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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
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