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Advancement in instruments and challenges in reprocessing

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The goal of CSSD is to prolong the life of each instrument by proper reprocessing.

Today, the work of the Central Sterile Services Department (CSSD) is a complex operation. Surgical techniques continually evolve, and surgical instruments have kept pace with the age of technology. Surgeons need these kinds of sophisticated instruments to achieve their goal. With the advent and introduction of advanced sterilisers and instruments made out of various materials ranging from the good old stainless steel and titanium to nylon, Teflon, silicon, fibreglass, etc., things have undergone a big change. There is also a constant pressure to speed up the entire process of sterilisation and minimise the amount of turnaround time. This requires highly trained and innovative CSSD professionals who are able to deal with this complex technology and process on a day-to-day scale. Furthermore, with new techniques of surgery evolving, newer surgical instruments also continuously evolve, which requires proper understanding of assembling and subsequently disassembling of these instruments.

Various surgical procedures pertaining to minimally invasive and single incision surgeries have resulted in the introduction of an entirely new breed of surgical instrumentation of different materials as stated above. Surgeons and patients realise the benefits of these advanced surgical procedures such as smaller incisions, which result in smaller scars, reduced tissue trauma, decreased need of blood transfusion, shorter hospitalisation, faster recovery, less post-operative pain, rare occurrence of hernia, and minimise infection rate if these instruments are reprocessed properly.

With this, the entire chain of processing, comprising of handling, disassembling, sorting, transportation, cleaning, lubricating and subsequently assembling and packing, requires a whole new paradigm shift in operations towards final sterilisation and sending it to the operating rooms.

These new breeds of instruments are not only complex by nature but very expensive as well and the hospitals rather than stocking them in multiples prefer a fast turnaround time from the CSSD, which altogether makes things more challenging. The goal of CSSD is to prolong the life of each instrument by proper reprocessing.

This new scenario leads to a highly efficient and coherent way of working from the CSSD professional who not only should have a high degree of understanding of their job but also are quick to adapt and improvise to the newer challenges. It is the duty of the CSSD professionals to ask their workplace about different kinds of instrumentation to adhere and meet the various quality controls, checks and balances and demands from the manufacturers and instruments and equipment, which come for sterilisation by means of different techniques for e.g., Robotic and Minimal Invasive surgical instruments.

Central sterile professionals, the ultimate experts on instrument reprocessing, need to educate themselves and then teach their customers about the factors that can affect instruments turnaround time. There are two types of factors affecting instrument management. One is direct while the other is indirect. The direct factors are CSSD processes that can be controlled by CSSD. Indirect factors are under the control of customers and to control it, CSSD staff should work collaboratively with them. These factors are scheduling parallel cases, case preferences, overbooking, low instrument inventory, lack of communication, transportation etc.

Healthcare management needs to provide different types of testing devices, material and other equipment, e.g., lighted magnifying lens for inspection. As these instruments are very delicate, sharp, fragile or insulated, it requires a special kind of container. The instruments need to be processed as early as possible after the procedure. Also, immediately flush narrow lumens after use. Try to keep these instruments in moist condition till processing to avoid drying of protein. Also, protect these instruments in transportation, do not stack instruments, place heavier instrument at the bottom and lighter at top. Keep all scopes and fragile instruments separately and handle carefully. The surgeon should use these instruments for their intended use only.

Failure to process instruments correctly can lead to nosocomial infection or possible patient injuries. These devices create more processing challenges because some of them are fragile like scope, fibre optic cable, and most of them are smaller in size and compact. Some of them are long and narrow lumen.

Devising and constantly changing the process and documenting them in an easily understandable manner should be an ongoing process of updating the SOP (Standard Operating Procedures). The SOP should be dynamic by nature and should be highly standardised.

Today’s challenges from users are to do it fast, do it right, keep patient and staff safe. Another challenge is loaner instrument. Most of the time these loaner instruments are received just in time and need immediate processing. To reprocess these devices, high temperature, steam sterilisation as well as low-temperature sterilisation is needed in the facility or healthcare centre. Remember no matter how talented the surgeon, surgery cannot be performed without properly cleaned, assembled, tested and functional sterile instruments.

“Man is a tool-using animal… without tools, he is nothing, with tools he is all.” – Thomas Carlyle (1896)

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