ASP SUMMIT 2023 Webinar 1 "Medical Device Reprocessing Efficiency impact in Healthcare: an overview"

Added: 2026-05-31

[00:00:00]foreign [Music] [Music] foreign [Music] foreign [Music] hello welcome everybody to our first ASP Summit 2023 webinar series 4. my name is Jai Mouse and I'm the senior education manager for the ASP email region it's my big pleasure to kick off today a new series program featuring six webinars under the topic efficiency in medical device repossessing the road ahead before we get introduced to our Ma moderator and speaker today I'd like to give you some um inputs about this series of six webinars and you can see as we already showing in in the video but you will see it here the SketchUp that we are planning so it's more or less every two months we're gonna have a webinar that will highlight some ways to impact efficiently the efficiency of the medical device reprocessing okay before we start this webinar I would like to give you some housekeeping tips and rules first make sure you switch off any non-necision applications on your device which may be taken away from you the ban the internet bandwidth like the Outlook or your browser window for example if you by any chance face any disturbance um during this webinar please refresh your browser window and or close it and log in again today's webinar will start with a presentation of 40 minutes followed by a 10 minutes q a session we will conclude webinar with key takeaways and we will introduce you to our next webinar topic and speaker this webinar will finish in one hour to respect everybody agenda if you have any questions for the presenter which is not answered during this presentation please type them on the chat box that you find right on your screen or if you are with the mobile device on the bottom part of the screen and in order to make the presentation part of this webinar more Interactive there will be several live pools uh where you can answer the presenters questions please use the few seconds that will be provided to vote in order to engage yourself during this presentation one last point this webinar will be recorded So the link with the reply will be sent to all the resistance shortly after the webinar is over now it's my big pleasure to introduce our moderator for today Dr Carlos Palos who is also our scientific director for this ASP Summit webinar series number four and for those that join previous series of webinars from the ASP Summit you maybe already know him so Dr Carlos welcome to again to ASP Summit CME webinar for the fourth series and thanks for joining us today I end over to you foreign welcome everybody so it's my huge pleasure to be here uh with you again uh in in this new webinar Series so since four years ago uh we have been working on these webinars and it's a huge pleasure uh to to be here with you so for today um we have uh participants that are coming from uh um every continent and as always we have our colleagues from the United Arab Emirates and the Middle East as the main uh attendees and also uh from other countries or the Middle East just like Egypt uh and uh also Qatar and Saudi Arabia so welcome everybody also from the United States of America and um South America South Africa India and of course Europe uh with Portugal as the most important country in terms of representation and also the UK and uh well so it's uh all planetary does um um regarding the to professions we can see that most of you are working on the uh reprocessing services and you are nurses and Healthcare managers most of you have more than 10 years of experience and uh well you work at the acute hospitals and uh sterile sterile service departments so a huge quantity of colleagues and professions so for today um it's my pleasure to receive once again Professor Francesco bennary you will talk about the medical device reprocessing efficiency and its impact in healthcare so it's the the overview of this webinar series and um uh you know Professor Francisco Vino is a well-known person uh in the world of reality and risk management so we use an emergency medicine and Trauma surgeon um he he belongs to the foreign sales care system in Italy and in fact is the clinical risk manager and patient safety officer uh for the Florence sales care system in Italy so um these are the topics of his CV and in fact well not taking more time I'm just going to end over to Professor Francesco so the stage is here thank you very much for being with us once again thank you thank you very much Carlos and uh may I be gratified great of gratitude for all of you who are experiencing these webinar series and for me it's a very high pleasure to be here and speak with you about uh the topics that are in agenda for today we're going to go through the impact of Hospital acquired infections and a focus on surgical site infections in healthcare the importance of the medical device reprocessing and the prevention of these infections and we're gonna stress our attention today mainly on something that is not new but it should be important to have in future a very very big impact which is the efficiency in health care and efficiency in medical device reprocessing especially on the perspectives of affordability sustainability and what is not you but will be reprocessed is of course the value-based healthcare and then we'll talk about the impact and optimization strategies and then have ourselves yield towards a conclusion and take home some messages that we can share with all our professionals may I go on please yes yes I will share my screen thank you thank you here it is right now okay now as we said these uh are the topics that we'll get into today so let's look into the first topic but first of all I would all like to ask you a question for example let's get into the first question what is the uh Hospital acquired infections and surgical safety impact in healthcare let's go on start voting start using your polls give us one of your responses of course okay all right then let's go on let's go see if there are any more start to give us your impressions and your understandings and the fire are they financial burden or are they the length of stay maybe it affects mortality and morbidity or maybe all of the above let's go on okay let's go see okay we're getting all right then okay all right 18 to 18 that's good okay let's go on then to the next uh to the next topic these are as you can see the uh results and as we all see many of us share all of the above which I would say is the correct answer thank you very much and let's go on then okay now as we said before Healthcare Associated infection is referred to as a communal or hospital infection I think this is one of the definitions with which we could always agree with they represent the most important and frequent adverse event during Healthcare and this is the prevalence of Health Care Associated infections throughout the world and as you can see the numbers are very significative and what about facts that give us that one in every 25 hospital patients will get a health care Associated infection and the risk of developing it is in developing countries eight times larger than that of development and what is the prevalence of all this in uh in healthcare the prevalence of Health Care Associated infections as you can see in this estimated incident and composite antimicrobial resistance index is the following and you can see is the major major areas of infections are of course the respiratory tract the lower and upper respiratory tracts the urinary infections and of course surgical site infections along with gastrointestinal infections and this should be something that should alert us in the topic of today and the burden in 2019 is that five million deaths were why were caused by situations Associated to antimicrobial resistance and this would also be a fact for the future and this should make us understand or help us understand what's going on and uh going on to this effect that we can also see that the average number of annual deaths due to uh these uh antimicrobial resistance are the numbers that you can see in this and we can understand that mortality rates are from 12 000 18 000 and in have an incidence on the length of state with from 7 to 12 extra lengths of stays and what about the expenditure that we put into this and the uh and the the number of billions of dollars per year or uh billions of Euros that are spent in Europe for these uh Hospital acquired infections are the following and of course this burden is very important because with the third three percent mortality and 2 to 11 times a higher risk of death and 75 percent of these debts among the patients are directly attributable to these surgical site infection well we must understand that in terms of morbidity we have long-term disabilities so the item is a very important to be discussed and talking about the length of Hospital stay when we add a seven to ten day additional post-operative Hospital stay the costs are very are very very high and as you can see the costs in Europe arrive to about more than 4 billion euros per year and this should make us have a little bit of considerations and let me just say that the impact of Hospital acquired infections on the economical status of hospitals are clearly seen for example in this simulation formula and as we understand that 15 percent of Hospital budget covers direct and indirect costs of malpractice claims and issues we must understand that if we can fight Hospital acquired infections in a very very uh efficient way efficient let me say this word again efficient efficientness and of course affordability and sustainability maybe we could have better outweight rates so let's go on to the importance therefore of the reprocessing system in the prevention of surgical site infections let's go on to the second question may I ask you regarding the reprocessing of medical devices which statements do you think are correct and let's start voting let's start answering to you is the stage so let me see what all of you consider and is it only important to prevent is it on the top 10 of patient safety concerns it must be a categorization of medical device according to the Spalding classification maybe has to be changed something or is it not a priority of CEOs worldwide well let's see how you think about that let's go on so let's see according to these results we have at least at least many of you understand and underline the fact that it may be one of the top 10 of patient safety uh of patient safety concerns and this would be a cred okay let's interrupt this poll the second poll and may I say that the correct answer is of course where 90 of all of you are focusing on and is that medical device reprocessing is one of the top 10 and concerns of patient safety thank you let's go on then okay and here we go so being one of the top 10 Mission safety concerns therefore if we focus ourselves in this special report we see that at the fifth place device cleaning disinfection and sterilization are very underlying and of course by cleaning disinfection and sterilization get in to the hospital uh steroid repossessing departments and there are some barriers and some of the barriers that you can see are the ones that are listed in this five list and of course as you can understand that the failures of all these sterilization processing and of all reprocessing processing may come and may yield and may favor surgical site infections and increase the mortality rate associated with very very high cost system just to get through to the public Regulatory and professional attention these are a few articles that pay a stress on some of the uh microbiological agents that we are common to deal with when we're talking about Hospital acquired infections and surgical site infections for as for example the ones among the mycobacterium tuberculosis and of course the importance of having a very very acute infection control for example in a bronchoscopy shoot and just to understand the impact of the contaminated bronchoscopes on patients having covid in the recent covet pandemic underlying the importance that when reusable bronchoscopes must be used they should be segregated from the gastrointestinal endoscopes and sterilize rather than relying on High level disinfection for the concerns that we have just understood and challenges in achieving an effective high-level disinfection in endoscope reprocessing are the facts that high level disinfectants commonly fail minimum effective concentration tests and that human factors contribute to the widespread of non-adherence with guidelines and these uh furnish us the new approaches that either both manufacturers and infection preventionists should adopt to understand to prevent the onset of these infections and this is a public and Regulatory and Regulatory concern and so reprocessing is a best practice in infection prevention control is testified by the reaper blows reclassification of semi-critical devices to critical devices for example flexible endoscopes in this in this classification proposed by rutila which gives us the onset of having a high level disinfection with no margin of safety whereas sterilization would give us an enormous margin of safety and of course these Repro these proposed reclassification should also guide us through the times that we are supposed to understand and consider medical device reprocessing as a true best practice to infection prevention and control and uh according to the who Global guidelines for the prevention of the specific surgical site infections as in This Global guidelines of 2018 can understand that having a process of risk assessment of contaminated instruments we see that critical semi-critical and non-critical uh category devices are of course understood where they are supposed to be inserted into the level of the method of decontamination as sterilization being the gold standard now let's focus on the one of the main topics of today's webinar as I said before efficiency in health care and let's go through the efficiency go through affordability go through sustainability and value-based health care and therefore let's go on the next question please how does efficacy and efficiency influence Quality Health Care outcome the stage is yours my friends who are on on the webinar and are these issues very seldom important with quality outcome is only efficacy influencer or is only efficiency a key influencer or both could be or should be considered influencers as a key in the outcomes of quality and safety in health care and let's go through your uh your votes your your true your choices and I think that we can say and we can consider uh the poll concluded and as we all see 89 of our Spectators and maybe furthermore chose the last answer and may I say according to the status and consideration of evidence-based medicine and evidence evidence-based Healthcare world wide this is the correct answer so stop in our polling let's go on and now let's go on to the next items stop our our and let's get into the key topic of today what is efficacy and efficiency in healthcare all right now uh efficacy in our sector of course is the capacity of a given intervention under ideal controlled conditions and uh this may be related to the effectiveness as an ability of an intervention to have a meaningful effect on patients in normal clinical conditions efficiency is doing things in the most economical way so may I ask you is economics the topic of choice today that we have to understand or connecting it to medical device reprocessing may we say that efficacy and efficiency in medical device reprocessing are very important key issues either on an economical basis or on a clinical evidence basis well may I say that reading what efficacy means is getting things done and maybe working and Effectiveness means doing it in proper ways and according to the proper guidelines to the proper skills and meaning that things are done in a right condition and they are doing things better than they should be doing well I would say that efficacy and efficiency are connected very truly and directly connected to the Health Care system and when we talk about a medical device reprocessing we must understand that efficacy and efficiency are not to be separated this should be our goal standards and being these gold standards very important as you can see in this slide how can we measure efficiency in healthcare well first of all let me say that it is very difficult as a cultural aspect to have medical and Health Care Professionals measure themselves and better yet measuring the outcomes is what we should put in our main goals as Healthcare professionals well in healthcare when we talk about clinical efficiency we're talking about how well resources are used to meet demands and needs either both of healthcare professionals or even patients and the needs and demands of this are in a twofold clinical setting patients are in some way uh need to be taken under care and Cure by their care provider and they have to be aware that the care provider is bringing them into a very efficient and efficient uh professional pathway and so when we talk about efficiency and efficacy we also have to tell about Effectiveness and so when we have relative value units for services provided by physician per month and the number of patients visited per position per month and the cost of each medical procedure in the episode of care together they can do they can sum up the uh the roles and the meanings of efficacy efficiency and Effectiveness and so when I can do the thing in a right way I can also do it in a better and quick way and also have a value that maybe I could save in that process and so at the end Effectiveness means that I can do it well too so when we have clear these Concepts let's move on we want the incidence of Adverse Events in your car because if it's true what I have what I have said therefore I could expect to have a very very important decrease in Adverse Events well in this slide you can see that some European countries the UK France Spain Sweden and Italy measured the incidence of their Adverse Events in their country understanding Adverse Events as patient harm and when we talk about patient harm we cannot say that hospital acquired in fact actions and surgical site infections are excluded because they are embedded into Adverse Events and as you can see in this Slide the percentage is very very high and in the very extreme right area of this slide you can see the areas where the cert where Adverse Events occur but what I want you to focus and be pay a very important attention to and this would mean also the topic of today look at the percentage of preventability that is the incident rate that should worry all of you who are who are in involved in reprocessing procedures the Medical Specialties according to the epidemiology of Adverse Events are of course these and look at the look at the incident rates they are very high and they are very also important let's say orthopedic surgery plastic surgery neurosurgery well I underline them I evidence these Specialties because we're not only speaking about the gross Hospital acquired infections which could be probable but if you imagine a specialty such as Orthopedics or better yet a specialty as plastic surgery reconstructive surgery if we have a a patient that gets an infection of his surgical site that could mean that it would ruin the result that we that we that we had the goal to reach and of course this could mean a very very poor outcome of the results and if these data are correct as I imagine they are we have to do something we're obliged to do something it's ethically important for all of us to pay attention to all and what all we do in the procedures of disinfection sterilization and also reprocessing and the importance of patient safety issues are very important because the cost of a of an adverse event is very high in terms of human cost because we can also a patient could die uh following a complication of surgery and the complication of a surgical site infection if you imagine a surgical site infection complication on surgery of the abdomen you can understand how the incidence of sepsis and sepsis rape could come on professional costs economical reasons and political reasons this is the issue of choice today politics should be involved in hospital accuracy efficiency and Effectiveness let's see if these could in quite a nice Manner and a very hard impact uh influence affordability and sustainability and as Deming used to say every system is perfectly designed to get the results it gets and this is very very important if we understand how the influence of human factors are on an organization for example in a medical device reprocessing unit if a professional health care workers working in that area are not well trained and they are not aware of what they're doing and the importance of following guidelines for example of high disinfection high level disinfection or sterilization they may not be aware carefully aware of what their results are going to have as an impact on patients so I think and I believe that we should use these uh these elements to these factors and this would be one of the most important things to do and this means that we should work as a team work as a team means that we should all work together for the same goal and the same identity would this be possible would it be possible to realize this in the sterilization Departments of hospitals working as a team we're even the most very low low health care worker has an impact has a a way of influencing the correct processing of the procedure and of course they the the the the the topics that we have to understand are the ones that are related to affordability sustainability and value-based health care and this has a very big impact on medical device reprocessing and of course these give us the opportunity to understand what would be the future optimization strategies that all Health Care organizations should meet let's go on to the for to the fourth question that I would like to ask you sustainability and value-based Health Care are the challenges of the future medical device reprocessing may have an important role in assuring these goals what are to be considered the milestones CEO's commitments Investments Health Care Systems are not modifiable systems CO's commitment to patient safety and process surveillance or systems change to better practices well let's understand how you would manage to understand how these topics sustainability and value-based Health Care influence the uh the role and the intervention of patient safety issues and as you are answering the question and I can see where uh where you are all oriented I would say that systems change to better practice would be surely the most uh logical and most uh I think practical way of assuring patient safety and the commitments towards the medical device reprocessing correctness and efficiency and efficacy so let's say that the answer which I would expect and as I see the poll is going through is of course the last response which is that systems have to change to better practices and so best practices must be a must in the healthcare organization I would say that we have finished this type of Bowl we can see that all have participated all have answered and therefore let's go on with the topic today my reliability organizations that what Healthcare systems are concerned The Who International Commission on patient safety defined hospitals and health care workplaces as high reliability organizations with an ultra safe perspective and attitude towards the prevention of harm and Adverse Events and may I ask you may I ask you all to reflect on this could hospitals really be really be taken into consideration as being high reliability organizations well according to the world Alliance provision safety we have to focus to answer that question we have to focus on two major aspects of human factor which is how humans behave and I would like for you now to understand what's happening in a medical device reprocessing unit understand what's happening see the flow the workflow see the workload look at the workers who are in there well behavioral aspects of performance are very important and behaviors sometimes are not related to the clinical expertise of either the equipment of drugs or either the professionals themselves and so if these are significant factors and influence the settings of these procedures and help us achieve efficiency efficacy affordability sustainability and of course also value-based Health Care well things are about to change right now and safe and efficient performance assure us a total reliability of these organizations so the equation in order to answer the question that I previously asked are Hospital titles and Health Care Systems considered to be really high reliability organization well we understand how their organizational and professional culture is assured and we have to add this to the professional behavior of technicians and also non-technicians so when we put together Latin conditions and individual actions we have the sum and give us of course job performance the idea of a job performance that may be necessarily near high efficiency in these systems but and as I would like to concise and be sure enough that the concept of today which is to introduce the future webinars that we will deal with in our series and maybe the ones that will also deal with the circular economy we have to talk about value-based Healthcare well what is value-based health care it's a measure of meaningful patient outcomes and according to the money that I spend in Therapeutics and diagnostic processes the patient outcomes for me are important because they uh they add a value to quality and safety and value-based health care is focused on improving efficiency by adding more high value activities to improve the outcomes and among these we have to take understanding about the right type of care the right time of care and the right place of care we're calling this appropriateness we're also understanding how business systems and structure perform in the health care in the healthcare area we have to also understand that systems and structures and processes to improve operating performance must be integrated into the building and linking of a healthcare Continuum and of course when we talk about leveraging academics to improve clinical and financial performance we have to have we have to deal with the topic of innovation in academics we have to continuously improve and of course efficiently creating and allocating the resources would mean also having and adopting a sustainable financial model as you can all see all five of these effects all five of these values contribute to giving value-based health care and when value-based Health Care is assured we have the integration of delivery system transformation and the pavement system transformation that together integrate themselves and constitute a value-based a value-based Model A value-based indicator and so when practice transformation Nation without a financial model can be decided to be not sustainable not sustainable so this is the key topic of Effectiveness efficiency and value-based health care that we have to understand how we're spending how much we're spending in what way we're spending it because we have to uh we have to improve outcomes but we have to add a very important value and I believe that all these considerations could be applied in the field of medical device reprocessing it is a must and so what's the big deal then you may say value versus volume today we're based on volume but we have to change our perspective the perspective is add value to what we're doing and so this framework means that we'll have four categories of the future the first is to understand that quality and value have to be linked to the FIFA services that we also have to build an architecture to sustain all of this and then we must categorize all and involve all our stakeholders into this and this means create incentives for volume instead of improved value based on higher quality lower costs and let me say a greater access and these are the words of the future suggestions as you said in the questions that you responded as a medical health care uh workplaces and organizations should go towards better practices so these are the words of the future this is how medical area is changing medicine is changing and Healthcare Improvement is changing and this makes me understand going to the end of our webinar today is what the value chain means in healthcare first of all what is a value chain it is a framework made up of five primary activities inbound operations the operations themselves the out buying Logistics marketing and sales and service and of course also other four secondary activities such as procurement and purchasing of of course all the needs and the and the the the needs that we need to use in the medical system the human resources management technological development and Company infrastructure all of this framework contributes to give and to add efficiency and efficacy in in the health care processes imagine this chain as a very value and value change in the medical device reprocessing field I think that this could be surely added surely connected to the future of circular economy in healthcare and what I like to end up with you before uh taking before going on to the conclusions and taking home messages is that the pillars of success is an integration of systems we have to have an Integrated Health Care System otherwise we're not going to go anywhere and I think that Medical Care reprocessing represents a model of integrated approach to Health Care Quality and patient safety in particular because the uh pillars of success of an integrated system are integrating the organizational structure with the transformation of the practices that were that we are introducing in the medical field the development of a work play and a Workforce the communication and connectivity worldwide which now we have to understand and take into consideration the analytics and Reporting I mean the importance of data the importance of measuring what we're doing because if we have to talk about a value chain and a value-based healthcare integration and we're talking about circular economy we have to talk with the data we have to measure ourselves and in a medical device reprocessing system measurement is obligatory is mandatory care patient management and engagement and then we have value-based payment if all this change this chain is considered to be an integrated system then of course we can bring ourselves to the Future in a very important way and the value chain the medical device reprocessing is that the steps of mult of medical device reprocessing including all these phases all these stages must be carefully understood and carefully focused on a patient safety basis and this means adding value to the importance of reprocessing so reprocessing is not something that is done away from the patient is not that it's done away from the doctors or away from the nurses it's something that is done with the patient with the nurses with the health care System show as returning to the public and Regulatory regulatory professional attention the recommendations for an independent expert review process are important so what about the guidelines we have to have optimization strategies and what are the strategies of the future a new certification and accreditation program maybe that could be but certainly louder recommendations are the ones that tell us that we have to revise or probably clarify in our field the Spalding's reclassification so I level this infection the sterilization booster pack as presented by The Joint Commission International give us important takeaways that the incidence of non-compliance with the standards are on the rise and therefore we have to understand that we have to employ better or maybe change the way we see our optimization strategies and probably maybe introduce peer review and introduce accreditation systems and this could be the challenge of the future and as we conclude and as I conclude we'd like to give you some take-home messages to have an overview and to uh and to reflect on optimization of medical device reprocessing through training and increase in Awareness among all the healthcare workers is the main goal of the upcoming future strategies are to be supported and among these accreditation and quality certification surely may be an added value outcomes are to be measured on a value-based health care basis and no longer on only volumes of Health Care bases and then of course circular economy circular economy what does that mean it means and that something has to be linked to the fields for example of Health technology assessment medical device reprocessing and economy itself in terms of expenditures expenses in the health care are key topics for future implementations and may I say they should be they are to be they must be the goals of all CEOs of the future otherwise we're not going to get anywhere and as I would like to conclude knowledge and errors have the same mental Origins as Ernest Max said many years ago only success May distinguish among them and so what are the keys for success in medical device reprocessing understand the guidelines apply them have continuous Healthcare Improvement educational basis on simulation and implementation of the work of the workplaces and have a much more integration with the value change understanding is importance and of course involve patients involve health care workers in all of this this is the key message that I would also like you to take home and maybe uh maybe a front when you're ongoing to the Future webinars that will become in this series so thank you very much for your uh your attention to this and I think that as a beginning we are all committed to the future of patient safety and quality and I think that maybe value-based Health Care should be a topic of understanding and maybe deepening in the Health Care system and Healthcare professionals worldwide thank you very much thank you very much Professor venary for this very very insightful and interesting um presentation uh I kindly asked the attendees to do some questions uh in fact um we have one question and the question for you is about the possibility of using more uh mono use or single use devices instead of reprocessing the the question is if reprocessing is risky uh what do you think about single use so the and I suggest you to to give the comment not only in terms of the risks but also all the consideration questions about circular economy and and so on so yeah thank you yeah thank you thank you Professor Palos uh well everything is risky in healthcare there is no thing that is not risky and even a prescription of a medical drug is risky so everything is risky talking about reprocessing reprocessing becomes risky if is it not if it is not followed well and correctly what about Mono use single-use disposable and all that in terms of circular economy of course it has an impact but we have to understand that we cannot say it's better or it's safer what we have to understand is the context into which we are working in for example in emergency procedures as covet taught us in the recent pandemic probably using mono use disposable endoscopes could have been uh could have been the choice of the high choice in that in that in that terms but we cannot uh strictly categorize this as a re as as a as a result so my personal opinion is being that everything is risky in healthcare let's risk less understand what the procedure is in what terms we're supposed to do that understand also the future of healthcare technology assessment that could maybe furnish more disposable use but I would not say that you should prefer one either than the other I think it depends on the single case the single situation and in the context of what you're working on where you're working on of course in terms of circular economy maybe you have to understand that the use of disposable instruments could also have an impact on costs in the Health Care System yes that is my opinion I don't know if you agree professor yes fully agree with you so the the the the perspective of adapting uh the choice uh between uh single use or multiple use is in fact um something that has an impact on the overall system and should be considered according to uh specific situations but as you said it's not possible to to move on from multiple use for a single use uh in a generalized way so it's it's the most important thing is to do it safer with the best Technologies available and the most efficient uh Technologies also because it's the only way of doing it properly so that's why we are here in this new webinar Series so I want to thank you once again and um we will see together on the last webinar so on to to write the wrong the round table and um uh uh uh well we have here another question sorry uh okay nothing in the department be correlated to efficacy and efficiency as far as value based and control from management um do you want to comment on that so how how can stuffing in the department be correlated to efficacy and efficiency yes uh Staffing is important we have to have in the correct workplace the uh the correct workers we have to adapt uh the systems to the workers and not vice versa as James reason many years ago said we have to understand that Staffing is important in a very delicate Medical Department as the medical repossessing Department because they have to deal with very delicate material they have to delegate they have to dedicate themselves to training so it's important to train them continuously and have them understand that it's important to understand it that they wear gloves they wear the protective individual equipment that they use for example swabs once in a while once and only once that they should be disposed and not continuously used they have to pay a very important attention to how they disinfect or sterilize or wash simply the endoscopes or any other medical device in the reprocessing they must be involved in the uh in the analysis of course and of course also they personnel must be and staff must be involved in understanding their data understanding the outcomes so it's a question of awareness if the Staffing is involved in the process knows what it's doing how they're supposed to do it and how good they're doing it and the outcomes are very better and they're giving and reaching excellent levels well then the Staffing is very important to reach the goals of efficacy and efficiency and may I say have that added value that is necessary for giving value based to the Health Care Systems and to all patients yeah thank you very much so um see you on the final round table and once again it's a it was a pleasure to to count on you in this webinar Series so now I'm going to and on to um and thank you very much for being with us today thank you thank you uh hello again and I want to thanks uh once again to Professor venary uh to be with us with this always busy agenda as well as Dr Palace for moderating this webinar and um it was a really insightful presentation that I'm positive sure uh it was really beneficial for our audience um value base is something that is knocking our door so it's something that we need to look for and I think it's also correlate with our previous series about circular recovery so it's it's good to make the bridge between the topics um it's now my pleasure to to to tell you uh um about our next webinar so we will Bridge these value-based Healthcare starting now or moving now to the or and how can applying green principles at your wires can improve the medical device for processing efficiency so we're going to have this webinar this webinar will take place on May 25th at the same time and the the speaker will be Mr Manuel valent from the quality Department of the Central Hospital Portugal so registrations will opening soon stay tuned for our upcoming Communications Okay so one other thing that I want to tell you before we we finish this webinar as a reminder we have done um we have recorded this webinar and you will receive a email with the replay Link in few hours um in that email you also have a link for a short survey please invest three minutes to fill it on and to share with us your opinion and because it's really important for us to improve for the following webinars another thing is you will receive on the same email a link for this webinar fact sheet with the key take on messages that professor of energy share with us and a link uh to the certificate of your attendance so please um make sure you you download both of them and positively sure that you will find the fact sheets resume really interesting so thanks for your attendance and participation today I wish you a lovely weekend and I hope to see you soon in our next webinar May 25th same time don't forget [Music] [Music] foreign foreign [Music] [Music] [Music] foreign