presentation on central sterile supply department and biomedical department in hospital

1. POSTING PRESENTATION
ON BME AND CSSD
DEPARTMENT
BY AYSHATHUL FEMITHA
MHA 1ST YEAR
9897
1

2. CENTRAL STERILE
SERVICE DEPARTMENT
2

3. What is CSSD
• CSSD can be defined as that services within
the hospital catering for sterile supplies to all
departments, both to specialized units like OT,
as well as to general wards and OPDs.
• Its mission is to have right item, at the right
place at the right time in the right condition
and always provide services without
interruption.
3

4. LOCATION :
• CSSD is located in the 5th floor of old building,
YMCH. It is located in the central part of the
hospital which can be accessible from all the
other floors
STAFFING:
• 8 staffs and 6 FNO/MNO
WORKING HOURS
8am – 4pm, 12pm – 8pm, 8pm- 8am
staffs is 8 hrs and FNO/MNO is 9 hrs
4

5. ORGANOGRAM
COO
INCHARGE OF OPERATION
CNO
CSSD INCHARGE
CSSD TECHNICIANS
CSSD ASSISTANCE
FNO AND MNO
5

6. FUNCTIONS OF CSSD
• Receiving and sorting soiled materials used
• Determining whether the item is to be
discarded or reused
• Carry out the process of decontamination or
disinfection prior to sterilization
• Carry out specialized cleaning of supplies
• Inspecting and testing instruments, linen and
equipments
6

7. • Assembling treatments trays, instruments
sets, linen packs etc.
• Packing all materials for sterilization
• Labeling and dating materials
• Sterilizing
• Storing of materials
• Issuing and distribution
7

8. DIFFERENT ZONES IN CSSD
UNSTERILE
AREA
PACKING
AREA
STERILIZATION
AREA
STERILE
AREA
THE WORK FLOW IS UNIDIRECTIONAL AND THERE IS A PHYSICAL
BARRIER BETWEEN THE SOILED, CLEAN AND STERILE ZONE
8

9. WORK FLOW
COLLECTION
PRE DISINFECTION
CLEANING
DISINFECTION
PACKAGING
STERLIZATION
STORAGE
DISTRIBUTION
9

10. COLLECTION:
• Used items from various departments of the
hospitals are shifted to cssd for cleaning and
sterilization
• The receiving area of cssd is having access to
outside through a window with counter
• Necessary entries are made for records
• Receiving time in cssd is
Morning : 9.30 am – 11 am
Evening : 3pm – 4 pm
Night : 7 pm – 8 pm
10

11. RECEIVING AREA WORK FLOW
RECEIVING ITEMS FROM DEPARTMENTS
CHECKING FOR ANY DAMAGE AND MISSING
DOCUMENTATION
SEGGREGATING LINEN AND DISPOSSIBLE WRAPPER
LINEN FOR WASHING AND WRAPPER DISCARD
SENDING TO WASHING AREA
11

12. COLLECTING
TROLLEY
RECEIVING COUNTER
12

13. CLEANING AREA
• This is the area where reusable instruments are
collected, cleaned and dried.
• These steps are done in unidirectional that is
nothing ever moves back towards the dirty zone
• Here the instruments are washed manually and
by machines
• For manual washing sinks with water supply is
provided
• Ultrasonic washing is done by ultrasonic cleanser
• Water used for cleaning should be <25° C
13

14. • Ultra sonic cleanser: It converts high
frequency sound waves into mechanical
vibration that produce small bubbles that
burst on the internal surface of instruments
and remove waste
• Manual cleaning : rinse instruments in running
cold water and disinfection is done manually
washing the materials with disinfectant
• RO Plant water is given to microbiology lab to
check the parameters monthly
14

15. CHEMICAL WAY OF USING TIME/ AREA USED
ENZYMATIC CLEANER 4 ml IN 1 liter 10 to 12 mints
RUST AND STAIN REMOVAL 10 TO 100 ml /liter 1 hour maximum
LUBRICATION FOR INSTRUMENT
LUBRICATION
--
HIGH LEVEL DISINFECTION
CHEMICAL
200 ml in 800 ml of water --
HAND RUB For rapid hand antiseptic
applied to clean and dry
hand
--
HAND WASH 5 ml in wet hand --
CHEMICALS USED FOR CLEANING
15

16. WORK FLOW IN CLEANING AREA
WEAR PERSONAL PROTECTIVE EQUIPMENTS
SORTING FOR MANUAL WASH AND ULTRA SONIC WASHING
3 SINK PROCEDURE FOR MANUAL WASHING
1ST SINK: FILL WATER AND ADD ENZYMATIC SOLUTION
SOAK INSTRUMENTS IN THE SINK FOR 10 MINTS
CLEAN THE INSTRUMENTS WITHIN THE SINK
2ND SINK: RINSE THE INSTRUMENTS THOROUGHLY
3RD SINK: RINSE WITH RO WATER
DRYING INSTRUMENTS AND SEND TO PACKING AREA 16

17. CLASSIFICATION OF INSTRUMENTS
• Based on the potential of a instrument to
spread infection it is classified into three:
CRITICAL INSTRUMENTS:
• Items that penetrates soft tissue, bone or the
vascular system or through which the blood
flows such as implanted medical devices
• These should be sterile when it is used
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18. SEMI CRITICAL INSTRUMENTS:
• Objects that touch mucous membrane or
non intact skin, such as respiratory
therapy equipment
• It require high level of disinfection
18

19. NON CRITICAL INSTRUMENTS:
• Objects that are in contact with intact skin,
such as blood pressure cuffs, suturing
materials etc
• They require low level disinfection
In our hospital all instruments are sterilizing in
order to reduce the chance of cross infection
19

20. PACKAGING AREA
• Working counters where the instruments
are packed before sterilizing
• so that it is not contaminated while
handling after sterilization till it is used
• This area is situated between the
unsterile and sterile zone
20

21. • Non woven fabric known as ‘Spun bond melt
blown spun bond’ is used to pack the
instruments which is to be steam sterilized
• It contains micro pores in it which will get
closed when the steam is passed through it
• It is one time use material; disposable
• It is there in different sizes:
50 * 50, 60 * 60, 75 * 75
90 * 90, 120 * 120
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22. • Pouches are used for packing the items for
ETO sterilization.
• Pouches consist of transparent sheet in one
side which help to see the material inside and
other side which micropores through which
the chemical gas enter during ETO
sterilization.
• The damaged items are together sent to store
monthly or weekly for condemnation
22

23. • Indicator is kept inside every packed items
that is to be sterilized in autoclave
• Sealing machine is used to seal date of
sterilization and expiry date and indicator on
the packed items
• Envelope folding technique is used for packing
the instruments
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24. ENVELOPE FOLDING TECHNIQUE
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26. WORK FLOW IN PACKING AREA
SEGREGATING ITEMS FOR STEAM AND ETO
CHECKING INSPECTING THE INSTRUMENTS
PACKING SETS AND INDIVIDUAL ITEMS
LABELING SET NAME, EXPIRY DATE AND INDICATORS
DOCUMENTATION IN THE STERILIZER LOG BOOK
SENDING FOR STEAM AND ETO STERILIZATION
26

27. INDICATORS
• There are 3 types of indicators :
PHYSICAL
INDICATORS
CHEMICAL
INDICATORS
BIOLOGICAL
INDICATORS
27

28. PHYSICAL INDICATORS
INDICATORS INDICATES
METER GAUGE Show the pressure
DISPLAY show the time, temperature and
pressure
DIGITAL PRINTOUTS time, temperature and pressure
SIGNALS indicate if power supply fails, or
door is not properly closed or in the
condition of low water
JACKET OF AUTOCLAVE Show the pressure in the jacket
CHAMBER OF AUTOCLAVE Pressure inside the chamber is
indicated 28

29. CHEMICAL INDICATORS
• External indicators :
INDICATOR CHANGE
LOAD CARDS Light rose changes to black
LABELS EtO Blue turns to green
BOWIE DICK Yellow turns to black
STEAM INDICATOR TAPE Green changes to black
BMS/PCD FOR STEAM AND EtO Yellow to black(steam)
Blue to green (EtO)
•INTERNAL CHEMICAL INDICATOR
Class 4 chemical indicator : orange turns to black 29

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32. 32

33. BIOLOGICAL INDICATOR
• GOEBACILLUS STEAROTHERMOPHILUS : used
in steam autoclave and plasma sterilizer
• BACILLUS ATROPHAEUS : EtO sterilizer
33

34. STERILIZATION
• Sterilization in hospitals is one of the
important process in order for prevention of
hospital acquired infection.
• It is a process by which living organisms (both
viable and non viable) are killed or removed to
the extend that they are no longer detected
by standard culture media which have
previously been found to proliferate
34

35. METHODS OF STERILIZATION
• PHYSICAL STERILIZATION
Autoclave : by means of steam
• CHEMICAL – PHYSICAL STERILIZATION
Plasma sterilization by hydrogen peroxide
EtO sterilizer by means of gas
35

36. STEAM STERILIZATION
• 2 machines are available in this department
1 semi automatic and 1 manual
• To sterilize instruments that are heat resistant
• Autoclaved instruments have 1 month of validity
OPERATION:
• Preparation of load
• Loading the chamber
• Autoclave cycle
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37. • Preparation of load :
Cleaned and disinfected instruments are
brought to the packing area and packed and
sealed
• Chamber loading
• Autoclave cycle
At high temperature 134°C, 30 psi pressure -
7min
At low temperature 121°C, 30 psi pressure -20
mints
37

38. 38

39. ETHYLENE OXIDE GAS STERILIZER
• 1 EtO sterilizer
• Used to sterilize plastic materials and linen that
cant sterilize in autoclave
• 1 Ethylene oxide gas cartridge is used in the ETO
sterilizer for 1 cycle
• Relative humidity 40 – 70%
• Temperature 37 – 55 °C
• 12 hours of cycle and 6 hours aeration period
• 40 days validity of sterilized instruments
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41. PLASMA STERILIZER
• 1 plasma sterilizer is present in our cssd
• But it is used in emergency cases
• Very less amount of instruments can be
sterilized in plasma sterilizer
• Both steel type and plastic type can be
sterilized in this, but no linen can be sterilized
• The materials should be thoroughly dried
before keeping to plasma sterilizer
41

42. • OPERATION:
PREPARE: after cleaning with an enzymatic
cleanser and rinsing all the soiled particles are
removed then dry and inspect the equipment
PACKAGE: pack the items in pouches together
with chemical indicator strip
PLACE: place evenly the packaged instruments
over trays so that the gas may circulate freely
and penetrates inside each package. Pouches
should be placed so that the transparent side
of one pouch faces the opaque side of the
next pouch.
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44. STORAGE
• After sterilization the items are temporarily
stored in a clean store (on racks) from where
they are distributed to user departments
• Storage area should have humidity <70%
and temperature 18- 24°C
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46. DISTRIBUTING AREA
• It should be away from the receiving area and
may comprise of a window with counter
where proper records of instruments issuing is
maintained.
• First in first out method is used
for distribution
46

47. sterile trolley
47

48. RECORDS MAINTAINED IN CSSD
• Items receiving register
• Items issuing register
• Biological indicator register
• Fumigation report register
• Recall register
• Autoclave batch monitoring register
• ETO sterilizer batch monitoring register
• Biomedical complaint register
• Maintenance complaint register
• MSDS
• OT set receiving register 48

49. FUMIGATION REGISTER
• Fumigation process is done monthly once in CSSD
• It is done to get rid of all flies and pests
• Fumigation is done a whole night with fumigation
machine (15 ml of chemical in 1 liter water) and
by sealing all the cssd
• And swabbing is done after this process and the
swab is sent to microbiology lab
• Areas where swabbing is done :washing area
Packing area, 2 autoclave, rack
49

50. Fumigation machine
50

51. RECALL REGISTER
• Biological indicator kept in autoclave is sent to
microbiology lab weekly,
• if any growth is there then the supplied
instruments should be sent back and recorded
in recall register
51

52. OBSERVATIONS AND SUGGESTION
• Adequate space is available for all procedures
in CSSD
• OT nurses are supposed to help CSSD staff for
segregation of materials during high workload
time, but they never used to do that.
• Proper PPE should be provided in CSSD as the
ergonomical risk is high in CSSD
52

53. BIOMEDICAL ENGINEERING
DEPARTMENT 53

54. BIOMEDICAL ENGINEERING
• Biomedical Engineering is a team of
engineering professionals working in a clinical
environment to resolve technology issues
related to patient care, improvement in
outcomes and cost effectiveness.
• This is accomplished via cost effective
maintenance, repair and acquisition of all
clinical technology, and proper management
of clinical technology resources.
54

55. BIOMEDICAL EQUIPMENTS
• The delivery of the best healthcare services
depends heavily on medical equipment,
whether for life support, for patient
monitoring, or for the delivery of therapies
purpose.
• The risks associated with the use of medical
equipments can only be controlled by
managing the whole life cycle of the
equipment
55

56. OBJECTIVE OF BME
• Evaluation, replacement, service and repair of
complex biomedical patient equipment to ensure
that equipment is in safe working condition
• To provide necessary support to the Doctors /
Nursing Staff / Operators with regard to
equipment usage
• Ensure the patient safety and result accuracy by
measures like periodic calibration, periodic safety
checks, etc
• Provide on the job training and support to
equipment users and operators
56

57. LIFE CYCLE
OF AN
EQUIPMENT
CONDEMNATION AND
DECOMMIISSIONING
MAINTENANCE
MONITORING OF USE
AND PERFORMANCE
PLANNING
PROCUREMENT
INSPECTION
INVENTORY AND
DOCUMENTATION
COMMISSIONING AND
ACCEPTANCE
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59. INVENTORY AND DOCUMENTATION
• When a new equipment is purchased and after the
inspection it is entered in asset register/inventory
register.
• It includes the details like:
 Basic ID
 Name of equipment
 Department working condition
 Date of instalmentation
 Warranty
 Price
 Supplier
59

60. MAINTENANCE OF THE EQUIPMENT :
• Proper maintenance of medical equipment is
essential to obtain sustained benefits and to
preserve capital investment.
• Medical equipment must be maintained in
working order and periodically calibrated for
effectiveness and accuracy of the results.
Planned preventive maintenance
Breakdown maintenance
calibration
60

61. PLANNED PREVENTIVE MAINTENANCE
• PPM involves maintenance performed to
extend the life of the equipments and prevent
its failure.
• PPM is usually scheduled at specific intervals
and includes specific maintenance activities
such as lubrication, calibration, cleaning etc
• It will enhance the efficiency, effectiveness
and reliability of medical equipments and
must be carried out at appropriate frequency
as suggested by the manufacturer/service
provider 61

62. BREAKDOWN MAINTENANCE
• Breakdown maintenance is a task performed to
identify, isolate and rectify a fault so that the out
of order equipment, system or machine can be
restored to an operational condition.
• if a complaint is notified then BME inspect the
equipment, check whether it is repairable, if
possible repaired or not BME identifies whether
the equipment is under annual maintenance
contract, if so, the contract agency is informed
62

63. CALIBRATION
• Calibration needs of various bio medical
equipments and their monitoring devices shall
be undertaken to ensure the accuracy of their
output/measurements.
• A calibration sticker with date of calibration,
due date and the company name who done
the calibration of equipment is pasted after
calibration
63

64. EQUIPMENT ID NUMBER
• Every device has a unique identification
number(YMCH-BME-0XX), assigned by BME
that is used to:
Track equipment history (incoming inspection
to disposal)
Assign and track Preventive Maintenance
work orders
Assign and track Corrective work orders
(repairs)
Analyze trends for replacement or other issues
64

65. ORGANOGRAM
COO
INCHARGE OF OPERATION
BME INCHARGE
BIOMEDICAL ENGINEERS
65

66. Improper
functioning of
an equipment
Raise the
complaint &
registering
Classifying the
complaint
Resolves
problems
quickly and
efficiently.
Close the
complaint.
WORK FLOW
66

67. • Repair and maintenance work is prioritized by:
Life support/life saving (ventilators, anesthesia
machines, defibrillators)
Diagnostic (laboratory, radiographic, imaging)
“Routine” technologies (ophthalmoscope,
exam lights)
67

68. CONDEMNATION
• If the equipment find out as not fit for further
use then it is informed to higher authorities
and if approved then the instrument is
brought to BME and all the possible spare
parts are removed (cannibalization)
• Then it is sent to store for condemnation
68

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