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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 6  |  Issue : 2  |  Page : 127-131

An audit of infection control practices in Central Sterile Supply Department in a Tertiary Care Hospital, Puducherry


1 Department of Microbiology, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, India
2 Department of Microbiology, Sri Siddhartha Medical College, Tumkur, Karnataka, India
3 Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, India

Date of Submission19-Nov-2020
Date of Decision17-May-2021
Date of Acceptance29-May-2021
Date of Web Publication08-Jan-2022

Correspondence Address:
Dr. Savitha B Hiremath
Department of Microbiology, Sri Venkateshwaraa Medical College Hospital and Research Centre, Ariyur, Puducherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bjhs.bjhs_119_20

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  Abstract 


BACKGROUND: Central Sterile Supply Department (CSSD) has broadened its significance from just an area where things just come cleaned and go with an autoclave machine to a huge department which regulates all the practices with standard procedures and has a huge role in infection control practices. A good CSSD indicates a good hospital infection control setup. We are nowadays more focused on standard practices following appropriate guidelines that can prevent nosocomial infections. CSSD has a huge role to play in the assurance of sterility check and the traceability of all the sterilized instruments for any suspected outbreaks from CSSD.
OBJECTIVES: The objectives of this study were (1) to audit the existing infection control practices in CSSD in a tertiary care hospital, (2) to implement the Infection control practices in the study area, and (3) to evaluate the impact of the progress after implementing changes in the study area.
METHODOLOGY: This is a descriptive interventional and hospital-based study carried out in Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry. The tools for the audit include questionnaire. Data was analyzed by SPSS 23.0 (IBM Corp. Released 2015.SPSS Statistics 23 for Windows, Armonk, New York, United States).
RESULTS: Pretest results for various questions ranged from 20% to 100% among the participants. The posttest was conducted after the training and teaching of and showed 100% results among all the participants.
CONCLUSION: We conclude that the auditing done in CSSD had basic knowledge of the needs and facilities. Implementation of practices in CSSD had been a huge learning process for all of us and was very fruitful. The impact of progress has been shown with the improvised quality of work being done now at various stages of CSSD.

Keywords: Central Sterile Supply Department, Central Sterile Supply Department staff, implementation of control practices, techniques and skills


How to cite this article:
Hiremath SB, Renushree B V, Vinod R, Shilpa P. An audit of infection control practices in Central Sterile Supply Department in a Tertiary Care Hospital, Puducherry. BLDE Univ J Health Sci 2021;6:127-31

How to cite this URL:
Hiremath SB, Renushree B V, Vinod R, Shilpa P. An audit of infection control practices in Central Sterile Supply Department in a Tertiary Care Hospital, Puducherry. BLDE Univ J Health Sci [serial online] 2021 [cited 2022 May 24];6:127-31. Available from: https://www.bldeujournalhs.in/text.asp?2021/6/2/127/335320



Central sterile supply department (CSSD) breaks the chain of infection in hospital.[1] It is considered today as an integral part of every hospital. The quality assurance given in CSSD can be considered as one of the significant hospital infection control indicators. Scope of CSSD has expanded from a department similar to an autoclave sterilization unit to encompass hospital infection control and stand for a dedicated workflow of sterile supplies and goods.[1]

Spaulding classification system is used in determining appropriate method of reprocessing of patient care items and equipment. The system classifies a medical device and also establishes the level of germicidal activity for the strategies of these medical devices.[2]

The technical break in the sterilization or disinfection process can cause many infection outbreaks from the surgical site or endoscopic procedures. These infections can be avoided, which may result in heavy damages for patients as well as the health system.[3]

Despite initiatives, implementation of infection prevention and control program in Indian health-care setting faces some important challenges. Nevertheless, there is clear interest among doctors and other providers to improve infection prevention and control.[4]


  Methodology Top


  • Study place: The study was conducted in Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry
  • Study period: The study was conducted from January 2019 to November 2019
  • Study type: It is an interventional-based study
  • Study population: The study population included CSSD technicians and an assistant staff nurse. The study was initiated after attaining permission from Institutional Ethical Committee.


Auditing existing infection control practices in Central Sterile Supply Department

Five criteria indicators were studied in the existing practices and the practices that may need a change to be implemented for an appropriate functioning. The criterias are mentioned in [Table 1]. The assessment of the same indicators was also documented in the form of pre and posttest.
Table 1: Criteria selected

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A structured questionnaire was prepared for conducting both pre and posttest.

Pretest was conducted after 1 month from the start of the study, and a score of 50% was expected from 70% of the staff and a posttest was conducted after the completion of the study and a score of more than 90% was expected from 90% of the staff.

Implementing the infection control practices in the study area

After studying the existing practices, the implementation in infrastructure and operating procedures were undertaken as per the standard guidelines given by National Accreditation Board for Hospitals and Health Care Providers.

Infrastructure

The institution has been provided with a neat segregated zone of working areas for the collection of soiled items, processing, packing, storage, and dispatch of sterile items. It is an exclusive one-way area. The workflow is unidirectional, and thus, chances of cross-contamination are minimal. All the areas were labeled as receiving area, decontamination area, disinfection area, clean area, store room, and dispatch area.

Ultrasonic washer was procured and was placed in disinfection room and operated as per manufacturer's instructions. The enzymatic solutions and disinfectants were procured and used and used with appropriate dilutions. The Food and Drug Administration-cleared and marketed formulations for disinfection include: ≥2.4% glutaraldehyde, 0.55% ortho-phthalaldehyde, and few more to include.[5] Ortho-phthalaldehyde has begun to replace glutaraldehyde in many health-care facilities for disinfection because it has several potential advantages over glutaraldehyde.[5]

Procurement of chemical indicators, biological indicators, and mechanical indicators for the regular check of the functioning of autoclave and Ethylene Oxide machine were initiated.

The operating procedures

Standard operating procedures (SOPs) were prepared and executed in the decontamination room, disinfection room, packaging area, sterilization area, storage area, and dispatch area.[6],[7]

Monitoring the efficacy of sterilization should be assessed by physical, chemical, and biological indicators as it may not be 100% effective at killing all organisms under all circumstances.[8]

We at our institute used Classes 1 and 3 indicators. Class 3 is single parameter indicators which react to only one of the critical process parameters of sterilization, either time or temperature. Class 5 indicators were procured since using of Class 5 chemical indicator formulations was a sufficient combination of 3 factors necessary for sterilization that is time, temperature, and saturated steam.[8],[9]

According to CDC and other medical associations to ensure heat penetration to all instruments during each cycle, a chemical indicator should be placed inside and in the center of a load of unwrapped instruments, routinely in every sterilization process.[8]

Fixed timings were stringently initiated for receiving and dispatch of instruments from CSSD.

The registers maintained were issue register and receipt register. Other registers started along with the above were equipment maintenance record (AMC once a year), equipment calibration register, recall register, sterility check–chemical indicator register, biological indicator validation register.

To evaluate the impact of the progress after implementation

Pre and posttests were conducted by simple questionnaire method throughout the audit of existing practices and setting up of infrastructure and procedures. Their knowledge, attitude, and practice were also assessed in these tests. Their ability to learn and acquire new things was also observed during the whole course.


  Results Top


For effective management, practices prevailing should have a well-orchestrated and integrated system of staff comprising of CSSD and maintenance personnel. We looked into the following auditing criteria as given in [Table 2] mentioning the existing practices and the changes that were implemented.
Table 2: Audit of existing practices

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The working personnel in CSSD could understand their key role in providing the items required to deliver quality patient care, the importance of delivering reliably sterilized articles available at the right place and at the right time to all departments. Effective policies and SOPs were developed for completing the many tasks. We also aim to train CSSD team members to follow these policies, and procedures will ensure a consistent and high-quality product and enhance service level. This in turn will support quality patient care.

The tests among the participants were conducted in 3 phases. All the tests had come with pre and posttests working together. One set was conducted before and after auditing existing practices. The second set was conducted before and after implementing infrastructure.

The third set was conducted before and after operational issues.

After auditing the existing practices, they were taught with basic working model of CSSD and the main components of the same. After the first pretest, it was concluded that the participants had some basic knowledge of the CSSD.

There were two training classes conducted for the participants in the first 4 months with a gap of 2 months. The second and third tests were conducted among this gap. Then, there were extensive discussions as and when the infrastructure was being developed over a period of time. The final posttest conducted after the whole work of CSSD showed 100% results among all the participants.

We now follow the following revised SOPs:

  1. Our institution assesses the efficacy by physical, chemical, and biological indicators
  2. The digital displays of the sterilizer equipment of temperature, time, and pressure are clear indications of physical or mechanical indicators
  3. Chemical indicators belonging to class 5 have been procured which measures the variables of time, steam quality, and temperature
  4. Biological indicators are considered as best indicators to check the effectiveness of sterilization. Spores of Geobacillus stearothermophilus and Bacillus atrophaeus are used for steam and ETO sterilization, respectively. We check for the efficacy of these indicators once a month, and whenever the load has any implants. However, CDC recommends biological sterility check once a week. (Reference).


Recommendations for the centralization of reprocessing, training of all staff with annual competency assessment, verification of cleaning, continual monitoring of reprocessing procedures to ensure their quality, and a corporate strategy for dealing with single-use and single-patient use medical equipment/devices are in the list for further workup.[2]


  Discussion Top


The aim of the study was to audit the present practices in CSSD and the standard practices that were to be implemented as per guidelines to manage the workflow and reduce nosocomial infections. The clinicians were also informed about the work in CSSD. This communication had a huge impact in developing trust between a microbiologist and clinician. The presence of chemical indicators in critical trays also assured the surgeons of adequate sterility check. All the people involved for setting up of standard guidelines and the trust of various health-care people among each other was overwhelming and satisfying. We are already in the process of acquiring further knowledge and upgrade and update ourselves with more finer points of CSSD.

Sterilization and disinfection in hospitals is a significant concern for both the medical and the general community.[10]

Achieving the purpose of providing health services with safety and quality depends on the application of safe processes and procedures based on scientific evidence. The use of these two factors requires a critical and careful reading of the current scientific articles, chosen by excellence, by the professionals.[3]

Basu et al. in their study emphasized about CSSD playing a critical role in ensuring the sterilization process and delivery to various users in the hospital in a quality-assured environment to reduce nosocomial infections.[11]

Basu et al. conducted a study regarding the operation of CSSD in a 167-bed oncology center in the eastern part of India and documented the importance of CSSD in control of nosocomial infections.[10]

A study done by Kulkarni S et al. concluded their study in assessing the knowledge, attitude, and practices among staff incharge having adequate knowledge and positive attitude with proper practices of sterilization methods in CSSD and recommends more such studies in India.[10]

As per our study findings and results, the staff is having very good knowledge and is having high positive attitude toward the use of sterilization techniques and is efficiently practicing the sterilization techniques. Positive correlation exists between attitude and practice. The staff of our CSSD is well trained and has scientific rationale behind principle. Our hospital also conducts regular training classes to update the knowledge of CSSD staff regarding new sterilization techniques.[10]

Sterilization facilities should aim for excellence in practices as this is part of patient safety. The guidelines that come with a checklist help service providers identify gaps for improvement to reach this goal.[2]

To develop Quality indicators for sterilization in CSSD. Quality indicators for sterilization in CSSD were searched by literature review and by current situation analysis by 79 infection control nurses (ICNs) and 83 heads of CSSD. Quality indicators were drafted and subsequently validated by 5 experts. The feasibility and applicability of the quality indicators were tested in 37 ICNs and 34 heads of CSSD. The quality indicators were finally refined by a forum of 5 experts and 5 representatives from CSSD. A total of 30 quality indicators were developed. These include 9 indicators for structure, 12 for process, and 9 for output of CSSD. The quality indicators were deemed appropriate for the assessment of the quality of CSSD in Thailand.[12]

CSSD at Tata Medical Centre– Kolkata is committed to the efficiency, economy, and uniformity of sterile supply for the care of all patients with aseptic techniques. The main aim is to supply the sterile medical devices to the clinical areas at right time, right place, and right condition.[13]

Effective IAQ monitoring methods and mitigation measures suitable for the hospital environment have been identified. Accordingly, strategies for the implementation of a hospital indoor air quality management system are recommended. Health-care workers, hospital engineers, and administrative staff can use the above as guidelines to manage and run their hospitals with healthful indoor air quality.[14]

The present study was designed to determine the effects of educational interventions in controlling of sterilization process with the current indicators since 1997–2011. Steam sterilization processes are validating with indicators in many countries. Our finding indicated that marked increases in the controlling of sterilization process with the use of chemical and biological indicators in the past 15 years. We focus on improving the sterilization process throw to detect and learn from experiences which are consistent with World Alliance for Patient Safety.[8]



Practices should be continually updated based on the latest research to enable the office surgical facility to provide the patient with the highest quality of care.[15]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Nautiyal S. Health care Infection Control Through cleaning and Sterilization. Clean India J 2012;8:58-62.  Back to cited text no. 1
    
2.
Ling ML, Ching P, Widitaputra A, Stewart A, Sirijindadirat N, Thu LTA. APSIC guidelines for disinfection and sterilization of instruments in health care facilities. Antimicrob Resist Infect Control 2018;7:25.  Back to cited text no. 2
    
3.
Stempluik V. The Central Sterile Supply Department and its Essential and Large Role in Quality of Care. ABRI 2017;22:59.  Back to cited text no. 3
    
4.
Swaminathan S, Prasad J, Dhariwal AC, Guleria R, Mishra MC, Malhotra R, et al. Strengthening infection prevention and control and systematic surveillance of healthcare associated infections in India. BMJ 2017;358:59-62.  Back to cited text no. 4
    
5.
Rutala WA, Weber DJ. Guidelines for disinfection and sterilisation in healthcare facilities and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). https://www.cdc.gov/infectioncontrol/guidelines/disinfection/. [Last updated on 2017 Feb 15].  Back to cited text no. 5
    
6.
World Health Organization. (2016). Decontamination and reprocessing of medical devices for health-care facilities. World Health Organization. Chinese version published by Shanghai Putuo District Center for Disease Control and Prevention in China. https://apps.who.int/iris/handle/10665/250232.  Back to cited text no. 6
    
7.
Central Sterile Supply Department. In: Sastry AS, Deepashree R, editors. Essentials of Hospital Infection Control. 1st ed. New Delhi: Jaypee; 2019. p. 301-28.  Back to cited text no. 7
    
8.
Jabbari H, Alikhah H, Sahebkaram Alamdari N, Behzad MN, Mehrabi E, Borzui L, et al. Developing the use of quality indicators in sterilization practices. Iran J Public Health 2012;41:64-9.  Back to cited text no. 8
    
9.
Policies and Guidelines provided by National Accreditation Board for Hospitals and Healthcare Providers. 5th Ed. Accredited by International Society for Quality in Healthcare (ISQua); 2020.  Back to cited text no. 9
    
10.
Chillarge CK. “Knowledge, attitude and practice regarding sterilization among staff in central supply department of Brims Bidar: A hospital based study”. Indian J Microbiol Res 2015:2:186-8.  Back to cited text no. 10
    
11.
Basu D, Bhattacharya S, Mahajan A, Ramanan VR, Chandy M. The importance of the central sterile supply department in infection prevention and control. Infect Control Hosp Epidemiol 2014;35:1312-4.  Back to cited text no. 11
    
12.
Sangthong K, Soparat P, Moongtui W, Danchaivijitr S. Development of quality indicators for sterilization practices of the central sterile supply department. J Med Assoc Thai 2005;88 Suppl 10:S128-32.  Back to cited text no. 12
    
13.
An overview of Central Sterile Supply Department of the Tata Medical Center, Kolkata. In: Scientific Operating Procedures for Sterilization Practices in India. New Delhi: Office of the Principal Scientific Adviser to the Government of India, 2012. p. 165-83.  Back to cited text no. 13
    
14.
Leung M, Chan AH. Control and management of hospital indoor air quality. Med Sci Monit 2006;12:R17-23.  Back to cited text no. 14
    
15.
Springer R. Sterilization/disinfection: Correcting common misconceptions in the office setting. Spring 2002;22:19-22.  Back to cited text no. 15
    



 
 
    Tables

  [Table 1], [Table 2]



 

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