The document describes the Central Sterile Supply Department (CSSD) in a hospital. The CSSD receives, sterilizes, processes, packs, stores and distributes sterile and non-sterile supplies throughout the hospital. It has separate areas for receiving soiled supplies, cleaning, packing, sterilizing via steam or gas, storing sterile items temporarily, and distributing supplies to user departments. The CSSD aims to provide sterilized materials and reduce hospital infections through strict protocols and quality assurance measures during each step of the process.
Laundry services in hospitals –linen handling
During any given hospital stay, patients spend most, if not all, of their time in bed.
•That means they are surrounded all day with hospital linens.
•From their gown to their sheets and blankets patients have more contact with these items than anything else in the hospital.
•Adequatesupplyofcleanlinensufficientforcomfortandsafteyofpatientandpersonalappereance&pleasant,neatlyattiredemployeesattendingpatientsinfreshcrispuniformdomuchsellthehospitaltothepublic
•Thereforeitmakessensetoensurethattheyareproperlycleaned,driedandtransportedtoavoidcrosscontamination
Laundry services in hospitals –linen handling
During any given hospital stay, patients spend most, if not all, of their time in bed.
•That means they are surrounded all day with hospital linens.
•From their gown to their sheets and blankets patients have more contact with these items than anything else in the hospital.
•Adequatesupplyofcleanlinensufficientforcomfortandsafteyofpatientandpersonalappereance&pleasant,neatlyattiredemployeesattendingpatientsinfreshcrispuniformdomuchsellthehospitaltothepublic
•Thereforeitmakessensetoensurethattheyareproperlycleaned,driedandtransportedtoavoidcrosscontamination
WASTE MANAGEMENT PROCESS AND INFECTION PREVENTION-Biomedical waste management is a systematic process .
Depending on the category of waste, according to the policy and planning of BMWM of a healthcare setting-the treatment, destruction and disposal method, many methods are adopted to treat and destroy or dispose of BMW-onsite or offsite.
Disinfection-The aim of disinfection is to eliminate microorganisms or at least reduce their numbers to a satisfactory level.
Chemical treatment: The types of chemicals used for disinfection of health-care waste are mostly aldehydes, chlorine compounds, sodium hydroxide or calcium hydroxide, ammonium salts and phenolic compounds.
On-Site Biomedical Waste Disposal
Autoclave:
Microbiological and biotechnological waste, waste sharps, soiled and solid wastes are treated in an autoclave.
It is ideal for treating all infectious waste (except anatomical and cytotoxic waste) even bulk liquid and pathological.
Hydroclave- It is an advanced autoclave with consistently high sterility and much more uniform heat penetration.
Microwave treatment: Microwave of the frequency of about 2450 MHz are used to decontaminate medical waste.
The waste to be treated must be humid as in presence of moisture, microwaves penetrate and sterilize the material.
HKRISHNA HOSPITAL, 18TH CROSS R.P ROAD, NANJANGUD
HOSPITAL INFECTION CONTROL & PREVENTION-2023
PRE TEST ON TRIAGING THE PATIENT AND MANAGING EMERGENCY PATIENT
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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2 Case Reports of Gastric Ultrasound
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
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In the DSM-5, all types of substance abuse and dependence have been
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The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
2. The Central Sterile Supply Department
(CSSD) comprises that service within a
hospital which receives, stores, sterilise,
disinfect, processes, packs, distributes
and controls professional supplies and
equipment, both sterile and non-sterile to
and from all departments of the hospital for
the care and safety of patients as per
standard protocol.
3. By custom food, medicines, laundry,
supply of blood are not included in
activities of CSSD.
4. Objective and Functions
a.To provide sterilized material.
b.To maintain record of effectiveness of cleaning,
disinfection and sterilization process.
c.To provide a safe environment for the patients and
staff.
d.Contributing to a reduction in the incidence of hospital
infection.
5. Designing of CSSD
• Size and location of CSSD varies
• It should be located as close as possible to Operation
theatres, Accidents and Emergency department and
wards
• The CSSD layout should be designed for a unidirectional
flow
6. CSSD should have three zones for a smooth work
flow:
• The soiled area
• The clean area
• The sterile area
7.
8.
9. PLANNING of CSSD
- The materials/ items from contaminated and sterile
areas should not get mixed.
- There should be physical barrier between clean and dirty
areas.
- The floor should be smooth, impervious, non skid and
robust.
- Relative humidity should be maintained at 45±5 %
10. should be maintained at positive
area
- The clean
pressures.
-The work area should be made of marble/granite/stainless
steel.
-The sterilization must be planned for autoclaving by steam
as well as by gas.
11. Location
• The CSSD should be close to the casualty,
Operation Theatre and wards which are the largest
consumer of the sterilized material.
• In multistoried buildings, CSSD may be planned in
the lower floor right under the Operation Theatre,
where vertical movement will be the quickest possible
movement of the material.
14. WORK FLOW
➢MAJOR ACTIVITIES IN A CSSD:
❖RECEIVING THE USED ITEMS FROM
DEPARTMENTS
❖CLEANING
❖PACKING
❖STERILIZING
❖STORING (TEMPORARY)
❖DISTRIBUTING TO USER DEPARTMENTS
16. 1.Steam sterilizer with Double door system
2. Ultrasonic Cleaner
3.Instruments Dryer
4.Ethylene oxide machine
5.Sealing machine (rolling)
6.Water gun & air gun
7.Assembling tables and Racks
17. RECEIVING AREA
• Used item from various departments of the hospital are
shifted to CSSD for cleaning and sterilization.
• Ideally, the items that get soiled with blood or body
fluid should be decontaminated with Sodium
Hypochloride solution in the user department itself
before sending to CSSD.
18. • The Receiving Area of CSSD should have access to
outside through a window with a counter.
• The items (Specially for instruments in trays) are
counted and Received.
• Thereafter, the instruments are inspected and
blunt/unsuitable Instruments are segregated/discarded.
•Necessary entries are made for records.
•Thereafter, the items are shifted to Cleaning area.
19. CLEANING AREA
• HERE THE INSTRUMENTS ARE WASHED EITHER MANUALLY
OR IN MACHINES.
• FOR MANUAL WASHING, SINKS WITH WATER SUPPLY AND
WORKING COUNTERS ARE ORGANIZED. DETERGENTS AND
BRUSHES OF VARIOUS SIZES AND SHAPES ARE REQUIRED IN
THIS AREA.
• ULTRASONIC WASHER IS A MACHINE USED FOR CLEANING
SURGICAL INSTRUMENTS. IT CONVERTS HIGH FREQUENCY
SOUND WAVES INTO MECHANICAL VIBRATION THAT
PRODUCES SMALL BUBBLES THAT BURST ON THE INTERNAL
SURFACES OF INSTRUMENTS AND DISLODGE THE WASTE
PARTICLES.
20.
21. WASHER IS SOPHISTICATE AND EXPENSIVE MACHINE. FROM
OPERATING ROOM OR OTHER DEPARTMENTS ARE PLACED INTO THE
TUNNEL WASHER WITHOUT ANY FURTHER HANDLING. THE
INSTRUMENTS ARE SUBJECTED TO CYCLES OF WASHING, RINSING,
ULTRASONIC CLEANING AND DRYING.
- AFTER THE INSTRUMENTS ARE WASHED, THEY ARE DRIED IN OVEN
DRYER AND SHIFTED TO PACKING AREA.
22. PACKING AREA
- CLEAN AND DRY INSTRUMENTS ARE PACKED
STERILIZATION, SO THAT THEY ARE NOT CONTAMINATED
BEFORE
WHILE
HANDLING AFTER THEY ARE STERILIZED. MOST OF THE
INSTRUMENTS ARE PACKED IN TRAYS (TRAY ASSEMBLY) THAT ARE
WRAPPED WITH DOUBLE LAYER OF COTTON CLOTH. PAPER
ENVELOPES ARE ALSO AVAILABLE FOR PACKING THE INSTRUMENTS.
THESE ARE EQUALLY EFFECTIVE BUT EXPANSIVE. PLASTIC BAGS
(ETO BAGS) ARE USED FOR PACKING THE ITEMS FOR ETO
STERILIZATION. THE PACKS ARE LABELED INDICATING DATE OF
STERILIZATION AND DATE OF EXPIRY (WHEREVER POSSIBLE).
- SEALING MACHINE IS USED FOR THE SEALING THE PLASTIC BAGS
IN WHICH INSTRUMENTS ARE PACKED. AFTER PACKING AND
SEALING, THE INSTRUMENTS ARE SHIFTED FOR STERILIZATION.
23. STERILIZING AREA
STERILIZATION IS DONE BY EITHER OF THE TWO METHODS IN CSSD:
❖STEAM STERILIZATION BYAUTOCLAVES
❖GAS STERILIZATION BY ETO (ETHYLENE OXIDE) MACHINES
❑AUTOCLAVE: STEAM UNDER PRESSURE IS THE MOST COST-
EFFECTIVE METHOD OF STERILIZATION, “AUTOCLAVE” GENERATES
STEAM AT A TEMPERATURE OF 121 DEGREE CENTIGRADE UNDER
15 POUNDS OF PRESSURE. AN EXPOSURE OF 20 MINUTES IS
REQUIRED FOR STERILIZATION.
❑FLASH STERILIZER: THIS IS A SPECIAL TYPE OF AUTOCLAVE THAT
HAS A VERY SHORT STERILIZATION CYCLE OF ABOUT 3 - 5 MINUTES
BECAUSE OF ITS ABILITY TO RAISE THE TEMPERATURE TO 132
DEGREE CENTIGRADE.
24. ❑ ETO STERILIZER: THE ITEMS LIKE CARDIAC CATHETERS ARE
THERMO SENSITIVE AND THEREFORE CANNOT BE STERILIZED BY
STEAM. SUCH ITEMS ARE STERILIZED BY ETHYLENE OXIDE (ETO)
GAS STERILIZATION. THE ETO IS AN EXPANSIVE AND TOXIC GAS. IT
IS ABSOLUTELY NECESSARY TO ENSURE THAT THESE ITEMS ARE
MADE FREE OF GAS MOLECULES BEFORE USING THEM ON A
PATIENT. THIS IS ACHIEVED BY SUBJECTING THE ITEMS TO FORCED
VENTILATION. THE ENTIRE CYCLE MAY TAKE ABOUT 8- 12 HRS.
25. STORE
AFTER STERILIZATION, THE ITEMS ARE TEMPORARILY
STORED IN A CLEAN STORE (ON RACKS) FROM WHERE
THEY ARE DISTRIBUTED TO USER DEPARTMENTS
26. DISTRIBUTION AREA
-IT SHOULD BE AWAY FROM THE RECEIVING AREA AND
MAY COMPRISE OF A WINDOW WITHCOUNTER.
-IN MODERN HOSPITALS, THERE MAY BE A SEPARATE
LIFT FOR TRANSPORTING THE STERILE MATERIALS TO
USER DEPARTMENTS.
28. SHELF LIFE
1. Shelf life of a sterile pack depends on the quality of the
wrapper, storage conditions, and conditions during transport
and amount of handling.
2. Shelf life is given as follows:
a.Linen packed trays or sets - 4 days
b.Medical grade paper packing - 15 days
c.Non woven packing material - 3 months
d. Peel pouch packing - 6 months
3. Sterile materials should be issued in a closed cabinet trolley
to OT and clean-decontaminated trolley to wards to minimize
contamination
4. Arrangement of sterile packs should be in sequence of their
expiry date.
29. STAFF
•CSSD IS USUALLY MANNED BY FOLLOWING STAFFS:
-CSSD IN CHARGE/ MANAGER: SUPERVISES ACTIVITIES OF CSSD.
-CSSD TECHNICIANS: OPERATE THE AUTOCLAVE AND ETO
MACHINES.
- CSSD ASSISTANTS: PERFORM THE CLEANING AND PACKING, GAUGE
CUTTING AND COTTON BALL MAKING.
-CLERK OR STOREKEEPER: TO MANAGE THE INVENTORY AND
STERILE STORES.
-HOUSEKEEPING STAFF.
30. ROLE OF CSSD MANAGER
•MAINTENANCE AND
REPAIR OF EQUIPMENT
.MANAGEMENT OF
SUPPLIES AND
CONSUMABLE
•ENSURE QUALITY OF
STERILIZATION
•ENSURE PROPER
DISTRIBUTION
AND TRANSPORT
• COST CONTROL MEASURE,TO
ANALYZE AND REDUCETHE
NUMBER OF CYCLE
• RECORD KEEPING AND DATA
ANALYSIS
• OPTIMAL UTILIZATION OF
MANPOWER AND EQUIPMENT
• MOTIVATION OF STAFF AND
TRAINING
• INTER DEPARTMENTAL
COORDINATION
31. Quality Assurance
• Mechanical Indicators:
MONITORING RECORD TIME, TEMPERATURE, HUMIDITY AND
PRESSURE DURING THE STERILIZATION CYCLE.
•Chemical Indicators:
DEVICES WITH A SENSITIVE CHEMICAL OR DYE TO MONITOR ONE
OR MORE PARAMETERS OF A STERILIZATION CYCLE.
•Biological Indicators:
EMPLOY THE PRINCIPLE OF INHIBITION OF GROWTH OF
MICROORGANISM OF HIGH RESISTANCE.
35. Conclusion
In most healthcare facilities, the Central Sterile
Supply Department (CSSD) plays a key role in
providing the items required to deliver quality
patient care. A well planned, well managed and well
staffed CSSD can ensure an infection free
environment of hospital and save valuable
life and money.