That the Central Sterile Supply Department (CSSD) in Gozo lacks modern equipment, which guarantees an acceptable level of sterility and safety to patients, was not stated by the undersigned but by the auditor himself year after year, since at least 2007.

For the non-medical readers, the CSSD is the core unit in every hospital where all the reusable instruments and items in contact with patients are cleaned and sterilized. Thus, it is the hub that sets the standards of sterility across the hospital and thus minimizes the pre- or post-operative risk of infection.

To put it simply, the whole sterilization process requires two main pieces of basic equipment. The first is a washer disinfector that cleans the items from any blood products or exudates, and the second is an autoclave that uses heat to sterilize the items and kill any residual organisms.

At least five years ago, the auditor had strongly recommended that significant changes had to take place at the CSSD Gozo in order for it to remain safe, but unfortunately most recommendations have fallen on deaf ears.

The Ministry of Gozo’s reply was that the tender for the washer disinfector did not fall through and that they were waiting for the supplier to inspect the autoclave. Very lame excuses indeed to cover up very serious shortcomings.

Therefore, in order to purchase a new washer disinfector, as the current model is in auditor language ‘obsolete’, one has to issue a tender that after five whole years has not come to fruition without any effort to rectify the situation? And as regards the autoclave, which has to be validated on a yearly basis, one still admits to chasing the suppliers, 13 years down the line? It is common knowledge that a regular validation test is a basic requirement for most pieces of equipment in order to verify their reliability, efficiency and reproducibility. It is obligatory to have a VRT on one’s car, so imagine the importance of such a validation test on equipment that has a direct bearing on people’s health.

And who is bearing the brunt of such serious inadequacies? Obviously, it’s the patient who suffers in silence. In view of the authorities being aware of the situation, were there any audits carried out to verify that the risk of pre- and post-operative infection was not higher than other hospitals?

As I am not employed at the Gozo General Hospital, I have no direct contact with the authorities and therefore I do not have the opportunity to air my views to the respective authorities. Definitely, my word carries much less weight than that of the auditor who had produced report after report in order to attract the authorities attention to the precarious situation the CSSD Gozo is in.

Would I be a responsible person, let alone doctor, if I am made aware of these serious shortcomings and do not take any action in order to rectify the situation but simply shelve the issue as the Ministry of Gozo is perennially doing. How would I live with my conscience if a few weeks or months down the line a series of infections break out at Gozo General Hospital?

I firmly believe that we have to move away from the current practice of ‘Management by Crisis’ and be proactive by preventing problems and not depend on knee-jerk reactions to crises. In the health sector we are dealing with people’s lives and thus there is no room for delay.

Would an occupational health and safety department be a must for such an establishment as the Gozo General Hospital, as it is in any other hospital in the Western world? The auditor’s final comment in the 2010 report was that if CSSD Gozo does not upgrade its equipment to meet European standards, it would not be in a position to guarantee patients that everything has been safely sterilised.

It is even more obvious now that in order to secure a good standard of practice, health services in Gozo cannot remain under the Gozo Ministry alone but should come under direct scrutiny of the line Ministry. With the Health Ministry having a posse of experts dealing in health policies, administration and standards, having the health services in Gozo under the remit of the Minister for Gozo does not follow any logic. This incident confirms yet again that the priorities of the Ministry for Gozo have been wrong with regard to health.