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Central Sterile Services Department
Irish Association of Sterile Services Managers
Amultidisciplinary team approach is central to the role of Sterile Services Management in preventing the spread of hospital-acquired infection. In the central sterile services department (CSSD) at the Beaumont Hospital, Dublin, this team consists of:
Each member of staff has their job description. Most members of the team are experienced personnel who have worked in the department for four to five years. They know what is expected of them on a daily basis.
There are policies and procedures for the collection, transportation, delivery, sorting, dismantling, cleaning, manual and automated washing, decontamination, inspection, packing and sterilisation of all instruments and pieces of equipment that are processed through the sterile services department.
Staff are encouraged to use gloves, protective clothing, eye protection and the appropriate uniform while working in the decontamination area. Infection control hazards and health and safety issues are identified and documented, and where appropriate sent to the risk assessment manager.
Incidents or near misses are reported and documented, and the relevant department contacted and informed of the incident. For recurring incidents from a particular area, management of the CSSD will go to the offending department and discuss the issue with the person in charge.
Sharp objects found in instrument sets are dealt with very seriously. Health and safety, infection control and occupational health staff are asked to collectively deal with the incidences and departments concerned. As a result, the incidence of sharps injuries or inoculation from needles and scalpel blades has reduced dramatically among the staff of
Supply of sterilised instruments
The CSSD at Beaumont Hospital services 12 operating theatres and 54 wards and departments, including: accident and emergency, cardiac intervention, X-ray, day theatre, and other areas that require sterilised instruments and sterile packs. The aim of the CSSD is to provide operating theatres, wards and departments with whom supply arrangements have been agreed, with all the equipment and materials required for clean and sterile procedures, correctly prepared to an agreed standard under accepted and controlled conditions by suitably trained staff. It is essential that those items required in a sterile condition have been sterilised under properly controlled conditions by machines that are regularly maintained and serviced.
Records are kept that show the competence of the ultrasonic washer/bath, washer disinfector and sterilisers to perform their tasks efficiently. The records relate to packs and instrument trays issued by the department to customers and conform to all national and European legislation governing the use of the above equipment. At present a manual traceability system is in operation. Instruments that are supplied to theatres can be traced back to the steriliser in which they were processed, giving time, date, batch number, steriliser number and identity of the instrument set. All instruments are checked before they are dispatched to theatres. If a fault occurs in the steriliser and inadvertently passes through the dispatch area, a load batch recall is carried out. All instruments from that batch are reprocessed. This does not occur, but protocols are in place to deal with it.
In recent years, with the appearance of Creutzfeldt–Jakob disease (CJD) and other infectious diseases, a greater emphasis has been placed on the decontamination of all instruments and equipment and the use of automated washing machines, to ensure that all processes are validated to an agreed standard.
Instruments sent for repair are accompanied by a “decontamination certificate”, as are surgical instruments that are on loan from time to time, being used for special procedures.
Education and communication
The infection control team gives lectures to the CSSD staff. Staff are requested to adhere to infection control protocols – both hospital protocols and departmental policies. Staff are also offered hepatitis B and tetanus vaccines on employment, an area that is monitored by the occupational health department. Communications between occupational health, infection control, and health and safety departments are extremely good.
In all areas of the department, staff are requested to wash their hands between all activities. This is the single most important activity in the prevention of cross-infection. All staff who work in the CSSD have the opportunity to communicate with other parts of the hospital, either by visiting wards and departments or by telephone. A code of conduct among staff who work in CSSD is in place when dealing with clients. All staff are informed of their responsibility under the terms of the Health & Safety Act.
Controlling the spread of new viruses
When the presence of a new virus is detected in the hospital, additional precautions at hospital ward level must be taken. The most recent virus to hit our hospitals countrywide has been the small round structured virus (SRSV) (also known as Norwalk-like virus, winter vomiting virus or norovirus). It is the most common causes of gastrointestinal outbreaks in hospitals, schools, hotels and various other places in which there is a high-density population in a small area.
SRSV is a short-lived infection with an incubation period of approximately 48 hours. Symptoms then last for approximately a further 24–48 hours, with a further carriage of the organism for 48 hours after symptoms have ceased. Visiting is restricted, and all personnel are monitored by security and the infection control department.
Lessons learnt from an infection outbreak
An outbreak of the SRSV in 2002 was a major problem for the hospital and required daily surveillance by the infection control team. The cooperation from all hospital departments was amazing in the effort to control the outbreak.
A great deal was learned by all as a result of the outbreak, and following the resumption to normal practice a follow-up meeting was arranged. The group felt it was very important to document the data and put in place a policy document that would be made available for any future outbreak, should it occur. Normal infection control policies and procedures would be put in place following the outbreak, but any symptomatic patients were to be reported by ward managers to the infection control department. Recommendations made by the hospital’s infection control team are listed below.
Within the sterile services department, constant efforts are being made on an ongoing basis by all members of staff to ensure the working environment is a safer place in which to work.
European Forum for Hospital Sterile Supply