Discovery of sterilization has been an epoch-making in the history of surgical medicine. In order to ensure sterilization, it is important to reduce the number of microorganisms originally attached by cleaning in advance. It can be considered that an instrument that has not been cleaned cannot be sterilized. In recent years, the number of instruments that are difficult to be cleaned has increased. In principle, it should be cleaned with a washer-disinfector, but manual cleaning such as brushing or dipping may be required. Ultrasonic cleaning is also an effective cleaning method. Regularly and when needed, assessments of cleaning are essential. If you want a safe instrument as a surgeon, you should know about cleaning and sterilization of the instruments you use. The central sterile service department (CSSD) is essential for the operation rooms that produces the greatest profit in the medical facility, and is also important in terms of infection control and safety management. Surgeons have the right and responsibility to seek improvements in the CSSD. This is because it is directly related to the improvement of surgical outcome. When the CSSD was unreliable, surgical treatment is not possible.

The first option for disinfection of surgical instruments in the use of heat. Temperature between 70 to 90℃ is generally recommended to disinfect. In situations where heating is not possible, disinfectants are used. On the other hand, surgical instruments are mainly sterilized by the use of the autoclave. Generally, sufficient sterilization is achieved within 8 min with 134℃, or within 20 minutes with 121℃.

We investigated the level of contamination of instruments for robotic surgery. Used and unused robotic instruments were collected after robotic procedures. Amount of protein attached to the surface in 3 parts of the robotic instruments were measured. Amount of protein collected from the surface of the robotic instruments was 1.37±0.34 mg, 1.22±0.37 mg and 28.3±10.1 mg for jaws, shafts and housings, and inside lumen of the instruments used in operation, respectively. In robotic instruments prepared but not used, the amount was 0.030±0.003mg, 0.27±0.22 mg and 0.44±0.07 mg, respectively. The level of contamination inside the lumen of robotic instruments was high after surgery, which would be associated with infiltration of body fluid. The cleaning efficiency was considered to be relatively low. It is important to retain cleanliness of the inside surface of surgical instruments with narrow lumens, including robotic instruments. Our results suggested that irrigation of detergent should be included in the cleaning procedure for robotic instruments.

In Japan, remanufactured single-use medical devices (R-SUD) have not yet appeared in the medical device market, but the collection of used SUD, which is the raw material, has already started in some medical facilities. The collection of used SUDs for medical facilities is not a conventional treatment of infectious medical waste, but a “sale of valuable resources”, which is an unfamiliar task for medical facilities. It is also necessary for the staff of the medical facility to arrange the administrative procedures for the sale and to determine the details of the specific collection method at the site where the SUD is consumed. When R-SUD products appear in the medical device market in the future, it is necessary to fully consider the merits and demerits of R-SUD when selecting whether to purchase original products or R-SUD products. It should also be noted that the significance of introducing R-SUD is not uniform depending on the position.

Bloodstream infections can have a fatal outcome and are one of the major device-related infections. Central line associated bloodstream infections are one of the surveillance that infection personnel in charge of infection control must address. Continuous monitoring of the rate of infections the central line can help one understand the status of their facility. The decrease in the infection rate can be achieved by providing feedback of the results to the staff and committee. Continuous collection of data can also contribute to the discovery processes associated with the infection risk and improvement staff awareness.

From May 2016, I was assigned to Mitsubishi Kobe hospital as a full─time infection control specialist. Mitsubishi Kobe hospital is a reginal core hospital with 188 beds (4 wards) and a substantial staff assignment of 7：1. Many problems of urinary catheter management were observed in the ward round. We planned a study group and conducted a questionnaire survey on catheter─Associated urinary tract infection countermeasures before and after that to verify whether it led to improvement of knowledge and behavior. At the same time, we examined whether the occurrence rate of CAUTI and the usage rate of equipment can be reduced by planning, implementing and CAUTI surveillance for the problems. The device usage ratio decreased from 0.15 before the intervention to 0.09 after the intervention. We were able to reduce the device usage ratio than before intervention. CAUTI incidence increased from 1.2 before intervention to 3.8 after intervention. The reason for the significant increase in the incidence of CAUTI after the intervention was that even if the patient had fever and CAUTI was suspected, a urine culture test was not submitted and catheter removal and antibacterial treatment were performed. This is probably because it was not implemented.

To reduce the incidence of ventilator-associated pneumonia (VAP), the National Healthcare Safety Network (NHSN) started the ventilator-associated events (VAEs) surveillance as “VAP surveillance” in adults, in 2013. VAE surveillance has advantages, in that its results have been shown to be correlated with the patients’ prognosis and it involves a simple evaluation process, that can potentially be computerized. On the other hand, it also has problems, including the differences in the results from those of “VAP surveillance,” ambiguous interpretation of the incidence, and influence of the method of ventilatory management on the results. VAE surveillance focuses not only on pneumonia, but also on other complications of ventilatory care. To introduce VAE surveillance, it is desirable to establish a system that would allow the ventilator settings to be adjusted according to the patient condition. After its introduction, general administration of ventilatory management is necessary. To utilize VAE surveillance, activities to reduce the incidence of VAP must be engaged in by persons responsible for infection control, in cooperation with various other relevant teams and professionals.

The surveillance for device-associated infections in the Neonatal intensive care unit (NICU) includes central line-associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP). NICUs are stratified into two levels according to patient severity and into five categories according to birth-weight. The facilities with zero CLABSI account for 75％ of the distribution of the CLABSI incidence density rate. This data was compared with the 2013 National Healthcare Safety Network (NHSN) data using a standardized infection ratio of 0.8. The incidence density rates of CLABSI are comparable with that of NHSN data. The device utilization (DU) of the central line is lower in the Japanese Healthcare-associated Infections Surveillance (JHAIS) data than that in the NHSN data. The incidence density rates of VAP was compared with the 2013 NHSN data using a standardized infection ratio of 2.1, which suggests that more VAPs are occurring in Japan than in the United States. The ventilator DU are comparable with that of NHSN data.