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Each day, millions of medical procedures are performed in healthcare facilities worldwide, with caregivers and patients relying on the availability and use of a wide range of supplies, instruments and equipment. These devices must be properly cleaned, disinfected and/or sterilized, inspected for quality to ensure good working condition, and available at the point of care. In the absence of proper handling, processing and storage, these devices may become contaminated and compromise quality patient care.
In most healthcare facilities, the central sterile supply department (CSSD) plays a key role in providing the items required to deliver quality patient care. To support infection control within the healthcare facility, the CSSD staff members must be well-trained and skilled, and committed to “doing what’s right” every step of the way. That means ensuring that shortcuts are never made and that processes and practices are consistently followed.
Centralizing the reprocessing of reusable devices helps ensure uniform standards of practice, while also providing for improved workflow (soiled, to clean, to sterile). This also facilitates the training and education of skilled technicians who must be knowledgeable about the standards, complexities, challenges, risks, and techniques associated with the CSSD function. Every CSSD task must be performed in a manner that protects the welfare and safety of patients, co-workers and the community.
It’s not enough for CSSD technicians to know how to perform their jobs; they must also know and understand why they do what they do. As they perform their daily tasks, they must have the knowledge to support effective problem-solving and decision-making, and the understanding that every step in the CSSD has a direct impact on infection control – and, above all, patient care and safety.
It is critical that CSSD personnel establish quality levels for the products and services they produce and then ensure that these levels are consistently attained. Quality is determined by customers and, therefore, the success of CSSD depends upon their satisfaction. Anyone who has an expectation about the products or services of CSSD is a “customer.” This includes surgical services personnel, physicians, patients, diagnostic imaging technicians and other medical personnel, and delivery staff. Quality (or lack of quality) can have dramatic consequences on the health and safety of personnel and patients. How well quality products and services are provided will impact the operation of the department and have a direct impact on the hospital’s financial success.
What is “quality?” A common definition relates to the “degree or grade of excellence of a product or service.” For example, emergency department personnel may believe that an emergency crash cart was delivered efficiently, but may be unsatisfied with CSSD staff because they failed to provide a needed item on the pick list. This could indicate good quality service, but poor quality of product. By contrast, assume that a surgical instrument set is needed quickly in the surgical suite and that set is delivered complete (no missing instruments). If the surgical staff is not informed that the set was delivered; however, then the CSSD essentially provided a good product, yet failed in terms of customer service. In short, it is through the eyes of the customer that quality is measured.
There are several ways that the quality of goods and services are described, but a key component relates to the ability to measure quality. This is reasonable because one must always compare ideal and actual quality levels. Identifying and completing the many tasks performed in CSSD can be accomplished through the development of effective policies and procedures that are supported by industry standards and guidelines. Training CSSD team members to follow these policies and procedures will ensure a consistent, high-quality product and level of service. This, in turn, will support quality patient care.
The actual work performed in a CSSD determines the knowledge, training and skills CSSD technicians require. The “processing cycle” can help CSSD professionals understand and define the tasks and processes necessary to provide quality products and services to their customers; it is important to note that inspection plays an essential part of almost all processes performed in the CSSD. This ensures that a safe, quality product is provided to customers, especially patients.
Working in the decontamination area of CSSD requires thorough knowledge and understanding of microbiology and the decontamination process; cleaning techniques; steps in the cleaning process; objectives of the cleaning process; levels of decontamination; identification and cleaning of specific to surgical instruments, syringes, needles, rubber items, and specialty items; cleaning agents and their application; disinfecting agents and their application; identification and effect of the cleaning process on different metals; special instrument lubrication and maintenance; proper disposal of all types of waste; the transportation of contaminated items; and the operation of equipment used in the cleaning process, such as washers, decontaminators, ultrasonic cleaners, cart washers, steam guns, scope washers, and so on.
To perform their tasks well in the preparation, packaging and sterilization area, technicians must be able to identify hundreds of surgical instruments. They must understand how instruments are manufactured, what they are made of, how to process and maintain them, and also know how to properly inspect them for cleanliness, proper condition and function. How to care for and maintain instruments is essential for driving quality and infection control efforts.
Surgical specialty instruments, equipment and implants that require special handling, packaging and sterilization also require careful attention and expertise. CSSD technicians must be able to select the proper packaging materials and use proper techniques for wrapping and packaging items for sterilization. Items to be sterilized must be properly identified, and the correct method and parameters for their sterilization must be determined and precisely followed. The principles necessary to achieve sterilization must be understood and applied. Sterilizers must be loaded and operated properly, sterilization quality assurance measures must be followed and interpreted to ensure that items are sterile, and records must be maintained. Factors that can compromise sterile packaging must be understood, prevented and promptly detected.
Service excellence skills are essential for CSSD to support a healthcare facility’s infection control department – and various infection control initiatives. Therefore, assessing and meeting the needs of CSSD customers is of prime importance. It is not enough to have the knowledge, tasks and processes in place to provide quality products. Great service and exceptional communication skills are also required, along with quality services and products.
CSSD professionals must understand that if they want the respect of others, they must deserve it. It isn’t something that can be demanded; it is earned. It takes quality products and service excellence for a CSSD to properly support infection control within the healthcare facility, and the best place for both of these to occur is at the front line.
Bruce Bird, CRCST, serves as central processing manager for Primary Children’s Hospital in Salt Lake City. He also serves as president-elect of the International Association of Healthcare Central Service Materiel Management (IAHCSMM).