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Anuradha Desai
Manager,
Getinge Academy
Design of CSSD and New Trends
Contents of Presentation
• Basic design concept for the CSSD/TSSU
• Trends and Developments
• Goods carriers
• Washer-Disinfectors
• Linen reprocessing
• Sterilizers
• The processing environment
• Centralization (”Super CSSD’s”)
• Reprocessing time
• Reprocessing cost
• Optimize = Customer Value
CAD illustrations
The CSSD (Central Sterile Supply Department) and TSSU (Theatre Sterile Supply Unit)
CAD illustrations
SOLUTIONS FOR
CENTRALIZED DISINFECTION AND STERILIZATION OF REUSABLE GOODS
Small Dental and Health Care clinics
CAD illustrations
Recommended:
Patient related
utensils - washed
and disinfected at
the user area –
as soon as possible!
Trolley flow
Staff &
Supplies
• By creating an U-
shape workflow you
often can solve the
CSSD design
Goods flow
• By creating an U-shape
workflow you often can
solve the CSSD design
Cont. &
Goods flow basket
flow
Trolley flow
Basic Design of CSSD
Goods flow
• Surgical
department with
double corridor
Table top clean.
system and Transf. Recovery
Disinfection
Rooms
Clean corridor
• Soiled corridor Disinf.
can be avoided room.
Pack.
• Trend to wash in
the CSSD instead
of this way
ORScrub Sterile store
46-4 &
46-5
Storage
8666 / 8668
requirements
GE69
HS66
88-Turbo
CM320 Work stn.
requirement
s
Calculation (Results)
User demand presentation Summary of production Wash & Sterilization Area requirements
9/28/2010 I Anuradha Desai I Getinge Academy I [CLASSIFICATION Public]disinfection demand
demand
DEMAND CALCULATION – New Improved
Finetuning of Calculation Results
• Calculated demand
for steam and
electrical heated
washer-disinfectors
for comparision.
• Calculation consider
Ao600 or Ao3000
processing times.
• 88TURBO and
CM320 now
included.
Step 1
• 2D plan drawing
• Legend specification
• Calculation
Step 2 - On request
only.
• 3D interior design
pictures inserted into a
Power Point
Presentation.
• Washer-disinfectors
of pass-through
design
• Dedicated
instrument
preparation area for
delicate and heat
sensitive items.
(Ultrasonic support)
CAD illustration
Changing rooms
Different ways to arrange Changing rooms to achieve different outer dimensions of the total changing area.
• A minimum distance of 1500mm between packing • Packing table located sideways from
tables and minimum 900mm, side facing against window avoiding light reflexes on
a wall, as a good recommendation. instruments and work surface.
CAD illustration
• Inspection and
recording of sterilized
goods to have a
tracing function!
• Assembly of goods
according to received
orders from user.
CAD illustration
Sterile store - 3
T-DOC
Management
• Designed, supporting work
areas and assisting equipment
optimize the work flow under
controlled conditions:
- ‘Barrier’ design
- Assisted Management
New demands:
- Soiled zone – negative pressure (-)
versus adjoining areas
- Clean zone – positive pressure (++)
versus to all adjoining areas
- Sterile zone – positive pressure (+)
∆+10 Pa
Background
- Requirement for cost reduction of the department (Area savings)
Consequences:
- More efficient work flow is required
- Demand for reduced processing time
Background
- Increased physical protection of the
surgical instruments
- Paper wrapping may break
Consequences
• Increased washer-disinfector capacity needed (compared to nested empty baskets)
• Mixed usage occurs – ISO/SPRI/DIN baskets and containers, others?
• Increased demand on the internal logistic (as T-Doc) within the CSSD. –As if the lid and
bottom of the container is one unit that shall be matched together after washer-disinfectors or
washer-disinfector / cart washer. (Increased number of work procedures!)
• More heavy goods carrier (empty container +50% weight compared to empty basket)
- Increases the demand of lifting devices
- Heavy load program extends the processing time of the sterilizers
Background:
- Big investment and maintenance costs.
- Energy loss during steam transport.
Consequences
• Electrically heated washer-disinfectors longer processing time than steam heated units
• More washer-disinfectors required at the CSSD
- Increased number of washer-disinfectors possible automation demand
• Equipment and installation practise have to be designed to reduce air flow and vent.
9/28/2010 I Anuradha Desai I Getinge Academy I [CLASSIFICATION Public] 38
Linen reprocessing
Background
- Disposable dressing sets used instead
(sometimes cheaper)
Linen usage
Consequences
• Existing CSSD’s planned for reprocessing of reusable linen have spare capacity in their
sterilizer barrier
• Area for linen handling can be reduced and used for other purpose
Note! Very important parameter since linen normally stands for 30-40% of total sterilization goods volume
Consequences
• Number of units required will be less, due to increased efficiency.
However, bigger units not always best selection!
• Installation might require more space totally as fixed or moving automated units are attached
to sterilizer.
• Equipment and installation practise have to be designed to reduce air flow
Background
- Avoid working injury. Sick leave costs
money.
- Computerized workplace, focus on close
connection to surgical department.
Consequences
• Sound-absorbing actions implemented at:
- washer-disinfector installations
- sterilizer installations (separate located vacuum pump)
• Focus on equipment with better ergonomics: Height adjustable tables and trolleys, side
mounted operator panels with at more convenient operator height.
Quote from Handbook for Health and nursing care (Sweden):
”Avoid to carry and lift.
Try instead to move by pushing or pulling and reduce the friction by means of assistance”
Background
- Low utilization of existing plants.
- Big investments required on existing
plants to be accredited according to
quality standard in accordance with
medical devices directive 93/42/EEC
- Reduce cost per produced unit
Consequences
• Large scaled CSSD’s as base, but adapted for “fast track” performance
• Longer opening hours, (7days/24h)
• Increased number of instruments needed higher investment for instruments?
• Optimize the goods flow from and to end users
• Short circulation time (Penalty fee if delivery delay)
• Transports considered as dangerous goods special demands on performance
• Automation may be required.
• Smaller chamber units? in standby mode for fast track needed.
9/28/2010 I Anuradha Desai I Getinge Academy I [CLASSIFICATION Public] 42
Reprocessing time
Background
- Since outsourcing companies normally
do not own the instruments, the high
investment made by hospitals in surgical
instruments do request a short turn-
around time.
- Reduced budgets put pressure on
supply departments, also at hospitals, for
increased efficiency.
REDUCE TIME!
Consequences
• Disinfection and sterilization processing time have to be reduced. ok! Turbo versions available!
• Queue of goods before Washer-disinfectors and Sterilizers as well as before Inspection and
Packaging have to be heavely reduced.
Consequences
• Need for an efficient work flow. ok! Use Demand calculation
• Increased use of standardised work routines ok! Use Getinge Academy
• More productive equipment. ok! Turbo versions available!
• Supply of ”superior total package” – ”All” what is required?
Consequences
• An initial detailed site condition examination should be presented by sales force.
• A more accurate equipment design and evaluation to be performed by sales force/support Pick
Demands to be addressed.
• Easy used, ”self-explaining”, guiding, presentation material required for the sales force.