Cssd ppt
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This document summarizes the results of an audit of the CSSD (Central Sterile Supply Department) performance and quality at a super specialty hospital in Coimbatore, Tamil Nadu, India. The audit was conducted over 2 months using a checklist to evaluate various aspects of CSSD operations, including instrument handling, cleaning processes, packaging, sterilization, and documentation. Several non-compliances were initially observed but corrective actions were taken, and a post-audit found improvements in complying with policies around secure transportation and cleaning of contaminated items, sterilization monitoring, and documentation. However, further work is still needed in some areas such as instrument packaging and transportation.
Cssd ppt
- 1. CSSD Performance Quality Analysis at a Super Speciality Hospital NAME : D. Gandhiraj DESIGNATION : Microbiologist
- 2. Background: (about hospital) • RoyalCare super specality hospital Inaugrated on 14th,Nov,2016 as a 750 bedded project at Neelambur, Coimbatore, Tamilnadu • Current bed strength - 270 • The hospital is provided with State of Art CSSD. • The study choosen to implement systematic workflow, sterilization performance and Quality Assurance.
- 3. Objective: • To impliment and monitor the necessary systems to ensure efficient functioning and support of the sterile service in the hospital. • To assess the effectiveness of sterilisation methods and turn-around by implementing Quality in CSSD performance. • To maintain record of effectiveness of cleaning, disinfection and sterilization process by physical and biological controls.
- 4. Audit case type (Descriptive) • Area Audited - CSSD • A checklist of APSIC used to analyse the performance quality (PQ) of CSSD and to impliment the necessary requirements. • Some of these questions have forced options and some are open ended questions regarding CSSD. • Project started on 18/12/2017 to 27/02/2018 • Data collected through Observation and interaction with CSSD personnel.
- 5. Checklist content 1. Handling,Collection and transportation of contaminated instruments 2. Cleaning and decontamination processes 3. Instrumentation inspection,preparation & Packaging 4. Sterilization and monitoring 5. Sterile storage and distribution 6. Documentation 7. Facility Design 8. Personnel Considerations
- 6. Handling,Collection and transportation of contaminated instruments: NON COMPLIANCE OBSERVED ITEM REVIEVED PROCESS Secured,dedicated containers are provided for soiled instruments Not practiced Use of puncture resistant leak proof containers for soiled items Not practiced Policy and procedure in place for transportation of contaminated items between buildings Not Applicable Transportation carts should be covered and should prevent items from falling over or off Not practiced
- 7. Cleaning and decontamination processes ITEM REVIEVED PROCESS Written policies and procedures in place for all cleaning and decontamination process Policy available but not practiced Appropriate brushes or cleaning implements designed for use on medical devices are used Partial practice Brushes/cleaning implemented are either disposable or if reusable ,are decontaminated atleast daily Partial practice
- 8. Instrumentation inspection,preparation & Packaging ITEM REVIEVED PROCESS Cleaning verification by users should include visual inspection combined with other verification ( ATP) methods that allow assessment of instrument surfaces Partial Practice Deligate/ sharp instruments are protected while being handled / assembled for sterilization (may use special holder ,tip guards, or foam sleeves). Tip protectors should be sterilant permiable Not practiced Basins : • graduated basins sholuld differ in diameter by one inch • use non lining absorbant material between nested basins. • wraped basin sets should not exceed 11.3 kg ( 7 pounds) Partial practice Ridged container system instructions are being followed regarding weight and density of instrument sets. Not practiced • Packing materials are held for a min.of 2 hours . prior to use at room temp (20 degree C - 23 Degree C) at a relative humidity ranging from 30-60% Not practiced
- 9. Sterilization and monitoring Sterilization and monitoring ITEM REVIEVED PROCESS 1.Paper - plastic pouches - use baskets to facilitate placing pouches on edge Not practiced 2.Implant loads : Monitor with a BI PCD containing a class 5 integrating indicator.Implants should be quarantined until BI results are known,except in emergency situations Not practiced 3.Non implant loads:optional monitoring with a PCD containing either : a class 5 integrating indicator Not practiced 4.Routine sterilizer efficacy testing testing with a BI PCD is done daily Not practiced 5.Use appropriate BI PCD depending on type of sterilizer Not practiced 6.Qualification testing :For sterilization process failures where the cause is not immediately identifiable and after majorsteam or sterilizers repairs,run 3 empty cycles BI PCD followed by 3 empty cycles with a Bowie - Dick test oif prevaccum sterilizer. Not practiced 7. Sterilizer maintenance :-drain strainers are inspected daily for debris -sterilizer external and internal surfaces are routinely cleaned Not practiced
- 10. Sterile storage and distribution ITEM REVIEVED PROCESS • Transport carts should have a physical barrier between the bottom shelf and the floor. • Reusable covers should be cleaned after each use. Not practiced • Carts are3 decontaminated/ dried before reused for transporting sterile supplies Not practiced
- 11. Documentation ITEM REVIEVED PROCESS PRODUCT RECALLS: • Policies &procedures are clear and concise record maintened • lot control label are used to include : sterilizer ID , lot number, sterilization date ,expiration date, name of pack and initials. Partial • Sterilization process failure : when cannot immediately identify cause of failure ( eg . selected incorrect cycle setting ), reprocess the load and recall / reprocess all items dating back to last load in sterilizer with negative BI results Not practiced
- 12. Facility Design ITEM REVIEVED PROCESS If centralized reprocessing is not possible , consistant policies and procedures between locations are in place Not applicable Emergency eyewash stations ( required by OSHA) located within 10 seconds travel time of all chemical usage locations , with a continuous flush for at least 15 minutes . E.g., Decontamination area Not practiced Temperature and Humidity monitoring controls in decontamination and clean areas and daily record Not practiced Appropriate positive and negative pressure ventilation system in place Not practiced
- 13. Personnel Consideration ITEM REVIEVED PROCESS All CS Personnel recieve a minimum annual training on department policies and procedures All CS personnel demonstrate comprtency annually Partial Wriiten policy on personal hygiene Not practiced Written policy on adherence to appropriate CS personnel attire Partial Written policy on adherence to appropriate PPE in decontamination area Partial
- 14. Pre - Audit Outcome
- 15. PROBLEM PRIMARY MEANS SECONDARY MEANS FEASIBILITY ACTION TAKEN Pre - Audit Outcome Policies and Procedures Standard operating protocols are not created Preventable CSSD manual implemented Facility there is seperate lift for transportation of but not having divider contaminated items Dedicated elevators provided Instrument Handling and Packaging Improper assembling of multipart instruments & overweight Regular instrrument sets weight monitoring and proper assembling Manpower Proper usage of PPE, Absenteesam Training on PPE usage is given Equipment Process Failure & Improper cleaning Cleaning Checklist implemented Documetation done for process failure Quality Assurance Monitoring PCD not implemented PCD Initiated for every cycle Deployment Chart
- 17. Handling,Collection and transportation of contaminated instruments: POST AUDIT COMPLIANCES ITEM REVIEVED PROCESS Secured,dedicated containers are provided for soiled instruments Implemented, yet to practice Use of puncture resistant leak proof containers for soiled items implemented policy and procedure in place for transportation of contaminated items between buildings Implemented, yet to practice transportation carts should be covered and should prevent items from falling over or off yet to implement dedicated elevators with direct access to decontamination area practicing
- 18. Cleaning and decontamination processes ITEM REVIEVED PROCESS written policies and procedures in place for all cleaning and decontamination process Implemented appropriate brushes or cleaning implements designed for use on medical devices are used Implemented brushes/cleaning implement are either disposable or if reusable ,are decontaminated atleast daily Implemented
- 20. Instrumentation inspection,preparation & Packaging ITEM REVIEVED PROCESS Cleaning verification by users should include visual inspection combined with other verification ( ATP) methods that allow assessment of instrument surfaces On discussion -Deligate/ sharp instruments are protected while being handled / assembled for sterilization (may use special holder ,tip guards, or foam sleeves). - Tip protectors should be sterilant permiable Implemented complex instruments (air-powered, endoscopes, having lumens or channels) are prepared according to written instructions from device mfr. Implemented basins : • graduated basins sholuld differ in diameter by one inch • use non lining absorbant material between nested basins. • wraped basin sets should not exceed 11.3 kg ( 7 pounds) Implemented and nested basins are yet to impliment Ridged container system instructions are being followed regarding weight and density of instrument sets. Yet to practice • Packing materials are held for a min.of 2 hours . prior to use at room temp (20 degree C - 23 Degree C) at a relative humidity ranging from 30-60% Implemented
- 22. Sterilization and monitoring Sterilization and monitoring ITEM REVIEVED PROCESS 1.Paper - plastic pouches - use baskets to facilitate placing pouches on edge implemented 2.Implant loads :Monitor with a BI PCD containing a class 5 integrating indicator.Implants should be quarantined until BI results are known,except in emergency situations implemented 3.Non implant loads:optional monitoring with a PCD containing either : a class 5 integrating indicator implemented 4.Routine sterilizer efficacy testing testing with a BI PCD is done daily implemented 5.Use appropriate BI PCD depending on type of sterilizer implemented 6.Qualification testing :For sterilization process failures where the cause is not immediately identifiable and after majorsteam or sterilizers repairs,run 3 empty cycles BI PCD followed by 3 empty cycles with a Bowie - Dick test oif prevaccum sterilizer. implemented 7. Sterilizer maintenance :-drain strainers are inspected daily for debris -sterilizer external and internal surfaces are routinely cleaned implemented
- 23. Sterile storage and distribution ITEM REVIEVED PROCESS • Transport carts should have a physical barrier between the bottom shelf and the floor. • Reusable covers should be cleaned after each use. implemented • Carts are3 decontaminated/ dried before reused for transporting sterile supplies implemented
- 25. Documentation ITEM REVIWED PROCESS PRODUCT RECALLS: • Policies &procedures are clear and concise • record maintened • lot control label are used to include : sterilizer ID , lot number, sterilization date ,expiration date, name of pack and initials. implemented • Sterilization process failure : when cannot immediately identify cause of failure ( eg . selected incorrect cycle setting ), reprocess the load and recall / reprocess all items dating back to last load in sterilizer with negative BI results implemented
- 26. Facility Design ITEM REVIEVED PROCESS If centralized reprocessing is not possible , consistant policies and procedures between locations are in place implemented Emergency eyewash stations ( required by OSHA) located within 10 seconds travel time of all chemical usage locations , with a continuous flush for at least 15 minutes . E.g., Decontamination area implemented Functional workflow pattern clear distinction (ie physical wall) between dirty and clean implemented Temperature and Humidity monitoring controls in decontamination and clean areas and daily record implemented Appropriate positive and negative pressure ventilation system in place implemented Floors and walls are constructed from materials that can withstand frequent cleaning implemented Ceilings are flush surfaces and not of materials that are of particulate or fiber- shedding composition implemented
- 27. Personnel Consideration ITEM REVIEVED PROCESS All CS Personnel recieve a minimum annual training on department policies and procedures All CS personnel demonstrate comprtency annually Implemented, yet to practice Written policy on personal hygiene Implemented, yet to practice Written policy on adherence to appropriate CS personnel attire Implemented, yet to practice Written policy on adherence to appropriate PPE in decontamination area Implemented, yet to practice
- 28. Conclusions • CSSD is an independent department with facilities to receive, clean, pack, disinfect, sterilizes, store and distribute instruments as per well-delineated protocols. Thus it provides all the departments of a hospital with guaranteed sterile equipment ready and available for immediate use in patient care – a step towards the prevention of hospital acquired infections(HAI’s). • Implementation of standard protocols can reduce loss of surgical instruments, reduce instrument damage and reduce repair costs, automate many tedious training and reporting tasks and reduce the cost spent on investigations for infection control issues. • The problems faced in the audit are all common- missing instruments, proper trolleys, infection control issues, lack of training, monitoring reporting leading to delay in surgeries, procedures. Along with issues like requirement of adequate staff, regular training, better communication between departments is must to streamline the process and make it tailor made for individual departments. • To bring about continuous improvement and update procedures one needs to recommend tools like end user satisfaction questionnaires and Infection control team audit and feedback. • End users need to be trained and make them aware of the techniques used. All the reusable medical devices must be decontaminated following each episode of use.
- 29. References or Bibliography • William A Rutala, David J. Weber(Health Infection Control Practices Advisory Committee), Guidelines for disinfection and sterilization in healthcare facilities, 2008. www.cdc.gov/hipac/disinfectionsterilization. • The APSIC guidelines for Disinfection and Sterilization of Instruments in healthcare facilities, Revised Jan 2017. • ‘Decontamination and Reprocessing Manual for Healthcare Facilities’ WHO Revised CSSD Manual and Guidelines.