Welcome! Thank you for attending today s meeting, it will begin shortly.

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1 Welcome! Thank you for attending today s meeting, it will begin shortly. How do I get a CE Certificate? Next week, all of today s meeting participants will be sent an containing instructions for obtaining a CE Certificate for today s meeting. The will be sent to the address you provided when you logged-in to today s meeting. If there are others listening with you today who did not log-on, you may forward the CE certificate to them. 3M Attest Sterile U Web Meeting October 21, 2010 Welcome! Topic: CSSD 101- What do you expect of your CSSD? Facilitators: Speaker: Susan Flynn, 3M IPD Dorothy Larson, 3M IPD Mark Duro, CRCST, IAHCSMM Approved Instructor Housekeeping Questions Mute feature (*7 = unmute; *6 = mute) Chat feature Technical difficulties CE Credits Post session follow-up For more information: 3 1

2 Mark Duro, CRCST, IAHCSMM Approved Instructor Manager, Central Sterile Processing Department New England Baptist Hospital Boston, MA Speaker is a consultant to 3M 4 Objectives Identify immediate needs in CSSD the first day/week on the job as a CSSD, OR Manager or ICP. Inspection/Audit of newly acquired CSSD. Understand the capacity and limitations of the CSSD. Strategies to work as a team (CSSD, OR and IC) to improve overall outcomes. 5 Week 1 Welcome to your new facility! What are some items you want to ensure are in place? Where do you focus your efforts? 6 2

3 Week 1 Conduct an internal audit and inspection Staffing Policies and procedures Manufacturers instructions for cleaning and sterilization Decontamination practices Tray inspection and assembly practices Sterilization practices, record keeping and quality assurance Sterile storage Relationship with Operating Room and Infection Control 7 Staffing Adequate instrument technician to OR ratio Proper supervision and technician structure. Do you have the right structure for success? Certification Assess education level of technicians and supervisors Prepare weekly in-service and routine staff meetings How is communication? Encourage professionalism 8 Policies and Procedures Review all policies and procedures How do the policies match up to current recommendations from AAMI and AORN? Are the minimum policies in place to function? Establish and prioritize what policies need to be drafted Work with IC and OR manger and explain any immediate needs and why 9 3

4 Manufacturers Instructions Do you have them? Where are they? Does staff know where they are and do they read them? Are they being followed? Do you have the equipment available to comply with instructions? Are they current? 10 Manufacturers Instructions Not all instructions provide the detail needed to effectively clean Some are vague and leave CCSD and OR to revert to AAMI and AORN recommendations The capture device to the right was a reported problem from a Surgical Technologist in the OR. The issue was investigated and resolved. 11 If it is not clean it is not sterile Some cleaning challenges for CSSD As newer instruments become more complex, they become harder to clean. We still have to focus on the ones that still give us difficulty 12 4

5 IM Flexible Reamer Very difficult to clean Flexibility harbors debris 13 Kerrison Ronguer Difficult to clean Slide carriage can harbor debris 14 Tray Inspection and Assembly Practice Ask OR staff what types of errors or mistakes might be occurring. Are the OR s needs being met by the CSSD? Tray error reporting - OR staff support needed. Tray error rates - compile data from CSSD Address issues as they occur Report great service! We are in this together for the best outcome for our patients! 15 5

6 Tray Inspection and Assembly Practice 16 12,442 ITEMS PROCESSED MAY Week Week Week Week Trays to Errors Errors Reported VisiPeel Item Medium Set Large Set Total Items Tray Inspection and Assembly Practice Is lighting in the area acceptable? Are inspection tools available? Magnifying glasses, video magnification and insulation testers are helpful. Are workstations appropriate? How are trays being assembled? 17 Sterilization and Sterilization Quality Assurance 18 6

7 Sterilization and Sterilization Quality Assurance Are sterilization instructions available - are they being followed? Is there one blanket sterilization cycle run for everything? What type of testing is done daily? How are implants being monitored in your sterilizers? Is every load BI monitoring practiced? Do technicians understand and are they able to interpret printouts? Is capacity sufficient for volume? Are sterilizers loaded properly? Are sterilizers overloaded? 19 Sterilization and Sterilization Quality Assurance Is the correct wrap/containment system being used? Are tray weights acceptable? How are loads being documented? Are loads allowed to cool? Is equipment being serviced as needed? Are staff dressed appropriately? 20 Sterilization and Sterilization Quality Assurance Integrated Recordkeeping 21 7

8 Storage Wrapped trays should be stored single layer on clean dust free storage shelves. Storage areas need to be monitored. Temperature up to 74 degrees F. Humidity 30 to 60% and should not exceed 70%. All floors, walls and ceilings should be made of surfaces that can withstand frequent cleaning. Storage should be cleaned daily. 22 Relationships with OR and IC Understand past relationships with CSSD, OR and IC. Build new relationships with your team. Speak with OR staff at weekly meetings. One of the most under utilized sources of helpful information in the OR can come from the Surgical Technologist. If possible rotate Surgical Technologists through CSSD. Attend Infection Control meetings. 23 Improving outcomes with your new team Understand the needs of the CSSD (staffing-equipmenteducation). Schedule weekly meetings with CSSD Manager and OR Manager. CSSD Manager and IC Manager should meet monthly to discuss sterilization and processing trends and share information on current processing issues. Use IC and CSSD networks to discuss issues and share processing information and guidelines. 24 8

9 Improving outcomes with your new team Most CSSD s were designed as an afterthought. Poor workflow can affect processing turnover which could lead to shortcuts. Shortcuts are taken to attain unreachable goals. Communication is key. Opportunities for failure can occur when we don't communicate. Reevaluate work practices to ensure all practices are Best Practice. Trust. 25 Invest in CSSD CSSD is the heart of the hospital. What is the condition of your heart? Are you in need of a transplant or some minor surgery? CSSD needs support from OR and IC to better serve. As instrumentation becomes more complex, newer cleaning and sterilization technologies may be required. Return on investment in CSSD results in better patient outcomes. 26 Team Projects All projects need support from CSSD,OR and IC to achieve results. Below are projects that facilities have recently worked on as a team: Reducing tray weights Implementing every load biological monitoring Flash reduction / elimination Rotating CSSD technicians to observe OR cases Rotating Surgical Technicians in CSSD Reducing tray assembly errors Departmental certification Surgical Services Pep Rally 27 9

10 Questions - Comments? 28 References Association for the Advancement of Medical Instrumentation (AAMI). Comprehensive guide to steam sterilization and sterility assurance in health care facilities. ANSI/AAMI ST79: 2006, A1:2008 and A2: Thank you! Next 3M Attest Sterile U Web Meeting: Nov 18, 2010 Register at