Central Sterile Supply Department Research Articles

Assess The Workload Management Model and Enhanced Quality Control in The Central Sterile Supply Department:  A Study Protocol.

Introduction The Central Sterile Supply Department (CSSD) plays a crucial role in ensuring the safety and efficacy of medical instruments and equipment used in healthcare settings. Effective workload management and quality control are essential for maintaining high standards of patient care and minimizing the risk of healthcare-associated infections. This study protocol aims to assess the implementation and impact of a new workload management model and enhanced quality control measures in a CSSD setting. Methods The study will employ a mixed-methods approach, including quantitative analysis of workload data, qualitative interviews with CSSD staff, and observational assessments of workflow and quality control procedures. The workload management model under investigation involves the allocation of resources based on demand patterns and the implementation of scheduling algorithms to optimize staff efficiency. Enhanced quality control measures include the implementation of advanced sterilization technologies, rigorous inspection protocols, and continuous staff training initiatives. Results The study expects to provide insights into the effectiveness of the workload management model in optimizing resource allocation and improving staff productivity. Additionally, it aims to evaluate the impact of enhanced quality control measures on the reliability and safety of instrument sterilization processes. Findings from this study will inform recommendations for further improvements in CSSD operations and contribute to the advancement of best practices in sterile supply management. Conclusion The successful implementation of an effective workload management model and enhanced quality control measures in the CSSD is crucial for maintaining patient safety and ensuring the efficient functioning of healthcare facilities. By systematically evaluating the implementation and impact of these interventions, this study protocol seeks to contribute to the ongoing improvement of CSSD operations and the enhancement of healthcare quality.

The environmental impact of hip and knee arthroplasty: An analysis of carbon emissions and disposal costs

Background and purposeThe rise in hip and knee arthroplasty for osteoarthritis requires addressing healthcare system pollution to support Ireland's climate change goals. This research aimed to quantify waste generated and determine environmental and economic impacts to promote sustainable strategies in joint arthroplasty and shed light on the suboptimal waste management practices. MethodsThe study was conducted at National Orthopaedic Hospital Cappagh (NOHC), measuring waste generated during hip and knee arthroplasty. Clinical, domestic, and recycled waste weights were recorded, including the segregation of Central Sterile Supply Department (CSSD) Blue Wrap waste in ten operations. Kilograms of carbon dioxide emissions (kgCO2e) and disposal costs were calculated. ResultsIn a sample of 100 joint arthroplasty operations, the study found that revision knees produced 23.58 ​kgCO2e per case, revision hips 23.50 ​kgCO2e, primary knees 15.82 ​kgCO2e, and primary hips 14.64 ​kgCO2e. CSSD Blue Wrap contributed on average 13.5% of OT waste. Extrapolating these findings to the estimated number of joint arthroplasties performed in 2022 ​at NOHC (1556 hip and knee joint arthroplasties), the emissions were estimated to be 24,576 kgCO2e, with the cost of disposal up to €29,228. Strategies to mitigate this waste have been identified and proposed. ConclusionThe research aimed to address the environmental impact of orthopaedic joint arthroplasties, offering strategies to reduce waste generation, carbon emissions, and cost. Utilising our methodology to calculate greenhouse gas emissions will empower sustainability offices to conduct their own waste audits and implementing our strategies for waste management practices can help minimise environmental waste.

Analysis of sterilization efficiency and application cost of three low temperature sterilization methods.

This paper discusses the sterilization efficiency of three low temperature sterilization methods used in thermosensitive medical devices and makes a preliminary analysis of sterilization costs so as to provide the basis for reasonable selection of low temperature sterilizer in Central Sterile Supply Department. Medical devices compatible with the three sterilization methods were selected for sterilization, and two packaging materials were selected for the three low-temperature sterilization equipment according to the compatibility of the packaging materials. The equipment packed with the same packaging materials were sterilized for five times, and each low-temperature sterilizer was sterilized for a total of ten times. The sterilization effect, sterilization cycle time, energy consumption, and cost of the three sterilizers were compared. The cycle time of ethylene oxide sterilizer was 393.6min, and the cycle time of hydrogen peroxide low temperature plasma sterilizer was 56.1min. The cycle time of low temperature steam and formaldehyde sterilizer was 105.7min. The hydrogen peroxide low temperature plasma sterilizes single cycle power consumption at a maximum of 5 kWh. The single cycle energy consumption of compressed air ethylene oxide sterilizer is up to 12 l. In terms of sterilization application cost, hydrogen peroxide low temperature plasma sterilization has the highest cost, followed by ethylene oxide sterilization, and low temperature steam and formaldehyde sterilization is the lowest. The sterilization efficiency of hydrogen peroxide low temperature plasma sterilization is the highest, followed by low temperature steam and formaldehyde sterilization, and the lowest is ethylene oxide sterilization. The three low temperature sterilization methods can achieve effective sterilization of devices. Each hospital can choose an appropriate low temperature sterilization method according to the characteristics of thermosensitive instruments, turnover efficiency requirements, and financial status.

Improvement and implementation of central sterile supply department training program based on action research.

This study aimed to improve and implement the central sterile supply department (CSSD) training program through action research and to evaluate its effect. The project was underpinned by action research. The problems that occurred in training were identified following scenario analysis, interviews, group discussions, and expert consultation to develop improvement measures. The training program characterized by CSSD was developed in the spiral circular process of "Plan-Act-Observe-Reflect". After the two rounds of training, the CSSD nurses significantly improved their professional knowledge, skills, and satisfaction with training compared with those before improvement. The nurses' overall satisfaction with the training and their performance improved. The implementation of the training program designed based on action research can improve CSSD nurses' professional knowledge and skills and increase their enthusiasm for learning, laying the foundation for CSSD talent development.

Investigation of the perceptions of operating theatre nurses and central sterile supply department technicians regarding the barriers and facilitators of surgical instrument counts and tray management in the operating theatre

BackgroundProper surgical equipment management is essential for ensuring patient safety in the operating theater (OT). Despite existing protocols, errors persist, leading to severe complications and emotional distress. This study aimed to investigate the perceptions of OT nurses and Central Sterile Supply Department (CSSD) technicians regarding barriers and facilitators of instrument counts and tray management. MethodsA multicenter cross-sectional, descriptive study was carried out using a SurveyMonkey conducted with a purposive sample of 52 participants of OT Nurses and CSSD technician from three hospitals in Saudi Arabia and the United Arab Emirates (UAE). The data were analyzed using frequencies and percentages, and to explore the relationship between the demographic variables and participants' overall perception scores, a chi-square test was employed. ResultsData analysis revealed that participant perceptions varied by years in the profession (p = 0.31) and gender (p = 0.003). About 52 % agreed that current policies are clear, while 36.5 % were uncertain. The majority (40.4 %) believed the current tray couldn't reduce OT costs. Participants disagreed with the lack of training (42.3 %) and communication issues during handover (38.5 %). Confidence in the current protocol was low (40.4 %), and 46.2 % agreed that a new protocol would impact OT operations. Alarmingly, 84.6 % of participants had a negative overall perception, indicating widespread concerns. ConclusionThese findings lay the groundwork for implementing a revised protocol for surgical tray management. Understanding healthcare professionals' perspectives will aid in identifying strategies to overcome barriers, enhancing instrument management practices, improving patient safety, and optimizing OT efficiency.

Establishing Nursing-Sensitive Quality Indicators for the Central Sterile Supply Department: A Modified Delphi Study.

Previous studies have shown that improving quality management in the central sterile supply department (CSSD) is an effective measure to control and decrease hospital-acquired infections. This study aimed to establish nursing-sensitive quality indicators for CSSD nursing in China. We drafted nursing-sensitive quality indicators on the basis of the Structure-Process-Outcome model, and then conducted 2 rounds of consultation with experts using a modified Delphi method to determine the indicators and scientific methods of measurement. We identified five CSSD nursing-sensitive quality indicators. Recovery rates of the 2 rounds of valid questionnaires were 100%. Expert authority coefficients were 0.810 and 0.902, respectively. Kendall's coefficients of concordance were 0.168 and 0.210, respectively ( P < .05). Evidence-based nursing-sensitive quality indicators for the CSSD were established.

Checking the Cleanliness of Surgical Instruments Using the Adenosine Triphosphate-Bioluminescence Assay

Purpose: Cleaning is crucial for reprocessing reusable surgical instruments (RSIs). In this study, we used the adenosine triphosphate (ATP) bioluminescence method to assess the cleanliness of RSIs according to the cleaning method used.Methods: From April 3 to June 2, 2023, surgical sets, including hemostatic forceps, needle holders, operating scissors, dressing forceps, and suction tubes, that arrived at the decontamination room in the central sterile supply department of one general hospital were selected through convenience sampling. For each of the three cleaning processes, 30 cleaned RSIs were sampled with test swabs for inspection, and the relative light unit value was measured using ATP test equipment.Results: Suction tubes, hemostatic forceps, and needle holders ranked low in cleanliness (&lt;i&gt;x&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt;=11.69, &lt;i&gt;p&lt;/i&gt;=.020), and the contamination rate after mechanical cleaning was significantly lower than that after manual cleaning (&lt;i&gt;x&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt;=31.34, &lt;i&gt;p&lt;/i&gt;&lt;.001).Conclusion: Surgical instruments treated by manual processing and those containing tubes were associated with the low cleanliness. Therefore, it is necessary to check whether surgical instruments, including tubes, are manually washed at an appropriate level, and regular monitoring will be required.

An action research study of quality improvement in instrument packaging procedures for the central sterile supply department

This study aimed to reduce instrument packaging defects in the Central Sterile Supply Department (CSSD) using action research. Data of the instrument packs packaged by the packaging personnel at the CSSD of the authors’ institution during March to May 2023 were collected and analyzed. After identifying the problems, 2 rounds of cyclic process of “plan-action-observe-reflect” were implemented to standardize the packaging procedures and develop and improve the applicable check of standard operating procedures for the CSSD. After strictly implementing the packaging operation standards and checklists, the number of packaging defect cases dropped from 274 to 41. A significant difference was identified between the number of packaging personnel who achieved a “pass” in the assessment of 3 items for maintenance. Also, 1 item for assembly had significant differences compared with the baseline number after the first cycle (P ≤ 0.001). A significant difference was identified between the number of packaging personnel who achieved a “pass” in the assessment of 20 items for 6 components after the second cycle compared with that after the first cycle (P ≤ 0.05). Through action research methodology, strict implementation of standardized packaging procedures in the CSSD can reduce packaging defects, thereby decreasing clinical complaints and ensuring patient safety.

Factors associated with cleaning quality of reusable medical devices at a single center in China

BackgroundImproper cleaning is one of the main causes of sub-optimal levels of sterilization, and also a risk factor in terms of nosocomial infections. We aimed to investigate the factors associated with the cleaning quality of the reusable medical devices and prescribe improvement measures for ensuring the safe use of the devices and for iatrogenic infection control. MethodsAn expert consultation was conducted to identify the factors associated with the cleaning quality of reusable medical devices. A self-designed quality inspection form for reusable medical device cleaning was used to collect the data concerning the factors associated with the cleaning quality of the reusable medical devices cleaned at our hospital's central sterile supply department (CSSD) during January to June 2022. We also investigated the cleaning personnel's perceptions and knowledge of medical devices cleaning by means of a self-designed questionnaire. ResultsStatistically significant differences (P < 0.05) were identified among incorrect cleaning procedures, improper cleaning methods, non-standard pre-treatment, wrong perceptions or lack of knowledge of medical device cleaning, and complex device structure. Correct cleaning procedures (odds ratio (OR) = 0.216, 95 % confidential interval (CI): 0.170–0.275), choice of cleaning method (ultrasonic cleaning OR = 3.995, 95 % CI: 2.937–5.434; spray cleaning OR = 0.893, 95 % CI: 0.735–1.085), standard pre-treatment (OR = 1.470, 95 % CI: 1.191–1.815), complex device structure (OR = 1.534, 95 % CI: 1.247–1.888) and cleaning personnel's correct perceptions of medical device cleaning (OR = 0.530, 95 % CI: 0.436–0.645) were the independent factors associated with the cleaning quality. ConclusionsThe quality of reusable medical device cleaning should be improved by: adherence to standard cleaning procedures, choosing the correct cleaning method and pre-treatment, improving cleaning personnel's knowledge and perceptions of medical device cleaning, and disassembling the medical devices with complex structures so as to reduce the quality defects of medical device cleaning.

Smart-detection approach for protein residues to evaluate the cleaning efficacy of reusable medical devices

Healthcare-associated infections are challenging problems to eradicate. In practice, infection prevention and control regarding the effective cleaning of reusable medical devices is performed. However, real-time monitoring of potentially contaminated devices is hindered by the complex, costly investigations and the time required. To develop an inexpensive approach providing high-sensitivity, rapid, and low-cost protein residue determination on medical devices. Colourimetric reactions for protein were modified and downscaled to produce a colour product on the moving drop platform and to operate combined with our custom-built smartphone application in order to evaluate and save protein contamination data. The intensity of a product colour was detected by photographing with a smartphone camera and was proportional to the protein concentration in the linear range of 5-20μg/mL. The protein content was processed on a custom-built smartphone application, namely PromoveCheck. The proposed procedure was highly sensitive, yielding limits of detection and limits of quantification, at 0.03 and 0.10μg based on the Bradford reaction. It was applied to reusable medical devices, showing no significant differences from the spectrophotometric method and a correlation with the o-phthaldialdehyde method (P<0.05). This approach demonstrates low cost, sensitivity, efficiency and traceability for investigating reusable medical device cleanliness. The PromoveCheck app can report and acquire protein content that can be used for traceability and alerts concerning questionable or discovered contaminant devices, improving the quality management of the Central Sterile Supply Department.

Updated review of wet pack complications in pulse vacuum pressure steam sterilisation processes in central sterile supply departments.

The quality of sterilisation and disinfection in a central sterile supply department is directly related to the quality of the hospital services and the patients' safety. Wet packs occasionally occur following the process of pressure steam sterilisation; reducing this occurrence is an important issue. Therefore, the causes of wet pack following sterilisation were analysed to identify the influencing factors and suggest improvements to prevent its occurrence. Understanding the sterilisation process and possible causes of exposure helps with risk assessment and identifying necessary corrective measures.

Linen Management and Presence of Staphylococcus sp. in the Laundry Unit and Central Sterile Supply Department (CSSD) RSUD Dr. Haryoto Lumajang

Linen menjadi media penunjang dalam seluruh pelayanan medis rumah sakit. Perlunya pengelolaan linen secara optimal dapat mencegah infeksi nosokomial. Tujuan penelitian adalah untuk mengkaji pengelolaan linen dan keberadaan Staphylococcus sp. di unit laundry dan CSSD RSUD Dr. Haryoto Kabupaten Lumajang. Penelitian menggunakan metode deskriptif kuantitatif, dengan teknik pengumpulan data menggunakan lembar kuesioner dan observasi. Sampel penelitian terdiri dari petugas pengelolaan linen RSUD Dr. Haryoto Kabupaten Lumajang sebanyak 21 sampel dan sampel linen sebanyak 7 sampel sprei dan duk operasi. Pengambilan sampel dan uji lab untuk sampel linen dilakukan pada bulan April 2023. Uji lab dilakukan di Balai Besar Laboratorium Kesehatan Surabaya (BBLK). Hasil penelitian menunjukan bahwa proses pengelolaan linen di unit laundry RSUD Dr. Haryoto Kabupaten Lumajang pada proses pengangkutan linen dari ruangan, pemilahan, pencucian dan desinfeksi, pengeringan, dan pengemasan linen tergolong kategori cukup. Proses penyetrikaan dan pelipatan linen tergolong kategori baik. Perendaman dan desinfeksi, penyimpanan, dan distribusi tergolong kategori kurang. Pada proses linen bersih menjadi linen steril dilakukan beberapa proses sterilisasi di unit CSSD meliputi penerimaan, pelipatan, pengemasan, sterilisasi linen, kontrol indikator, penyimpanan linen, dan distribusi linen steril. Berdasarkan uji laboratorium menunjukkan bahwa seluruh linen tidak mengandung kuman Staphylococcus aureus melebihi 20 CFU/cm2.

Analysis of the Effect of Quality Control Circle on the Central Sterile Supply Department

Objective: To analyze the effect of quality control circle on the central sterile supply department (CSSD). Methods: The control group and the observation group each consisted of 180 instruments received by the sterilization supply center from January to March 2023 and 11 CSSD staff. The control group underwent routine management while quality control circle was implemented in the observation group. The quality of work, disinfection and sterilization qualification rates, disinfection and sterilization of various instruments, cleaning indicators, and management satisfaction of both groups were compared. Results: The observation group scored higher in terms of work quality, the qualification rate of disinfection and sterilization in each link, the disinfection and sterilization of instruments, and cleaning indicators compared to the control group. Besides, the management satisfaction of the observation group was higher than that of the control group (P &lt; 0.05). Conclusion: A quality control circle ensures the quality of work, improves the cleaning, disinfection, and sterilization of instruments of the CSSD, and improves the management satisfaction of the CSSD staff.

Decontamination of a robot used to reprocess reusable surgical instruments

Using robots to handle medical devices in the decontamination area of the Central Sterile Supply Department (CSSD) can reduce risks and address staff shortages. The gripper design must allow reliable cleaning using standard CSSD procedures to avoid build-up of biofilms and possible cross-contamination between different instrument trays and the gripper's functionality. This study explores the design of the robot's gripper regarding cleanability, aiming to determine whether successful cleaning can be achieved even after prolonged drying for a working shift of 8h. We optimized a gripper for cleanability and used it to assess the spread of different test soils depending on different forms of motion. Subsequently, we analysed the cleanability using sheep's blood as test soil, reprocessing the gripper in different assembly configurations after 4 and 8h of drying, and measuring residual protein. Based on our investigations, we documented the spread of contamination depending on the type of motion of the gripper's components. Sheep's blood exhibited the highest dispersion among the test soils, permeating through thin crevices. Importantly, all samples displayed residual protein levels below the warning threshold, irrespective of drying time and gripper disassembly or cleaning position. Cleaning in a device-specific optimized position achieved results comparable to cleaning the disassembled individual components. These findings indicate that cleaning even after one working shift of 8h and without the labour-intensive disassembly of the gripper is feasible, supporting the future use of robots to handle contaminated medical devices in the CSSD decontamination area.

Retracted: Construction of Training Program for Specialized Nurses in the Central Sterile Supply Department (CSSD) Based on Post Competency.

[This retracts the article DOI: 10.1155/2022/3282245.].

Incidence of Adverse Events in Central Sterile Supply Department: A Single-Center Retrospective Study.

Adverse events bring pain to patients, prolong hospitalization, and may even endanger life, it is necessary to effectively identify and manage adverse events. However, in Chinese mainland, there are few studies on adverse events in Central Sterile Supply Department. The purpose of this study was to investigate the prevalence of adverse events in Central Sterile Supply Department and offer suggestions for enhanced quality management. A retrospective study was conducted to assess the prevalence of adverse events in a tertiary hospital from January 2020 to December 2022, employing a convenient sampling approach. The occurrence of adverse events of CSSD shall be collected for the basic information of the principal person of adverse events and the information of the adverse event. Descriptive statistics are described by frequency (percentage) and are analyzed by using X2 test. A total of 101 adverse events were reported, with the majority being attributed to substandard cleaning quality (34, 33.66%), followed by faulty instrument assembly (25, 24.75%) and defective marking (7, 6.93%). Additionally, incorrectly sterilized items (6, 5.94%), occupational exposures (3, 2.97%) and late distribution (5, 4.95%) were also observed, accidents (8, 7.92%) and other types of adverse events (13, 12.87%). The highest risk chain for adverse events was identified as inspection and packaging (49, 48.51%) and device cleaning (32, 31.68%), with the majority of adverse events occurring on a scale of three (30, 29.7%) and four (70, 69.31%), respectively. Furthermore, it was determined that the type of person responsible, education, years of work and the structure of the device, the number of instruments in the operating kit, and the size of the kit may be factors in the occurrence of adverse events (P < 0.05). Adverse events occur frequently in central sterile supply department, thus necessitating strict supervision during cleaning and inspection of packaging. Managers should pay special attention to staff with low working life and education. Furthermore, a grading system, in line with the central sterile supply department, should be implemented to ensure the management of adverse events and the quality of services provided is harmonized.

Application of business model canvas to merchandising sterile supplies from a hub hospital to smaller hospitals in India

BackgroundOutsourcing and regionalization of Central Sterile Supply Department (CSSD) could mutually benefit both smaller and bigger hospitals. Larger hospitals with established CSSDs have an opportunity to extend their services to maximize the utilization of their equipment. For outsourcing the sterile supplies department to smaller hospitals, extra capital investment is not required. This study highlights the application of merchandizing sterile supplies from hub hospital with a large CSSD to smaller hospitals. MethodsA prospective observational study is conducted at a hub hospital with return on investment observations as the study tool. Business Model Canvas was used to identify spoke hospitals. Two business options, known as the processing model and the rental model, were proposed to the owners of spoke hospitals. ResultIn both models, the infrastructure of CSSD is owned by the hub hospital. In the processing model, the smaller hospital owns the instruments, and in the rental model, hub hospital supplies instruments, and spoke hospitals pay rent for the instruments. The cost of CSSD building and equipment, sterilizing cost, manpower costs, and transporting costs were considered. In the processing model, the profit to the hub hospital will be 60%, 44%, and 28% annually. In the rental model, we see diminished profit margins of 50%–35%. ConclusionThe smaller hospitals can benefit by avoiding investing in infrastructure, skilled workforce, and space. The bigger hospitals can use their vast existing infrastructure more efficiently and break-even quicker on the initial capital investment.

Optimizing Sterilization Packaging through Root Cause Analysis: An Exploration into Sealing Defects of Paper-Plastic Pouches.

BACKGROUND Paper-plastic sterilization pouches are essential in healthcare for preventing instrument contamination. However, sealing defects in these pouches can jeopardize patient safety. To address this issue, our study uses Root Cause Analysis (RCA), aiming to identify contributing factors to these defects and propose practical solutions. Through this, we aim to enhance the overall sterilization process. MATERIAL AND METHODS A retrospective analysis was conducted on 35,762 instruments sterilized and packaged in paper-plastic pouches at our hospital's Central Sterile Supply Department (CSSD) across two periods: July 2020 to June 2021 (pre-RCA, 17,563 instruments) and September 2021 to August 2022 (post-RCA, 18,199 instruments). We evaluated RCA scores, packaging personnel's perceptions of sealing quality, and sealing defect rates before and after RCA implementation. RESULTS Root causes for sealing defects included lack of a standardized inspection procedure, inadequately sized packing table, missed inspections, incorrect distribution procedures, inadequate staff training, and insufficient lighting through the pass-through window between storage and distribution rooms. Among these, lack of a standardized inspection procedure, small packing table size, and missed inspections were statistically significant risk factors (P<0.05). The sealing defect rate decreased from 0.15% pre-RCA implementation to 0.07% post-RCA implementation. CONCLUSIONS Implementing RCA has been shown to effectively enhance the CSSD staff's perception of sealing quality and significantly reduce the incidence of sealing defects in paper-plastic pouches. Thus, RCA serves as an invaluable tool for quality improvement in sterilization packaging processes.

Evaluation of the holistic nursing mode based on responsibility system in the high-quality nursing service of the Central Sterile Supply Department

Evaluation of the holistic nursing mode based on responsibility system in the high-quality nursing service of the Central Sterile Supply Department

Survey of the processes of the central sterile supply department in tertiary care hospital

Both patients and hospitals are harmed by hospital-acquired infection, sometimes known as “nosocomial infection.” To prevent these hospitals, require excellent disinfection and sterilization technologies, which are now integrated into a single department known as the central sterile supply department (CSSD).Aim is to study Organization, workload and the Quality Control Practices in CSSD. This descriptive, observational and hospital survey based study was carried out over a period of 6 months from November to April in Santosh Medical College &amp; Hospital Ghaziabad. Monitoring of CSSD is done to oversee the use of different sterilization methods and capturing indicators to monitor sterilization process and ensure technical maintenance of the equipment according to National standards and manufacture’s recommendation. CSSD of the institution is centrally located within the hospital. Various articles including linen, dressings, surgical instruments and trays are sterilized in the CSSD. Sterilization is done by steam sterilization and gas sterilization with a total of seven autoclaves and two ETO machines. Physical, chemical are regularly used during the process of sterilization. CSSD of institute with proper practices of sterilization methods helps in continuous improvement required to decrease hospital acquired infections (HAIs).