The ideal scenario in any Central Sterile Supply Department would be to
have the items to be sterilised arrive in a condition that would allow
them to be placed directly into the machines without having to resort to
any further handling, dismantling, pre-treatment measures or repacking.
This would also be desirable in respect of personnel protection. But the
reality is somewhat different and hence there remains much to be desired.
Having described in
Part 2 of the Recommendations by the Quality Task Group (Central Service 1998; 6 (6): 423 ff)
the importance of quick transport, the means of transportation and
cooperation with the OR, the wards as well as other departments will
now be discussed.
In general a distinction is made between two types of transportation,
which are briefly described here:
In the case of
DRY TRANSPORTATION all used items are transported dry, i.e. without placing them in a disinfectant
solution, in closed containers to the CSSD. The used instruments are placed on
mesh trays (with jointed instruments opened), labelled and transported together
with the unused instruments. Dry transportation is recommended for many reasons
and is carried out in most establishments. The fear that adhering residues as
well as blood will dry too firmly and that the machines will not be able to
master cleaning has not been borne out. The advantages reside in the lower weight
of the containers, in the reduced consumption of disinfectant solution, which
cannot be used anymore, and in avoidance of coagulation processes, problems with
foam as well as corrosion if instruments are left too long in the solution.
In the case of
WET TRANSPORTATION the used items are arranged on mesh trays, then placed in the disinfectant
solution and transported in this manner. Disinfection takes place during the
wait and transportation time. Based on the manufacturer's instructions,
the disinfectant solution must be freshly prepared using in each case the
concentration tailored to the desired purpose, e.g. efficacy against HBV.
It is important that residues of the disinfectant solution should not get
into the washer-disinfector, as this would induce foam formation. A cleaning
enhancer should be added in accordance with the respective recommendation of
the manufacturer. Mixing substances at one's own discretion can lead to
a loss in efficacy and to other problems.
Described below are the problems most commonly encountered in the
interaction between the CSSD and other departments:
- The mesh trays are overfilled so that other mesh trays have to be used to accommodate them.
- It is not assured that jointed instruments have been placed on the trays in a properly opened condition.
- The mesh trays contain single-use items and waste, i.e. items that should have been consigned to the waste already in the OR.
- Residues of skin disinfectants are poured over the instruments, leading to discolorations and to hardening of blood residues.
- Items are all placed pell-mell on the mesh trays, hence they must be properly arranged in the CSSD.
- Parts are missing, and a search for them must be launched.
- Identification of the associated mesh trays ("used/unused") is not successful.
- New medical devices appear on the scene without any explanation given as to how they are processed.
To resolve these issues the Quality Task Group proposes the following measures:
- Provide training for OR personnel.
- Improve goodwill. Arrange joint training courses for OR and CSSD personnel so as to achieve a joint goal: quality.
- Influential persons e.g. the nursing management or infection control nurse can play a coordinating role and help to overcome disagreements and excuses ("we've no time for that type of thing!"; "we've always done that in this way!").
- Record agreed working procedures in the quality manual.
- Deploy OR personnel temporarily to the CSSD so that they also see this side of the coin and experience what problems can arise for the CSSD staff from an inconsiderate approach to disposal in the OR.
- Overcome anonymity by getting to know and understand each other.
- Employ special disposal assistants in the CSSD
- Label the disposal mesh trays with the code or name of the person effecting disposal so that selective corrective and retraining measures can be taken.
- Compile a list for special items, such as e.g. for syringes or sharp instruments.
- Provide information or instructions for OR personnel as regards placement of special items.
with kind permission of|
What types of disposal are there for used instruments?
In the case of DRY TRANSPORTATION the items are transported without being placed in a disinfectant solution. This is the method used in the majority of establishments.
In the case of WET TRANSPORTATION the used items are transported in a disinfectant solution. Here various aspects have to be borne in mind.
What are the main problems in the interaction between the CSSD and other departments?
How can problems in interaction be resolved?