In the past we discussed the uses for computers in a medical healthcare facility or hospital. While we provided some solid guidelines, we didn’t address the various departments, their specialties, and unique requirements.

Here we’ll be covering one of them ﹘ the Central Sterile Supply Department ﹘ from its importance in the hospital, its various tasks like sterile processing, to how medical computers benefit them. 

Role of the CSSD

We’ve covered the importance of sterile environments in hospitals many times in our articles. All aim to protect patients from further infections like hospital-acquired infections. The ICU and the operating room especially need to be scrutinized for pathogens due to the delicate state of their patients. 

One way to ensure patient’s safety is to make sure hospital supplies and equipment like surgical tools are as sterile as possible. This is the role of the central sterile services department (CSSD), also called the sterile processing department, sterile processing, the central supply department, or central supply. 

The CSSD provides sterilized materials to wards, operating rooms, transplant units, and outpatient departments. Depending on the hospital, its responsibilities may include:

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

Ancient Origins 

The cleaning of medical instruments to prevent infection has a long and extensive history.  In 3000 BC the Egyptians used pitch and tar as antiseptics. The fumes from burning sulfur were found to have been used to cleanse objects of infectious material. The Greek medical practitioner Galen (130-200 AD) cared for wounded Roman gladiators by boiling his instruments prior to use.

Reusable Medical Equipment: A Breakdown

Much of the work performed by the CSSD revolves around reusable medical equipment, or RME. These can consist of any medical items ranging from stainless steel surgical instruments to IV pumps and crash carts. They are separated into three classes: 

  • Non-critical
  • Semi-critical
  • Critical

Non-critical items consist of such equipment as IV poles and pumps. The sterilization at this class can be accomplished with most hospital disinfectants.

Semi-critical items consist of equipment that will have contact with intact mucous membranes like the inside of the nose, mouth, or anus. The endoscope like those used in colonoscopies is an example of such an instrument. Unsurprisingly, items in this class require high level disinfectants such as glutaraldehyde solution, peracetic acid, or hydrogen peroxide plasma to sterilize them.

Critical items involve any instrument which will be introduced into a patient’s blood stream or in a normally sterile area of the body. Use of sterilizers of such equipment is a must.

Major Areas of Sterile Processing

Sterile processing departments are typically divided into four major areas:

  1. Decontamination
  2. Assembly and sterile processing (sterilization)
  3. Sterile storage
  4. Distribution

Tasks in each area are primarily handled by the sterile processing technicians.

Decontamination Area

Decontamination is the physical and chemical processes that render medical equipment contaminated with harmful microbial life forms safe for further handling. In the decontamination area, RME are cleaned and decontaminated by various manual, mechanical, and chemical cleaning means. 

Decontamination processes include:

  1. Transport – Used supplies and equipment throughout the hospital are collected and taken to the Decontamination Area in the Sterile Processing Department. Effort is made to avoid contamination of personnel or any area of the hospital.
  2. Attire – The sterile processing technicians in the decontamination area wear protective clothing. This ranges from a scrub uniform covered by a moisture-resistant barrier, shoe covers, rubber or plastic gloves, to safety goggles and face masks.
  3. Sorting – The used supplies and equipment are sorted into appropriate areas in the department for cleaning.
  4. Soaking – Performed if the equipment is of a complex design that’s filled with debris, or if the devices are very bloody and cannot be rinsed or wiped. 
  5. Washing – A wide variety of materials and devices are used at this step. Detergent should be compatible with the materials in the device and suited for the type of soilage.  A washer/decontaminator is used to clean heat-tolerant items. An ultrasonic washer is used to remove fine soil from surgical instruments after manual cleaning and before sterilization (see below). Tunnel washers and cart washers resemble mini car-washes with most allowing totally hands-off processing. 
  6. Inspection – All instruments after cleaning undergo inspection before being packaged for reuse or storage. 

Assembly and Sterile Processing Area

Items coming from the decontamination area are assembled and prepared here for issue, or to be sent back into the hospital for use. Others are put into the Sterile Storage Area, which is covered later in this post. 

Items are also brought into the area to undergo further sterilization.

Sterilization is the process of destroying all living organisms on an object. It’s also called sterile processing. It differs from decontamination in the processes and equipment used. The sterile processing technicians are also responsible in performing the sterilization duties.   

The CSSD has multiple methods of sterilizing medical items. Which one is used depends on factors like costs, potential hazards to workers, efficiency of method, time, and composition of the materials being sterilized. 

In the US, one of the cheapest and easiest methods is steam sterilization. Instrumentation trays and packages are placed in an autoclave which is then filled with steam at temperatures between 250–270 °F (121–132 °C). 

Not all items can withstand such temperatures. Previously steam sterilization using ethylene oxide (ETO) gas would then be used. It performs similarly but at a lower temperature. 

Unfortunately, ETO sterilization took far longer than the steam method. Worse, the compound was hazardous to workers. In the US, steam sterilizing at low temperatures is now done through the use of hydrogen peroxide as a medium. It not only poses near zero risk to technicians but is much faster.

Other sterilization methods used in this area include using dry heat, microwaves, formaldehyde and ozone gasses, chemical solutions, and ionizing radiation

Pasteur’s Pupil and The Autoclave

In the late 1800s, French chemist and microbiologist Louis Pasteur confirmed that heat kills microbes. This led to the development of the pasteurization process used on many of today’s perishable goods. However, it would be one of Pasteur’s pupils, Charles Chamberland, who developed the first pressure steam sterilizer, or autoclave, which is still used today.

Sterile Storage Area

Items transferred to the sterile storage area are held there until it’s time for them to be issued. The area is carefully controlled from air temperature to moisture to prevent the growth of microorganisms. 

Items are also packaged to maintain their sterility. Information like dates are clearly marked for instance. This helps determine the item’s shelf-life. 

Distribution Area

When sterilized items are ready to be issued, it’s brought to the Distribution Area. 

Several functions are carried out at this location. Case cart preparation and delivery; exchange cart inventory, and telephone-order and requisition-order filling are just a few examples of these activities. 

Medical Computers and the CSSD

The importance of maintaining a sterile environment in CSSD poses unique requirements for medical computer use in the department. 

Antibacterial – It goes without saying you don’t want bacteria growing on the surfaces of the computer. While antibacterial sprays are available, such properties can actually be baked into the casing’s resin. They don’t need to be reapplied and inhibit growth even if the casing is scratched or damaged. 

Fanless – Computers cooled with fans take in pathogens in the air and blow them around the room. That’s the last thing you want in any area of the CSSD. Medical computers with fanless design do not create such problems, keeping cool using heatsinks. 

IP65 – An errant spray from water, detergents, or body fluids can cause damage if it gets inside a computer. Medical grade monitors and medical tablets with IP65 rating are sealed against such accidental splashes. This also makes them easier to clean with hospital-grade cleaners. 

Medical Grade – As seen above, there are a lot of machines used in the decontamination and sterilization of medical devices and equipment. No one wants any of them to suddenly break down in the middle of a cycle due to electronic interference. Computers deemed medical grade have been tested for hazards like fire, ignition from flammable anesthetics, electrical shock, mechanical impact, excessive electrical energy output, and radiation. They won’t affect the function of the equipment in the various areas. 

Closing Comment

Sterile processing departments like the CSSD are responsible for the decontamination, sterilization, storage, and distribution of reusable medical equipment throughout a hospital.  Infections can be dangerous to patients, many of whom are in critical condition. Medical grade and fanless design are just a couple of features that should be on healthcare IT’s checklist for computers in the CSSD.

If your medical group or hospital wants help with such vital equipment, contact a representative from Cybernet. As a true device manufacturer, Cybernet can customize products to meet your specific needs in a timely and cost-effective manner. 

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