Autoclave machines are the core and the very heart of the hospital, almost as vital as electricity and water supply. Running the operations of such machines is the Central Sterile Services Unit (CSSU), which is an integrated place in hospitals and health care centres that performs sterilisation on medical devices, equipment for aseptic procedures and operations.
The health care infrastructure in Sabah has long been neglected over the past few decades, but has come to light especially in the acid test of the Covid-19 pandemic — from personal protective equipment (PPE) supply, human resource, bed occupancy, and now autoclave machines.
This letter is written by a group of government doctors and staff to highlight certain issues that have plagued the state for many years; to acknowledge efforts that are ongoing to fix the situation; and to hope for prompt action from the federal government. Efforts have been taken to obtain data as accurately as possible, but exact numbers are uncertain.
Sabah has over 20 hospitals with five major tertiary health care centres. Out of over 30 autoclave machines, many have broken down frequently and some are labelled “beyond economic repair” (BER), but have yet to be replaced.
The breakdown of machines will result in outsourcing of sterilising services — meaning equipment and devices that need sterilising will have to be sent to another centre and brought back. Some centres are six hours, 300km+ away (Sandakan Hospital-Tawau Hospital). During the recent breakdown in Sandakan, this wasted time, money, and human resource.
There are four machines in Queen Elizabeth Hospital I in Kota Kinabalu (eight years old): two broke down more than 30 times in 2021 and the other two, more than 10 times.
Likas Hospital has a machine that has not been used for five years after breaking down. Semporna Hospital’s machine breaks down nearly once a week, while Kinabatangan Hospital’s autoclave machine has broken down beyond repair since August 2021.
Both machines in Lahad Datu Hospital are over 20 years old with Condition Appraisal (serious maintenance issues) reports issued for both; while one has been labeled BER.
The other neighbouring hospital, Tawau Hospital (about 170km away from Lahad Datu Hospital), has five machines: two of them are 15 years old and one is 22 years old! Two have also been labeled BER.
A word of thanks must be given to the administration of Hospital Duchess of Kent, Sandakan and the state health administration for their swift action during the recent breakdown of its autoclave machine, which directly affected elective operations and aseptic procedures in the hospital.
Partial repairs have been carried out (services are still affected) and an emergency application to the Ministry of Health (MOH) was approved for a new machine, but we have no idea of the date of purchase, installation, and usage as paperwork and processes can take many months.
The situation in the east coast of Sabah is indeed urgent. Should any more machines break down, it will severely cripple the three major hospitals here. Prompt action needs to be taken.
We welcome and applaud YB Khairy Jamaluddin’s effort in the preparation of a White Paper for health care reforms in Malaysia and cheer him on as he strives to gain bipartisan support, since health care should always be an apolitical issue.
We hope that infrastructure upgrades and facility maintenance will be on the top priority list in this White Paper, for there is no use having the world’s best specialists and expertise if we do not have sterile equipment to work with.
Meanwhile, as we wait for the White Paper to be tabled in November, it is hoped that all state health departments will look into the health of their autoclave machines in their respective states.
As mentioned above, many other tertiary centres do need new machines. We should not wait for a complete breakdown of services before writing in for a replacement. Let us prevent disruption of the “high quality health care system” (sistem kesihatan kualiti tinggi) that is one of the missions of the Ministry of Health of Malaysia.
CodeBlue is publishing this letter anonymously as civil servants are prohibited from writing to the press without prior authorisation.
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