such as incoming emergencies.
On the other hand, OR planning must be based on the available supplies.
Kirmse also pointed out that such systems meant a major change in working practices and that acceptance among users was the key to its success.
Conclusion: The approaches used in industrial logistics systems could by all means be applied to the world of sterile supply logistics, but they needed to be adapted and risks had to be borne in mind. These systems could markedly improve the efficiency, reliability and availability, but also reduce the complaint rate.
A more detailed report, also on other lectures at the of the DGSV Congress, can be found at bit.ly/
The date for the next DGSV annual congress has also already been announced: it will be held from 3 to 5 October 2022 – hopefully again with all speakers and delegates present on site in Fulda.