central sterile service department - medicahospitals.in · 09-10-2018 1 prof (col) dr rn basu...

09-10-2018

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Prof (Col) Dr RN Basu

Content of the Presentation

Content

Part 1

1. History of sterilisation

2. Sterilisation concepts

3. Classical sterilisation practices

Part 2

4. Functional zones and work flow

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Content of the Presentation

Part 3

5. Current sterilisation process

6. Storage

Part 4

7. Planning and Designing

Part 5

8. Quality control

9. Bibliography

3 4

Planning and Designing

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5

Functional Relationship

LEGEND

Location of CSSD

• The CSSD should be centrally located

• All related service areas should have ready access

• Some of these areas are:

• Operating department – should have direct access

• ICU

• Ward

• Emergency department

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Design Consideration

• Design for Infection control

• Design of CSSD plays an important part in infection control

• The design features should include the following aspects:

• Restricted/controlled access

• Unidirectional work flow, progressing from dirty to clean to sterile areas

• Controlled air flow with positive air pressure from clean to dirty areas

• Containment of steam and moisture, preventing potential contamination of stored sterile articles.

• Building and layout details that would facilitate easy cleaning

• Selection of suitable building materials and finishes

• Selection of fixtures, fittings and equipment with suitable detail, materials and finishes for easy cleaning, and prevention of build-up of harmful organisms

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• Adequate facilities for cleaning and waste management

• Access to the area should be limited and controlled.

• This should prevent any unauthorised person from entering the area without permission

• Staff/visitors should have access to hand-washing facilities, separate from those used for cleaning devices, before entering or leaving the areas.

• The flow of both staff and equipment must allow no cross-over of soiled and clean materials

• The operating procedure for infection control in a CSSD falls outside the scope of this guideline.

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• Design for Change and Technology

• It is not easy to predict future trend in CSSD technology

• Flexibility in design to be incorporated

• Consideration should be given for:

• Adaptability in space requirements

• Electrical consumption and layout

• Air handling capacity

• Current trends that need to be considered are as under:

• The increasing complexity of surgical procedures requires more intricate equipment and Instruments

• These need specialised care and handling during the sterilisation procedure

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• Contd.

• Integrated computerised tracking facilities have become widely used and have become an essential tool in the validation of the sterilisation process

• Changing staff-flow patterns due to changing work-flow patterns as a result of procedural and/or equipment innovations

• Design towards sustainable architecture:

• Water-saving equipment, and

• equipment with reduced toxic emissions.

• Constant improvements and innovations lead to products that run more economically and reach a higher level of environment compatibility

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• Ergonomic and user-comfort Consideration

• Design of CSSD should protect staff from avoidable injury

• Workplace should be sufficiently flexible and adaptable to

accommodate adequate working space for individual working comfort

• The design should reduce any unnecessary physical stress or risk of injury

• For larger facilities provision need to be made for manager’s office,

general staff area for eating and drinking and storage area

• This contributes to staff morale

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• Design for Occupational Health and safety

• Design features should incorporate features for occupational health and safety

• These features should consider the following aspects:

• Floor finishes should be non-slip finish

• Fixtures, fittings and equipment should be of materials and finishes to prevent personal injury through accidents or misuse

• Facilities of observing a high level of personal hygiene

• Should have adequate provision to practice hand hygiene

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• Provision of adequate personal protection items (PPE)

• Area specific provisioning of these PPE must be easily accessible to enable strict enforcement of protection of healthcare workers, especially preventive measures against HIV AIDS

• Top-loading, worktop equipment should be accessible to staff members of all heights

• Dimensions and layouts of fixtures and fittings should be carefully considered

• These could have a significant negative effect on occupational health and safety of staff.

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• Sound

• Noise must be controlled

• A threshold of 60dBA must not be exceeded

• The walls and ceiling should be made of absorbent material

• Insulation of sterilisers and washer disinfector in technical walls will reduce the noise level

• Offices should allow confidential discussion

• Privacy and quiet environment is required

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• Natural light• It is highly desirable

• This is particularly so in work areas

• Whenever possible this should be used

• Direct sunlight, however, should be avpoded

• Natural ventilation• This should be limited to offices and staff rooms

• This is not recommended in internal spaces

• Mechanical ventilation should be provided in all other areas

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• Determinants of size of the CSSD

• The size of a CSSD in a hospital depends on various factors

• These are unique to a particular hospital and depends on:

• Operational Policies and procedure

• These policies define the “What, How, When, Where, Who, and with What” of any activity

• They have an impact on the size, configuration, and the nature of accommodation

• Operation policies will vary from unit to unit

• These depends on wide ranging factors – both external and internal to the CSSD

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• Determining Factors external to the CSSD

• Number of theatres / case mix

• Surgical procedures

• Extent of storage in theatres and wards

• Distribution system that will be used (vertical, horizontal, trolleys, lifts)

• Amount of space needed for waste management

• Processing needs for re-usable textiles (receiving, transporting, collecting,

storing)

• Staff facilities to be shared with adjacent departments

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• Determining factors internal to the CSSD

• Types of processing equipment to be used

• (Washer, washer-disinfector, single or multi-chamber washer, ultrasonic cleaners, endoscope processors)

• Types of packaging to be used (disposable wraps and pouches, reusable wraps, rigid containers, technology to be used for sterilisation (high temperature or low temperature sterilisation, other chemical sterilants, steam)

• Anticipated inventory storage

• Anticipated volume of consumable supplies

• Type of documentation and record keeping system to be used (manual vscomputerised)

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• Contd.• Instrument inventory

• Equipment inventory

• Projected workload

• Staffing structure – number of offices

• Staffing policy – number of staff to be accommodated

• Types of cleaning equipment selected such as multi chamber or single chamber

• Number of sterilisers and whether front or double sided chamber

• Emergency sterilisation requirements

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• CSSD area determination

• Following broad-based calculation of CSSD space has been

recommended:

• 0.7 m²/bed from 0 to 300 beds

• 0.6 m²/bed from 300 to 600 beds

• 0.5 m²/bed for more than 600 beds.

• Based on these ratios, the following table can be compiled

20Hoet (1989 cited in AFS Working Group, 2008b, p. 281)

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CSSD Area Determination

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Ratio of Hospital Bed to CSSD Area


• AFS Working Group (2008b, p.291) states

• that the CSSD has few internal corridors,

• the commonly used net to department functional factor adopted

is 1.30.

• The 1.30 factor anticipates that the internal circulation must be added to connect functional areas and individual rooms.

• This minimal surface area required can be estimated as being

200m² useful and 260m² net floor areas.

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• Contd.

• Equipment from outside may need to be brought in

• The facility should be able to reasonably accommodate access and positioning of these equipment.

• Outside equipment has to be provided access, receipt at delivery point, transportation and to point of positioning

• Production demand may increase in future.

• Design needs to consider this aspect for provisioning of extra capacity for extra machinery.

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• Based on the above assumption, AFS Working Group (2008b,

p.291) calculates the useful surface area

• This calculation uses the MSO ratio based on the number of

beds used for Medical – Surgery – Obstetrics (MSO)

• The calculation basis

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SPACE ALLOCATION IN A CSSD (PUTSEP AND COWAN, 1983, P.9)

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IUSS Health Facility Guide - Central Sterile Services Department. Available at https://www.iussonline.co.za/docman/document/support-services/94-central-sterile-service-department-gazetted/file

AIR Flow

Waste Disposal

• Function• Contaminated waste articles are stored for collection and transport to

the respective disposal areas

• Location• Attached to the receiving area

• Activities• The sluice area and waste disposal area could be combined in smaller

units

• Contaminated waste articles are temporarily stored for collection and transport to the respective disposal areas

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Waste Disposal

• Contaminated linen is temporarily stored in canvas bags or hampers for collection and transport to the laundry

• Categories of waste stored include:

• Healthcare waste, infectious waste, sharps

• General office waste

• Packaging and cartons from bulk supplies in the ubit

• Linen-bags used to collect reusable items

• Sharps from theatre

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Waste Disposal

• Requirements• An independent secure area for temporary storage of clinical waste

awaiting collection

• The door to the receiving/sorting area side should be lockable from inside to prevent unauthorised entry

• Space for linen bags and waste containers

• An impermeable hard floor with good drainage with water supply

• A bumper rail to protect the walls behind the trolley

• Size as per waste volume generated and holding duration

• Containers as per the waste policy

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Trolley Wash and Storage

• Location

• Near the receiving area

• Activities

• This area receives returned contaminated trolleys from the decontamination area

• Trolleys are washed and cleaned before being moved through a trolley hatch to holding bay

• Requirements

• Trolleys must be transferred via a trolley hatch to prevent entry

• The floor in the washing area needs to have a gradient and floor drain as well as hosing facility

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Location and Relationship of receiving and sorting area, Trolley wash, chemical tore and PPE

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Ventilation

• Natural Ventilation

• Natural ventilation through opening-section windows should be limited to offices and staff rooms.

• However, this is not recommended as it could promote contamination of the internal space by outside sources.

• Mechanical ventilation should be provided through the remainder of the CSSD,

• Good primary and secondary filters must be appropriately used

• Monitoring needs to be done

IUSS 33 34

ASHRAE Guideline: Amendment h to ASHRAE 170:2013

Communication

• Provision must be made for communication systems to minimise the passage of staff to and from the clean zone.

• Glass partitions, communication panels, IT and video links for data transfer, intercom and telephones can serve as appropriate means of communication.

• Glass partitions should be used to permit observance of the activities within the clean zone (from the outside) • This will obviate the need to enter it.

• The glass panels must be of a non-opening design and must be waterproof and flush-mounted.

IUSS 36

Thank you

central sterile service department - medicahospitals.in · 09-10-2018 1 prof (col) dr rn basu...

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