Design of cssd

Design of CSSD and New Trends

Anuradha Desai

Manager,

Getinge Academy

04/08/23 I Anuradha Desai I Getinge Academy I Public

• Basic design concept for the CSSD/TSSU

• Trends and Developments

• Goods carriers

• Washer-Disinfectors

• Linen reprocessing

• Sterilizers

• The processing environment

• Centralization (”Super CSSD’s”)

• Reprocessing time

• Reprocessing cost

• Optimize

Design of CSSD and New Trends

Contents of Presentation

2

SOLUTIONS FOR WARDS AND OUTPATIENT CLINICS

Disinfection room - examples

CAD illustrations


Basic Design of CSSD

4

Disinfection Room

Hand wash basin

Discharge table for soiled arrivals

Flusher Disinfector with clinical sink

Clean storage shelves

Wall hung items improve floor cleaning!

SOLUTIONS FOR

CENTRALIZED DISINFECTION AND STERILIZATION OF REUSABLE GOODS

The CSSD (Central Sterile Supply Department) and TSSU (Theatre Sterile Supply Unit)

CAD illustrations



Small Dental and Health Care clinics

CAD illustrations

SOLUTIONS FOR

CENTRALIZED DISINFECTION AND STERILIZATION OF REUSABLE GOODS



SOLUTIONS FOR MANAGEMENT AND QUALITY ASSURANCE - TDOC



• Physical separation between soiled, clean and sterile zone

• The risk of cross-infection spread by staff is minimized

GENERAL CSSD DESIGN CONCEPT - 1



• Separated entries and exits for soiled, clean and sterile goods

• Strict separation of the staff working in the 3 different areas

• Room ventilation separated - for good production conditions

• Straight workflows - for simple, reliable working routines to have an economic and ergonomic production

Recommended: Patient related utensils - washed and disinfected at the user area –as soon as possible!

GENERAL CSSD DESIGN CONCEPT - 2



Goods flow – access from one side

• By creating an U-shape workflow you often can solve the CSSD design

Goods flow

Trolley Trolley flowflowStaff & Staff &

SuppliesSupplies

GUIDELINES FOR CSSD DESIGN



Goods flow – access from two or three sides

• By creating an U-shape workflow you often can solve the CSSD design

GUIDELINES FOR CSSD DESIGN

Trolley flowTrolley flow

Cont. & Cont. & basket basket flowflow

Goods flow


TSSU DESIGN CONCEPT – Goods Flow


• Surgical department with double corridor system and Disinfection Rooms

• Soiled corridor can be avoided

• Trend to wash in the CSSD instead of this way

Pack.

Transf.Table top clean.

Sterile store

Sterile supply corridor

Clean corridor

Recovery

ORScrub

Disinf.

room.

13

Decontamination starts at point of use

PROJECT WORKFLOW - Make Demand Calculations & Evaluate the Results.

Storage requirements

Work stn. requirements

Wash & disinfection demand

Qu

esti

onn

aire

( I

np

ut

dat

a )

Summary of productionUser demand presentation

Cal

cula

tion

(R

esu

lts)

Sterilization demand

Area requirements

HS66

GE69

46-4 &

46-5

8666 / 8668

CM32088-Turbo


PROJECT WORKFLOW – Presentation Material

Step 1

• 2D plan drawing

• Legend specification

• Calculation


• Try to locate the CSSD in a way that gives daylight to the main part of staff working here.

TYPICAL CSSD DESIGN

An actual design of a CSSD – plan drawing

Goods flow



Step 2 - On request only.

• 3D interior design pictures inserted into a Power Point Presentation.

PROJECT WORKFLOW – Presentation Material To Our Customer


TYPICAL CSSD DESIGN

An actual design of a CSSD - 3D view seen from the supply side



19

The Soiled arrival area - different solutions

• If the space is limited, try to arrange one side wider than the other to accommodate big trolleys on one side and small trolleys on the other side.

• Area should be able to hold arriving goods volume..


20

The preferred method of cleaning is in an automatic washing machine, withan integrated disinfection step. For thermo stable medical devices thermal disinfection is preferred to chemical disinfection.

AUTOMATIC WASHING MACHINE

21

• Soiled sorting area

• Washer-disinfectors of pass-through design

• Dedicated instrument preparation area for delicate and heat sensitive items. (Ultrasonic support)

• Hatch for clean goods transfer to packing area

CAD illustration

TYPICAL CSSD DESIGN

Soiled goods flow - 2





• Porter can supply goods to a reception without entering clean area

• One way workflow

• When linen is inspected, folded and packed in a CSSD, a separate room should be dedicated for that purpose, to avoid spread of lint.

• Linen packing table can be used by 2 persons, working together standing on each side.

TYPICAL CSSD DESIGN

Clean supply/linen goods flow



Solutions for the Linen room

• Example – calculated demand of 3.2 people in the Linen packing area, make space for totally 4 persons

• Drawing shows minimal recommended dimensions to fulfill the work tasks in the linen inspection, folding and packing area.

• The linen trolley can accommodate approx 1000 liters of linen. This corresponds to 33 baskets, when later packed into baskets.

• If space is limited – consider inspection, folding and packing at the laundry and only pre-storage, assembly, labeling and sterilization at the CSSD.

TYPICAL CSSD DESIGN



Changing rooms

•Local requirements should be followed.

Different ways to arrange Changing rooms to achieve different outer dimensions of the total changing area.

TYPICAL CSSD DESIGN



• A minimum distance of 1500mm between packing tables and minimum 900mm, side facing against a wall, as a good recommendation.

TYPICAL CSSD DESIGN

Control & packing area - 1

• Packing table located sideways from window avoiding light reflexes on instruments and work surface.



28

Clean Hands on Clean Goods

• By the inspection of the cleaning result, functional test and packing, height adjustable tables can be used for optimal ergonomic work conditions.

• Loading trolleys can also be designed as height adjustable units, to support and ease work conditions

CAD illustration

TYPICAL CSSD DESIGN

Control & packing area - 2



• Air lock with a recommended minimum 1400mm width and including hand washbasin.

• Air lock can also be used as service area at narrow installations.

• Return transfer hatch for racks - if, as in this design, used by loading of sterilizers.

TYPICAL CSSD DESIGN

Sterilizer area



32

• Mobile or stationary storage for sterile goods in baskets and/or containers.

• An over-pressure shall be kept in sterile store – creating an airflow from sterile store to the surrounding areas.

TYPICAL CSSD DESIGN

Sterile store - 1



• Open storage units, allowing good ventilation of stored goods as well as a good overview of the content.

• Inspection and recording of sterilized goods to have a tracing function!

• Assembly of goods according to received orders from user.

CAD illustration

TYPICAL CSSD DESIGN

Sterile store - 2



35

Sterile store - 3

• Position Baskets racks so that the baskets easily can be pulled out.

• Try to achieve corridors width min 1200mm between Basket racks and/or Wire shelf.

• If space is limited, there are questions to be raised:

Will goods be sent out directly to the users?

Can goods be stored at the users site?

• Sterile store capacity, according to demand of individual sites.

• Lockable Pass-through cabinets available for pickup of goods when CSSD is closed.

TYPICAL CSSD DESIGN



37

LOGISTICS IN STERILE SUPPLY SYSTEM

• Sterile goods meets clean trolley in the issue area, where the porter can collect sterile goods without entering sterile store.

• Goods further protected by use of tote box or trolley cover during ‘external transports’.

• Issue to op through direct connected elevator.

TYPICAL CSSD DESIGN

Issue area



• Standardized carriers used to promote productive, ergonomic goods handling:

- Controlled reception of goods

- Controlled washing and disinfection result

- Controlled sterilization result

- Optimized equipment usage

- Reduced workload for staff

BASICS FOR A GETINGE CSSD DESIGN



40

BASIC WORKFLOW IN THE CSSD Planning of Hospital Infection Control System

PACK

STERILIZATION

STOCK

RETURNDISINFECTION

INFECTION CONTROLTRENDS & DEVELOPMENTS


NEW TRENDS AND DEVELOPMENTS!

04/08/23 I Anuradha Desai I Getinge Academy I Public 42

Trends and DevelopmentBasic design concept for the CSSD/TSSU

• Controlled room ventilation (air flow) to get good production conditions:

- Soiled zone – negative pressure (-) versus adjoining areas

- Clean zone – positive pressure (++) versus to all adjoining areas

- Sterile zone – positive pressure (+)

New demands:

- Soiled zone – negative pressure (-) versus adjoining areas

- Clean zone – positive pressure (++) versus to all adjoining areas

- Sterile zone – positive pressure (+)

(-) (++) (+)


Goods carriers

• Increased usage of solid instrument containers, used as goods carrier for the surgical trays

Background

- Increased physical protection of the surgical instruments

- Paper wrapping may break

Consequences

• Increased washer-disinfector capacity needed (compared to nested empty baskets)

• Mixed usage occurs – ISO/SPRI/DIN baskets and containers, others?

• Increased demand on the internal logistic (as T-Doc) within the CSSD. –As if the lid and bottom of the container is one unit that shall be matched together after washer-disinfectors or washer-disinfector / cart washer. (Increased number of work procedures!)

• More heavy goods carrier (empty container +50% weight compared to empty basket)

- Increases the demand of lifting devices

- Heavy load program extends the processing time of the sterilizers


Washer-Disinfectors

• Transition from house steam supply to electrically heated equipment

Background:

- Big investment and maintenance costs.

- Energy loss during steam transport.

• Transition from external drying to washer-disinfectors with integrated drying.

(An interpretation of SS-EN ISO 15883)

• ”Air-tight” installation by pass-through installations.

• Non-vented units (No conn. to ventilation)

Consequences• Electrically heated washer-disinfectors longer processing time than steam heated units• More washer-disinfectors required at the CSSD

- Increased number of washer-disinfectors possible automation demand

• Integrated drying extends the processing time• More washer-disinfectors required at the CSSD

- Increased number of washer-disinfectors possible automation demand

• Equipment and installation practise have to be designed to reduce air flow and vent.


Linen reprocessing

• Reduced usage of reusable sterilized dressing sets for surgeon, patient and equipment.

Background

- Disposable dressing sets used instead (sometimes cheaper)

Consequences• Existing CSSD’s planned for reprocessing of reusable linen have spare capacity in their

sterilizer barrier

• Area for linen handling can be reduced and used for other purpose

Note! Very important parameter since linen normally stands for 30-40% of total sterilization goods volume

Linen usage


Sterilizers

• Reduced processing time

• Automation increase

• ”Air-tight” installation by pass-through installations

• Service access from unloading side by pass-through installations

• Sound level reduction

• Increased water and energy consumption awareness (”Green”)

Consequences• Number of units required will be less, due to increased efficiency.

However, bigger units not always best selection!

• Installation might require more space totally as fixed or moving automated units are attached to sterilizer.

• Equipment and installation practise have to be designed to reduce air flow

• Separated vacuumpumps - on site adapted equipment.

• Adaptation of automation units and options to actual conditions to be observed – increase awareness.


The processing environment

• Improved working environment within CSSD

• The CSSD work getting a higher “status”

• ”Green concept”

Background

- Avoid working injury. Sick leave costs money.

- Computerized workplace, focus on close connection to surgical department.

Consequences• Sound-absorbing actions implemented at:

- washer-disinfector installations - sterilizer installations (separate located vacuum pump)

• Focus on equipment with better ergonomics: Height adjustable tables and trolleys, side mounted operator panels with at more convenient operator height. Quote from Handbook for Health and nursing care (Sweden):”Avoid to carry and lift. Try instead to move by pushing or pulling and reduce the friction by means of assistance”

• Less energy, water consumption required.


Centralization (”Super CSSD’s”)

• Outsourced processing by a Super CSSD provides ”factory like” sterile services outside hospitals (UK, NL, FR, Singapore)

Background

- Low utilization of existing plants.

- Big investments required on existing plants to be accredited according to quality standard in accordance with medical devices directive 93/42/EEC

- Reduce cost per produced unit

Consequences

• Large scaled CSSD’s as base, but adapted for “fast track” performance

• Longer opening hours, (7days/24h)

• Increased number of instruments needed higher investment for instruments?

• Optimize the goods flow from and to end users

• Short circulation time (Penalty fee if delivery delay)

• Transports considered as dangerous goods special demands on performance

• Automation may be required.

• Smaller chamber units? in standby mode for fast track needed.

49

Leeds, England

SUPER CSSD

Calais, France

50

SUPER CSSD

Glasgow, Scotland

51


Reprocessing time

• Speed-up reprocessing time including the return and distribution transports.

Background

- Since outsourcing companies normally do not own the instruments, the high investment made by hospitals in surgical instruments do request a short turn-around time.

- Reduced budgets put pressure on supply departments, also at hospitals, for increased efficiency.

Consequences• Disinfection and sterilization processing time have to be reduced.

• Inspection and packaging process have to be more efficient.

• Queue of goods before Washer-disinfectors and Sterilizers as well as before Inspection and Packaging have to be heavely reduced.

• Logistic assistance must be implemented.

REDUCE TIME!


Reprocessing cost

• Bring investment, running cost and processing area down on reprocessing equipment.

• Reduce staff

• Separate purchase of reprocessing equipment to get optimal benefits?

Consequences• Need for an efficient work flow.

• Increased use of standardised work routines

• More productive equipment.

• Supply of ”superior total package” – ”All” what is required?


Optimize

• Adaptation of an optimal work flow to each customer requirements.

• Production area reduction

Consequences

• An initial detailed site condition examination.

• A more accurate equipment design and evaluation, Peak Demands to be addressed.

• Requirement of compact interior design proposal and the installed equipment.


Design of cssd

Health & Medicine

height adjustable

good production

versus adjoining

goods flow

disinfectorspossible

reduce air

typical cssd

sterile store