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Technological Aspects of Infection Control in Healthcare
By nature of its role, the CSSD plays a decisive role for
the healthcare providers.
Rahul H Patil |
As the market for healthcare services develops rapidly, there
is an increased focus on activities affecting overall quality of services provided
and process productivities. This naturally touches upon in-house services departments
like the CSSD.
By nature of its role, the CSSD plays a decisive role for the healthcare providers
against the battle of infection. This needs consideration right from the design
and conception stage.
Modern CSSDs are typically designed using a three zone concept — for soiled,
clean and sterile goods respectively — with pass through equipment serving
as barriers between them.
The First Barrier in the fight against pathogenic microorganisms
is between the reception area for soiled goods and the clean zone where inspection,
sorting and packing take place. The barrier itself consists of high capacity,
pass-through washer-disinfectors.Since soiled and disinfected goods are handled
in entirely separate rooms by different staff, the risk of cross-infection is
minimised. The volume of goods dictates the sizes and number of these machines.
Picture Courtesy: Getinge |
Steam and hot water are the most common disinfection agents
used in healthcare, since they are energy efficient and require no harsh chemicals.
Cleaning is performed by flushing first with cold water, then with warm water
and detergent. This is followed by disinfection at a minimum temperature of
80°C (176°F) or at 90°C (194°F), following today's standards.
The hallmark of a good washer disinfector is it ability to process items of
varying application, and hence shapes and sizes. The final phase of drying is
equally important from the point of preparing the goods for the next part of
the process -sterilisation.
The Second Barrier between the clean zone and the sterile store, consists of
pass-through sterilisers, in suitable sizes and models depending upon the volume
and type of goods that need to be processed. In fact, there are sterilisers
for every application within the hospital, including sterilisers with steam
or formaldehyde, ethylene oxide processes for heat sensitive goods and cycles
for fluid production. Moreover, ergonomic handling system of modular wire baskets
allows the steriliser chamber to be utilised to its maximum volume. With appropriately
engineered loading and unloading equipment (both automatic and manual), easy
handling of sterile goods is possible.
 Once
again, the staffs are physically separated, one group working in the clean zone,
the other working in the sterile store. Better storage conditions are also created
by using a ventilation system with over-pressure, a rising pressure gradient
from soiled to sterile zone. This is easily achieved using differential setting
on the AHU's.
The Carrier Systems also play an important role. Increasingly standardised carriers
(instrument trays, wire baskets and containers), designed to be highly functional
and ergonomical, are used while taking into account the requirements of infection
control. The carriers can be modular, in sizes to fit exactly with the machinery
used in the CSSD (washer-disinfectors and sterilisers) and with loading, transport
and storage equipment. This can result in optimal capacity utilisation of the
machinery, easier handling and reduced costs.
Moreover, one and the same carrier can be used to take sterile goods all the
way from the sterile zone of the CSSD to the point of use, and soiled items
back to the soiled zone of the CSSD — with no unnecessary reloading! Such
a circulation system can protect both the surroundings and the sterilised goods
from being re-infected.
Today's technology extends the battle against infections beyond the CSSD, to
include wards and operating areas. We see increasing use of lower capacity ‘Mini
CSSD's’ or Theatre Sterile Supply Unit ( TSSU's ) — near the operating
rooms. Other point of use disinfection solutions includes automatic endoscopic
washers for endoscopy suits and bed pan washers in sluice areas.
IT plays an increasingly impacting role. Today, this extends
from traceability and quality assurance right upto materials management. Besides
documenting process parameters and batch records, the system can be extended
in its application right up to the point of use. This can help optimise management
of that increasingly expensive inventory of surgical instruments.
The writer is Product Sales Manager Getinge Infection Control
E-mail: rahul.patil@maquet.com
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