CENTRAL STERILE & SUPPLY DEPARTMENT

IN A QUATERNARY CARE HOSPITAL

Understanding Process & SWOT analysis

Dr. Sudha Pathak & Mr. Omkar More

CSSD is a service unit in a hospital that processes, issue & controls the sterile stores supply to all departments of the hospital.

Or

CSSD is the Department which deals with receiving, cleaning, packing, disinfecting, sterilizing, storing and distributing all surgical instruments and equipments as per well-delineated protocols and standardized procedures.

FACTS

o First CSSD was set in India at Jaslok Hospital in July, 1973 by Nalini Gaithonde

o Analysts say that 85 per cent of most of the upcoming hospitals have a well-equipped CSSD.

WHY CSSD ???• By having separate CSSD, we can decrease the cost

of sterilizers through centralization of equipment in one department. Besides, this would also ensure that a dedicated staff can effectively monitor the sterilization process as per the Standard Operative Procedures (SOPs).”

Ganesh Devadiga, Head, CSSD, Dr L H Hiranandani Hospital, Mumbai.

• “CSSD requires technical competency, which implies that the department controls all the activities of asset management pertaining to selective procurement of general and specialised surgical instruments and other inventory.

Vishwanath Kokitkar, CSSD and Laundry In- Charge, S L Raheja Hospital.

WHY CSSD ???• “The rise in incidence of nosocomial infection

with corresponding increase in mortality, length of stay and cost can be brought down by establishing a good CSSD set-up.”

Gopinathan T, Manager, CSSD, Amrita Institute of Medical Sciences (AIMS), Kochi.

• CSSD was generally looked upon as an essential part of an OT as the use of sterile supplies in a hospital is maximum to the OT. However, all that has changed. CSSD is considered today, integral to the function of Out Patient Department (OPDs), wards and other departments.”

Rekha Batura, Asst Medical Superindentent, Tata Memorial Hospital (TMH), Mumbai.

COST OF INFECTIONS

• Prolonged stay in hospital

• Additional resources and burden on hospital.

• Loss of manhours - doctors and patients

• Mental agony

• Significant economical loss.

• Poor surgical results

FUNCTION OF CSSD1. Receiving unsterile stores, instruments, equipment & linens from medical stores & various

consumer department of hospital.

2. Sorting out the items.

3. Washing, disinfection & drying.

4. Checking & packing of sets/trays/instruments.

5. Sterilization of all items received, by using the appropriate techniques as applicable to the items.

6. Storage & issue of the sterilized items to the consumer departments.

7. Maintaining records of the stores received, processed & issued.

8. Validation of the effectiveness of sterilization techniques.

9. Training of staff in techniques of sterilization.

10. Advice to consumer departments on sterilization of items of different nature

QUALITY MANAGEMENT OF SERVICES IN CSSD

Quality management of services in CSSD is extremely important in view of its role

• In hospital infection control &• The catastrophic effects the poor quality

service may have on patients.

However, quality of services can be judged from level of satisfaction of the clientele.

The clients in case of CSSD are all internal (Consumer departments/clinicians).

QUALITY MANAGEMENT OF SERVICES IN CSSD

High quality CSSD services to them means:

Hundred percent reliability of sterility of stores supplied by CSSD.

Timely supplies in right time. Contents of the trays/ sets are as per the standard list

provided by users & all the contents are in full operational order.

Trays/ Sets are labeled correctly. The sterile items supplied remain sterile up to their pre-

determined shelf life. Quality of the items does not deteriorate by the sterilization

technique used.

(The quality of outcome, however, depends upon the quality of infrastructure & process used in CSSD.)

SPACE, LAYOUT, SURFACE FINISH

The space requirement in CSSD is 7-10 sq. F/ bed.

The layout must follow the zoning concept & functional flow with receipt (dirty) counter on one end & sterile issue on other end.

Inside CSSD there should be no criss crossing & area should be divided by partitions into dirty, clean & sterile zones.

Similarly, gas & steam sterilization should be separated.

The entrance lobby should have….o A changing room with toilet & hand washing facility.

The flooring should be non-skid type.

2. ORGANIZATION & STAFFING

Department should be under overall control of HOD of OT/Nursing.

Should be headed by trained & experienced manager.

Should have trained staff(technicians, attendants) on each shift at each zone irrespective of volume

3. EQUIPMENT QUALITY /AVAILABILITY

• Ultrasound cleaners.

• Instrument washers

• Steel racks for storage of unsterile & sterile sets.

• Work tables

• Gas sterilizers

• ETO

• Autoclave machines fitted with sterimeters for temperature/time recording,

• Self recording pressure gauze for pressure/ time recording.

• Computer terminals.

4. QUALITY OF MATERIALS

Quality of disinfectants, detergents, cotton-wool gauze & other supplies should be of ensured.

5. ENGINEERING SUPPORT SERVICES

• Stable & uninterrupted power supply.

• Running water of desired quality

• Temperature with comfort zone.

• Ventilation with 10 air change per hour.

• Humidity level 50-60 %

• Illumination level of 200 Lux

IN QUATERNARY CARE CENTERCURRENT SITUATIONS

Operation

Theater.Wards

Receiving Instrument

Room

Decontamination Room

Drying & Packing

Sterilization

Sterile Storage

Trolleys Cleaning

Operation Theater Ward

Process followed Currently

• OT Instruments

• Ward Instrument

• Trolleys

• Chemicals

• Plastic Apron

• Preparation Tables

• Bins

• Sealing Machine

• Loading trolleys

• Paper holding trolleys

• Racks

• Linens

• Computers

• Registers

• Measurable Cups

Items Handled by CSSD currently

MAN POWER

CSSD Manager

Technicians(4)

Helpers(6)

SHORT COMINGS• Manpower.

• Instruments

• Door bell.

• Keys.

• Drying cabinet.

• Water jet in decontamination.

• Exaust fan in ETO room.

• Plastic crates

• Validation not done by IC

SWOT ANALYSIS

Strengths Weakness

Opportunities Threats

• Technology• Instrument• Accessories

• Untrained Staff• Instruments• Inappropriate

changing room• Other essential

requirements compromised.

• Training Staff• Physical

structure

• Structure (Validation)

• Lack of trained staff• Increased HAI• Back up for packing• Security• Safety

Strength Weakness

OpportunitiesThreat

IMPROVEMENT INITIATED

• Manuals & SOPS are ready.

• Key are provided to department.

• Backups have been planed.

• Safety is been considered.

• Checklist is provided.

THANK YOU