SINGAPORE: The constant clank, clank, clanking of metal on metal.
It’s the sound you hear as you step into the Theatre Sterile Supplies Unit (TSSU). And it’s no wonder as the unit processes over 25,000 pieces of surgical equipment every month.
Located in the basement of the Singapore General Hospital (SGH) in Block 3, this little known unit is responsible for cleaning, sorting and sterilising all the surgical tools used by the hospital. This gruelling task lies with the team of 63 staff, whose main aim is to ensure the surgical tools are infection free, as this could make the crucial difference between life and death for patients.
To cater to the surgical needs of SGH, the TSSU operates round the clock, with the staff rotated in eight-hour shifts across 24 hours.
With thousands of items under its care, the unit has a comprehensive inventory tracking system to ensure each and every piece is accounted for.
Seventy per cent of the washing and sterilisation processes are automated. The remaining 30 per cent of the work, however, still requires the human touch. This includes the manual checking, sorting and packing of instruments.
TSSU staff checking surgical equipment post-surgery before they are sent for washing. (Photo: Cheryl Goh)
After surgery, the used tools are given an initial rinse, then transported to the TSSU via a specially designed lift that limits their exposure. They are then scanned, and checked for defects or if there are any missing items.
“When instruments don’t work, we’ve got to identify the problem. This is very important for patient safety. We need to get to the heart of the problem, so that we can rectify and take the necessary action,” said Koh Ka Cheong, a senior technician at TSSU.
Senior technician Koh Ka Cheong reassembles a surgical power tool after it has been washed and cleaned. (Photo: Cheryl Goh)
The instruments are arranged in trays to ensure water can reach every nook and cranny before they are loaded into special washing machines. The water temperature in these machines can go up to 93 degrees Celsius.
Washing machines where the surgical tools are washed with water heated up to 93 degrees Celsius. (Photo: Cheryl Goh)
After the tools are dried, the staff meticulously packs and wraps the items in sets. This process requires sharp eyes to ensure each set has the right tools. Each set can have up to 80 items.
The packed tools then go through part two of the cleaning ritual, where they are sterilised with steam at up to 134 degrees Celsius for about an hour to ensure all the germs are killed. They are cooled in storage before being delivered to the operating theatre when required. After each session of surgery, the whole cycle begins again.
The items are scanned at every step of the cleaning process to ensure they are accounted for. In the unlikely event something goes missing, stringent measures are in place.
“If the item cannot be located, we will inform the operating theatre nurses, who will inform the surgeon concerned. The surgeon will then decide whether to order an X-ray to exclude the possibility of the item being inside the patient,” said senior nurse manager Seah Soon Peng.
These back-end tasks at the TSSU are laborious and unglamorous, a far cry from the patient-facing work of doctors and nurses going on just one level above.
But the staff here takes great pride in what they do. “If there’s no problem and everything goes smoothly where patient safety is concerned, then I’m very happy,” said Mr Koh.
“The greatest satisfaction would be when the surgery goes smoothly without any hiccup,” he said.
