Central sterile services department
The central sterile services department (CSSD), also called sterile processing department (SPD), sterile processing, central supply department (CSD), or central supply, is an integrated place in hospitals and other health care facilities that performs sterilization and other actions on medical devices, equipment and consumables; for subsequent use by health workers in the operating theatre of the hospital and also for other aseptic procedures, e.g. catheterization, wound stitching and bandaging in a medical, surgical, maternity or paediatric ward.
The operations of a Central Service department usually consist of the reprocessing, that is cleaning, disinfecting, and sterilizing of reusable medical equipment. Reusable medical equipment, or RME, can consist of any medical equipment from stainless steel surgical instrumentation, to IV pumps and crash carts. Manufacturers are, in most cases, required to provide "instructions for use," usually contain the required steps to properly reprocess their equipment. RME is separated into three classes: non-critical, semi-critical, and critical. Each class requires a minimum level of reprocessing. Non critical items are items that do not have direct contact with a patient. This would be items like IV poles, IV pumps, carts, suction machines etc. Non-critical items require a minimum of intermediate level disinfection which can be accomplished with most hospital disinfectants like a bleach spray or wipes. Semi-critical items are items that are expected to have contact with what is usually an intact mucus membrane. These items usually consist of endoscopes like those used in colonoscopies. Semi Critical items require high level disinfectants like Glutaraldehyde solution, paraceitic acid, or hydrogen peroxide plasma. Critical items are items that will be introduced into a patient blood stream, or in a normally sterile area of the body. Critical items require sterilization, these would be all of what is usually considered surgical instruments used in various procedures.
Sterilization is the process of destroying all living organisms on an item and is the main task of most Central Service departments. Items to be sterilized must first be cleaned in a separate decontamination room and inspected for effectiveness, cleanliness and damage. There are multiple methods of sterilization, and which one is used is depentdant on many factors including: operational cost, potential hazards to workers, efficacy, time, and composition of the materials being sterilized. In the US, one of the cheapest and easiest methods is steam sterilization, where instrumentation trays and packages are placed in a chamber which is them filled with steam(usually 250-270 °F), killing all microorganisms. Sterilization can also be achieved using Ethylene Oxide(ETO) gas. This process was created in the 1950s by the US military and is used on items that cannot withstand the high temperatures of steam sterilization. ETO sterilization takes far longer than steam sterilization and is hazardous to workers, so alternative methods were created in the 1990s. The most common method for sterilizing at low temperatures today is by using hydrogen peroxide plasma, which has near zero risk to workers and cycles take a fraction of the time of ETO sterilization.
Depending on the healthcare facility's policy, there will be either an event related or time related sterile storage policy. If the policy is time related, an expiration date is placed on the sterile package, before being supplied to the end-user as a sterile product. If along the supply route, the sealed package got damaged or opened by a health worker, it needs to be returned to the CSSD for re-sterilization. If the healthcare facility's policy is event related, the package is considered sterile until an event occurs to compromise it's sterility (e.g. opened, dropped package, high humidity conditions, torn muslin wrap, etc.)
Sterile processing technician
A sterile processing technician is someone who cleans and sterilizes used surgical instruments and other medical supplies so that they can be safely redistributed and reused on future patients. This work is usually centralized in a special department of the medical facility.
Job titles include the following:
- Sterile processing and distribution technician (SPD tech or CPD tech)
- Central sterile supply technician (CSS tech)
- Central processing technician (CPT)
- Central service technician (CST)
- Certified Sterile Science Technician (CSST)
- Sterile Science Associate(SSA)- Degree.
- Sterile Scientist (SS)- Degree.
- Master of Sterile Sciences (MSS)- Degree.
Sterile processing departments are typically divided into four major areas to accomplish the functions of decontamination, assembly and sterile processing, sterile storage, and distribution.
- Decontaminating used surgical instruments and other medical devices
- Operating and maintaining special decontamination equipment like automatic washers
- Inspecting decontaminated items to make sure they are clean
- Organizing clean items and packaging them into appropriate instrument trays and sets
Sterilization and storage
- Sterilizing assembled trays of instruments
- Precisely operating and monitoring special sterilization equipment like autoclaves
- Keeping detailed records of items that have been cleaned, sterilized, and stored
- Stocking crash carts
- Organizing sterilized medical supplies
- Ensuring that sterile supplies don’t become outdated / preventing event related sterility issues
- Delivering sterile supplies where they are needed and picking up dirty ones
- "Sterilization basics". University of Rochester. Retrieved 16 June 2016.