The role of CSSD in a healthcare institution: An experience from Tata Medical Center, Kolkata

1
The role of Central Sterile Supply Department
in a Healthcare Institution An experience from
tata medical center, kolkata
2
Unsterile medical device application and
associated problems

• Symptoms like HepB, HepC, HIV, rashes.
• Infections like
• Surgical site infections
• Urinary tract infections

3
Some special device where cleaning and
sterilizing agent penetration is essential

1. Orthopedic instruments
2. Neurological instruments
3. Cardiological instruments
4. Implants
5. Loaner instruments
6. Laparoscopic instruments
7. Endoscopic instruments
8. Long hollow instruments

4
Articles on poor sterilization related issues

• http//www.cnn.com/2014/11/12/world/asia/india-ste
  rilization-deaths/
• http//www.king5.com/story/news/local/2015/08/26/s
  eattle-childrens-reports-sterilization-problems/32
  436087/
• http//www.beckershospitalreview.com/quality/poorl
  y-sterilized-instruments-still-a-problem-among-hea
  lthcare-facilities.html

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Awful impact of antibiotics due to poor
sterilization

• Requirement of high dose antibiotics
• Chances of antibiotics resistance
• Huge cost of antibiotics
• Ill impact of unnecessary or over dosage of
  antibiotics to the patient

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What does CSSD mean

• Central Sterilization Supply Department
• The term Central suggest that services are
  centralized
• The term Service means an activity that helps
  or assists one or more person or group of person

7
Why CSSD is important in every healthcare
facilities

• CSSD acts as a backbone of the hospital
• Because they are not directly associated with
  the patient services but to control infection and
  cross contamination the department takes a major
  responsibility all over the hospital wherever
  medical devices applied to the patient.

8
Other importance

• Due to concentrating on surgery and patient care,
  O.T people pay less attention on Cleaning,
  Disinfection and Sterilization practices.
• TSSU can supply sterilized items only in
  Operation theatre.
• A high quality Re-processing and Sterilization
  unit ensures the continuous improvement of safety
  and quality of patient care throughout the
  hospital.

9
Special areas where high qualitysterility
maintaining is essential

• In stem cell (BMTU) unit where less immune
  patients are there.
• In Operation theatre where surgical instruments
  touches with blood, body fluids, mucous membrane,
  vascular system etc.

10
Functions of CSSD in a hospital

• Functions of CSSD depending upon cleaning,
  disinfection and sterilization of a large number
  of medical devices used in a hospital which
  includes dressing materials, surgical
  instruments, endoscopes, various catheters,
  ventilators and reusable linen also.
• This is a centralized department from where all
  the sterilized medical devices service to the
  various wards, emergency, OPDs, ICU, BMTU and
  especially to the Operation theatre.

11
Aim of CSSD personnel

• The aim of Central sterile service department is
  to provide sterilized medical devices in right
  time, right place and right condition.
• The person involved in this area must remember
  that they are an integral part of quality patient
  care by servicing sterile materials through
  controlled environment.

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CSSD area separation

• Main areas
• Decontamination room
• Preparation room
• Linen packing room
• Sterilization room
• Clean storage room
• Ancillary areas
• 1) C.S.S.D Officers room
• 2) Meeting room
• 3) Consumable store
• 4) Dress changing room with toilet facility
• 5) Trolley wash

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CSSD workflow
Pathway of CSSD should be unidirectional under
controlled environment
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CSSD Pathway(see the red arrow)
RAW MATERIAL STORE
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Control air flow in controlled environment

• Work and Material Dirty to Clean

• Staff Segregate area wise

• Air Clean to Dirty

• Pressure Positive to Negative
• Air exchange 10 times/hour
• Air velocity 300 cfm

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Requirement in CSSD

• Water quality TDS 50 ppm (R/O or DM water)
• Water pressure Minimum 4Kg/sqcm
• Electricity Uniformly or UPS system
• Compressed Air Free from moisture
• Air pressure Minimum 5-7 Kg/sqcm
• Manpower 20 bed 1 CSSD manpower

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Equipment and Accessories required in CSSD

• Equipments Water and Air jet gun, Ultrasonic
  cleaner, Washer disinfector, Thermal drying
  cabinet, Rotary sealing machine, Steam
  sterilizer, ETO sterilizer, Plasma sterilizer
• Accessories Open/closed trolleys, wash basins,
  racks/shelves, washable and sterilizable baskets,
  instruments and linen packaging tables, table
  attached magnifying lamp etc

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Consumable requirement

• Readymade dressing materials- Gauze, gamzee,
  cotton, mops, eye pads, bandage etc.
• Packaging materials- Wrappers, reels, pouches
• Indicators- Washers and sterilizer indicators
• Solution- Cleaning solutions, High level
  disinfectant, lubricants or instrument spray etc

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Types of materials sterilized by C.S.S.D
Steam Sterilizer ETO Sterilizer Plasma Sterilizer
All stainless Steel Instruments All types of plastic, rubber items All types of plastic, rubber items
All kinds of dressing materials Stainless Steel Instruments Stainless Steel Instruments
Long metallic lumen device Long lumen device Lumen device bigger than 2mm diameter smaller than 1mt length can be sterilized
Silicon or Rubber based materials All dry cellulose items Except gas or liquid absorbable items cannot be sterilized
Re-usable linen (woven fabric) Except gas or liquid absorbable items
Liquid (Water)
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Compare between Industrial and Hospital
sterilization

• Industrial (New sterile items)
• Disadvantage
• Bulk items sterilization
• Poor condition of sterilizer
• Poor quality packaging materials for cost control
• Sometimes no indicators are there. Problem to
  distinguish sterile and non sterile items
• Environment outside traffic condition
• Compromise the integrity of packaging materials
  because of multiple handling
• Faulty loading technique
• Compromise sterility maintaining
• Lack of Quality manpower
• Lack of staff education

• Hospital (Re-use sterile items)
• Advantage
• Limited items sterilize
• Validated sterilizer
• FDA approved medical grade packaging materials
• Use internal and external indicators for easy
  understanding
• Use good quality water and detergent
• Cleaning , packaging, sterilization and storing
  done in controlled environment
• Maintain the technique of sterile product
  handling
• Properly maintain loading technique
• Product handled by all trained personnel
• Low cost and less manning involved

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Important CSSD record retention policy
CSSD different important records Preservation period in MRD
Bowie-Dick test file with Batch label system 6 months in CSSD and 3 years in MRD
Biological Indicator file (Steam/EO/Plasma) 6 months in CSSD and 3 years in MRD
Sterilizer Cycle Print out (Steam/EO/Plasma) 6 months in CSSD and 3 years in MRD
Washer disinfector cycle record 6 months in CSSD and 3 years in MRD
Sterilizer Register (Stem/EO/Plasma) (Including implantable materials) 6 months in CSSD and 3 years in MRD
Sterile product dispatch register 6 months in CSSD and 3 years in MRD
Equipment preventive maintenance by 3rd party and calibration report 6 months in CSSD and 3 years in MRD
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Hospital benefitted for CSSD

• Reduce infection and cross contaminations
• Less inventory on costly antibiotics
• Reduce hospital cost by re-cycling process
• Make an extra millage of a hospital for infection
  prevention

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Patient (customer)satisfaction

• Reduce patient billing charges
• Reduce other medications including antibiotics
• Less antibiotics related side effect
• Less hospital acquired infection
• Reduce hospital staying cost

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Revenue generation
Surgical sets Surgical sets Minor procedure sets Minor procedure sets Surgeons Gown set Surgeons Gown set Patient Drape set Patient Drape set
Cost heads Cost per day INR (US ) Cost per unit INR (US ) Cost per day INR (US ) Cost per unit INR (US ) Cost per day INR (US ) Cost per unit INR (US ) Cost per day INR (US ) Cost per unit INR (US )
Manufacturing cost and laundry cost
Water cost
Electricity cost
Consumable cost
Human Resource cost
Depreciation cost with maintenance contract cost
Total
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