By Esther Espunyes, EORNA President

Last week, I reflected on sterility as the invisible foundation of safe surgery. But behind every sterile instrument and every safe surgical procedure, there is a team whose work often remains unseen: Sterile Services, or Central Sterile Services Department (CSSD).

A safe CSSD depends first on a well-designed workflow, ensuring a clear separation between contaminated, clean and sterile areas and preventing the risk of cross-contamination. This requires compliance with appropriate structural requirements, supported by adequate space, appropriate zoning and proper ventilation to maintain safe environmental conditions.

Technology alone, however, does not guarantee safety. Trained and competent staff are essential to ensure that every stage of decontamination, inspection, assembly, packaging, sterilisation and storage is performed correctly. Equipment must be appropriately selected, maintained and validated, demonstrating that sterilisation processes consistently achieve the required performance.

At the centre of this process are perioperative nurses, whose expertise is pivotal in connecting sterile services with clinical practice. Their understanding of surgical procedures, instrumentation, aseptic principles and patient safety enables them to contribute to the development of appropriate workflows, ensure that instruments and sets meet clinical requirements, identify potential risks, and support continuous improvement across the entire reprocessing pathway.

Quality cannot be assumed – it must be demonstrated. Regular quality audits, monitoring, documentation and continuous improvement are essential to ensure that standards are consistently maintained.

And finally, traceability connects the entire process. Knowing which instruments were processed, by which cycle, using which equipment, and ultimately used for which patient provides an essential layer of accountability and allows rapid response when something goes wrong.

CSSD may work behind the scenes, but its contribution is at the very heart of patient safety.

Next week, I will reflect on why managing risk in the operating room is not about correcting problems when they occur, but about anticipating them, preventing them and building systems that make safe practice the easiest choice.