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Healthcare Infection Control through Cleaning & Sterilization

Infection Control and Nosocomial committee

Areas which come under infection control are Maintenance, Engineering, Nursing, CSSD, Pathology and Clinical Administration. It is chaired by the Medical Director along with a team of Nursing Director, Nurse Managers of separate areas, most importantly surgical areas, pathologists, microbiologists, Hospitality Manager, CSSD Manager and Maintenance Executives.

The Infection Control Doctor/Nurse, who is assigned the job of infection control management collects data at different levels, analyzes and presents it to the infection control committee on a monthly or quarterly basis as per the requirement. If there is any serious non-compliance, corrective action is taken in accordance with international and local standards.

Accreditation

AHI is India’s Highest Accredited Hospital with JCI, ISO and NIAHO & also recognized as ‘India’s Best Private Cardiac Hospital’ (separate, All India survey by ICICI Lombard General Insurance & CNBC TV-18 & The WEEK). Even the lowest level of the housekeeping staff and all the other outsourced staff are thoroughly trained in such a way that they are clear about purpose of every single activity they perform.

Work Flow and Training

To maintain good workflow, sterilisation process involves proper functioning and co-ordination between four zones: dirty area, which is also called as washing area, assembly area or packing area, sterile area and finally, the sterile goods storing area.

CSSD’s dedicated workflow design aims at meeting microbiological demands. The Central Sterile Processing is generally based on three areas for soiled, cleaned/disinfected and sterile goods with products designed for a pass-through processing flow, serving as barriers between the areas.

The first barrier, used in the fight against pathogenic microorganisms is between the washing area and the assembly area where the inspection and packing take place.

The physical barrier itself consists of high-capacity, pass-through washer-disinfectors. Since soiled, cleaned and disinfected goods are handled in entirely separate rooms by separated operators, the risk of cross-infection due to staff and the surroundings is minimised.

There is a provision for mandatory training of nine hours in a month for all the personnel involved in CSSD and cleaning. The training for the staff is however customised based on the workload.

The second barrier between the assembly area and the sterile storage area includes pass-through sterilizers. Once again, the operators are physically separated between the two areas. An effective workflow also requires the use of standardised goods carriers by and between the various work procedures.

The in house staff maintains the work flow in CSSD. The instrument set has to be packed by the designated technician followed by wrapping to maintain sterility. Post sterilization, by means of double door system of modern sterilizers, the packs are unloaded to the sterile storage area and finally issued to the user departments. SOPs need to be strictly followed in CSSD so that right instruments get assembled in respective sets after a thorough checking of the instruments. In Sterile Storage area, sterile material is kept till it is being issued to the concerned departments like Operation Theatre (OT). Here, cleaning material is kept separately with clear identification in order to avoid using it in the dirty area and contaminate the sterile storage area. To avoid this, the hospital has a Janitors room where back up cleaning supplies are kept.

Cleaning practices

Since outsourced housekeeping agencies at Asian Heart have their own set of targets to meet and well defined protocols, the hospital management checks their activities for compliance or non- compliance on a periodic basis. Corrective and preventive action is followed, if required.

Basic cleaning practices that need to be followed in CSSD entail following daily, weekly and monthly schedules by the staff in maintenance and usage of different materials in designated areas. In house training is given to the cleaning staff to address any emergency before the CSSD staff and management could realise the discrepancy and send alerts on the same.

Human Resource and Efficiency

In case of an emergency, not only the clinical and nursing representatives rush to the patient, but, even the maintenance supervisor and concerned staff join them to complete a dedicated team effort.

Specialized Manpower Application required for CSSD is two to three per cent of the housekeeping department, which can be shared tentatively with other departments based on the patient influx. There is a requirement of more people at patient care areas considering more application of service in this area, which housekeeping department needs to attend to. “That is why you can draw an inference that ever since its inception as a centre of excellence in cardiac care nine years ago, the standard has never come down at AHI,” explains Nair.

It is now being widely accepted that efficient pre-washing / cleaning is essential in the sterilization process. Moreover, with the current technologies in the CSSD, the demanding thermo disinfection processes are possible to assure high levels of disinfection in perfectly dry materials, deeply reducing the time factor. Mishandling and improper sterilization of the instruments can be fatal. Safe and effective disinfection and sterilization can be guaranteed with clean medical products. CSSD provides tangible tools for securing high quality infection control because it is equipped with disinfectors and sterilization facilities. Muralikrishnan Nair concedes, “CSSD breaks the chain of infection in the…

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