⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 11
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 22
ÜÜ Even with the tremendous strides beingEven with the tremendous strides beingmade in the health care facilities,made in the health care facilities,nosocomial infectionsnosocomial infections or hospitalor hospital--acquired infection (HAI)acquired infection (HAI) continued to becontinued to bea significant drain on human and economica significant drain on human and economicresources causing human suffering andresources causing human suffering andhigher healthhigher health--care costs.care costs.
INTRODUCTIONINTRODUCTION
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 33
ÜÜ One aspect of preventing these nosocomialOne aspect of preventing these nosocomialinfections in health care facilities is theinfections in health care facilities is theeffective decontamination of medicaleffective decontamination of medicaldevices.devices.
ÜÜ The provision of well controlled andThe provision of well controlled andvalidated decontamination processes willvalidated decontamination processes willhave far reaching effects.have far reaching effects.
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 44
Goal of infection control &Goal of infection control &CSSDCSSD
ÜÜ Sterilization Department and InfectionSterilization Department and InfectionControl teams work together to preventControl teams work together to preventcross infection tocross infection to
1.1. PatientsPatients
2.2. EmployeesEmployees
3.3. EnvironmentEnvironment
4.4. OthersOthers
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 55
Relationship between infectionRelationship between infectioncontrol and sterilizing servicescontrol and sterilizing services
ÜÜ Most departments that areMost departments that aresupported by Central Servicesupported by Central Servicehavenhaven’’t fully oriented their staff tot fully oriented their staff tothe role of CSSD in infectionthe role of CSSD in infectioncontrol.control.
ÜÜ Infection control and CSSD mustInfection control and CSSD mustjointly be involved in thejointly be involved in thedevelopment of sterilization anddevelopment of sterilization anddisinfection policies anddisinfection policies andproceduresprocedures
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 66
The Role of CSSDThe Role of CSSD
ÜÜThe Central Sterile SupplyThe Central Sterile SupplyDepartment's major function is toDepartment's major function is toprovide surgical instruments andprovide surgical instruments andmedical equipment that have beenmedical equipment that have beenthoroughlythoroughly DECONTAMINATED ,DECONTAMINATED , totorender them bacteria free and safe torender them bacteria free and safe touse during patientuse during patient’’s operation ors operation ormedical procedure.medical procedure.
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 77
ContCont------
It also follows thatIt also follows that
ÜÜ CSSD personnel should be aware of localCSSD personnel should be aware of localand state wide infection control policies thatand state wide infection control policies thatmay affect the service they provide.may affect the service they provide.
ÜÜ CSSD personnel have a responsibility forCSSD personnel have a responsibility forachieving consistent production andachieving consistent production andmanagement standards in the reprocessingmanagement standards in the reprocessingof reusable instruments and equipment.of reusable instruments and equipment.
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 88
They should realize thatThey should realize that
Reusable medical instruments if notReusable medical instruments if not
properly handled, cleaned, disinfectedproperly handled, cleaned, disinfected
or sterilized will be a source ofor sterilized will be a source of
infection risk to both patients andinfection risk to both patients and
staff.staff.
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 99
The role of infection controlThe role of infection control
ÜÜOne of the major roles of infectionOne of the major roles of infection
control with respect to CSSD is tocontrol with respect to CSSD is to
prevent healthcare nosocomialprevent healthcare nosocomial
infections, necessitating a closeinfections, necessitating a close
working relationship with the CSSD.working relationship with the CSSD.
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 1010
Implementation of infectionImplementation of infection
control policies in CSSDcontrol policies in CSSD
ÜÜ Infection control policies andInfection control policies and
procedures are bared in mind fromprocedures are bared in mind from
the first moment ofthe first moment of Designing andDesigning and
Construction of CSSDConstruction of CSSD andand
throughout the wholethroughout the whole
Decontamination Life CycleDecontamination Life Cycle
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IQIQ 1111
CSSDCSSD –– Basic DesignBasic Design
PrinciplesPrinciples
ÜÜ The physical design of CSSD is an essentialThe physical design of CSSD is an essentialcomponent of infection control strategy,component of infection control strategy,incorporating infection control issues toincorporating infection control issues tominimize the risk of infection transmissionminimize the risk of infection transmission..
ÜÜ It makes sense, therefore, that the area inIt makes sense, therefore, that the area inwhich the medical device is prepared, packed,which the medical device is prepared, packed,processed and stored should be free fromprocessed and stored should be free fromsources of contamination.sources of contamination.
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 1212
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IQIQ 1313
Design of CSSDDesign of CSSD
Internal Design of CSSD gives specialInternal Design of CSSD gives specialconsideration to the following :consideration to the following :
11-- Material of construction and interiorMaterial of construction and interiorfinishes ,ventilation ,etcfinishes ,ventilation ,etc……
22-- Design of work flow during theDesign of work flow during theDecontamination Life CycleDecontamination Life Cycle
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IQIQ 1414
Material of construction andMaterial of construction and--11interior finishesinterior finishes
Material of construction and interior finish is ofMaterial of construction and interior finish is ofprime importance to control spread of infection.prime importance to control spread of infection.
FINISHES
Ü In processing areas, finishes should besuitable for frequent cleaning and tolerantto surface-cleaning agents.
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 1515
ContCont------
Ü Joints( walls &floors)should be avoided asthey can hold moisture,encouraging the growthof organisms.
Ü Exposed drains shouldbe avoided specially inthe clean zones
X
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IQIQ 1616
ContCont------
Ü Worktops, sinks etc– should be built upto walls and any gaps sealed
Ü Where gaps are unavoidable, theyshould be wide enough for easycleaning.
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 1717
ContCont------
Ü To enable easycleaning andmaintenance of theclean zone, it isadvisable thatworkstations andstorage units shouldnot be fixed.
CSSD in Kuwait
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 1818
ContCont--------FLOORINGFLOORINGÜÜ Should have an impermeable, nonShould have an impermeable, non--
slip floor covering uplifted at theslip floor covering uplifted at theedges onto the walls.edges onto the walls.
ÜÜ PVC sheet is recommended withPVC sheet is recommended withwelded seams.welded seams.
ÜÜ This construction ensures aThis construction ensures awatertight, hygienic surface, whichwatertight, hygienic surface, whichwill withstand daily cleaning.will withstand daily cleaning.
ÜÜ Carpet or similar soft flooring shouldCarpet or similar soft flooring shouldbe avoidedbe avoided
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 1919
ContContWALLSWALLS
ÜÜ surfaces should be smooth, freesurfaces should be smooth, freefrom crevices to hide or harbourfrom crevices to hide or harboursoilsoil
ÜÜ Exposed piping connectionsExposed piping connectionsshould be avoidedshould be avoided
ÜÜ Epoxy coating or a sprayed paintEpoxy coating or a sprayed paintfinish is appropriate in processingfinish is appropriate in processingareasareas
ÜÜ Walls should be protected againstWalls should be protected againstaccidental damage from wheeledaccidental damage from wheeledtraffic .traffic .
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 2020
ContCont--------
CeilingÜ should be to clean-room standard
and sealed to prevent ingress ofairborne particles or othercontaminants from the ceilingvoid”
Ü Ceilings should be resistant tohumidity in zones where steamand moisture may take place
(BS EN ISO 14644-4: 2001, E.2.1.2).CSSD in Kuwait
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 2121
ContCont------Lightening
Ü Light fittings and controls inprocessing and storage areasshould be carefully selected toavoid ledges or crevices wheredust can collect.
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 2222
ContCont----------
Windows
Ü Windows in the wash room and cleanzones should be non-opening, sealed andflush fitting.
Ü Windows should not be installed in storageareas.
Ü Good access, internally and externally,should be provided to all windows tofacilitate cleaning.
X
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 2323
ContCont------Doors
Ü Automatic/semi-automatic doors make iteasier for collection and distributiontrolleys to pass unimpeded
ÜÜ self closing doors and air locks to provide aself closing doors and air locks to provide abarrier against loss of pressure and againstbarrier against loss of pressure and againstentry / exit of contaminated air intoentry / exit of contaminated air into cleancleanareaarea..
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 2424
Design of Air Conditioning and ventilation isDesign of Air Conditioning and ventilation isgoverned by IC to:governed by IC to:
ÜÜ Prevent less clean air from neighboring areasPrevent less clean air from neighboring areasentering the clean area byentering the clean area by different air pressures.different air pressures.
ÜÜ Create an air flow pattern that carries contaminatedCreate an air flow pattern that carries contaminatedair away from the clean areaair away from the clean area
Ventilation
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IQIQ 2525
ContCont--------ÜÜ Provide a comfortable environment for theProvide a comfortable environment for the
staff with controlled temperature, humiditystaff with controlled temperature, humidityand ventilationand ventilation
ÜÜ Grant the required number of air changesGrant the required number of air changes
per hour suitable for each area .per hour suitable for each area .
ÜÜ Air Fans should not be used in theAir Fans should not be used in theprocessing zonesprocessing zones
X
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 2626
Design of work flow throughout theDesign of work flow throughout the--22Life CycleLife CycleDecontaminationDecontamination
ÜÜ Work flow should be designedWork flow should be designedin such a way to achieve thein such a way to achieve thefollowing minimum ICfollowing minimum ICrequirementsrequirements
ÜÜ Zoning i.e sequence ofZoning i.e sequence ofincreasingly clean zonesincreasingly clean zones
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 2727
ContCont----------
ÜÜ The flow of both theThe flow of both the STAFFSTAFF and theand theEQUIPMENTEQUIPMENT must allow no crossmust allow no cross--over of soiledover of soiledand clean materials.and clean materials.
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 2828
Decontamination Life CycleDecontamination Life Cycle
Success in decontaminatingSuccess in decontaminatingmedical devices is dependantmedical devices is dependanton the successful completionon the successful completionof each stage of theof each stage of the
Decontamination Life CycleDecontamination Life Cycle..
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 2929
Decontamination Life CycleDecontamination Life Cycle
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 3030
INFECTION CONTROL POLICIESINFECTION CONTROL POLICIES
ÜÜ CSSD must have a written policies,CSSD must have a written policies,procedures and guidelines thatprocedures and guidelines that cover allcover allstages of thestages of the Decontamination Life CycleDecontamination Life Cycleand other related critical issues such as:and other related critical issues such as:--
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 3131
ContCont--------ÜÜ Hand Hygiene and Skin CareHand Hygiene and Skin CareÜÜ The Use of Personal Protective EquipmentThe Use of Personal Protective Equipment
(PPE)(PPE)ÜÜ Risk assessmentRisk assessment
ÜÜ Spillage ManagementSpillage ManagementÜÜ Management and treatment of needleManagement and treatment of needle
stick/sharps injuries.stick/sharps injuries.ÜÜ the Safe Handling and Management of Clinicalthe Safe Handling and Management of Clinical
WasteWasteÜÜ Environmental CleaningEnvironmental Cleaning
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 3232
Hand Hygiene and Skin CareHand Hygiene and Skin Care
P R E V E N T IO NIS P R IM A R Y !
P ro te c t p a t ie n ts… p ro te c t h e a lth c a re p e rs o n n e l…
p rom o te q u a lity h e a lth c a re !
X
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 3333
The Use of Personal ProtectiveThe Use of Personal ProtectiveEquipment (PPE)Equipment (PPE)
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 3434
Risk assessmentRisk assessment
ÜÜ Staff must decontaminate allStaff must decontaminate all reusablereusablemedical devicesmedical devices following each episode offollowing each episode ofuseuse
ÜÜ In 1968, Dr E.H. Spaulding classifiedIn 1968, Dr E.H. Spaulding classified
medical devices into three groups thatmedical devices into three groups that
require differentrequire different levels of processing.levels of processing.
"ヴャゅわャや"ヲエレャや"ヴヤハ"ゅヰヘレタ"ギホヱ"ヴャゅわャや"ヲエレャや"ヴヤハ"ゅヰヘレタ"ギホヱ::--
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 3535
Classifying Medical DevicesClassifying Medical Devices
before Processingbefore Processing
ÜÜ NonNon--criticalcriticalÜÜ SemiSemi--critical Acritical AÜÜ SemiSemi--critical Bcritical BÜÜ Critical ACritical AÜÜ Critical BCritical BÜÜ Critical CCritical C
-- Robert KochRobert KochInstituteInstitute ––( RKI )( RKI )
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 3636
Spillage ManagementSpillage Management
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 3737
Management and treatment ofManagement and treatment ofneedle stick/sharps injuries.needle stick/sharps injuries.
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 3838
The Safe Handling andThe Safe Handling andManagement of Clinical WasteManagement of Clinical Waste
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 3939
Precautions with end usersPrecautions with end usersÜÜ Another IC issue is to maintain theAnother IC issue is to maintain the
sterility of sterile goods till used bysterility of sterile goods till used byend users.end users.
ÜÜ Therefore all necessary precautionsTherefore all necessary precautionsand guide lines for proper handlingand guide lines for proper handlingshould be strictly adheredshould be strictly adhered
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 4040
CSSD StaffCSSD Staff
ÜÜ Enough investment should be paid toEnough investment should be paid tomake the staff well trained to and havemake the staff well trained to and havefaith on what they are doingfaith on what they are doing
ÜÜ Qualified and faithful staff will make ICQualified and faithful staff will make ICpolices implementalpolices implemental
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 4141
To give room for continuous improvementTo give room for continuous improvement
and updating the procedures and policesand updating the procedures and policesfollowing tools are recommended:following tools are recommended:
ÜÜ Customer (end user ) satisfactionCustomer (end user ) satisfactionquestionnairesquestionnaires
ÜÜ IC team feed back and commentsIC team feed back and comments
FEEDBACKFEEDBACK
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 4242
Kuwait experienceKuwait experienceIntegration between IC&CSSD was given the priority from the earlIntegration between IC&CSSD was given the priority from the early stagesy stages
of the service in Kuwaitof the service in Kuwait
ÜÜ IN 1978 CSSD was put under the supervision of theIN 1978 CSSD was put under the supervision of theInfection Control Committee, and this was the starting point.Infection Control Committee, and this was the starting point.
ÜÜ In 1983, the Directorate of Sterilization and Infection ControlIn 1983, the Directorate of Sterilization and Infection Controlwas established.was established.
ÜÜ In 1984 specialized training programs to graduate qualifiedIn 1984 specialized training programs to graduate qualifiedtechnicians had started in cotechnicians had started in co--operation with the Publicoperation with the PublicAuthority for Applied Education & Training.Authority for Applied Education & Training.
ÜÜ Since then, the Directorate of Infection Control set specialSince then, the Directorate of Infection Control set specialemphasis on introducing the latest technologies in the fieldemphasis on introducing the latest technologies in the fieldof sterilization parallel with continuous training programs.of sterilization parallel with continuous training programs.
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 4343
CSSD in Kuwait
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 4444
CSSD in Kuwait
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 4545
CSSD in Kuwait
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 4646
CSSD in Kuwait
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 4747
CSSD in Kuwait
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 4848
ReferencesReferencesÜNHS (E states training program)
HBN 13 Sterile Services Department
ÜÜ BS EN ISO 14644BS EN ISO 14644
ÜÜ HTM 2025:HTM 2025: ‘‘Ventilation in healthcareVentilation in healthcare
premisespremises’’.).)
ÜCDC
⇔⇔WFHSS W/S MuscatWFHSS W/S Muscat20062006
IQIQ 4949