Impact of negative pressure system on microbiological air quality in a Central Sterile Supply Department

OBJECTIVE

Guidelines recommend that the cleaning area in a Central Sterile Supply Department (CSSD) maintain a negative pressure of the environmental air, but how much this system can impact the contamination of the air by bioaerosols in the area is not known. The objective of this study was to assess the impact of negative pressure on CSSD by evaluating the microbiological air quality of this sector.

METHODS

Microbiological air samples were collected in two CSSD in the same hospital: one with and one without a negative air pressure system. Outdoor air samples were collected as a comparative control. Andersen six-stage air sampler was used to obtain the microbiological air samples.

RESULTS

The concentration of bioaerosols in the CSSD without negative pressure was 273.15 and 206.71 CFU/m3 , while in the CSSD with negative pressure the concentration of bioaerosols was 116.96 CFU/m3 and 131.10 CFU/m3 . The number of isolated colonies in the negative pressure CSSD was significantly lower (P = .01541).

CONCLUSION

The findings showed that the negative pressure system in the CSSD cleaning area contributed to the quantitative reduction in bioaerosols. However, the concentration of bioaerosols was lower than that established in the guideline for indoor air quality of many countries. Therefore, it cannot be concluded that CSSDs which do not have a negative pressure system in their cleaning area offer occupational risk.

Surgical Instrument Decontamination: A Multistep Process

Surgical instrument decontamination requires the collective input of facility leaders, OR staff members, and sterile processing department personnel. Individual accountability can ensure that instruments are cleaned according to the manufacturers' written instructions for use, appropriate regulations, and facility policies. Information about the instrument decontamination process-from point of use to sterilization-should help enable perioperative nurses to advocate for and participate in the appropriate implementation of the necessary process steps. Sterile processing department leaders should develop policies and procedures for decontamination of surgical instruments and devices and the various accountabilities for the process steps. They also should help provide education for their staff members and complete required documentation. This article reviews the steps of instrument cleaning and decontamination and provides a framework to help perioperative leaders and educators facilitate these steps in their work environments, prevent instrument damage, and help ensure safe patient care.

Reflecting on the development of the decontamination services: pondering the past, presenting the future

This paper explores the historical developments of the UK decontamination services workforce over the past century. It will look back at how the services originated and look forward towards what the future could hold. This evolving workforce has progressed from traditional in-house training programmes towards accredited education, aiming to pave the way towards becoming a new profession--the healthcare scientist. The paper also explores some of the main drivers behind how previous healthcare professions have developed, and how these may impact on evolving professions such as decontamination services. The paper concludes by highlighting the importance of ensuring that staff are educated to national standards and keep abreast of current healthcare advances, in order to develop and retain the sterile services leaders of the future.

Exploring the perceptions of sterile services staff: a qualitative constructivist study

With innovations in medicine and science, the extended roles for practitioners continue to evolve and merge, often crossing interprofessional boundaries. This paper presents a qualitative study which explored sterile services staff experiences of current practices and how they perceive the prospect of professionalisation.

Infection control in operating theatres

The operating theatre complex is the heart of any major surgical hospital. Good operating theatre design meets the functional needs of theatre care professionals. Operating theatre design must pay careful consideration to traffic patterns, the number and configuration of nearby operating rooms, the space required for staff, administration and storage, provisions for sterile processing and systems to control airborne contaminants (Wan et al 2011). There have been infection control issues with private finance initiative built operating theatres (Unison 2003, Ontario Health Coalition 2005). The aim of this article is to address these issues as they relate to infection control and prevention.

New prion inactivation treatment presented

Information on breakthroughs in prion decontamination and detection were presented by Dr Graham Jackson, head of molecular diagnostics at the Medical Research Council, to a Central Sterilising Club meeting held in Manchester earlier this year.

Trabalho do enfermeiro no Centro de Material e seu lugar no processo de cuidar pela enfermagem

Estudo sobre o trabalho do enfermeiro na central de material e esterilização (CME), com a finalidade de analisar sua realidade social e seu papel transformador no cuidar em saúde e pela enfermagem. Tratou-se de pesquisa estratégica, com análise de discurso de enfermeiras da CME. Obteve-se que a gerência é sua principal atividade, em um processo estruturado que confirma a prática tradicional da enfermagem, tendo como objeto a coordenação do processamento de materiais médico-hospitalares utilizados em atos cuidadores. Tal prática caracteriza-se pelo cuidado indireto, que instrumentaliza não apenas o trabalho da enfermagem, mas os de outros profissionais. Em conseqüência, não se caracteriza como cuidado específico da enfermagem e do enfermeiro. Seu potencial transformador nas relações e novos modos de produção do cuidar em saúde e pelo enfermeiro deverá ocorrer antes pela competência do conhecimento específico em CME do que administrativo.

A study on the application of pasteurization of medical equipment

OBJECTIVES

To study the need of pasteurization of medical equipment and the possibility of production of pasteurizer in Thailand.

MATERIAL AND METHOD

The need of pasteurization of medical equipment was studied by a set of questionnaires to heads of the central sterile supply department (CSSD) and head ward nurses in 29 hospitals across Thailand. Efficacy of pasteurization was demonstrated by disinfection with an imported pasteurizer. A pasteurizer was later produced by the researchers and had it tested for efficacy in disinfection.

RESULTS

There were 26 items of medical equipment that could be disinfected by pasteurization. The number of the equipment was 6.2 pieces per bed per week. Disinfection of the equipment was done in C.S.S.D. as well as in patient's wards. The imported pasteurizer was efficacious in disinfection. The pasteurizer made by researchers was convenient for use, not expensive to manufacture and the operating cost for disinfection was 2 to 6 folds less than that done by ethylene oxide gas.

CONCLUSION

Pasteurization is effective in disinfection and is applicable to certain heat labile medical equipments. A pasteurizer is not difficult to produce, cheap and the operating cost is low. Pasteurization should be more widely applied in Thailand

A study on powdering of reusable surgical gloves

OBJECTIVES

To study the need of powdering surgical gloves and to produce a powdering machine.

MATERIAL AND METHOD

The need of powdering surgical gloves was done by questionnaires to directors or chiefs of purchase departments in 29 hospitals across the country. The practice in powdering surgical gloves was given by chiefs of the central sterile supply department (CSSD). A powdering machine was produced by the researchers in consultation with CSSD personnel in a hospital. The quality of powdering surgical gloves was evaluated by infection control nurses in the hospital. Cost comparison was done by a health economist.

RESULTS

The study in 2002 revealed that all of the 29 hospitals used recycled surgical gloves. Powdering of surgical gloves was done by hand in 27.6% and by powdering machine in 62.10%. Corn powder was used in 55.2% and talc in 41.4%.Defects in powdering ranged from 1.1% to 51.7%. No defects was found in surgical gloves powdered by the machine produced by the researchers. The costs for powdering and one pair of reused surgical gloves were 0.10 and 5.59 baht respectively.

CONCLUSION

Surgical gloves were reused in all hospitals in Thailand The powdering machine was effective and was not difficult to make.

Surface fixation of dried blood by glutaraldehyde and peracetic acid

The difficulties of successful prion inactivation by chemical agents has led to changes in recommendations regarding the reprocessing of instruments including flexible endoscopes. One of the changes is the preference for peracetic acid instead of glutaraldehyde in order to avoid fixation of organic material, but the surface fixation by various active agents has not been fully investigated. We used a standardized amount of dried blood soil on metal carriers (on average 22 mg). One part of the carriers was exposed to different disinfectants (four based on peracetic acid, three based on glutaraldehyde, two based on quaternary ammonium compounds (QAC), one based on QAC and amines, one based on phenols and one cleaning agent) and air dried. The difference compared with the non-exposed soiled carrier was taken as the measure of blood removal by exposure to the disinfectants. In addition the other part of the carriers was exposed to a cleaning agent and air dried. The cleaning agent itself was capable of removing more than 99% of the dried blood and served as a control for non-fixation. The rate of fixation of dried blood was calculated as the ratio of the weight of residual soil on 'soiled, disinfected and cleaned' carriers and on 'soiled and disinfected' carriers. All experiments were repeated eight times. Blood removal varied between 90.3% +/- 1.5% (phenol-based disinfectant) and < 10% (glutaraldehyde-based preparations). Fixation of the remainder was between 76.9 +/- 8.4% and 102.5 +/- 1.1% with glutaraldehyde and between 19.2% +/- 3.3% and 78.1% +/- 2.4% with peracetic acid. No other preparations showed a potential for blood fixation (< 1.3%). Our findings underline the potential for blood fixation, not only by glutaraldehyde, but also by peracetic acid, and support the evidence that effective cleaning should precede the chemical disinfection.

Kaiser shares ambulatory surgery benchmarks

The benchmark for utilization, or the amount of time the operating room is being used, is 85% in main ORs and 80% in ambulatory surgery unit, according to a study of Kaiser Foundation Hospitals of Southern California. Here are five ways to improve utilization: Use block scheduling and run at least some of your ORs through lunch. Schedule similar procedures after each other. Have your physicians standardize equipment and supplies as much as possible. Use certified registered nurse anesthetists. Reprocess and sterilize equipment on site.

Chemical hazards in health care workers

A comprehensive occupational health program is essential in health care settings to minimize the risk of occupational injury and illness in chemically exposed workers. Careful exposure assessment is the framework on which such a program is built. Medical surveillance provides an additional check by allowing earlier identification of at-risk workers. Regular analyses of these data are needed to increase knowledge regarding occupational hazards for health care workers. Correlation of adverse health effects detected in medical surveillance with exposure level is a powerful, although underutilized, tool for advancing occupational health. Worker training is the other critical element in an effective occupational health program. Employees are better able to comply with workplace rules designed to protect health and safety if they understand their rationale.

[Nursing staff and occupational accidents in a central supply unit]

The aims of this study are to analyse the occupational accidents that affected nursing workers in the central supply unit of the public hospitals that make part of the ERSA-2 in the city of São Paulo and also identify the work load performed by these workers. Data were obtained by verifying all accidents registers that were listed in the Worker Health Attending Service of the institutions related above and by interviewing the workers. Sample was divided in two groups. In the Group I are included sixty-one (61) nursing workers that have registered ninety seven (97) occupational accidents and in the Group II, are included forty five (45) nursing workers who have pointed seventy-eight (78) accidents during the interview. Results were evaluated by quantitative analysis and association tests have been applied, in order to verify the possible differences between the groups of workers. Thus, this study has been able of observe that the major part of affected workers are the female nursing attendants aging from twenty (20) to forty (40) years old. The occupational accidents were also analysed by considering the kind, the place and period in which the accidents occurred; the sort of objects and the injuries that caused them; the body region that has been affected in the worker and if the medical leaves has been necessary and how long it has been taken. The work load evaluated are those identified by the workers of the central supply unit as chemical, physical, biologic, mechanical and physiological loads; The psychic loads have not been mentioned. In this study, the occupational accidents occurrence shows relation with the human and the material resources as well as with the environment and also, the suggestions to minimize them have to consider these points.

Meeting instrument needs of incoming surgeons

Have you ever wondered what it would be like if you had the opportunity to be involved in surgeon recruitment? What kind of planning would be necessary? Who else would be involved? How many hours would it take? As director of central services, Oak Hill Hospital (Joplin, MO) for nine years, I had never before had an opportunity like this presented to me until recently. When asked to help prepare for the arrival of a new ear, nose, and throat (ENT) surgeon, I felt elated at the prospect of this challenge. This article reviews the steps we went through to prepare for the new physician with special emphasis on meeting his specific instrument needs.

Comparison of costs for reusable and disposable syringes

The cost for reusable and disposable syringes was studied in Maharaj Nakorn Chiang Mai Hospital, a university hospital in the northern part of Thailand. The cost for operating reusable syringes includes that for cleaning and sterilization. This consists of labour, replacement for defective syringes, tap water, electricity, depreciation of instruments. The cost for disposable items was calculated from the number of syringes used multiplied by the price of the individual size. Results showed that 34,598 syringes were used monthly from August to October 1989. The cost for reusable syringes was 84,714 baht in comparison with 81,874 baht for disposable items. The latter was cheaper by 2,840 baht per month. It is concluded that disposable syringes are cheaper, at least in this university hospital.

Partnership in education: central service prepares students for materiel management duties

Partnership in education looks at one technical college's approach to meeting the demand for trained workers in central service and materiel management. This article examines the partnership formed between a college, area health care facilities, and industry to design, develop, and implement a central service materiel management program.

Laparoscopic equipment troubleshooting

1. A successful laparoscopy program requires dedicated personnel, standardized inventory, and ongoing inservice training. Members of the operating team must realize their individual responsibilities and establish accountability while providing safe, efficient care for their patients. 2. A standardized inventory and checklist of all laparoscopic equipment and instrumentation deemed necessary for the procedure by the physician must be maintained and checked on a daily basis. 3. Adequate primary and backup instrumentation must be readily available at all times.