Every area in the hospital has got checklist that is shared between BSCs, supervisors and process owners of the respective area. There is a provision for back up staff to be in place to take care of any emergency arising during the workflow. Based on certain parameters, the performance of the contractor is evaluated periodically and assessed which helps them to improve their services. Meetings and discussions are conducted to address the gaps.
Bio-medical Waste Disposal
At Asian Heart, waste that can be discarded at the point of use like Single Use Devices (SUDs), which includes needles and glass pieces, are fed into the sharp container in the washing area for disposal. In most of the public and government hospitals, only dustbins are used for such purposes. Different colour bags are in place at AH for disposal of other wastes.
Designated workers, specialised in collecting municipal waste are recruited by Maharashtra Pollution Control Board (MPCB). The vehicle used for the purpose is designed in such a way that there is no chance of spillage or contamination.
Dump Waiter, an automated Vertical Transport System (VTS) facilitates the transport of sterile material from the Sterile Storage Area to the Operation Theatre. Moreover, there is a window opening to the Dump Waiter, which is an interface between the OT and CSSD to maintain proximity of the VTS to OT.
The system is set up in the initial stage of the construction of the hospital because it entails a lot of civil work to be performed. A shaft has to be made through which the lift moves to deliver sterile goods to OT. The size of the VTS can be customized depending on the volume of sterile goods and the number of OTs in the hospital.
The dirty instruments from the OT, once the operation is done are transported through the service lift for reprocessing in the washing area.
Indian hospitals are generally known to clean, disinfect or sterilize Single Used Devices (SUDs). This practice should be adopted judiciously to reduce disposable medical waste and cost, without compromising on patient safety. Another trend, very new in Indian hospitals is that hospitals don’t outsource sterilisation of equipment to third party processors. US-FDA ensures that the hospitals, companies and third party processors, reprocessing of SUDs should meet the same standards used by the original manufacturer. Some Indian hospitals even prefer using indigenous sterilisers for cost cutting.
Regulation and Guidelines
Though the government has laid down guidelines to protect sweepers and waste collectors, there is sheer absence of guidelines or a regulatory body to check if instruments used are properly sterilised. A ray of hope is perhaps the Government’s initiative in laying down guidelines for hospital hygiene. In the absence of guidelines, most of the private and corporate hospitals (especially an Infection Control Committee) have its own protocols.
While hospitals are waking up to the importance of CSSD and the need for guidelines, some experts suggest that CSSD should also be installed at primary health centres. This may take some time; however what hospitals can start with is taking the initiative to train their staff in using latest technologies and using available international guidelines in CSSD.
Maintaining high standard of maintenance practices is no more a luxury in hospitals, but a necessity, especially in a department like CSSD. Being a back office, there may be a tendency to cut the corners which needs to be addressed separately. Any compromise in hygiene in these sensitive areas should be avoided to achieve quality patient care.