Business Accent

Emerging Trends in Sterile Supply

CSSD's role lies in receiving, cleaning, packing, disinfecting, sterilising, storing and distributing instruments as per well-delineated protocols and standardised procedures

Saurabh Gupta

The Central Sterile Supply Department (CSSD) in recent times has expanded from a mere support entity which consisted of steam sterilisation units to process instrument and linen packs. Today, CSSD is the heart of hospital infection control and the most important unit of clinical support services.

CSSD's role lies in receiving, cleaning, packing, disinfecting, sterilising, storing and distributing instruments (both multi-use and single-use devices), as per well-delineated protocols and standardised procedures. However, with newer techniques of surgery and subsequent sophisticated instruments, these functions have become critical and specialised. Modern medical technology has thus given a host of transformations, which have helped to ensure that the sterile supply remains—sterile. Broadly, the reflections could be felt in the following points:

New-age Sterilisers & Modalities

Manual sterilisers are now a passe and now fully automated pre-vacuum-assisted sterilisers are replacing them. These sterilisers are generally more efficient and leave very little space for error. Computer-operated sterilisers with automated recording system are also available now-a-days which record vital details like temperature, pressure, etc. Also, they record the load weight, cycle time and other details vital to business analysis.

On the other hand, ETO is now not the preferred choice for sterilising the thermo labile items due to their toxicity and environmental hazards. Hydrogen Peroxide sterilisers and Gamma irradiation have shown a new way to safe and speedy sterilisation.

Process Challenge Devices

With the change and sophistication of surgical sciences, sophisticated minimally invasive instruments (MIS) have also come into picture, which generally have very narrow lumen. Improperly maintained old sterilisers generally cannot put air out of the lumen, which is an essential element for kill kinetics. This could not be detected by normal chemical indicators, rather a process challenge device and PCD Bowie Dick indicator is required to get this checked and corrected. PCD tests the steriliser by simulating worst situations which can happen while sterilisation.

Biological & Chemical Indicators

Biological and chemical indicators remain a preferred choice for testing the sterility. However, with recently launched chemical integrators, it is easy to check for multiple parameters at the same go in every cycle/pack.

Quality & Documentation

A modern CSSD must follow well-established Quality Management System like EN ISO 14937, EN 550, 552. ISO 900:2001 (with reference to ISO 13487), which states the requirements for a quality management system for sterile supply services department.

Batch Processing Label System

Another useful device is the batch monitoring system. In case of sterilisation breakdown, when the entire lot needs to be retrieved from various parts of the hospital, this system comes handy.

The entire lot could be just called back by simply identifying the packets with the label bearing the same lot number. Also, the label gives you the sterilisation and the expiry date, ruling out chances of error while calculating 48 hours or seven days time frame. The presence of autoclave number and the operator code also helps to identify the malfunctioning machine and fix the accountability.

Lubricants & Enzymatic Detergents

Instruments, generally, have a tendency to develop crust or sometimes even rust near the grooves and hinges, which may be a potential source of infection. Also, they decrease the life of the instruments drastically, which could be prevented by using instrument lubricants.

Lubricant generally develops a protective film on the instruments. In addition, some of these lubricants have anti-bacterial property, which prevents pathogenic growth on the instruments. It is true that whatever is not clean cannot be sterilised. This is where the enzymatic detergents come into picture. These enzymatic detergents clean the human enzymes from the tiny instruments and thus decrease the bio burden to ensure proper sterilisation.

Management & Training

CSSD is no longer run by nurses and general technicians, but by hospital management graduates and senior technological officers, who are specially trained in varied techniques of quality management. You will also come across CSSD departments having a MoU with the sterilisation product companies who take steps for complete training and quality assurance of the department.

Re-use

Most Indian hospitals use devices like catheters, balloons, octopauss and tissue stabilisers multiple times in order to minimise cost to the patient. However, if not done properly, this could be a health hazard. Therefore, the sterile supply department must ensure adoption of a standard protocol with non-toxic marking of the items with non-toxic markers. These single use items generally get defected on using for few times and thus it is very important to know their number of use for patient safety.

saurabh.gupta@fortishealthcare.com
The writer is Co-ordinator-Medical Services at Fortis Hospital, Vasant Kunj, New Delhi and a NABH assessor responsible for maintaining the hospital as per ISO & NABH standards