CURRENT CONCEPTS OF STERILIZATION HOSPITAL AND ORGANIZATION
At present the creation of a specific sector, whose responsibility is the preparation and sterilization of all the equipment (instrumental, surgical clothing, hydrophilic material, etc.) of the hospital, is a happy reality.
This sector is the CSSD (EC)
By definition, the CSSD is the hospital service recepciona, conditions, processes, controls and distributes textiles (clothing, bandages, dressings, etc.), biomedical instruments and equipment all Sectors of the hospital with the ultimate goal of obtaining a safe input to be used with the patient.
This centralized sterilization system has the following advantages:
EFFICIENCY: properly organized, this system provides efficiency through monitoring in the cleaning, maintenance and sterilization itself.
Standardization, uniformity and coordination of procedures are facilitated as there is constant supervision by a person dedicated to this activity.
ECONOMY: the centralized economical, because it avoids the multiplied existence of expensive equipment (steam autoclaves, dry heat stoves, sealers pouches, etc.). The life of the instruments is prolonged thanks to an efficient manipulation (cleaning, conditioning, sterilization) by specialized personnel.
SAFETY: the old decentralized sterilization systems with unsupervised personnel, the possibilities of process failures increased. Example of this:
-Materials Exposed to improper methods of sterilization: no high temperature resistant elements have been destroyed by dry heat processed.
-Modification of safe process parameters: (increase in temperature and process time by dry heat to increase process safety empirically.) By centralizing the sterilization all process control systems are unified, obtaining a sterilized input with high Margins of security.
There is another system currently in place for the sterilization of materials, the so-called “sterilization unit”. Located generally in the vicinity of the surgical plant, their function is only to process, by specialized personnel, the instruments already armed in their respective boxes, as well as the special packages to support the surgeries.
The advantage of these decentralized sterilization units is associated with the decrease in the number of instruments that are circulating in the hospital, thus eliminating the risks of the transfer of such materials.
LOCATION OF THE STERILIZATION CENTER
To define the correct location of the Sterilization Plant, it is important to keep the following points in mind. It should be:
.Situated in a restricted circulation area.
.Ablished from the area of movement of people.
.Installed with ease of access to the maintenance services of the area’s own equipment.
. Located next to the main services that consume sterilized material.
.Installed with easy access to the exterior of the air extraction system, to avoid long sections of ducts.
.Remove from places that present a risk of inflammation.
The definitive location will arise from a careful evaluation of these points, then adapted to the reality of the hospital in question.
DESIGN OF THE STERILIZATION CENTRAL
In the design considerations of the Sterilization Plant, consideration should be given to the needs of a sector that effectively and specifically facilitates processes, minimizes environmental contamination and facilitates maintenance of the sterility of the material or raw material processed.
The centralization of all processes, although possible, is a complex task.
Sterilization is a complex process that requires sophisticated equipment, adequate space and qualified personnel to maintain a training program and continuous quality assessment.
Considering security and cost reduction, centralization of all processes is the most recommended, but there are particular circumstances that make this centralization impossible. In this case, firm work policies must be followed in order to maintain the ultimate goal of obtaining a sterile input to be used reliably with the patient.
Definitions of areas
Reception Area and cleaning: Area where reusable elements: instruments, equipment, etc., are received, recorded, and subjected to a cleaning process.
Support Area: Area, showers and Office and other facilities for staff.
preparation and packaging areas: Area where clean and dry elements are inspected, assembled in sets, boxes, wrapped or packaged properly selected for the sterilization process. It can be a single area or divided into two: one for conventional instruments and the other for different biomedical devices, anesthesia circuits, respirators, thermolabile mats in general.
preparing textile area: Area where reusable clean textiles(surgical lingerie), and different hydrophilic materials: gauze, bandages, etc., are inspected, armed and packed their packaging process. Inspection of the wrapping materials is also carried out in order to detect irregularities, defects, foreign objects.
This sector may be within the Sterilization Center or in a sector separate from it.
Example: Arrangement of the surgical clothing package in a sector external to the sterilization plant, for example, wardrobe.
Sterilization Area: Area where steam autoclaves are located, ethylene oxide (ETO), dry heat stoves, and all other sterilizing equipment: ormaldehído, hydrogen peroxide plasma; Including the space for loading and unloading cars.
In case of autoclaving by ethylene oxide, it must be in an area separated from the rest of the equipment.
Storage Area sterilized material: Area where materials are sterilized and previously stationed distribution.
Area raw material tank: Storage Area textiles, packaging materials and other clean products. It can be located in or out of the Sterilization Center.
3.1. 8. Administrative Area: Office chief supervisióndonde area and staff documentation CSSD, library and reference material is concentrated.
3.2 Design criteria
Prior to the design of the work areas of the Sterilization Plant, basic operations should be defined. Here are some of the specific decisions that need to be made:
3.2. 1. If cleaning of instruments will be centralized or decentralized. In the case of being centralized, it can be done with washing machines or manually.
3.2. 2. If the preparation or packaging of hydrophilic material will be centrally or not
3.2. 3. If sterilization will be no centralized or sterilization units
3.2. 4. If the assembly of boxes will be instrumental in the user of the same sector Surgical Center, Obstetric Center or CSSD.
3.2. 5. Where the prewash (first step decontamination process) of reusable materials will be patient.
3.2. 6. What elements of anesthesia and inhalation therapy will be discarded which will be reused and how and where they will be processed and stored.
3.2. 7. What level of Stock must be kept in the warehouse of sterile materials.
3.2. 8. If the disposable supplies will be stored or not in the CSSD.
3.2. 9. What kind of distribution system will be used: horizontal, vertical and if projected an increase in tasks.
3.2. 10. How much equipment will be necessary if you agree with the project work.
3.2. 11. If you do not need or creating an area for the preparation of surgical clothing package, since currently there are rental options surgical clothes and use disposable clothing.
Considering that the validation of the sterilization process involves the validation of each and every step involved in the process, all the factors mentioned above should be considered in the design of the work area in order to facilitate the tasks that in those areas Are developed.
3.3 Circulation model
The sterilization plant must be designed in such a way that the separation of areas is clearly visible: a pre-washed input is “received” in a sector for cleaning, then conditioning (“preparation sector”) and sterilized to be finally stored. All this with a unique sense of movement and no setbacks.
The design of the work area should allow a good space for everything to work properly, minimizing the distances between area and area. This limits the possible environmental contamination and, therefore, the contamination of inputs.
Transit in the areas of the Sterilization Center must be exclusive to your staff. The supervisor will define, with strict criteria, who and with what clothing they can move through the sector. This care must be taken because both staff and visitors are potential carriers of microorganisms and thus increase the risk of contamination on the sterile input.
It is also important to protect personnel from the germs present in the soiled area, from inputs that need to be washed. Consequently good practices in traffic control and the use of protection barriers are essential.
3.4 Infrastructure requirements
3.4. 1. Space Requirements: vary significantly according to the processes that perform the sterilization and are always estimated during the planning of it. The general recommendation will be 1 m2 for each hospital bed.
3.4. 2. Mechanical Systems: In addition to the mechanical requirements, electricity, water and steam sterilization processes usually require pressurized systems as compressed air, nitrogen, floor steamer and vacuum systems. A system of distillation or demineralization of the water to be used, both in cleaning and in steam autoclaves, is recommended.
3.5 General industry requirements
3.5. 1. Floors and walls: They must be constructed with washable materials that do not release fibers or particles. They should not be affected by the chemical agents usually used in cleaning.
3.5.2. Ceilings shall be constructed so as not to leave angles and present a single surface (health angles) to prevent condensation of moisture, dust and other possible causes of contamination.
3.5.3 Ventilation: Ventilation systems should be designed so that air flows from clean to dirty areas and then is released to the outside or recirculation system filter must not be less than 10 parts of air, per hour. Ventilators are not allowed in the Central Sterilization System because they generate great turbulence in the air by recycling dust and microorganisms from the floor to the work tables.
3.5.3. Temperature and humidity is desirable to be between 180 C and 220 C and a humidity between 35 and 70%. At higher temperature and humidity, microbial growth is favored and at lower temperature and humidity, certain parameters of sterilization, such as penetration of the sterilizing agent, may be affected.
3.6. Special Requirements by Areas
3.6. 1. Areas of cleaning soiled area: They must be physically separated from all other areas (preparation, processing, storage) and easily accessible from an exterior corridor. The importance of physical separation is based on the need to prevent aerosols, microdroplets and dust particles from being transported from the dirty to the cleaned area by air currents, since in this sector, due to the type of work, Develops (brushing, ultrasound) a lot of aerosols are generated.
Floors, walls, ceilings and work surfaces shall be constructed of non-porous materials that support frequent cleaning (minimum daily) and moisture conditions.
All the air of this sector must be, expelled to the outside without recirculation; Thus preventing the reintroduction of contaminating clean areas that put the patient and the personnel at risk.
3.6. 2. Area preparation: Ideally, this sector possesses aeration system with positive pressure.
3.6. 3. Processing area: Yes there is an ETO sterilizer in this sector should be paid special attention to gas removal systems abroad.
3.6. 4. Area of deposit sterilized material: must be located adjacent to the processing area and preferably in a separate area with limited access.
The tank system (open or closed shelves) should be selected based on the rotation of materials and the type of packaging material used.
The ventilation system will be designed (via positive pressure) so that the air flows out of the reservoir area.
Maintaining the sterility of the input is essential. Since most packages do not provide an absolute microbial barrier it is important that environmental contamination is minimized in order not to compromise the sterility of the material during storage.
CLEANING ROUTINE OF THE STERILIZATION CENTRAL
At least daily floors and work surfaces must be cleaned. Other surfaces (shelves, ceilings, glass, walls) will be cleaned periodically according to a regular program given by the supervisor.
Personnel must be very careful to avoid altering the integrity of the containers of the materials already processed during the cleaning process.
Cleaning will always be done from “clean” areas to “dirty” areas, in order to avoid the transfer of contaminants.
It is ideal to have cleaning implements (rags, flannels, sponges) differentiated by areas: dirty and clean.
The basic staff consists of 1 boss / supervisor and staff of procedures (technicians in sterilization, technical auxiliaries and housekeepers).
All preparation and processing of materials, including decontamination, cleaning, packaging, sterilization, storage and distribution steps, should be under the responsibility of a supervisor.
The person assigned to this task must have experience, training and education in the subject.
You should maintain ongoing training and refresher programs as well as participate in the infection control standards drafting committees of the institution in which you provide services.
It will also be within its competence the evaluation of the personnel that, in charge, will carry out its tasks in the area (auxiliary technicians, maids).
These operators will demonstrate a perfect understanding of the specific processes of sterilization used in the health area, as well as in all aspects related to such processing (cleaning, packaging, circulation).