Each and every hospital around the world got a Central sterile supply department (CSSD). These departments come in different sizes depending on the activity in the hospital. People in these departments are doing a very important job, because their main focus is patient safety and the prevention of hospital associated infections. I have been working for some years in the CSSD, and I have been asking myself many times: Does the hospital management, the suppliers, the surgeons, the peri operative nurses and hospital staff in general got the enough knowledge about reprocessing of the surgeons tools?
What is the surgeons tools?
The “tools” I am talking about is actually a medical device, an instrument made of different components. Each instrument is made to serve a specific purpose like cutting, desiccation or holding tissue. The length on each instrument will differ too depending on the tissue to operate in, and if the patient is a child, adult, slim or obese.
Some are power tools like a saw or a drill. Other instruments are more or less made of stainless steel, but even these instruments will corrode if they are not being taken properly care of. Each instruments got a name and most of these instruments are named after famous surgeons.
The CSSD staff
People working in a CSSD got different background. They can be nurses, peri operative nurses, technicians and so on. But they all need a basic knowledge how to maintain and take care of each instrument. Each and everyone need knowledge about microbiology, hygiene, chemistry, metallurgy, physics, technical and IT skills.
I can´t write about all the topics whish are important in a CSSD. But the staff are taking care of the cleaning and disinfection, control of the instruments, wrapping of instruments sets, sterilizing and the storage of each sterile product. But it is not a quick fix job. Each step means a lot of work like controlling the disinfector, controlling the autoclave, rewash, sending an instrument for repair, oiling the box lock, change an instrument, update the content list, wrapping the instrument, putting a set in a container and more. To put an instrument set in an autoclave depends on the different instrument sets which are ready for sterilizing. There must be a thought behind each step in the CSSD to make sure that you and I can be operated safely.
But despite this knowledge the CSSD staff need, they are like lowest in the hierarchy. Why?
Over time with a lot of lifting of 8 -10 kg´s instrument sets, the staff get problems with muscles and joints. The job is very stressful, because there is often no correlation between the work to be done and the available staff. We all know that chronic stress may cause a burnout. Burnout is dangerous in the CSSD because you need to be concentrated when you are doing the instrument control.
In my department we say that it takes 3 hour to reprocess an instrument set. But our customers don´t believe that. So do they have any knowledge about reprocessing of the surgeons tools? Apparently not.
The washer disinfector use one hour. After the washing the instruments hold 90 degree and need to cool down, before you can hold them. The control time may take up to an 1.5 hour. It depends whether you have to rewash it in the washer machine. It may be repeated if the instrument is very dirty. First when it is visually cleaned you can wrap and sterilize it. The sterilizing process take about 1 hour, and if there are errors in this process, you have to unwrap and rewrap. When the sterilizing process is done, the instruments need to cool down before storage or sending to the customers. It takes no time to make an instrument unsterile or dirty, but the reprocessing takes at least three times more.
But it seems like the staff in the operating room forget that the CSSD is serious business. Each step is important to keep the instruments sterile.
Cooperation with customers
It seems like production and the usage of single use instrument is a trend. That is good. But it is not to your benefit that single use instruments come to the CSSD for reprocessing. It happens when the operating room staff want to save money.
The industry makes a lot of money for in some occasion tiny little parts, and I find it unethical. Single use instruments being reprocessed is dangerous, because you change the instruments features. The risk is lack of strength and danger of breakage. Yesterday I experienced some handles that don´t tolerate liquid. These handles were actually not a single use instrument.
So suppliers must take their responsibility. Reprocessing must be the first thing you want to know something about before you buy it. The instruments are expensive, but a patient with infection is even more expensive and could actually be lethal.
It takes no time to make an instrument unsterile or dirty, but the reprocessing takes at least three times longer.