Background: Sterilization services are the basis of all safe and affordable surgery–as well as infection prevention and control activities to prevent surgical site infections (SSIs), sepsis and other health care associated infections (HAIs). Sterilization quality improvement rarely included in public health programs. Therefore, we aimed to assess the current state of sterilization services as a first step of foundational importance to safe surgical care and infection prevention and control at primary and referral level in Mongolia. Methods: One national and 4 sub-national facilities were identified for the first sterilization assessment and planning in Mongolia using checklists of the WHO/WPRO guideline: Making Hospitals Safe: Sterilization Services. Data were collected in 6 key areas: sterilization environments, sterilization practices for cleaning and disinfection, inspection and packing, sterilization, sterilizer review and sterilization function tests and sterilization system supports and quality mechanisms. Results: All sterilizers were functional and met temperature, pressure and time parameters. Wet packs at the end of the sterilizer cycle were noted in 17% of test packs observed. 52% cleaning and disinfection sinks observed met standards. 86% staff protection standards were met. 28% of inspection and function testing tasks were completed. Common gaps in inspection and function testing were instruments not all inspected separately, joints, serrations and crevices not all inspected for cleanliness (no magnifiers used). 26% packing standards were met. 52% sterilizer loading standards were met. 60% unloading standards were met. 88% of central sterilization rooms met wall, floor and work surface standards. Conclusions: Improving cleaning, inspection and packaging, sterilization, sterile storage, infection prevention and control measures and SOPs for sterilization processes to maximize outcomes with current resources is needed. Many can be addressed by practice changes that require little additional equipment or resources.