The hospital sterile service society of India (HSSSI) is an active organization. HSSSI is provide regular consultancy service for project work
related to CSSD, TSSU, power laundry in hospital
and medical institution provide technical specifications and select cost effective advanced equipment
and furniture for the CSSD, TSSU,
power laundry in the hospital.
The society was founded in 2004, Registration of Society Act xx1 of 1860 sl.no.646/2004,
Government of Kerala...
Cleaning involves the removal usually with a cleaning agent and water of visible and non-visible soil from the surfaces (including crevices, serrations, joints and lumens) of medical devices. A device that has not been cleaned cannot be sterilized. Dead organisms in the soil or the organic matter left on the device will cause pyrogenic or foreign reaction. It can also create a breeding place for an infection or cause the instrument not to function properly. (For example artery forceps, scissors and bone cutters may not open and close smoothly) Cleaning is different from disinfection as it physically removes dirt as well as micro organisms whereas disinfection kills micro-organisms.
Most of the items supplied by CSSD are used in OT, Smaller quantities are taken by Cath Lab, Labour Room, Casualty, OPD and other departments. If the CSSD is unable to supply all these departments it must first provide service to OT and then to ICU as these are critical departments. Wherever these instruments are used these should be initially and immediately rinsed with ordinary tap water at room temperature to remove gross dirt. This step is very, very important since blood, saline and other chemicals used in surgery are harmful to the instruments causing rusting and corrosion. Also if this is not done bio soils dry on the instruments which are difficult to clean later. In case of non-visible soil it may never ever get cleaned since it cannot be seen. The soil also acts as a nutrient media for the growth of microorganisms. Though the first rinse should be within a few seconds after the use of the instrument sometimes this is not possible. In this case the instrument should be covered with a wet mop or soaked in a basin of water containing enzymatic detergent or covered with a foaming detergent
Contaminated items should be transported in covered trolleys. (Like a small cupboard on wheels) If a closed trolley is not possible atleast it should have a solid bottom/shelf to avoid spills. Also in this case the instruments and other material should be contained in plastic bins or other containers to avoid spread of infection to the areas they pass through. Leak proof plastic bags can also be used. If possible containers and bags should be marked with a bio hazard sign. The trolleys and containers should be cleaned and decontaminated after every use.
CSSD personnel should treat all items that have been used on any patient as contaminated and potentially infectious. When items arrive in the washing area they should be checked for removal of gross dirt. (No visible dirt should be seen .This has to be compulsorily removed at the User level) The instrument trays should also be checked for completeness of set and damage. Visibly dirty, incomplete or damaged instruments should be returned with a note stating the reason and not accepted till they are cleaned / a note is given accepting onus or reasons for damage or missing. These will then be repaired and replaced by CSSD, according to hospital policies to prevent disruption of work at user level. Received items may be documented on Received Note / Ledger, either brought by user or kept in CSSD. In either case 1 copy should be available in each department.
Items and interior baskets should be removed from their containers and sorted for Cleaning. The containers and interior baskets also need to be cleaned each time. Items Can be segregated according to the method of cleaning (manual, ultrasonic or washer / disinfector. ) Items composed of more than one piece like metal tracheostomy tubes , Procedure needles hand pieces and laparoscopic instruments should be disassembled (taken apart) to expose all surfaces to the cleaning agent. Written instructions (either obtained from the manufacturer of the device or developed in house) should be available in Washing Area for disassembly and reassembly. Small parts like screws, nuts and washers as also parts belonging to one assembly should be put into a small container with holes to avoid misplacing them. Special care should be taken while retrieving reusable shafts or shafts left inadvertently (by error) to prevent self injury. Delicate micro instruments should be segregated from bulky heavy ones and washed manually or in a separate cycle of the ultrasonic machine. Non-immersible instruments like power saws and drills should be separated for manual cleaning.
Ideally the method of cleaning for any medical device should be specified by the device manufacturer if he claims it is reusable. It is his responsibility to provide reprocessing instructions including the cleaning agent to be used as well as the method.
In case of both manual and mechanical cleaning the device should be rinsed thoroughly with large (copious) amounts of water to see that the loosened dirt as well as cleaning agents is removed. Initially tap water should be used. However the final rinse should be performed with distilled or deionized water.
Water soluble lubricants ("milk") help to keep instruments in good working condition. After through rinsing the instruments may be dipped, in an instrument milk bath or the lubricant can be sprayed on them manually in the Assembly Area. Take care to see that the lubricants are steam penetrable (permeable) and are specially labeled as "meant for instruments which are to undergo steam sterilization".
Assembly and packing of sterile supplies should only be performed by the department responsible for sterilization .”never sterilize what you have not seen” in good maxim. OT, ICU, X-ray and other dept. .should be discouraged from washing and packing as they are not trained for these. If this is unavoidable ,then special training must be given by CSSD in charge , Nursing Supervisor or an outside faculty as packing plays an important role in proper sterilization.
Before Packing, instruments have to be inspected for cleanliness as well as functionality. Check visually for dirt, rust, small marks where the plating is absent (pitting), small pieces of metal scraped off but attached to instruments (burrs), small pieces removed (nicks and chips) and cracks. Moving parts must move smoothly over instruments. Instruments not meeting the above criteria should be removed and replaced with the inventory available with CSSD. The removed instruments should be sent for repair or discarded (condemned). Decision on whether an instrument needs to be condemned can be taken by a condemnation committee or with the help of a senior surgeon or based on the expertise of the CSSD manager. All condemned items should be writer off the inventory and cleaned before discarding. Usually these are sold as scrap by the materials department
* GENERAL ASSEMBLY PROCEDURES
The key principle to remember is that items should be assembled and packed in a manner that allows easy sterilant (steam, EO) contact. Also it should allow the exit of air in the beginning if the cycle as air hampers contact of steam with the surface of the instruments. Also the items should be assembled so that they allow exit of steam and water at the end of the cycle to ensure dry packs. Any pack which comes out wet from the sterilizer (wet from outside or contains moisture within) is considered a "wet" pack and must be re-sterilized. Therefore methods of assembly containers and packing material have to be carefully chosen. Instruments are assembled in trays or sets. Trays are used in the OT and other departments use smaller sets or kits for minor procedures as in ICU, wards, cathlab and other departments.
Sterilization is the process of destroying all forms of microbial life, including spores. This is a rigid, uncompromising absolute term. There is no condition as partial sterility; The article is either sterile or unsterile. Just because an article has undergone sterilization process does not guarantee it is sterile. The purpose of rendering instruments dressing, implants and other medical devices sterile is to ensure that they do not transfer any micro-organisms into patients Challenged with technological advances in medical instruments, patients are greatly vulnerable due to shock, trauma medications and existing infections which may tax his immune system. Transplant Patients, Cancer patients on chemotherapy and otherwise Immuno-compromised patients are especially susceptible. The introduction of even new microorganisms can lead to a full blown infection in a few hours
Sterility Assurance requires attention not only to the performance of the sterilizer but all aspects of the sterilization process. It involves continuous supervision of personnel and work practices and seeing that they adhere to the laid down policies and procedures. Since it is difficult to prove an item's sterility without contaminating it, we have to monitor (check) that conditions which cause sterility have been achieved. Hence we use indicators or monitors for this purpose There are 3 types of indicators which are compulsory to use:
After sterilization, inspect all packages for proper color change by the external chemical indicator. Do not handle any package that is visibly wet as this will compromise sterility of the items inside. Sterile packages should be stored in a clean, dry location and preferably closed (i.e. cabinet not open shelf in dentistry). The shelf-life of sterile items is event-related and depends on the quality of the packaging material, storage conditions and amount of handling. Prior to distribution, be sure to inspect sterile packages and do not use any that are damaged, wet or opened.