Infection Control and the Central Sterile Supply Department

By Bruce T. Bird

Central sterile supply departments (CSSD) are known by a variety of names in different facilities. Some go by central service, central processing, surgical supply and processing, or maybe sterile supply and distribution. Sometimes the name of the department helps the other areas of a healthcare facility to identify their specific functions.

CSSD departments may have all or some of the following responsibilities:

- Decontamination of instruments for surgery, the delivery room, emergency department, nursing divisions, clinics, and/or offsite urgent care facilities, etc.

- Instrument set assembly and packaging.

- Sterilization services

- Patient equipment cleaning, distribution, and billing

- Case cart system for surgery and/or the delivery room

- Managing loaner instrumentation and implants

- OR scheduling and/or billing

- Cardiac arrest cart processing, stocking and distribution

- Staffing surgical core areas

- Surgical instrument purchasing

- Acquisition of special order implants and supplies

- Instrument processing within surgery

- Monitoring operating budgets for other departments within the facility

Reporting structures for CSSDs are also different. Many CSSDs now report to surgical services, whereas others report to materials management or directly to administration. I have also heard, in some instances, of CSSD reporting to the pharmacy or nursing. Sometimes reporting structure helps ensure better communication and service between departments.

United in Infection Prevention

While CSSDs may not have the same label, responsibilities or reporting structure, there is one thing that never changes -- the fight against infection. This is the common goal of all CSSDs. Properly designed departments facilitate one-way flow of items between soiled and clean work areas and sterile storage. Walls and other barriers separate the functional areas of a CSSD: decontamination, preparation and packaging, sterilization and sterile storage.

We develop policies and procedures for our team members to follow so their efforts result in the elimination of harmful microorganisms. We research the proper chemicals to use for cleaning and the various levels of disinfection. Maintaining the cleanliness and sterility of items once they have been processed requires more good products and plenty of attention. We spend hundreds of thousands of dollars on equipment to effectively clean and sterilize items for successive use.

It isnt always easy to do all thats required to prevent infection. Sometimes there seem to be barriers along the way. There are barriers of knowledge or rather lack of knowledge; in other words, ignorance. Many barriers seem to be financial in nature -- whether its not enough staff, inadequate space, too few instruments, unreliable equipment or something else.

I have been involved in CSSD for more than 30 years and have had to overcome many barriers. While it wasnt always easy, I am happy to say that with the help of others, my knowledge increased, processes improved, and he work environments became more conducive to infection prevention. This was not by chance, but by design.

Sharing Critical Knowledge

Over the years, some of my very favorite people have been involved in infection prevention and control. Some have been nationally renowned speakers. They probably dont even know who I am or how much positive influence they have had. I have been very fortunate to have worked with the very best infection preventionists. Clinical excellence is very important and this is what I found in my infection control heroes. Their expertise went beyond the principles of infection control. They had caring, nurturing natures that helped build confidence in my ability to affect change.

Early in my career, Phyllis Smith from Idaho, Peggy Ryan from Colorado, and Mary Margaret Reichert from Ohio shared their wisdom with me at seminars, training classes and through many printed articles and texts. They were the movers and shakers in the CSSD world and were major forces in raising the bar of practice in the discipline. New, improved equipment processes and practices were introduced into the CSSD world because of their foresight and correct application of principles. I am certain that they had a background in infection control. They helped me to develop an infection control conscience. Their practical application of infection control principles in CSSD made it much easier to apply them in the real world and inspire several generations of CSSD team members.

I have fond memories of Sue Crow from the Louisiana State University Health Care Center in Shreveport. I heard her speak many times at IAHCSMM meetings and had the pleasure of hosting her in Utah at one of our chapter meetings. She added a lot of southern humor to her presentations. The humor helped me remember principles that I may have otherwise forgotten. I remember she compared most peoples erroneous concept of disinfection to "sheep dip", the processing of dipping sheep into a solution to prevent insect infestation. I still use her example and still get laughs (I give her credit, by the way).

I have enjoyed listening to William A. Rutala, PhD, MS, MPH, from the University of North Carolina School of Medicine and Martin S. Favero, Ph.D, previously with the CDC and Advanced Sterilization Products. For many years it seems that Perkins "Principles and Methods of Sterilization in Health Sciences" was the major resource for sterilization. While the principles remain the same, it has been great to have recent studies and data to support and improve the cleaning, disinfection and sterilization practices within our departments. Through their presentations and publications, I have learned that many of the new disease-causing organisms can be eradicated using current processes and others require processes to be modified. They are able to bring scientific studies to a level that is enjoyable, practical and understandable.

Michelle Alfa, PhD, FCCM from St. Boniface General Hospital in Winnipeg, Manitoba, Canada is always a delight. Her presentations on studies dealing with difficult-to-kill microorganisms and managing difficult-to-process instrumentation have helped me to better understand the complexities of what we do in CSSD. I very much appreciated her comments at a recent international meeting that in a very kind way helped to put someone elses presentation into perspective.

Our Infection Prevention Heroes

I have enjoyed working with the best infection preventionists. Rouett Abouzelof at my current facility, Primary Childrens Medical Center, and Carrie Taylor and Vickie Anderson at prior facilities, LDS Hospital and Intermountain Medical Center. All of these facilities are part of Intermountain Healthcare located in Salt Lake City. I know their responsibilities are not always easy to perform. They have mentioned that sometimes people view them as the police and hide when they see them coming. I view them more as guardian angels. We are definitely partners in preventing and controlling infection. They help ensure that we are doing things properly in our CSSD.

I am amazed at their knowledge of cleaning and disinfecting agents. I think they have all of the labels memorized! I remember Phyllis Smith teaching us that "If it isnt on the label, it isnt in the jug." I always have to read the labels, and they dont. They are always a resource for which liquids to use and how to use them properly.

I recall years ago when universal precautions (later changed to standard precautions) were first introduced. Their explanation of the concept and its practical application made it so easy to follow and apply in our everyday practices. Also, when standard processes for handling hazardous and infectious wastes, sharps, etc. were implemented, the changes made sense and were much easier to implement because of their preparation and approach. In reality, we didnt have to make many changes because our practices just needed a little "fine tuning" due their prior guidance.

They support changes in CSSD. They understand staffing, equipment and environment needs in our department. When additional resources are required, they support and help us justify changes we request. They help to keep us grounded and keep processes as simple and practical as possible. They help serve as a buffer when we sometimes overreact to issues impacting us in the CSSD and beyond. On the other hand, they dont hesitate to discuss concerns or research problems to help us improve, when necessary. I hope everyone working in a CSSD has this same relationship with their infection prevention and control department. If you dont, start working on creating a better one. It may have to start with you. My job is so much easier because of these individuals. We are partners in infection prevention and I know I can always rely on them for guidance and support, and for that I am grateful!

Bruce T. Bird is central processing manager at Primary Children's Medical Center in Salt Lake City.