Project on cssd

INTERNSHIP PROJECT ON DEPARTMENT OF CENTRAL STERILE

SUPPLY DEPARTMENT

DEPARTMENT OF MHA & M, DMIMS, SAWANGI WARDHA

PREPARED BYDR MANJIT RAMESH

BARSAGADEMHA & M 1ST YEAR

TABLE OF CONTENTSR NO PARTICULARS PAGE NO

1 INFORMATION ABOUT SHRI KRISHNA HRUDALAYA & CRITICAL CARE HOSPITAL

2 AIMS & OBJECTIVES

3 METHODOLOGY

4 INTRODUCTION OF CSSD

5 FUNCTION OF CSSD

6 LOCATION OF CSSD

7 STAFF

8 WORK FLOW AND SPACE PLANING

9 RECEVING AREA

TABLE OF CONTENT SR NO PARTICULARS PAGE NO

10 CLEANING AREA

11 PACKING AREA

12 STERILIZING AREA

13 STORE

14 DISTRUBATION AREA

15 SUPPORT AREA IN CSSD

16 CSSD AT SHRI KRISHNA HRUDALAYA AND CRITICAL CARE

17

18

INFORMATION ABOUT SHRI KRISHNA HRUDALAYA & CRITICAL CARE HOSPITAL

INTRODUCTION

PATIENT CARE

EVERY YEAR NEARLY 6,000 PATIENTS VISIT THE CLINICS FROM MAHARASHTRA, MADHYA PRADESH, CHHATTISGARH, AND ANDHRA PRADESH AND FROM NEIGHBORING COUNTRIES. MANY PATIENTS ARE REFERRED TO US AFTER RECEIVING TREATMENT INITIALLY AT THEIR NATIVE PLACE. THIS GROUP OF PATIENTS IS REFERRED FOR VARIOUS INVESTIGATIONS LIKE 2D ECHOCARDIOGRAM, TREAD MILL TEST, HEMATOLOGICAL AND BIOCHEMICAL INVESTIGATIONS, CARDIAC CATHETERIZATION (FOR CORONARY, VASCULAR AND VALVULAR INTERVENTIONS). EQUAL NUMBER OF SUCH PATIENTS ARRIVES DIRECTLY TO US. WE HAVE BEEN DOING INTERVENTIONS FOR ALL ACUTE CORONARY EVENTS LIKE UNSTABLE ANGINA AND MYOCARDIAL INFARCTION (HEART ATTACK). WE PERFORM MORE THAN 100 CORONARY ANGIOGRAPHIES EVERY MONTH. SIGNIFICANT POPULATION UNDERGOES PRIMARY ANGIOPLASTY FOR HEART ATTACK AND WE HAVE A SIZABLE NUMBER OF PATIENTS COMING TO US FOR PLANNED PCI (PERCUTANEOUS INTERVENTIONS). WE HAVE INFRASTRUCTURE, EQUIPMENTS AND STAFF TO MANAGE ALL TYPE OF CARDIAC EMERGENCIES LIKE HEART FAILURE, PULMONARY EDEMA, PULMONARY EMBOLISM, ETC. OUR SURGICAL UNIT HAS TEAM O CARDIOVASCULAR SURGEON, PERFUSIONIST, CARDIAC ANESTHETIST AND SUPPORTIVE STAFF. AT SHRIKRISHNA HRUDAYALAYA, EVIDENCE BASED MEDICINE IS THE KEYSTONE OF OUR ENDEAVOUR. APART FROM THE PATIENT CARE AND SERVICE, CLINICAL RESEARCH PROGRAMMES AND RANDOMIZED TRIALS CONTRIBUTE INCREASINGLY TO IMPROVED DELIVERY OF CARE AND HIGHEST STANDARDS OF WORK ETHICS. THE STRATEGIES FOR PREVENTION, EARLY DIAGNOSIS, TREATMENT MANAGEMENT AND REHABILITATION HAVE BEEN ESTABLISHED IN A COMPREHENSIVE AND MULTIDISCIPLINARY APPROACH FOR A TOTAL CARDIAC CARE PROGRAMME.


PATIENT CARE

MANY ADVANCES HAVE TAKEN PLACE IN EVERY SPECIALTY. IN CARDIOVASCULAR

SURGERY, CONCEPTS HAVE CHANGED TAKING INTO ACCOUNT THE ADVANCES

AND AVAILABILITY OF NEWER TECHNIQUES. WE HAVE TRAINED AND

EXPERIENCED CVTS TO TACKLE CHALLENGING AND COMPLEX CARDIOVASCULAR

SURGERIES. THERE IS SPECIALIZED UNIT FOR INTERVENTIONAL RADIOLOGY FOR

PATIENTS WITH STROKE, ARTERIAL AND VENOUS THROMBO EMBOLISM AND

DISEASES OF THE VESSELS LIKE VARICOSE VEINS. SUPPORTIVE CARE IN THE

FORM OF TOTAL REHABILITATION AND COUNSELING OF PATIENTS IS WIDELY

RECOGNIZED TO BE VERY IMPORTANT ASPECTS OF THERAPY. EXCELLENT WORK

HAS BEEN CARRIED OUT IN AREAS OF REHABILITATION, PHYSIOTHERAPY,

OCCUPATIONAL THERAPY, PSYCHOLOGY AND MEDICAL SOCIAL WORK.


ABOUT HOSPITAL

SHRIKRISHNA HRUDAYALAYA AND CRITICAL CARE CENTRE WAS STARTED BY DR. MAHESH

FULWANI IN 1998, WITH THE VISION OF SERVING THE SUFFERING MANKIND AND TO BRING

THE LATEST MEDICAL TECHNOLOGY AVAILABLE TO CATER THE CHALLENGES IN THE FIELD

OF CARDIOVASCULAR DISEASES. INITIALLY IT WAS RELATIVELY SMALL UNIT PROVIDING

SERVICES IN CARDIOLOGY. IT FLOURISHED IN FEBRUARY 2008 AND TOOK A SHAPE OF

HUGE CENTRE PROVIDING TERTIARY CARE FOR ‘EVERY ALIMENT IN CARDIOLOGY AND

CRITICAL CARE’ UNDER ONE ROOF.

THE HOSPITAL IS WELL EQUIPPED WITH ROUND THE CLOCK CARDIAC CATHETERIZATION

LAB. IN ADDITION, 24 HOURS’ AVAILABILITY OF SKILLED STAFF AND INTERVENTIONAL

CARDIOLOGISTS. THE CRITICAL CARE UNIT HAS FULL TIME INTENSIVISTS AND CRITICAL

CARE PHYSICIANS TO TAKE CARE OF CRITICALLY ILL PATIENTS. WE ARE RECOGNIZED BY,

EMPANELLED ON VARIOUS LEADING CORPORATE, SEMI-GOVERNMENT AND GOVERNMENT

ORGANIZATIONS, AND ARE ENGAGED IN PROVIDING ROUND THE CLOCK SERVICE AT MUCH

AFFORDABLE COST TO EVERYONE.


SERVICES KEEPING PACE WITH RECENT ADVANCES IN INFORMATION

TECHNOLOGY, SHRIKRISHNA HRUDAYALAYA AND CRITICAL CARE CENTRE IS ALSO A TECHNO-SAVVY AND HAS ESTABLISHED A COMPREHENSIVE COMPUTERIZATION OF MEDICAL PRESCRIPTIONS, RECORDS, MATERIAL MANAGEMENT AND ADMINISTRATION. THE PATIENTS CAN COMMUNICATE ON TELEPHONE ROUND THE CLOCK AND QUALIFIED DOCTORS TO GET THEIR QUERIES ANSWERED WILL ATTEND THEM. THERE IS FACILITY OF SENDING THE REPORTS/ DATA VIA FAX OR E MAIL IF YOU WISH TO REVIEW YOUR RECORDS PRIOR TO VISIT HOSPITAL OR ANYTIME YOU FEEL IT IS URGENT TO MAKE A DECISION ABOUT THE TREATMENT MANAGEMENT.


SPECALITY SERVICES ECHOCARDIOGRAPHY

INTERVENTIONAL CARDIOLOGY

CARDIAC CATHETERIZATION AND INTERVENTIONAL CARDIOLOGY

CARDIAC AND VASCULAR SURGERY

PREVENTION AND REHABILITATION


CORONARY ANGIOGRAPHY & ANGIOPLASTY

BYPASS OPERATION

2D ECHO AND COLOUR DOPPLER

BALOON VALVE TREATMENT

FETAL ECHO

ARRYTHMIA CLINIC

ICCU

COMPUTERISED TMT

PACEMAKER HUT TEST

24 HOURS EMERGENCY

CRITICAL CARE UNIT

NEURO SURGERY

ORTHO SURGERY

TRAUMA CARE

GENERAL SURGERY

DIALYSIS

24 HOURS AMBULANCE


CLINICAL RESEARCH EVERY MOLECULE HAS TO BE EXTENSIVELY SUBJECTED TO RESEARCH BEFORE IT ENTERS

INTO THE MARKET ANY PARTICULAR DISEASE. CENTRAL ETHICS COMMITTEE CRITICALLY REVIEWS THE PROPOSED RESEARCH PROGRAMMES AND PROJECTS IN DETAIL AND ENSURES THAT THE RESEARCH EFFORTS ARE AT PAR WITH ICH-GCP GUIDELINES. ETHICS COMMITTEE CONSISTING OF DOCTORS AND SCIENTIFIC OFFICERS, EXPERT MEMBERS IN THE FIELD OF MEDICINE, LAW AND SOCIAL SCIENCE CRITICALLY EVALUATE THE RESEARCH AND MEDICAL PRACTICES FOLLOWED IN THE HOSPITAL. A SEPARATE DATA MONITORING AND SAFETY COMMITTEE, IN ADDITION, EVALUATE AND MONITORS ALL OFFICIALLY SANCTIONED INTRAMURAL RESEARCH PROGRAMMES. PATIENT’S SAFETY IS OF PRIME CONCERN FOR US WHILE CONDUCTING BIOMEDICAL RESEARCH.

COMPLETED PROJECTS: PHASE III CLINICAL STUDY ENTITLED EFFICACY AND SAFETY OF INTRAVENOUS

ADMINISTRATION OF CONIVAPTAN HYDROCHLORIDE IN THE TREATMENT OF EUVOLEMIC HYPONATREMIA - A MULTICENTRE, OPEN LABEL, NON-COMPARATIVE, PHASE III STUDY.

A PHASE III, ACTIVE (WARFARIN) CONTROLLED, RANDOMIZED, DOUBLE-BLIND, PARALLEL ARM STUDY TO EVALUATE EFFICACY AND SAFETY OF APIXABAN IN PREVENTING STROKE AND SYSTEMIC EMBOLISM IN SUBJECTS WITH NONVALVULAR ATRIAL FIBRILLATION (ARISTOTLE: APIXABAN FOR REDUCTION IN STROKE AND OTHER THROMBOEMBOLIC EVENTS IN ATRIAL FIBRILLATION)

LOCATION SHRIKRISHNA HRUDAYALAYA AND CRITICAL CARE CENTER TIKEKAR ROAD, CONGRESS NAGAR SQUARE, OPP. NEW ENGLISH HIGH SCHOOL, DHANTOLI, NAGPUR - 440 012. TEL. NO. : +91-712-2444434, 2442136 FAX: +91-712-2440120 E-MAIL: [email protected]

AIMTO STUDY THE PLANNING, ORGANISATIONAL STRUCTURE, MANAGEMENT, EVALUATION AND GIVE RECOMMENDATIONS IF ANY OF CENTRAL STERILE SUPPLY DEPARTMENT

OBJECTIVES

•TO STUDY ORGANISATION AND WORKING OF CENTRAL STERILE SUPPLY DEPARTMENT.

•TO SEE THE FACILITY AND SERVICES PROVIDED BY CENTRAL STERILE SUPPLY DEPARTMENT.

•TO FIND OUT ANY NEED TO IMPROVE BASIC SERVICES PROVIDED BY CENTRAL STERILE SUPPLY DEPARTMENT.

METHODOLOGY•AN OBSERVATIONAL STUDY WAS CARRIED OUT IN CENTRAL STERILE SUPPLY DEPARTMENT AT SHRI KRISHNA HRUDALAYA & CRITICAL CARE NAGPUR.

•THE DATA HAS BEEN COLLETED THROUGH OBSERVATIONAL AND INFORMAL DISCUSSION WITH DOCTORS, NURSES, PATIENTS & OTHER STAFFS.

INTRODUCTION OF CSSD ENSURING A HIGH STANDARD OF STERILIZATION AND DISINFECTION TO MINIMIZE THE INCIDENCE OF HOSPITAL

INFECTION HAS BEEN UPPERMOST IN THE MINDS OF CLINICIANS AS WELL AS HOSPITAL ADMINISTRATORS. STANDARDIZATION OF SURGICAL DRESSINGS, AND CENTRALIZING ALL SURGICAL SUPPLIES FROM ONE POINT OF ORIGIN WERE NECESSITATED DURING THE SECOND WORD WAR BECAUSE OF THE REQUIREMENT OF A LARGE NUMBER OF CASUALTIES IN DIFFERENT THEATERS OF WAR. THE CONCEPT OF A STERILE SUPPLY ORGANIZATION, IN THE FORM OF AN INDEPENDENT UNIT OR ONE ATTACHED TO LARGE BASE HOSPITALS CAME INTO BEING. STERILIZATION ACTIVITIES IN A HOSPITAL ARE BETTER CENTRALIZED IN ONE SINGLE DEPARTMENT FOR EFFICIENCY AND EFFECTIVENESS. THIS DEPARTMENT, CALLED THE CENTRAL STERILE SUPPLY DEPARTMENT (CSSD) BECOMES RESPONSIBLE FOR PROCESSING, STERILIZING AND DISPENSING OF ALMOST ALL ITEMS OF STERILE EQUIPMENT, SETS AND DRESSINGS IN THE HOSPITAL. CENTRALIZATION OF STERILIZING ACTIVITIES IN ONE DEPARTMENT HAS RESULTED IN MANY ADVANTAGES, THE CHIEF AMONG THESE ARE (I) IMPROVED EFFICIENCY, (II) STERILE SUPPLIES AVAILABLE AT ALL TIMES OF THE DAY OR NIGHT, (III) ECONOMY OF TRAINED MANPOWER, (IV) STERILIZATION SAFETY AND (V) QUALITY CONTROL.

THE OBJECTIVE OF ESTABLISHING A CENTRAL STERILE SUPPLY DEPARTMENT IS TO MAKE RELIABLY STERILIZED ARTICLES AVAILABLE AT THE REQUIRED TIME AND PLACE FOR ANY AGREED PURPOSE IN THE HOSPITAL AS ECONOMICALLY AS POSSIBLE, HAVING REGARD TO THE NEED TO CONSERVE THE TIME OF USERS [ESPECIALLY DOCTORS AND NURSES]. THE STERILE SUPPLY DEPARTMENT WITHIN A HOSPITAL RECEIVES STORES, STERILIZES AND DISTRIBUTES TO ALL DEPARTMENTS INCLUDING THE WARDS, OUTPATIENT DEPARTMENT [OPD] AND OTHER SPECIAL UNITS SUCH AS OPERATING THEATRE [OT]. MAJOR RESPONSIBILITIES OF CSSD INCLUDE PROCESSING AND STERILIZATION OF SYRINGES, RUBBER GOODS [CATHETERS, TUBING], SURGICAL INSTRUMENTS, TREATMENT TRAYS AND SETS, DRESSINGS ETC. IT IS RESPONSIBLE FOR ECONOMIC AND EFFECTIVE UTILIZATION OF EQUIPMENT RESOURCES OF THE HOSPITAL UNDER CONTROLLED SUPERVISION.

THE CSSD ALSO AIMS AT ASSUMING TOTAL RESPONSIBILITY FOR PROCESSING HOSPITAL ITEMS THEREBY ASSURING THAT ALL OF THEM RECEIVE THE SAME DEGREE OF CLEANING AND STERILIZATION. IT ALSO CONTRIBUTES TO THE EDUCATIONAL PROGRAM WITHIN THE HOSPITAL RELATING TO INFECTION CONTROL AND DEVELOPS A COST-EFFECTIVE PROGRAM BY COST ANALYSIS OF PERSONNEL, SUPPLIES AND EQUIPMENT.

FUNCTIONS OF CSSD RECEIVING AND SORTING SOILED MATERIALS USED IN THE HOSPITAL.

DETERMINING WHETHER THE ITEM SHOULD BE REUSED OR DISCARDED.

CARRY OUT THE PROCESS OF DECONTAMINATION OR DISINFECTION PRIOR TO STERILIZATION.

CARRY OUT SPECIALIZED CLEANING OF EQUIPMENTS AND SUPPLIES.

INSPECTING AND TESTING INSTRUMENTS, EQUIPMENTS AND LINEN.

ASSEMBLING TREATMENTS TRAYS, INSTRUMENT SETS, LINEN PACKS, ETC.

PACKING ALL MATERIALS FOR STERILIZATION.

STERILIZING.

LABELING AND DATING MATERIALS.

STORING AND CONTROLLING INVENTORY.

ISSUING AND DISTRIBUTING.

LOCATION IN HOSPITALS WITH WELL-UTILIZED SURGICAL SERVICES, THE

OPERATION THEATERS (OT) REQUIRES HUGE SUPPLIES OF STERILE SURGICAL INSTRUMENTS AND STERILE LINEN AND THEY ARE THE MAJOR USERS OF CSSD. THE OTHER USERS OF CSSD INCLUDE WARDS, ICUS, EMERGENCY AND LABOR ROOM ETC. THEREFORE THE LOCATION OF CSSD SHOULD PREFERABLY BE IN PROXIMITY TO OT AND SHOULD HAVE EASY ACCESS TO OTHER USER DEPARTMENTS. IN SOME HOSPITALS, THE OT COMPLEX HAS ITS OWN STERILE SUPPLY UNIT WITHIN OR JUST ADJACENT TO IT. THIS IS KNOWN AS THEATER STERILE SUPPLY UNIT (TSSU). THE AUTOCLAVE MACHINES IN THE CSSD EMIT LOT OF HEAT SO THE FACILITY SHOULD HAVE AT LEAST ONE SIDE EXPOSED TO OPEN SPACE. BECAUSE OF SHORTAGE OF SPACE, NOW A DAY’S MANY HOSPITALS ESTABLISH THE CSSD IN THE BASEMENT. THE CSSD CAN BE CONNECTED TO OT COMPLEX THROUGH SMALL ELEVATORS.

STAFF THE STAFF IN CSSD COMPRISE OF TECHNICIANS WHO OPERATE THE

AUTOCLAVE AND ETO MACHINES. ASSISTANTS WHO PERFORM THE CLEANING AND PACKING, GAUGE CUTTING AND COTTON BALL MAKING ASSIST THEM. THERE MAY BE CLERKS OR STOREKEEPERS TO MANAGE THE INVENTORY AND STERILE STORES. ONE OR MORE HOUSEKEEPING STAFFS MAY BE REQUIRED. A MANAGER SUPERVISES THEM ALL.

CSSD IN CHARGE/ MANAGER

CSSD TECHNICIANS

CSSD ASSISTANTS

HOUSEKEEPING STAFF

WORK FLOW AND SPACE PLANNING

MAJOR ACTIVITIES IN A CSSD ARE:

RECEIVING THE USED ITEMS FROM USER DEPARTMENTS

CLEANING

PACKING

STERILIZING

STORING (TEMPORARY)

DISTRIBUTING TO USER DEPARTMENTS

THESE ACTIVITIES ARE CARRIED OUT IN ABOVE SEQUENCE AND EFFORTS ARE MADE TO MAINTAIN A UNI-DIRECTIONAL FLOW OF ACTIVITIES SO THAT STERILE AND UNSTERILE ITEMS REMAIN SEPARATE. ACCORDINGLY THE SPACE PROGRAMMING IS DONE. EACH AREA IS DESCRIBED BELOW:

RECEIVING AREA USED ITEMS FROM VARIOUS DEPARTMENTS OF THE HOSPITAL ARE

SHIFTED TO CSSD FOR CLEANING AND STERILIZATION. IDEALLY THE ITEMS THAT GET SOILED WITH BLOOD OR BODY FLUIDS SHOULD BE DECONTAMINATED WITH SODIUM HYPOCHLORITE SOLUTION IN THE USER DEPARTMENTS ITSELF SO THAT THE STAFFS WHO HANDLE THESE ITEMS FOR TRANSPORTATION OR CLEANING ARE NOT EXPOSED TO THE RISK OF CONTACTING INFECTIONS. AFTER DECONTAMINATION, THEY ARE SHIFTED TO CSSD. THE STAFF OF THE USER DEPARTMENT OR THROUGH CENTRALIZED STAFF CAN TRANSPORT THESE ITEMS TO CSSD EITHER.

THE RECEIVING AREA OF CSSD SHOULD HAVE ACCESS TO OUTSIDE THROUGH A WINDOW WITH A COUNTER. THE ITEMS (ESPECIALLY FOR INSTRUMENTS IN TRAYS) ARE COUNTED AND RECEIVED. THEREAFTER THE INSTRUMENTS ARE INSPECTED AND BLUNT/ UNSUITABLE INSTRUMENTS ARE SEGREGATED/ DISCARDED. NECESSARY ENTRIES ARE MADE FOR RECORDS. THEREAFTER THE ITEMS ARE SHIFTED TO CLEANING AREA.

CLEANING AREA HERE THE INSTRUMENTS ARE WASHED EITHER MANUALLY OR IN MACHINES. FOR MANUAL,

WASHING SINKS WITH WATER SUPPLY AND WORKING COUNTERS ARE ORGANIZED. DETERGENTS AND BRUSHES OF VARIOUS SIZES AND SHAPES ARE REQUIRED IN THIS AREA. ULTRASONIC WASHER IS A MACHINE USED FOR CLEANING SURGICAL INSTRUMENTS. IT CONVERTS HIGH FREQUENCY SOUND WAVES INTO MECHANICAL VIBRATION THAT PRODUCES SMALL BUBBLES THAT BURST ON THE INTERNAL SURFACES OF INSTRUMENTS AND DISLODGE THE WASTE PARTICLES.

TUNNEL WASHER IS HIGHLY SOPHISTICATED AND EXPANSIVE MACHINE THAT ALLOWS TOTALLY HAND-OFF PROCESSING. INSTRUMENTS IN PERFORATE OR MESH BOTTOM TRAYS COMING FROM OPERATING ROOM OR OTHER DEPARTMENTS ARE PLACED INTO THE TUNNEL WASHER WITHOUT ANY FURTHER HANDLING. THE INSTRUMENTS ARE SUBJECTED TO CYCLES WASHING, RINSING, ULTRASONIC CLEANING AND DRYING. MOST OF THE HOSPITALS CANNOT AFFORD THESE WASHERS.

AFTER THE INSTRUMENTS ARE WASHED, THEY ARE DRIED IN OVEN DRYER AND SHIFTED TO PACKING AREA.

IF USED ITEMS ARE NOT DECONTAMINATED IN USER DEPARTMENT THAN BLOOD/ BODY FLUID SOILED SHOULD BE DECONTAMINATED WITH SODIUM HYPOCHLORITE BEFORE HANDLING FURTHER.

PACKING AREA CLEAN AND DRY INSTRUMENTS ARE PACKED BEFORE STERILIZATION SO THAT THEY ARE

NOT CONTAMINATED WHILE HANDLING AFTER THEY ARE STERILIZED. WORKING COUNTERS ARE REQUIRED IN THIS AREA. MOST OF THE INSTRUMENTS ARE PACKED IN TRAYS (TRAY ASSEMBLY) THAT ARE WRAPPED WITH DOUBLE LAYER OF COTTON CLOTH. PAPER ENVELOPES ARE ALSO AVAILABLE FOR PACKING THE INSTRUMENTS. THESE ARE EQUALLY EFFECTIVE BUT EXPANSIVE. PLASTIC BAGS (ETO BAGS) ARE USED FOR PACKING THE ITEMS FOR ETO STERILIZATION. THE PACKS ARE LABELED INDICATING DATE OF STERILIZATION AND DATE OF EXPIRY (WHEREVER POSSIBLE).

SEALING MACHINE IS USED FOR THE SEALING THE PLASTIC BAGS IN WHICH INSTRUMENTS ARE PACKED. AFTER PACKING AND SEALING, THE INSTRUMENTS ARE SHIFTED FOR STERILIZATION.

A LARGE QUANTITY OF COTTON BALLS AND GAUGE PIECES ARE USED IN VARIOUS PATIENT CARE AREAS AND ARE REQUIRED TO BE STERILIZED BEFORE USING THEM. TRADITIONALLY THESE ARE PREPARED IN THE CSSD. CUTTING THE GAUGE IS VERY ARDUOUS JOB AND IS DONE WITH THE HELP OF GAUZE CUTTING MACHINE. DURING THE PROCESS OF GAUGE CUTTING, THE COTTON FIBERS ARE DISPERSED IN THE AIR AND MAY GET SETTLED ON THE STERILIZED ITEMS SPOILING THEM. THEREFORE, A SEPARATE ROOM IS REQUIRED FOR CUTTING THE GAUGE AND PREPARING COTTON BALLS ADJACENT TO THE PACKING AREA.

STERILIZING AREA

STERILIZATION IS DONE BY EITHER OF THE TWO METHODS IN CSSD:

STEAM STERILIZATION BY AUTOCLAVES

GAS STERILIZATION BY ETO (ETHYLENE OXIDE) MACHINES

AUTOCLAVE: STEAM UNDER PRESSURE IS THE MOST COST-EFFECTIVE METHOD OF STERILIZATION, THEREFORE, MOST COMMONLY USED FOR STERILIZATION OF INSTRUMENTS AND LINEN IN HOSPITALS. “AUTOCLAVE” IS THE NAME OF THE MACHINE THAT GENERATES STEAM AT A TEMPERATURE OF 121 DEGREE CENTIGRADE UNDER 15 POUNDS OF PRESSURE. AN EXPOSURE OF 20 MINUTES IS REQUIRED FOR STERILIZATION. BEFORE FEEDING THE STEAM, VACUUM IS GENERATED IN THE CHAMBER OF THE AUTOCLAVE SO THAT NO AIR POCKET REMAINS IN THE FOLDS OF LINEN AND THE STEAM IS DISTRIBUTED UNIFORMLY IN THE CHAMBER.

1. AUTOCLAVE IS AVAILABLE WITH SINGLE DOOR OR DOUBLE DOORS. DOUBLE DOOR AUTOCLAVES HAVE TWO DOORS ON TWO OPPOSITE SIDES AND HAVE THE ADVANTAGE OF MAINTAINING UNI-DIRECTIONAL MOVEMENT OF MATERIALS. THE UNSTERILE ITEMS ARE FED INTO THE CHAMBER THROUGH ONE DOOR AND THE STERILIZED ITEMS ARE TAKEN OUT FROM THE OTHER DOOR OF THE AUTOCLAVE.

2. THE AUTOCLAVES OF DIFFERENT CAPACITIES ARE AVAILABLE- 1/2, 1, 2 TON ETC. AND CAN BE SELECTED DEPENDING ON THE WORK LOAD.

ETO STERILIZER: THE ITEMS LIKE CARDIAC CATHETERS ARE THERMO SENSITIVE (DAMAGED BY HEAT) AND THEREFORE CANNOT BE STERILIZED BY STEAM. SUCH ITEMS ARE STERILIZED BY ETHYLENE OXIDE (ETO) GAS STERILIZATION. THE ETO IS AN EXPANSIVE AND TOXIC GAS. THE ITEMS THAT ARE TO BE STERILIZED ARE PLACED IN A CHAMBER THAT IS FILLED WITH ETO. AS A RESULT OF THE EXPOSURE TO THE GAS ALL ORGANISMS ATTACHED TO THE ITEM GET KILLED BUT THE ITEM GETS COATED WITH GAS MOLECULES. IT IS ABSOLUTELY NECESSARY TO ENSURE THAT THESE ITEMS ARE MADE FREE OF GAS MOLECULES BEFORE USING THEM ON A PATIENT. THIS IS ACHIEVED BY SUBJECTING THE ITEMS TO FORCED VENTILATION. THE ENTIRE CYCLE OF STERILIZATION AND VENTILATION IS LONG AND MAY TAKE ABOUT 8- 12 HRS. FOR EACH CYCLE OF GAS STERILIZATION ONE ETO CARTRIDGE IS REQUIRED THAT IS FIXED WITH THE MACHINE BEFORE STARTING THE CYCLE.

FLASH STERILIZER: THIS IS A SPECIAL TYPE OF AUTOCLAVE THAT HAS A VERY SHORT STERILIZATION CYCLE OF ABOUT 3 - 5 MINUTES BECAUSE OF ITS ABILITY TO RAISE THE TEMPERATURE TO 132 DEGREE CENTIGRADE. THE MACHINE IS GENERALLY KEPT IN THE OT. DURING THE OPERATIONS IF THERE IS URGENT A REQUIREMENT OF STERILIZING AN INSTRUMENT, IT IS DONE ON FLASH STERILIZER.

STORE AFTER STERILIZATION, THE ITEMS ARE

TEMPORARILY STORED IN A CLEAN STORE (ON RACKS) FROM WHERE THEY ARE DISTRIBUTED TO USER DEPARTMENTS

DISTRIBUTION AREA IT SHOULD BE AWAY FROM THE RECEIVING AREA AND MAY COMPRISE OF A

WINDOW WITH COUNTER. IN MODERN HOSPITALS, THERE MAY BE A SEPARATE LIFT FOR TRANSPORTING THE STERILE MATERIALS TO USER DEPARTMENTS.

SUPPORT AREAS IN CSSD THE FOLLOWING SUPPORT AREAS WOULD BE

REQUIRED IN A CSSD

1. CSSD MANAGERS OFFICE

2. WORKERS REST ROOM WITH LOCKERS AND TOILET FACILITY

3. UNSTERILE STORES FOR COTTON, GAUGE, LINEN AND INSTRUMENTS

QUALITY ASSURANCE IN ORDER TO ENSURE THE QUALITY OF STERILIZATION THE FOLLOWING MEASURES ARE TAKEN:

ENSURE THE EQUIPMENT IS FIT I.E. IN AUTOCLAVE THE TEMPERATURE IS MAINTAINED AT 121 DEGREES CENTIGRADE, 15-POUND PRESSURE AND HOLDING TIME IS MINIMUM 20 MINUTES. MODERN MACHINES ASSURE THAT AND ARE FITTED WITH GOOD QUALITY MONITORS. THEY PROVIDE PRINT OUTS OF READINGS. THE DOORS OF THE AUTOCLAVE DO NOT OPEN UNLESS THE CYCLE IS COMPLETE.

BOWIE DICK’S TAPES ARE FIXED WITH EVERY PACK OF ITEMS TO BE STERILIZED. THIS TAPS CHANGES THE COLOR WHENEVER THE REQUIRED TEMPERATURE IS ATTAINED. AFTER A CYCLE, THE TAPES ARE CHECKED FOR CHANGE OF COLOR. HOWEVER, THE CHANGE IN COLOR ONLY INDICATES THAT THE SPECIFIC TEMPERATURE HAS BEEN ACHIEVED DURING THE CYCLE BUT CANNOT GUARANTEE THAT THE ITEMS ARE STERILIZED. INDICATORS ARE ALSO AVAILABLE FOR CHECKING THE QUALITY OF ETO STERILIZATION.

PERIODICALLY BACTERIOLOGICAL TESTS ARE TO BE DONE. A CAPSULE CONTAINING BACILLUS STEREOTHERMOPHILUS (FOR AUTOCLAVE) AND BACILLUS SUBTILIS (FOR ETO) ARE PUT ALONG WITH THE LOAD. THESE BACTERIA ARE CONSIDERED MOST RESISTANT TO STEAM OR GAS RESPECTIVELY. AFTER THE CYCLE IS OVER THESE CAPSULES ARE TESTED IN MICROBIOLOGY LAB FOR PRESENCE OF LIVE ORGANISMS. IF THERE ARE NO LIVE ORGANISMS IN THE CAPSULES, IT INDICATES THE STERILIZATION PROCESS WAS EFFECTIVE.

THE STAFFS WHO WORK ESPECIALLY IN STERILIZATION AREA, STERILE STORE AND DISTRIBUTION AREA SHOULD CHANGE SLIPPERS AND THEIR DRESS, AND WASH THEIR HANDS BEFORE RESUMING WORK.

LIFE OF STERILIZED ITEMS THE LIFE OF THE STERILE MATERIALS DEPENDS ON THE QUALITY OF PACKING MATERIALS USED AND THE STATUS OF CLEANLINESS OF STORING AREA. GENERALLY, THE ITEMS STERILIZED BY STEAM AUTOCLAVE CAN BE USED FOR ONE WEEK AND ETO PACKS CAN BE USED FOR 6 MONTHS.

HOSPITAL MANAGEMENT INFORMATION SYSTEM

NO OF CYCLE PER EQUIPMENT

WORKLOAD PER EQUIPMENT- NO OF PACKS PER CYCLE

DEPARTMENT WISE UTILIZATION

COST INCURRED ON STERILIZING ONE PACK ON AUTOCLAVE AND ETO

NO OF PACKS EXPIRED AND RE-STERILIZED

ROLE OF CSSD MANAGER

MAINTENANCE AND REPAIR OF EQUIPMENT

INVENTORY MANAGEMENT OF SUPPLIES AND CONSUMABLE

ENSURE QUALITY OF STERILIZATION

ENSURE PROPER DISTRIBUTION AND TRANSPORT

COST CONTROL MEASURE, TO ANALYZE AND REDUCE THE NUMBER OF CYCLE

RECORD KEEPING AND DATA ANALYSIS

OPTIMAL UTILIZATION OF MANPOWER AND EQUIPMENT

MOTIVATION OF STAFF AND TRAINING

INTER DEPARTMENTAL COORDINATION

MATERIALS TO BE STERILIZED SOME OF THE TRAYS/ INSTRUMENTS USED FOR DIFFERENT PROCEDURES IN DIFFERENT AREA OF THE HOSPITAL ARE:

OT INSTRUMENTS AND DRAPES

GLOVES

DRESSING SET/ TRAY

SUTURE REMOVAL SET

SUTURING SET

CUT DOWN TRAY

TRACHEOTOMY SET

LUMBAR PUNCTURE SET

BONE MARROW/ LIVER/ KIDNEY BIOPSY SET

CVP SET

BURN PACK

INTRA COSTAL DRAINAGE (ICD) PROCEDURE SET

OP SUPPLIES- SIMS SPECULUM, SPATULA, ENT SETS, PROCTOSCOPES, DENTAL INSTRUMENTS

CSSD AT SHRI KRISHNA HRUDALAYA & CRITICAL CARE

LOCATION OF CSSD•CENTRAL STERILE SUPPLY DEPARTMENT IS SITUATED ON TERRACE OF THE HOSPITAL

STAFF IN CSSD•CSSD INCHARGE - 1•CSSD TECHNICIAN - 1•INCHARGE OF CSSD – DR PIYUSH NAIDU

INSTRUMENTS USED IN CSSD•AUTOCLAVE MACHINE – 2•ETO SERILIZER (ETHYLENE OXIDE STERILIZER) – 2•SEALING / PACKING MACHINE•WATER FILTER – 2

LAYOUT OF CENTRAL STERILE SUPPLY DEPARTMENT

ENTRANCE

ETHYLENE OXIDE STERALIZER 1

ENTRANCE

AUTOCLAVE MACHINE 2

AUTOCLAVE MACHINE 1

ETHYLENE OXIDE STERALIZER 2

SEALING MACHINE

WASHING AREA

STERILE + PACKING AREA

WASHING ROOM

OPEN AREA OF TERRACE HAVING ROOF OF PLASTIC SHED

CSSD CONSIST OF•CSSD CONSIST OF 2 ROOMS


STERILE + PACKING AREA

WASHING ROOM


•IT CONSIST OF 2 AUTOCLAVE MACHINES

•THESE AUTOCLAVE MACHINES ARE KEPT UNDER PLASTIC SHED.

STERILE AREA + PACKING AREA

•IT CONSIT OF

ETO STERILIZER MACHINE.

SEALING MACHINE.

RACKS FOR MAINTANANCE OF CSSD REGISTER.

PACKING IS ALSO DONE IN THIS AREA.

WASHING ROOM IT CONSIST OF

ETO STERALIZER MACHINE

WATER TAPS FOR CLEANING OF INSTRUMENTS, FOR FLUSHING OF CATHERATER ETC

TWO WATER FILTERS WHICH ARE CONNECTED TO TWO SEPARATE TANKS WHICH IS USED FOR CATHERATER FLUSHING

SHIFT OF CSSD STAFF CSSD INCHARGE – 2PM TO 11PM

CSSD TECHNICIAN – 11AM TO 11PM

LIST OF ITEMS & SPECIAL TRAY COMMONLY PROCESSED IN CSSD

INSTRUMENTS APPLIANCES DRESSINGS SPONGES OT LINEN SPECIAL PACKS GAUZE AND COTTON MATERIALS GLOVES BOWLS AND TRAYS

REGISTERED MAINTAINED IN CSSD AUTOCLAVE IN TIME – OUT TIME REGISTER

ETHYLENE OXIDE STERILIZER IN TIME - OUT TIME REGISTER

OT REGISTER

CARDIAC OT REGISTER

CCU + ICU REGISTER

WARD REGISTER

DUTY ROOSTER REGISTER

PROCEDURE

COLLECTION OF MATERIALS FROM VARIOUS DEPARTMENTS

CSSD

NURSING UNIT

CAT LAB

OT

OPD

IPD

LABOUR ROOM

PROCEDURE RINSING: RINSING OF ARTICLES AFTER USE SHOULD NOT BE PERMITTED IN PATIENT CARE AREAS UNLESS

CARRIED OUT BY A TRAINED MEMBER OF THE STAFF

INSPECTION AND ASSEMBLY: EACH ITEM SHOULD BE INSPECTED FOR FUNCTIONALITY, DEFECTS, BREAKAGE AND THEN APPROPRIATELY ASSEMBLED

CLEANING: ALL REUSABLE MEDICAL DEVICES SHOULD BE THOROUGHLY CLEANED PRIOR TO DISINFECTION OR STERILIZATION.

DRYING: ALL ARTICLES SHOULD BE DRIED APPROPRIATELY.

PACKAGING: ARTICLES SHOULD PREFERABLY BE PACKED IN POROUS MATERIAL.

LABELLING: EACH PACK SHOULD BE MARKED WITH NOMENCLATURE OF THE ARTICLE, CONTENTS OF THE PACK, INITIALS OF THE PERSON WHO PACKED IT, DATE AND INITIALS OF THE PERSON WHO CARRIED OUT THE STERILIZATION.

STERILIZATION: THE OPERATION OF THE STERILIZER SHOULD BE ENTRUSTED TO A RESPONSIBLE AND FULLY TRAINED PERSON. IT SHOULD BE KEPT IN A STATE OF GOOD MAINTENANCE AND REPAIR.

AFTER STERILIZATION, STERILE MATERIALE IS TAKEN TO STORES

STORAGE: SHOULD BE PROPERLY MANAGED SEPARATELY FOR STERILE AND NON-STERILE STORES. FOR

STERILE GOODS, CLEAN ROOM CONDITIONS SHOULD BE FOLLOWED.

DISTRIBUTION: REFERS TO CLEAN AND DIRTY ARTICLES EXCHANGE SYSTEM. A PROGRAM SHOULD BE

ESTABLISHED FOR THE COLLECTION OF USED ITEMS FROM PATIENT CARE AREAS AND DISTRIBUTION OF STERILIZED GOODS.

STERILITY INDICATORS MECHANICAL INDICATORS: ARE MONITORING INSTRUMENTS WHICH RECORD TIME, TEMPERATURE,

HUMIDITY AND PRESSURE DURING THE STERILIZATION CYCLE.

CHEMICAL INDICATORS: ARE DEVICES WITH A SENSITIVE CHEMICAL OR DYE TO MONITOR ONE OR MORE PARAMETERS OF A STERILIZATION CYCLE.

BIOLOGICAL INDICATORS: EMPLOY THE PRINCIPLE OF INHIBITION OF GROWTH OF MICROORGANISM OF HIGH RESISTANCE TO THE MODE OF STERILIZATION. SUBSEQUENT FAILURE OF GROWTH OF MICRO-ORGANISMS INDICATES ADEQUACY OF STERILIZATION.

NO SINGLE METHOD IS CAPABLE OF MONITORING COMPLETELY ALL PARAMETERS NECESSARY FOR A FOOLPROOF STERILIZATION.

RECORDING INSTRUMENTS ON THE AUTOCLAVE THAT GIVE A GRAPHIC RECORD OF TEMPERATURE, PRESSURE, ETC. CAN BE INSPECTED IMMEDIATELY AFTER A LOAD HAS BEEN AUTOCLAVED.

IN ADDITION, CHEMICAL INDICATORS PLACED INSIDE CHANGE COLOR WHEN CONDITIONS NECESSARY FOR STERILIZATION HAVE BEEN MET. THESE ARE AVAILABLE AS TAPES AND STRIPES, AND ARE ATTACHED OR IMPLANTED INSIDE THE PACKING MATERIAL.

THIS SHOULD BE SUPPLEMENTED WITH PERIODICAL USE OF BIOLOGICAL INDICATORS TO DETECT (WHICH MAY TAKE SEVERAL DAYS) FAILURE OF THE AUTOCLAVE. BIOLOGICAL INDICATORS SHOULD BE PLACED IN THE MOST INACCESSIBLE LOCATION IN THE LOAD AND THEN CULTURED. THEY PROVIDE POSITIVE ASSURANCE, ALBEIT RETROSPECTIVELY, THAT EACH PACKAGE HAS BEEN SUBJECTED TO PROPER STERILIZING CONDITIONS.

TOTAL TIME REQUIRED

AUTOCLAVE – 45 TO 50 MIN

ETO STERILIZER – 11 TO 12 HOURS

OBSERVATION

CSSD IS SITUATED ON TERRACE OF HOSPITAL.

CSSD HAS TWO ROOMS STERILE + PACKING ROOM AND WASHING ROOM

PLASTIC BAGS ARE USED TO BRING THE UNSTERILED MATERIAL

FIRE EXTINGUISHERS ARE NOT INSTALLED.

ONLY 1 STAFF WORKING IN CSSD

STERILE + PACKING ROOM AREA 13*13 SQ FT

WASHING ROOM AREA 13*10 SQ FT

AUTO CLAVE SIGNAL LOCK & ETO SIGNAL LOCK USED TO INDICATE THAT MATERIAL IS STERILISED

MASK, HEAD CAP ARE USED BY CSSD TECHNISIAN FOR SAFTEY

AFTER STERILISATION STERILE MATERIAL IS TAKEN TO STORE

RECOMMANDATION PACKING ROOM, STERILE ROOM SHOULD BE SEPRATE.

AN ETO IS A TOXIC GAS. BREATHING APPARATUS FOR EMERGENCIES MUST BE STORED IN AN,

EASILY ACCESSIBLE PLACE NEAR ETO AREA.

USE OF EXHAUST SYSTEM TO EXHAUST GAS TO OUTSIDE,

ALARMS TO ALERT IN CASE OF LEAK SPILL OF GAS.

FIRE EXTINGUISHER SHOULD BE INSTALLED

STAFF SHOULD BE INCREASED IN CSSD

STERILE SUPPLIES AND PACKS AND CONTAMINATED ARTICLES SHOULD NEVER BE CARRIED ON THE SAME TROLLEY OR BY THE SAME STAFF.

ELECTRICAL WIRES SHOULD BE PROPERLY INSTALLED AND ELECTRICAL MAIN SWITCH SHOULD BE INSTALLED OUTSIDE CSSD

RECOMMANDATION THERE SHOULD BE SEPRATE ROOM FOR GAUGE CUTTING & MAKING COTTON

BALLS.

SEPRATE SLIPPERS SHOULD BE USED IN CSSD

CSSD SHOULD BE SHIFTED FROM TERRACE

CLEANING SHOULD BE PROPER IN CSSD

ONE ATTENDANT SHOULD BE THERE IN CSSD TO BRING UNSTERILISED MATERIAL FROM ALL DEPARTMENT

TROLLEY SHOULD BE USED TO BRING UNSTERILISED MATERIAL

THANK YOU

Project on cssd

Health & Medicine

Transcript of Project on cssd