Observing the management of surgical instruments at the Central Supply Department (Sterilization Department). The staff on the left side is Kimratanak.

I am Kimratanak, in charge of the Pediatric Surgery Project in Cambodia.

In October 2023, I traveled to Japan and it was my first time to visit medical sites in Japan such as Saitama Prefectural Children’s Medical Center, Hyogo Prefectural Kobe Children’s Hospital, Kindai University Nara Hospital, and also talked with an occupational health nurse at Fuji Electric's Kobe Plant.

I was impressed by the warm welcome I received from the staff at all the places I visited. I was also really surprised and impressed by the modern medical technology, treatment and care skills, and how medical staff communicate and share information with each other in Japan, which were very different from those at the Kratie Provincial Referral Hospital, the site of the Pediatric Surgery Project.

Visiting various departments in the hospital, I was interested in three department; Sterilization Department, Surgical Department and Operation Theatre. I wondered if there was anything that could be incorporated in the Kratie Provincial Referral Hospital.

Patient rooms in the Surgical Department were well-organized to take good care of the patients, with enough bed space for each. In Cambodia, it is the role of the accompanying family members to take care of and watch over patients, but at the medical institutions we visited, the Surgical staff monitors patients 24 hours without family or parental surpervision. I was particularly interested that staff were carefully explaining the procedure of the surgery to the patient’s family, and trying to reduce the fear of surgery from patient. Staff always accompanied patients to the Operation Theatre, and reported all processes being performed on the patient by Surgical Department staff to Operation Theatre staff (Type of serum, medicine, patient information.etc.). I want to take all these good points to develop Surgical Department and Operation Theatre department in Cambodia because it is very important to make patient safety and comfortable.

I was also surprised at the thoroughness of these procedures in Operation Theatre in Japan;

1. ① Before moving a patient to the Operation Theatre, we reconfirm the name of the patient or his/her escort.
2. ② The staff in charge of surgery receives information from the staff of the surgical department (disease name, planned surgery, patient's preoperative condition in the ward, patient information such as medicine, etc.).
3. ③ The surgical team carefully finalizes the information using a checklist just before the surgery.

The Sterilization Department were managing the cleaning, sterilization, and preparation of surgical instruments in cooperation with a company specializing in sterilization, following the guideline of the Ministry of Health, Labor, and Welfare. To prevent infections to the patient, hospital separated clean and unclean area, as well as line of flow for collecting used instruments/placing sterilized instruments.

In the Sterilization department of Kratie Provincial Referral Hospital, sterilizer doesn’t have enough antiseptic solution and material to use such as steam sterilizer machine (hospital have only one hot sterilizer machine) .
Also, cleaning, sterilization, and storage space of surgical instruments are all in one area, therefore distinction between clean and unclean is unclear.
I learned a lot about how surgical instruments are managed in Japanese hospitals.

After visiting hospitals in Japan, I want to make use of my experience to improve KPRH.
What I discovered at each site I visited may be commonplace in Japan, but they are not yet thoroughly implemented in Cambodia.
I would like to introduce what I have learned during this visit such as "Patient-centered thinking” "Team medicine (communication and cooperative attitude across departments)," and "Preoperative checklis," to KPRH staff so that we can make changes.