Central Sterile Services Department Research Articles

Reusable Medical Device Pre-Cleaning in Care Units: What Are the Indicators to Prevent Biofilm Formation and Control Occupational Biological Risk?

The pre-cleaning of reusable medical devices is essential for successful cleaning, as it prevents biofilm formation that can compromise disinfection and sterilization. This study aimed to reflect on the recommendations regarding the pre-cleaning of reusable medical devices carried out in care units, such as wards, based on recommendations from guidelines/standards related to this important step in reusable medical device reprocessing. However, recommendations for pre-cleaning in care units are not unanimous and contrast with detailed recommendations on reusable medical device reprocessing in the Central Sterile Services Department (CSSD). This topic is an unresolved issue, strongly related to patient and worker safety, which points to the lack of investigations to provide indicators of best practice and highlights the need for shared responsibility management between care units and CSSD.

Fungal contamination of the water distribution system of a tertiary hospital water supply system in a resource-limited setting.

Fungal contamination of hospital water distribution systems has been implicated in outbreaks of healthcare-associated infections. To evaluate the prevalence of fungi in the water distribution system of a tertiary hospital in Nigeria. This was a descriptive cross-sectional study. Swabs and water samples were collected from taps and faucets in the hospital categorized into low (Accidents and Emergency Unit, Children Emergency Unit, Acute Stroke Unit and the 24 in-patient hospital wards) and high-risk (Renal Dialysis Unit, Central Sterile Services Department, Theatres and Intensive Care Units (ICUs)) units based on the vulnerability of patients being managed there. The membrane filtration method for water analysis was used. Where possible, isolates cultured were identified to species level. In total, 105 water and 49 swab samples were collected for analysis. All analysed water samples grew fungi. A total of 289 (high-risk; n = 178; low-risk; n = 111) and 76 fungi isolates were recorded from water and swab samples, respectively, with 31 different species identified. Aspergillus was the most predominant genus with five different species: Aspergillus niger (9.9%), terreus (4.4%), flavus (3.3%), fumigatus (8.8%) and versicolor (2.20%) isolated. Twenty-five and 18 species of fungi were identified in the low and high-risk units, respectively. The labour ward (n = 46; 25.8%) and modular theatre (n = 47; 42.3%) were the most contaminated units. Cladosporium spp. and Paecilomyces spp. were the most frequently isolated fungi in the low and high-risk units, respectively. The dialysis centre (n = 9; 8.1%) and renal transplant theatre (n = 7; 6.31%) had the lowest contamination rates in the high-risk units. Aspergillus niger, Cephalosporium curtipes, Penicillium chrysogenum and Penicillium glabrum were each identified in 4/6 units from which swabs were taken. The facility had no documented protocol for its water safety and quality. Our data reveal a high rate of contamination of hospital water sources by fungi, some of which are known to cause life-threatening infections. For better water treatment and water tank cleaning and disinfection, a standard protocol is advised. Ensuring that the water distribution systems in hospital settings are free of fungal contaminants is important to prevent the possibility of waterborne mycosis outbreaks.

SG-APSIC1177: Improving the quality of sterile medical devices to international standards

Objectives: The central sterile services department (CSSD) offers a variety of procedures, including collecting contaminated medical equipment from various agencies through a process of washing, cleaning, packing, and sterilization, followed by storage and distribution to internal and external departments. Plans to expand and open service to the Center of Excellence continue, which will result in a rapid increase in the processing of specialized medical devices. The Center of Excellence is a source of education, learning, teaching, and practice in the cleaning, disposal, and sterile treatment of medical devices. We sought to improve the quality of sterile medical equipment to satisfy international standards of safety. Methods: We implemented a 7-stage process in the CSSD and we developed a checklist with 8 categories of environmental development based on APSIC guidelines. We provided knowledge to CSSD employees, developed their skills, and promoted attitudes in various areas, including sterile work standards, the use of sterilization machines, and infection prevention and control both inside and outside the facility. Results: We established inventory control systems, storage guidelines, and disbursement of medical supplies and equipment in the CSSD. To improve machine use in sterilization treatment or disposal, we educated staff and provided practice of machine skills according to instructions for use. Information technology (IT) was used for the distribution process, medical device identification, recording sterilization, and statistical logging of sterilization and sterile services. Conclusions: Overall, we improved the quality of CSSD services and knowledge and practice of CSSD staff, and we achieved compliance with international standards. These measures ensure the safety of service providers and patients and build trust in the quality of CSSD services and output.

Evaluation of the Efficacy of Nitrile Gloves Exposed to Chemical Germicide on Medical Devices in Central Sterile Services Department

Nitrile gloves are commonly used in Central Sterile Services Department in order to be often used when manually cleaning medical equipment such as personal protective equipment. As a result they are resistant to a wide range of chemicals and germicides, including alcohols, peroxides, and other sterilizing agents. In addition to providing chemical protection, nitrile gloves are resistant to punctures and tears, which is important when working with sharp medical instruments. This research focuses on the efficacy of gloves in relation to the multi-chemicals or compounds of nitrile gloves and observation at the point of use to remove soil and contact with chemicals on medical devices at the Central Sterile Supply Department. The powder-free nitrile exam gloves and extended cuff methods of chemical analysis of permeation testing of standard practice for assessment of resistance of medical gloves to permeation by chemotherapy drugs (ASTM D 6978-05), EN455 Part 1: 2000 were used to test the test method for single-use medical gloves. The standard of protective gloves against dangerous chemicals and microorganisms was tested by EN 420:2003 + A1:2009, EN388: 2016, ISO 374-1:2016, and ISO 374-5:2016. The testing of chemotherapy drugs and UV/NIS absorption spectrometry were used to measure the absorbance of test chemicals, which permeated through the specimens into the collection medium. The collection medium was circulated in a closed loop at an 11 ml/minute flow rate through the testing period. As a result, a glove user must protect against the specific chemicals or chemical mixtures to which they were exposed while manually cleaning medical devices. The physical properties of the gloves were evaluated by visual observations at the point of use for soil removal and chemical exposure to medical devices at the Central Sterile Supply Department of five hospitals. The results showed that nitrile gloves protected chemical exposure during manual cleaning of medical equipment at the point of use.

Evaluation of the Microbiota and Integrity of Respirators Reused by Health Professionals in a Hospital Environment

The shortage of PFF2, N95, and KN95 respirators and their equivalents for the respiratory protection of the population and health professionals during COVID-19 pandemic has driven the adoption of alternative measures to address the lack of personal protective equipment (PPE). The use of surgical masks, handmade masks, and even the prolonged use of respirators were some of the measures adopted in response to the high demand for these products, and their consequent shortage. In this context, the present study evaluated the microbiota and integrity of reused PFF2 respirators in the central sterile services department of a hospital. Respirators that had been used for 0 h, 12 h, 24 h, and 36 h were sampled for the inoculation and cultivation of fungi and bacteria and the identification of their microbiota. To assess the integrity of the respirators, a filtration efficiency assessment test was conducted of the respirators used for 36 h. The results obtained showed that the microbiota of the respirators comprised commensal fungi and bacteria from the oral and nasal regions of human beings. It was also found that after 36 h of use, the respirators did not demonstrate a decrease in filtration efficiency; that is, they retained their 97% filtration efficiency Considering the findings regarding the presence and pathogenicity of microorganisms, it is possible that the reuse of respirators for up to 36 h does not harm the health of immunocompetent users. In terms of PPE efficiency, no compromises were evidenced.

Time is Money! Influence on Operating Theater and Sterilization Times of Patient-specific Cutting Guides and Single-use Instrumentation for Total Knee Arthroplasty: A Full Factorial Design of 136 Patients.

BackgroundPatient-specific cutting guides (PSGs) and single-use disposable instrumentation (SUI) have emerged as potential beneficial innovations for total knee arthroplasty. The aim of this study was to evaluate the impact of PSG and SUI for total knee arthroplasty on operating room (OR) and sterilization times.MethodsA monocentric, prospective, interventional, full factorial design study, including 136 patients, compared patient-specific (PSG, n = 68) to conventional cutting guides (n = 68) and SUI (n = 68) to conventional instrumentation (CVI, n = 68). In the OR, we recorded the number of instrument trays, operating time, and room occupancy time. In the central sterile services department, the total sterilization duration was assessed. The primary outcome was operating time and sterilization duration. Secondary outcomes were difference in the number of trays, Oxford Knee Score, and postoperative mechanical axis.ResultsThe median operating time was 80 minutes (Q1-Q3: 73-90) and was significantly increased for SUI compared to that for CVI (+5 minutes, P = .0072). The median sterilization duration was 1261 minutes (Q1-Q3: 934-1603). It was significantly in favor of SUI (936 minutes) over CVI (1565 minutes) (+629 minutes, P < .0001). The total number of instrument trays was 404 for 136 patients: 252 for CVI and 152 for SUI (P < .0001) and 189 for PSG and 215 for conventional cutting guides (P = .0006). There was no significant difference in OKS (P = .86) nor in the postoperative alignment which was between 177° and 183° (75% patients, P = .24).ConclusionsSUI lowers the number of instrument trays and sterilization duration. PSG is not associated with significant OR or sterilization time reduction. The use of SUI could reduce the risk of noncompliance of instrument trays.

Comparative Double-Blind Study of Efficacy of Pre-Cleaners for Surgical Instruments and Medical Devices in the Central Sterile Services Department

The Central Sterile Supply Department (CSSD) is one of the hospital's critical support services. It is a place to receive medical equipment blood-stained from the other departments to be cleaned. It is responsible for cleaning, receiving, storing, sterilizing, and returning medical equipment to everyone and delivered to different departments within the hospital. Nowadays, various cleaning and dissolving blood stains are used to clean and remove blood stains. This research aimed to compare the efficacy of pre-cleaning spray and pre-cleaning spray foam cleaners for blood-contaminated surgical instruments and medical devices in the Central Sterile Services Department. The pre-cleaning spray was significantly higher than the pre-cleaning spray foam (p ≤ .005). A significant difference in the 2-minute pre-cleaning spray was observed by using cleaning indicators. The pre-cleaning spray foam started dissolving blood after 5 minutes. Therefore, from the study, using the pre-cleaning spray for dissolving blood stains and pre-cleaning has a more practical effect than pre-cleaning foam.

A study on the understanding of sterilisation in the central sterile services department by the healthcare personnel in a tertiary care hospital in Sikkim

Background: Globally, hundreds of millions of people are affected every year by avoidable infections in healthcare (healthcare-associated infections, [HAIs]). Through knowledge, best practices and infection prevention and control (IPC), we can prevent HAI to patients and health workers. Following recent threats caused by widespread epidemics and increasing awareness about the spread of antimicrobial resistance, several countries are paying more attention and investing resources to strengthening IPC infrastructures and improving practices. Objective: The objective was to assess the practices by the healthcare staff regarding the sterilisation process in the central sterilisation service department (CSSD) and to bring about improvements in the practices in the hospital. Materials and Methods: A cross-sectional study was conducted where the healthcare staff were given a set of questionnaires on sterilisation in the CSSD. The staff who participated in the study included doctors, intensive care unit nursing staff, infection control nurses, operation theatre nursing staff, CSSD staff and outpatient department nursing staff. Results: The questionnaire was administered to 120 health staff. All the staff agreed that instruments should be cleaned at the source. The majority of the participants (82%) believed that medical devices should be reprocessed centrally in CSSD; however, very few of them (18%) have felt otherwise. Almost 70% of staff did not know about the indicators used in CSSD and the zones in CSSD. The expiry date of the items once received from CSSD, 60% said it is not mentioned on the pack and 40% of participants agreed that it is mentioned on the pack. Conclusion: The processes of sterilisation and decontamination are complex, require specific infrastructure and equipment and involve several steps that need to be correct, from device collection, receipt by the unit, processing, storage and distribution them throughout the facility. Quality control measures to evaluate the proper functioning of the equipment are of the utmost importance.

Central sterile services department: screening of automated cleaning in liposuction cannulae.

To evaluate the effectiveness of automated cleaning of 4 mm liposuction cannulas using ultrasonic washer machine, screening for dirt using a cannulate microscope device and the screening of viable strains of Staphylococcus aureus, with microbiological analysis. Experimental study with 14 units of 4 mm liposuction cannulas performed at the Central Sterile Services Department and at the Microbiology Laboratory of a Hospital Complex, located in Porto Alegre, RS, Brazil, from October 2018 to April 2019. Of the 14 liposuction cannulas that constituted the sample, 42.9% remained dirty despite automated cleaning, and all of them showed recovery of viable microrganisms in the microbiological laboratory. The study showed that it is not possible to ensure the cleaning efficacy of automated cleaning of 4 mm liposuction cannulas, especially due to the conformation of the material with internal spaces with accumulation of dirt.

Central sterile services department: screening of automated cleaning in liposuction cannulae

RESUMO Objetivo: Avaliar a eficácia da limpeza automatizada realizada com lavadora ultrassônica de cânulas de aspiração de 4 mm, por meio do rastreamento de sujidade interna feito com aparelho de microscopia para canulados e o rastreamento de cepas viáveis de Staphylococcus aureus, por análise microbiológica. Métodos: Estudo experimental realizado com 14 cânulas de lipoaspiração de 4 mm em um Centro de Material e Esterilização e no laboratório de microbiologia de um hospital de Porto Alegre, Brasil, no período de outubro de 2018 a abril de 2019. Resultados: Das 14 cânulas de lipoaspiração que constituíram a amostra, 42,9% permaneceram com sujidade mesmo após a limpeza automatizada e todas apresentaram recuperação de microrganismos viáveis nos testes do laboratório de microbiologia. Conclusão: O estudo mostrou não ser possível garantir a eficácia da limpeza automatizada nas cânulas de lipoaspiração de 4 mm, em especial devido à conformação do material com locais onde acumula sujidade.

Evaluation of working conditions at a central sterile services department in northern Brazil.

Introduction:Environmental conditions and the work process in the Central Sterile Services Department expose workers to many hazards.Objectives:To analyze the working conditions that have an influence on the overall health of workers at a Central Sterile Services Department of a hospital in northern Brazil.Methods:This study used employed the ergonomic analysis of work. Three data collection tools were applied to characterize sociodemographic and occupational profiles. Furthermore, physical environmental hazards were analyzed using specific equipment. Descriptive and bivariate analyses were performed in Stata®13 software.Results:Thirty-five workers participated in the study, most of whom were women, aged above 40 years, and worked as nursing technicians. It became evident that workers were exposed to inappropriate lighting and to noises coming from autoclaves, from the central air conditioning, and from the use of medicinal gas. The risks for musculoskeletal injuries on spine, shoulders, and lower limbos were specifically related to overload resulting from the posture maintained for long periods. Female sex was associated with severe or excruciating pain” (p = 0.04).Conclusions:Sound, mechanical, and visual hazards were found. Most participants complained of musculoskeletal pain, and the cervical spine was the site with the most frequent reports of excruciating pain. These results point out to the need of a policy to improve the quality of work in the health care unit studied; however, these findings may also bring light to the problem in other institutions that have a physical structure similar to that found in this research.

Central Sterile Services Department: psychosocial risks related to the prescribed organization of nursing work.

The aim of this study is to investigate the characteristics of work-flow organization of the Central Sterile Services Department and analyze whether nursing workers are subject to psychosocial risks. Mixed study, carried out between November 2017 and July 2019 with nursing workers of the Department of Central Sterile Services of a university hospital. Sampling for the quantitative stage of this study consisted of 36 professionals who have filled the Prescribed Work Organization Scale form, followed by statistical analysis. Qualitative sampling was obtained through collective interview with 19 members of the nursing team. Of the 36 nursing workers, 68.3% were female, 69.4% were over 45 years of age and 75% of the professionals assessed reported as being exposed to a medium psychosocial risk with the emergence of two categories. The aspects related to pleasure at work were highlighted as being the importance of the unit, indirect patient care, professional recognition, and teamwork. The main reported suffering triggers were the lack of human resources, supplies, maintenance, communication, and the devaluation of the unit. The prevalence of medium psychosocial risks indicated the need for actions aiming at improving work processes.

Dermatosurgery Practice and Implications of COVID-19 Pandemic: Recommendations by IADVL SIG Dermatosurgery (IADVL Academy).

Dermatosurgery Practice and Implications of COVID-19 Pandemic: Recommendations by IADVL SIG Dermatosurgery (IADVL Academy).

Estrutura informatizada para processos no centro de material e esterilização

Objetivo: Descrever as etapas de desenvolvimento e avaliação da estrutura informatizada para processamento de bandejas cirúrgicas na área de preparo do centro de material e esterilização. Método: Trata-se de um projeto de desenvolvimento de produção tecnológica embasada na teoria de “ciclo de vida do sistema”. Resultados: A estrutura foi criada utilizando formulários e planilhas do Google Apps. Os formulários foram desenvolvidos com base na coleta de informações das referências gravadas nos instrumentais, consulta ao nome correto nos catálogos dos fabricantes e registros fotográficos de detalhes das peças. Foi realizada a avaliação pelos colaboradores, e foram feitas as alterações sugeridas pelos mesmos. Os formulários permitiram identificar o nome do instrumental e a referência do fabricante e acessar as fotos dos materiais, o que passou a gerar planilhas que permitiram a rastreabilidade e o gerenciamento dos materiais cirúrgicos. Conclusão: A informatização do preparo das bandejas de cirurgia minimamente invasiva contribuiu para o preparo de maneira fácil, intuitiva e de forma rastreável. A tecnologia pode otimizar o tempo de assistência do enfermeiro do centro de material e esterilização com as questões relacionadas ao planejamento das ações gerenciais e à rastreabilidade dos processos.

Monitoramento da limpeza de produtos para saúde com teste adenosina trifosfato

Objetivo: Avaliar a qualidade da limpeza dos produtos para saúde utilizando o teste de superfície adenosina trifosfato (ATP) em um Centro de Materiais e Esterilização. Método: Trata-se de um estudo transversal, descritivo, de natureza quantitativa, realizado em uma clínica particular de Belo Horizonte, Minas Gerais. Foram avaliados 26 formulários com 102 testes de ATP entre maio de 2017 e maio de 2018. Resultados: Os valores dos testes de ATP nos canulados variaram de 55 a 206 unidades relativas de luz (RLU), com média de 124±46. Para instrumentais, os resultados alternaram entre 14 e 82 RLU, com média de 54±28. Conclusão: Os testes de ATP não são específicos, mas sugerem ausência de resíduos em todos os instrumentais. Conclui-se que uma estrutura física adequada, protocolos de limpeza baseados em evidências e o gerenciamento de recursos materiais e humanos contribuem para a garantia da qualidade do processo de limpeza.

The Cost and Economics of Endoscopic Cyclophotocoagulation in the United Kingdom: A Tertiary Center Experience.

As the only microinvasive glaucoma surgery (MIGS) with a reusable component, the cost per procedure of endoscopic cyclophotocoagulation (ECP) diminishes with each successive use. We present a cost comparison of ECP with other MIGS devices, based on our clinical practice. ECP delivers diode laser via a reusable probe to the ciliary processes under direct visualization. The aim of our study is to evaluate the direct cost of ECP based on a retrospective review of cases and compare the cost per procedure with other MIGS devices. We conducted a retrospective review of ECP procedures performed at St Thomas' Hospital over 4.5 years. The cost of the ECP endoscope and diode laser consoles, reusable probes, and maintenance contracts were obtained from the hospital procurement log. The on-site Central Sterile Services Department was contacted for probe sterilization and repackaging costs. The cost per device for ECP and commonly performed MIGS procedures were obtained from the product specialists of each company. A total of 332 procedures were performed using 37 ECP probes during the study period. Each reusable ECP laser probe was found to give an average of 8.97 laser treatments. The cost per procedure decreased over the course of 4.5 years from £819.43 for the first 42 cases to £341.50 after 332 cases. Compared with other MIGS devices, the cost per procedure of ECP after 100 procedures is second lowest to the Kahook Dual Blade and reduces with each successive procedure performed. The ability to reuse each ECP probe significantly lowers the cost per procedure compared with other MIGS devices in the United Kingdom. The cost per procedure continues to reduce with each successive procedure.

Avaliação da contaminação microbiana em fitas e resinas identificadoras de instrumental cirúrgico

Objetivo: Avaliar a esterilidade de fitas coloridas e resinas utilizadas como identificadores em instrumentos cirúrgicos. Método: Foi realizado umestudo experimental, laboratorial, que utilizou uma amostra de 140 instrumentos cirúrgicos diversos, de aço inoxidável, identificados com fita ou resina,doados voluntariamente por Centros de Material e Esterilização para a presente investigação. As amostras foram inoculadas diretamente em trypticasesoy broth (TSB) e em tioglicolato de sódio e incubadas por 14 dias. Resultados: Foi observado crescimento positivo em três amostras de fita e nenhumcrescimento foi observado nas amostras de resina. Conclusão: Marcadores de instrumental do tipo fita albergaram microrganismos nos instrumentaisavaliados, possivelmente protegidos por biofilme.

Psychosocial factors at work and stress among the nursing staff of a central sterile services department.

ABSTRACT |Background: The international literature points out an association between stress and psychosocial factors at work (PFW) in different occupational groups. Among health care workers, providing direct patient care might be rewarding or contribute to cause stress, and central sterile services departments (CSSD) provide relevant support to in-hospital care.Objective: To investigate PFW liable to cause stress among the nursing staff of a university hospital CSSD.Methods: Quantitative and qualitative study of a non-probabilistic sample of 63 workers who responded a sociodemographic questionnaire and the Effort-Reward Imbalance (ERI) scale. Fifty-one participants were also subjected to individual interviews, which were recorded, transcribed and subjected to content analysis, resulting in thematic matrices and categories.Results: The sample mainly comprised women (92%) and was aged 45 years old, on average. Effort-reward imbalance was found for 16% of the participants. Working conditions, equipment and materials, relationship among coworkers, and management support were listed as factors related to job satisfaction or dissatisfaction. Lack of peer recognition was described as the main factor associated with dissatisfaction and stress.Conclusion: CSSD workers feel they are stigmatized and underestimated by their coworkers involved in direct patient care and the institution as a whole. Recognition of the work done is fundamental for job satisfaction and health protection and preservation.

A state-wide survey of disinfection techniques for nasendoscopies in Queensland ENT out-patient departments

Background: Flexible nasendoscopy is an important part of the diagnostic process in Otorhinolaryngology. Flexible nasendoscopies come in close contact with mucous membranes of the upper aerodigestive tract. Therefore, appropriate and effective disinfection is vital to prevent iatrogenic infection and cross contamination. The lack of official national reprocessing guidelines has led to varying and inconsistent practice amongst ENT centres in Australia. Methods: A questionnaire was sent to 14 Queensland ENT out-patient departments to establish current practice. Results: In total, 50% (N=7) of hospitals used manual disinfection and 50% (N=7) used automated endoscope reprocessors (AEMs). Manual disinfection with Tristel was used in most (N=6) departments and Cidex was used in one hospital. The same disinfection technique was used after hours and in high risk patients (HIV, hepatitis B, hepatitis C, pulmonary tuberculosis) in all hospitals. The efficacy and time to reprocess were the main factors that influenced the disinfection techniques used. The majority (64.3%) of centres cleaned nasendoscopies in the ENT out-patient department and remaining hospitals (35.7%) did so in the Central Sterile Services Department (CSSD). A permanent record of nasendoscopy maintenance, reprocessing and patient tracking system was used in all departments. Conclusions: The disinfection techniques and disinfectant agents vary considerably across ENT out-patient departments in Queensland. Hence, a state wide disinfection guideline would be beneficial to ensure that reprocessing of nasendoscopies is standardised regardless of the technique used across the state.

Cataract surgery and environmental sustainability: Waste and lifecycle assessment of phacoemulsification at a private healthcare facility

To measure the waste generation and lifecycle environmental emissions from cataract surgery via phacoemulsification in a recognized resource-efficient setting. Two tertiary care centers of the Aravind Eye Care System in southern India. Observational case series. Manual waste audits, purchasing data, and interviews with Aravind staff were used in a hybrid environmental lifecycle assessment framework to quantify the environmental emissions associated with cataract surgery. Kilograms of solid waste generated and midpoint emissions in a variety of impact categories (eg, kilograms of carbon dioxide equivalents). Aravind generates 250grams of waste per phacoemulsification and nearly 6kilograms of carbon dioxide-equivalents in greenhouse gases. This is approximately 5% of the United Kingdom's phaco carbon footprint with comparable outcomes. A majority of Aravind's lifecycle environmental emissions occur in the sterilization process of reusable instruments because their surgical system uses largely reusable instruments and materials. Electricity use in the operating room and the Central Sterile Services Department (CSSD) accounts for 10% to 25% of most environmental emissions. Surgical systems in most developed countries and, in particular their use of materials, are unsustainable. Results show that ophthalmologists and other medical specialists can reduce material use and emissions in medical procedures using the system described here.