Central Sterile Supply Departments Research Articles

Analysis of Wet Pack Incidence in Steam Sterilization: A Study in a Chinese Medical Center.

BACKGROUND Central sterile supply departments (CSSDs) play a vital role in hospital infection control. We investigate the factors associated with wet pack occurrence after steam sterilization. MATERIAL AND METHODS We designed a log sheet to record information concerning sterilized packs. The data included the type of sterilized pack; outside weather (sunny, overcast, or rainy); the item in the sterilized pack; packaging material; whether the item had been packaged in compliance with guidelines; whether the pack had been laid flat, upright, or leaning at an acute angle; which sterilizer was used for sterilization of the pack; whether the pack had been placed on the top or bottom shelf inside the sterilizer chamber; whether the pack had been loaded in compliance with guidelines; the drying time following sterilization; and cooling time after sterilization. The sterilized packs in our study were selected from all of the packs that were sterilized in the CSSD of the authors' institution during June to December 2021. RESULTS Factors associated with wet pack occurrence after steam sterilization include: outside weather on the day of sterilization; the item in the sterilized pack; packaging material; whether the item had been packaged in compliance with guidelines; whether the pack had been placed on the top or bottom shelf; and cooling time after sterilization. Statistically significant differences (P<0.05) in wet pack incidence were identified for all of these factors. CONCLUSIONS Various factors are associated with wet pack occurrence after steam sterilization. Recommendations for reducing the risk of wet packs include regular maintenance of the steam pipeline, regular replacement of thermal insulation materials for the steam pipeline, and extension of the drying time.

Quality indicators for the processing of health products: A mixed-methods study.

to analyze the use of quality assessment indicators and their implementation to improve quality in the processing of health products. a mixed-methods study with a multiple case approach using Structure, Process and Results indicators and elaboration of a plan using Appreciative Inquiry, carried out in four central sterile supply departments from hospital units. the indicators for the Cleaning stage presented 47.8% compliance for Structure and 59.0% for Process: in addition 71.8% of the products were clean. In the Preparation operational stage, 50.0% of the Results indicators were in compliance for Structure and 66.7% for Process. In the Sterilization, Storage and Distribution stage, 43.5%compliance was obtained for Structure, 55.7% for Process and 78.6% for Packaging conservation. Appreciative planning proposed improvements to the physical structure, review of processes and protocols, promotion and appreciation of the work done and strengthening of teaching about processing and service management, highlighting the protagonism of the group and of the leaders. using indicators was positive in materializing reality; however, it was verified that the improvements proposed are related to people. The affirmative and constructive view of Appreciative Inquiry presented itself as a path to changes and quality improvements.

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.

SG-APSIC1127: Digital transformation of the central sterile supply department: Justify by tracking system

Background: Avoidable infections in healthcare (healthcare-associated infections or HAIs) occur globally. The causes of HAI are influenced by a complex combination of gaps in policies, infrastructure, organization, knowledge, healthcare worker behavior, and patient-related factors. Through knowledge, best practices, and infrastructure improvement, the infection prevention and control (IPC) team aims to prevent harm to patients and healthcare workers due to HAIs. The most common HAIs are surgical site infections (SSIs) caused by harmful device-reuse practices, inadequate sterilization, and/or inadequate decontamination procedures. Disinfection and sterilization of instruments and medical devices play very important roles in HAI and SSI prevention. World Health Organization (WHO) Collaborating Centre in Quality Improvement Program certification, the first pilot project in Thailand, included the Central Sterilizing Services Association of Thailand and 15 hospital central sterile supply departments (CSSDs). This quality improvement program for sterilization reprocessing aimed to prevent harm to patients and healthcare workers due to HAIs. Objectives: We sought to reduce damage to instruments caused by inadequate reprocessing sterilization to zero incidents. We sought to reduce inadequate packing to ≤3 events per month. We sought to reduce the need to resterilize instruments by &gt;80%. Methods: A root-cause analysis meeting was held by CSSD staff, and an IT vendor was consulted about developing an electronic alert system. The following changes were implemented: Staff packed instruments using a list of pictures for each set. Sticker labels were applied showing the proper number of pieces in the set. Identification O-rings were added to instruments with inventory dates, serial numbers, and instructions for use. Stickers were added to indicate the method of sterilization, such as ethylene oxide gas only or hydrogen peroxide only. Results: Reports of damage due to the sterilization process decreased to zero. No events related to the packing process were reported, and resterilization of instruments decreased by 98.94%. Conclusions: In this project, we implemented a quality improvement process and tracking system, reduced defects, and increased healthcare worker competency to improve patient safety.

Patient safety culture in central sterile supply departments: nurses' perceptions.

To know the perceptions of nurses with experience in Central Sterile Supply Departments about the safety culture. A qualitative study developed with 12 nurses from hospitals in the South and Southeast Brazilian regions, with data collected in March 2021 through online interviews. Bardin's content analysis was performed with the support of the IRaMuTeQ software. The interpretations were classified considering the following aspects: indirect care provided by Central Sterile Supply Departments (27.16%), low visibility of Central Sterile Supply Departments for patient safety (26.92%), difficulty in internal communication (30.69%) and difficulties learning from errors and fair culture (15.23%). The perceptions about the safety culture are related to the quality control of processes and to infection prevention; however, there were perceptions about its low recognition and devaluation. The communication, learning from errors and fair culture subcultures proved to be weak.

Patient safety culture in central sterile supply departments: nurses' perceptions

RESUMO Objetivo Conhecer percepções de enfermeiros com experiência em Centro de Material e Esterilização sobre cultura de segurança. Métodos Estudo qualitativo, desenvolvido com 12 enfermeiras de hospitais das regiões Sul e Sudeste do Brasil, com dados coletados em março de 2021 por meio de entrevistas on-line. Procedeu-se a análise de conteúdo de Bardin, com apoio do software IRaMuTeQ. Resultados Interpretações foram classificadas considerando os seguintes aspectos: cuidado indireto do Centro de Material e Esterilização (27,16%), baixa visibilidade do Centro de Material e Esterilização para a segurança do paciente (26,92%), dificuldade de comunicação interna (30,69%) e dificuldades no aprendizado com erros e cultura justa (15,23%). Conclusões Percepções sobre cultura de segurança estão relacionadas com o controle de qualidade dos processos e prevenção de infecções, entretanto, houve percepções sobre baixo reconhecimento e desvalorização destes processos. As subculturas comunicação, aprendizado com erros e cultura justa demonstraram-se fragilizadas.

Monitoring the Cleanliness of Reusable Surgical Instruments in Central Sterile Supply Department by Adenosine Triphosphate Method.

Cleaning is very important in reusable surgical instruments (RSI) reprocessing. The adenosine triphosphate (ATP) method is widely used to assess cleanliness, but few studies focus on using this method on RSIs. To assess the effectiveness of the ATP Bioluminescence Assay for monitoring the cleanliness of RSIs. The study was conducted in three central sterile supply departments (CSSD) from 2015 to 2020. Surgical scissors, hemostatic forceps, and other non-lumen instruments were sampled after cleaning. The surface of each instrument was swabbed in a uniform manner, including hinged joints and teeth, and the amount of ATP (amol) was calculated. A total of 871 RSIs were tested, the mean ATP lg (amol) was 2.829 ± 0.539 and the qualified rate was 80.57%. Washer-disinfector cleaning was more efficient than manual cleaning, the mean ATP lg (amol) were 2.776 ± 0.513 and 2.948 ± 0.575, respectively; the qualified rates were 84.97% and 70.59%, respectively. With the time of bare instruments expose to environment increased, the qualified rate was decreased (Ptrend = 0.044). ATP levels are stable and repeatable for continuous monitoring of the cleanliness of RSIs. It is a rapid and viable method for assessing the cleanliness of RSIs. Washer-disinfector cleaning is recommended and cleaned instruments should be placed in sterile packaging in good time. The ATP method is viable for assessing the cleanliness of RSI in CSSDs.

Bundles for the central sterile supply department

Traditional resources, such as bundles, can help experts define essential steps of health product processing to prevent infections. The present study developed bundle content construction and validation criteria for central sterile supply departments (CSSDs). The present study employed a Delphi technique modified for content evaluation. Eleven professionals with at least 4 years of experience in sterilization were enlisted. Participants discussed main stages of the process virtually and compiled a list of items based on scientific references justified by law and/or logical reasoning. Agreement, disagreement, and/or suggestions on each step resulted in bundles for a CSSD. Items were then reassessed by experts using a Likert scale with a 90% approval criterion. Six bundles were developed: cleaning, inspection, preparation and packaging, sterilization, and storage resulting from 384 responses and 373 agreements (Interassessor coefficient = 97%). Items obtained from the criteria assessment received majority agreement from the first document. Agreement among varying professionals was achieved, and bundles were successfully developed to evaluate the processing of goods in CSSDs.

Investigation of Cold Atmospheric Plasma-Activated Water for the Dental Unit Waterline System Contamination and Safety Evaluation in Vitro

The disinfection of the inner surface of a medical device has long been a challenge for the central sterile supply departments. Dental unit waterline system (DUWLs) foster the attachment of microorganisms and development of biofilm, which lead to continuous contamination of the outlet water from dental units; this contamination may be responsible for a potential risk of infection due to the exposure of patients and medical staff. The present study investigated the disinfection effects of cold atmospheric plasma-activated water (CAPAW) on DUWLs using a model of 5-day-old Enterococcus faecalis biofilm. The results showed that the colony-forming unit was reduced from 107 to 0 after 5 min of treatment. The physicochemical properties of CAPAW were evaluated, including the pH value, oxidation reduction potential, and NO radical. The results showed that the inactivation mechanisms were mainly triggered by the reactive oxygen/nitrogen species. Additionally, CAPAW had a metal corrosion rate same as that of deionized water. We conclude that CAPAW can be applied as an appropriate alternative disinfectant against biofilm contamination of DUWLs.

Reuse Practices of Single-Use Medical Devices in Secondary and Tertiary Hospitals

Background: Reusing single-use medical devices can have serious risks for patients. Objective: To determine the type of single-use medical devices being re-used and management methods. Methods: This descriptive research study aimed to determine the type of single-use medical devices being reused and management methods among 96 heads of Central Sterile Supply Departments in secondary and tertiary hospitals under the Ministry of Public Health, Thailand using the Reuse of Single-use Medical Devices Questionnaires which were developed from literature reviews. The data were collected between October and December, 2014 with a response rate of 87.50% and analyzed using descriptive statistics. Results: The results showed that 82 hospitals (97.62%) re-use single-use medical devices. Sixty-sevensingle-use medical devices were re-used. The groups of devices most reprocessed were respiratory tract system devices (96.34%), devices for surgery (80.49%), and urinary tract system devices (71.95%), respectively. The most practiced management processes of used single-use medical devices included validation of the sterilization process (100%), the inspection of reprocessed single-use medical devices (90.24%), proper storage of reprocessed single-use medical devices (89.02%), the packaging of reprocessed single-use medical devices (87.80%) and the reprocessing area for single-use medical devices (68.29%). The least practiced management processes included informed written consent from the patients to reuse single-use medical devices (4.88%), authorization allowing the reuse of single-use medical devices (7.32%), the distribution of reprocessed single-use medical devices (7.32%), formation of a billing schedule of single-use medical devices (7.32%), and identifying when to discard the reused single-use medical devices (13.41%). The cleaning of used single-use medical devices was one step of the management process which was not practiced properly by all hospitals. Conclusion: The study results indicate that it is necessary to develop guidelines for reprocessingsingle-use medical devices and monitoring the practices of responsible personnel, especially regarding the cleaning process and deciding when to discard the devices.

Preventing Healthcare-Associated Infections by Monitoring the Cleanliness of Medical Devices and Other Critical Points in a Sterilization Service.

It is well known that the common goal of all central sterile supply departments (CSSDs) is to prevent healthcare-associated infections. Such infections entail high costs to society, not only economic but also social. Therefore, delivering safe medical devices and guaranteeing a positive contribution to the control of healthcare-associated infections form the main responsibilities of a CSSD. The monitoring of the effectiveness of medical device cleaning processes is highly recommended. However, ensuring a flawless environment for the preparation, assembly, and packaging of medical devices and clean handling of sterilized items is crucial to achieving the goal of safe medical devices. This study analyzed not only the cleanliness of surgical instruments but also two critical aspects of the surrounding environment: the cleanliness of work surfaces and the cleanliness of workers' hands. To evaluate the cleanliness of surgical instruments, two methods were used: the adenosine triphosphate (ATP) detection method and a residual protein test. It was not the intention of this work to make an exhaustive comparison of these methods. The ATP bioluminescence method was also used for monitoring the cleanliness of work surfaces and workers' hands. The aims of this study were to establish the most suitable method of evaluating the cleanliness of reusable medical devices in the CSSD and to assess the quality of the environment. Assessing the surgical instruments, work surfaces, and staff hands for cleanliness allowed the identification of possible contamination sources and to correct them by improving cleaning/disinfection protocols. Furthermore, the use of ATP monitoring tests of workers' hands highlighted the importance of staff compliance with good practice guidelines. Thus, these results have a positive impact on the CSSD quality system and, consequently, on patient safety.

Analysis of quality indicators of central sterile supply departments at accredited public hospitals

This study aimed to describe and analyze quality indicators of Central Sterile Supply Departments in Accredited Public Hospitals in São Paulo state and their management by those in charge of those departments. It is a multiple-case study, presenting interconnected data from three accredited hospitals in a report on cross-referenced cases. Data were collected by semi-structured interviews with the person in charge and by technical visits with documental analysis. Results showed the difficulty which those in charge have in identifying specific indicators for the department; the indicators mentioned relate to production and client satisfaction surveys, and do not describe the effective quality of the service, as they are fragmented and do not consolidate results in the search for improvement. This suggests low specificity and low sensitivity of the National Accreditation Organization criteria to this department's context.

Measurement of the microbial barrier effectiveness of sterilization containers in terms of the log reduction value for prevention of nosocomial infections

The microbial barrier properties of 216 sterilization containers of 4 central sterile supply departments of different hospitals were measured using a microbial challenge test. Uncovered thermoresistant plates filled with Sabouraud agar were placed on the base of the containers prior to sterilization. After sterilization, the containers were exposed to a defined microbial aerosol and periodic atmospheric pressure reductions of 10 to 70 hPa in an exposure chamber. After exposure and incubation of the entire containers, colony growth was registered as colony forming units (CFU) on the plates and the control plates to calculate the barrier effectiveness in terms of the logarithmic reduction value (LRV). Two out of 11 standard containers with paper filters and 9 out of 79 containers with textile filters showed no growth on the plates. The mean colony numbers were 222 CFU/600 cm(2) (standard container with paper filter) and 209 CFU/ 600 cm(2) (container with textile filter). Fourteen out of 15 containers with permanent plastic filters did not show any growth on the plates. No recontamination was observed in 18 of 111 half-size containers. The mean colony numbers of the recontaminated half-size containers were 110 (paper filter) and 34 CFU per 300 cm(2) (textile filter). The LRVs of the full-size and half-size containers tested ranged between 1.08 and >4. As shown in this study, the microbial barrier effectiveness of sterilization containers in the routine clinical setting can be tested with a quantitative microbial challenge test at intervals of 1 year to eliminate defect or ineffective containers as potential causal factors for nosocomial infections. An LRV of >4 should be envisaged as the target assurance level.

Cleaning of surgical instruments: a preliminary assessment.

An assessment has been made of some techniques used for cleaning surgical instruments at the Central Sterile Supply Departments (C.S.S.D.) at Dudley Road Hospital, Birmingham and the Walsgrave Hospital, Coventry. Tests were carried out using radioisotope methods, instruments being soiled with human serum albumin (h.s.a.) labelled with Technetium 99m (99mTc). It was found that cleaning efficiency varies with the kind of instrument: polypropylene instruments are cleaned more easily than stainless-steel ones: instruments with serrated surfaces, joints, or hinges are particularly difficult to clean. As would be expected, the use of detergents improves the degree of cleaning; the cleaning effect seems to depend on the alkalinity of the washing medium.

An Approach to Locational Analysis

This paper introduces an exact procedure to solve a class of locational problems where there is a catalogue of available sites to choose from; economies of scale and capacity restrictions are prevailing at each site. The procedure was applied to the problem of siting central sterile supply departments and the computational experience is reported. The applicability of the procedure to similar applications and the treatment of the dynamic facility location problem are discussed.

Microbial penetration of muslin- and paper-wrapped sterile packs stored on open shelves and in closed cabinets.

Microbial penetration of sterile packs was studied using single-wrap (two layers) muslin, double-wrap (four layers) muslin, and two-way crepe paper (single layer) to wrap 20 gauze sponges (2 by 2 inch). These packs were stored in the central sterile supply departments of two hospitals and processed for sterility at predetermined intervals. Microorganisms penetrated single-wrap muslin as early as 3 days and double-wrap muslin and single-wrap two-way crepe paper in 21 to 28 days stored in open shelves. The time required for microbial penetration was at least twice as long when closed cabinets were used. Single-wrap muslin packs stored in sealed, impervious plastic bags remained sterile for at least 9 months. All sterile materials in pervious wrappers should be handled as little as possible and then only with extreme care and caution. Closed cabinets offer more protection than open shelves, and single wrappers are not recommended.

Microbial Penetration of Muslin- and Paper-Wrapped Sterile Packs Stored on Open Shelves and in Closed Cabinets

Microbial penetration of sterile packs was studied using single-wrap (two layers) muslin, double-wrap (four layers) muslin, and two-way crepe paper (single layer) to wrap 20 gauze sponges (2 by 2 inch). These packs were stored in the central sterile supply departments of two hospitals and processed for sterility at predetermined intervals. Microorganisms penetrated single-wrap muslin as early as 3 days and double-wrap muslin and single-wrap two-way crepe paper in 21 to 28 days stored in open shelves. The time required for microbial penetration was at least twice as long when closed cabinets were used. Single-wrap muslin packs stored in sealed, impervious plastic bags remained sterile for at least 9 months. All sterile materials in pervious wrappers should be handled as little as possible and then only with extreme care and caution. Closed cabinets offer more protection than open shelves, and single wrappers are not recommended.

Asepsis in general practice.

Aseptic techniques in hospitals have been changing over the past few years and the influence of these changes on techniques in general practice will be considered in this article. A report on sterilizing practices in six hospitals published by the Nuffield Provincial Hospitals Trust1 indicated many deficiencies in traditional sterilizing methods. Following this and other publications, many central sterile supply departments have become established in hospitals. These departments pack and sterilize syringes, dressings, and other equipment, and distribute as required to wards and operating theatres. The main advan tages of this system are that sterilizing processes are carried out in one central department and are safer and more easily controlled ; boiling of equipment in the wards is almost or entirely eliminated and there is a saving of nurses' time. Dis posable equipment has also become more readily available and where necessary can be obtained in pre-sterilized packs from commercial sources. Although the use of disposables is some times expensive when compared with similar non-disposable equipment, costs will probably become less with increased demands. It is impossible to prove that the establishment of central sterile supply departments and the increased use of disposables has reduced hospital cross-infection, although some reports suggest that a reduction has occurred. Although wound sepsis is not a major problem in general practice, it is obviously preferable to use efficiently sterilized materials and equipment for all aseptic techniques, whether in hospital or in a patient's home. A recent report by the Queen's Institute of District Nursing2 indicates that standards of asepsis in domiciliary practice could be improved by the adoption of these new methods.

SURVEY ON PREVACUUM HIGH-PRESSURE STEAM STERILIZERS.

None of the 10 prevacuum high-pressure sterilizers of different makes tested was able to produce and maintain the conditions advocated by the Medical Research Council working party on high-pressure steam sterilizers (1959) or by Knox and Penikett (1958) with the result that steam did not penetrate adequately the single challenge load and it was not sterilized. The sterilization of ;group drums' of various sizes and contents was erratic and tended to give operators a false sense of security. An alarming number of minor engineering faults were present in seven out of 10 machines tested and they require very much more skilled maintenance than is being given at the moment. The possibility of centralizing sterilizers to central sterile supply departments and placing them under the care of a regional engineer cannot be too highly recommended. The presence of undetected ;leaks' and a failure to draw a prevacuum of 20 mm. even with a steam burst interferes with sterilization of a challenge load. A leak test should be performed twice daily and should not exceed more than 1 mm. in one minute at 20 mm. absolute. The centre of the load should be monitored by crossed tapes or Brownes tubes in each sterilizing cycle. Although the challenge load was sterilized when the chamber was filled to capacity, a more reliable cycle consisting of a double prevacuum of 20 mm. or more with intermediate steam burst to 10 lb. ensured the sterilizing of a single challenge load, which could be adequately controlled by the chamber drain temperature.

Central Sterile Supply Departments

Central Sterile Supply Departments