Why the CSSD is so important

The central sterile supply separtment (CSSD) is probably the most underestimated yet essential part of a hospital. It is responsible, among others, for cleaning, disinfection, maintenance, packing and sterilization of reusable surgical instruments and medical devices. The CSSD staff do their utmost to ensure that the surgeon has all these goods at hand when treating patients in the operation room, and that the instrument sets are complete, sterile, and in good condition. Without the CSSD, not a single surgery could be performed.

But infrastructure does not fit in accordingly

Does this sound familiar? 

If so, you probably know about these difficulties.

Overloaded instrument sets provoke unnecessary reprocessing

In some hospitals, one surgical set can contain up to 120 instruments and often not even half of them are used during surgery. ^{[1], [2]} These overloaded and most often unstandardized sets are very heavy and difficult to handle for the CSSD staff and the nurses in the operating room. The overloading leads to unnecessary reprocessing of unused components. Clearly, this increases the costly use of personnel resources and reduces the life span of the instruments and devices, which in turn leads to a higher purchasing rate of new instruments. ^{[3], [4]}

A poorly designed or insufficient backup of surgical instruments makes the completion of sets impossible

If instruments need repair or must be substituted, CSSD often can’t provide appropriate replacement. As a consequence, incomplete sets come into the OR and cause time consuming delays. Often, hospitals have never built an outright backup stock. In addition, in many cases, hospitals do not provide good storage space organization and inventory management. This leads to a missing overview of what is available and also might result in incorrectly packed sets because items cannot be found or are not available in the amount needed. Digital solutions for the inventory management are often overlooked. That applies too for solutions that help with restocking, for example when items must be reordered, or with tracking items under repair. But the features of digital solutions could help with an impeccable item organization.

Incomplete or incorrectly packed instrument sets

Although many sets are overloaded, they often do not include what is needed by the surgeon, or even contain the wrong instruments. For example, gynecological instruments are sometimes packed by mistake into trays for orthopaedic operations. ^[5] Such mistakes happen quickly when the CSSD is understaffed and time is “stolen” by successive calls from the surgical department. Another factor might be non-optimal instrument management, often based on bulky paper files, so required items can quickly be overlooked or cannot be identified properly.

More than half of the instruments are in bad condition and unusable

On average, only 42% of the instruments within a set are fit for use. The rest needs replacement (27%), repair (24%) or surface treatment (6%) due to corrosive effects. ^{[6], [7]} This leads to complaints from the operating room and always means more work for the CSSD staff, as more than one set per surgery is required.

Technical service might not be full-fledged or is not well organized

Many hospitals see the necessity to repair broken instruments, but fail to install reliable routines for funding, contracting and organization. This leads for example to varying response times, that make planning impossible. Even worse, missing reasonable repair budgets lead to changing service partners, often without specific knowledge and unable to provide high quality repair for a safe OR outcome.

Soft wrap packaging is prone to pinholes

The instruments are often packed in soft wraps, which are prone to pinholes if they are not handled appropriately, for example during stocking. When this happens and pinholes are detected, the whole set is considered as non-sterile and requires reprocessing, thereby negatively affecting the workload in CSSD. Even worse, regarding patient safety, 18% of pinholes are not detected by the medical personnel ^[8] increasing the risk of surgical site infections (SSIs).

Daily challenges in the CSSD – how can they be solved?

At Aesculap, we understand the daily challenges a CSSD faces to meet demanding operating room schedules. Our teams, with more than a century of industry experience, are dedicated to help hospitals optimizing their perioperative performance. In the light of increasing size and complexity of surgical inventories, our experts are equipped with the specialized tools and methodology required to identify potential areas of improvement and support CSSD staff in their daily work.

Discover your opportunities for improvements 

What can be done to solve the problem?

Set optimization

Our findings show that set optimization is a highly important and effective measure: Surgical sets are often overloaded, but can be optimized and adapted for a variety of surgical procedures. Our experts found that an average set reduction by 22% for existing set structures is possible, in one case study 90 instruments could be reduced to 70 instruments per set. ^[9] In this way, reprocessing and wear of unused devices can be reduced, and lighter weight makes handling and transport much easier.
With a digital tool, the loading of sets can be effectively supported. According to standardized packing lists of all necessary trays, overloading is as well avoided as placing wrong items.

Optimized backup stock

Ensuring functioning and complete sets is a vital task for an efficient and safe OR process. Transparency about your inventory, in particular your trays and its contents, as well as establishing a reliable tracking of tray usage according to your OR routines brings in the fundamental basis to identify the optimized backup stock, no matter if your CSSD already has some items available or starts from scratch.

Establishing a well-defined backup stock with the right instrument-mix ensures that any set is fit for use in the OR, because the CSSD is always in the position to replenish, while instruments are under repair or new purchases are done. A properly organized backup stock helps you avoiding incomplete sets. The reserve is available in a reasonable amount fitting your surgical routines and in such an organized manner, that CSSD staff can quickly refill any gaps.

In combination with an efficient digital solution the handling of the backup stock becomes significantly faster and easier. An app enables CSSD staff to identify instruments, deposit or find them at defined locations. At the same time the system simplifies the overall management of the backup stock including features such as an alarm, if items fall behind a minimum stock level, or lists that allow timely orders of items that ran out of stock. Another benefit is the management of items under repair, as well as optimized restock functions. In addition, powerful analytic features show options where item handling can be optimized.

Digital instrument management system

The trend of digitalization is a driver of automation and efficiency. Recent advances offer a clear benefit for the CSSD: Modern digital tray organizing solutions reduce assembling errors and workload in an easy and smart way. The digital organization of your trays generates, collects and analyzes all relevant data and creates updated set lists to assist you in performing everyday processes such as packing, tracking, documenting and reporting.

Depending on your need and/or legal requirements, the implementation of an instrument management system (IMS) will optimize reprocessing by providing necessary information on the whole sterile goods supply, including the entire documentation of the reprocessing cycle, SOP and cost transparency. Interfaces allow the complementary use of different solutions such as backup stock and repair management within the IMS.

Value preservation

Ensuring the optimal functionality and availability of surgical equipment allows operations to go ahead as planned, avoiding delays, complaints and stress. A professional high-quality repair management and a technical service that is reliable and always available when needed can help you to achieve a long lifetime and proper functioning of your instrumentation and thus preserves the value of your surgical assets.

Containerization

Soft wraps are commonly used to pack sterilized surgical instruments, but are very prone to pinholes. Damaged packaging cannot keep the contents sterile and is a high risk for the patient’s health. By contrast, containerization does not only enable safer storage, but also easier handling as containers can be stacked and sorted by disciplines due to different lid colors. Containers with PrimeLine® lid maintain sterility for at least 360 days. ^[10] Shelf-life of containers with basic lid maintain sterility for at least one year. ^[11] Over ten-years old containers comply with the requirements of the DIN EN686 (Part1) norm. ^[12]

What could be different in your CSSD is, that you could always provide the right set at the right place at the right time and in right condition.