Ms. Anuradha Desai - Design of CSSD

Design of CSSD and New Trends
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
9/28/2010 I Anuradha Desai I Getinge Academy I [CLASSIFICATION Public] 2

Basic Design of CSSD
SOLUTIONS FOR WARDS AND OUTPATIENT CLINICS

Disinfection room - examples
CAD illustrations
9/28/2010 I Anuradha Desai I Getinge Academy I [CLASSIFICATION Public]

SOLUTIONS FOR
CENTRALIZED DISINFECTION AND STERILIZATION OF REUSABLE GOODS
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

SOLUTIONS FOR MANAGEMENT AND QUALITY ASSURANCE - TDOC

GENERAL CSSD DESIGN CONCEPT - 1
• Physical separation between soiled, clean and sterile zone
• The risk of cross-infection spread by staff is minimized

• Separated entries and exits for

soiled, clean and sterile goods
• Strict separation of the staff

working in the 3 different areas
• Room ventilation separated -

for good production conditions
• Straight workflows - for simple,

reliable working routines to
have an economic and
ergonomic production
Recommended:
Patient related
utensils - washed
and disinfected at
the user area –
as soon as possible!


Functions required for a CSSD.

GUIDELINES FOR CSSD DESIGN

Goods flow – access from one side
Trolley flow
Staff &
Supplies
• By creating an U-
shape workflow you
often can solve the
CSSD design
Goods flow

GUIDELINES FOR CSSD DESIGN

Goods flow – access from two or three sides
• By creating an U-shape
workflow you often can
solve the CSSD design
Cont. &
Goods flow basket
flow
Trolley flow
TYPICAL CSSD DESIGN

An actual design of a CSSD – plan drawing
• Try to locate the

CSSD in a way
that gives daylight
to the main part of
staff working here.
Goods flow

TSSU DESIGN CONCEPT – 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
Sterile supply corridor

PROJECT WORKFLOW - Make Demand Calculations &
Questionnaire ( Input data )
Evaluate the Results.
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.
• Ongoing project! Cart

washer calculation.

PROJECT WORKFLOW – Presentation Material To Our
Customer
Step 1
• 2D plan drawing
• Legend specification
• Calculation

PROJECT WORKFLOW – Presentation Material To Our
Customer
Step 2 - On request
only.
• 3D interior design
pictures inserted into a
Power Point
Presentation.

TYPICAL CSSD DESIGN

An actual design of a CSSD - 3D view seen from the supply side

TYPICAL CSSD DESIGN

Soiled goods flow - 1
• Porter can return goods

without entering soiled area
(When not working with
processing of soiled goods)
• One way workflow
• Special instrument preparation

for delicate and heat sensitive
items.

TYPICAL CSSD DESIGN

Soiled goods flow - 2
• Soiled sorting area
• Washer-disinfectors
of pass-through
design
• Dedicated
instrument
preparation area for
delicate and heat
sensitive items.
(Ultrasonic support)
• Hatch for clean

goods transfer to
packing area
CAD illustration

TYPICAL CSSD DESIGN

Clean supply/linen goods flow
• Porter can supply goods to a

reception without entering clean
area
• One way workflow
• When linen is inspected, folded

and packed in a CSSD, a separate
room should be dedicated for that
purpose, to avoid spread of lint.
• Linen packing table can be used

by 2 persons, working together
standing on each side.

TYPICAL CSSD DESIGN
Solutions for the Linen room
• Example – calculated demand of

3,2 people in the Linen packing
area, make space for totally 4
persons
• Drawing shows minimal

recommended dimensions to fulfill
the work tasks in the linen
inspection, folding and packing
area.
• The linen trolley can accommodate

approx 1000 liters of linen. This
corresponds to 33 baskets, when
later packed into baskets.
• If space is limited – consider

inspection, folding and packing at
the laundry and only pre-storage,
assembly, labeling and sterilization
at the CSSD.

TYPICAL CSSD DESIGN

Staff facilities
• Staff change for male /

female (In this design
changing from private
clothes in the basement)
• Staff rest area
• Office for supervisor

TYPICAL CSSD DESIGN
Changing rooms
Different ways to arrange Changing rooms to achieve different outer dimensions of the total changing area.
•Local requirements should be followed.

TYPICAL CSSD DESIGN

Control & packing area - 1
• 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.

TYPICAL CSSD DESIGN

Control & packing area - 2
• By the inspection of the

cleaning result, functional
test and packing, height
adjustable tables can be
used for optimal ergonomic
work conditions.
• Loading trolleys can also

be designed as height
adjustable units, to support
and ease work conditions
CAD illustration

TYPICAL CSSD DESIGN

Sterilizer area
• Air lock with a

recommended minimum
1400mm width and
including hand washbasin.
• Air lock can also be used

as service area at narrow
installations.
• Return transfer hatch for

racks - if, as in this design,
used by loading of
sterilizers.

TYPICAL CSSD DESIGN

Sterile store - 1
• Mobile or stationary storage for sterile

goods in baskets and/or containers.
• An over-pressure shall be kept in

sterile store – creating an airflow from
sterile store to the surrounding areas.

TYPICAL CSSD DESIGN

Sterile store - 2
• Open storage units,

allowing good
ventilation of stored
goods as well as a
good overview of the
content.
• Inspection and
recording of sterilized
goods to have a
tracing function!
• Assembly of goods
according to received
orders from user.
CAD illustration

TYPICAL CSSD DESIGN
Sterile store - 3
• Position Baskets racks so that

the baskets easily can be pulled
out.
• Try to achieve corridors width

min 1200mm between Basket
racks and/or Wire shelf.
• If space is limited, there are

questions to be raised:
Will goods be sent out directly
to the users?
Can goods be stored at the
users site?
• Sterile store capacity, according

to demand of individual sites.
• Lockable Pass-through cabinets

available for pickup of goods
when CSSD is closed.

TYPICAL CSSD DESIGN

Issue area
• Sterile goods meets clean

trolley in the issue area,
where the porter can collect
sterile goods without entering
sterile store.
• Goods further protected by

use of tote box or trolley
cover during ‘external
transports’.
• Issue to op through direct

connected elevator.

BASICS FOR A GETINGE CSSD DESIGN
• Standardized carriers used to promote

productive, ergonomic goods handling:
- Controlled reception of goods
- Controlled washing and disinfection

result
- Controlled sterilization result
- Optimized equipment usage
- Reduced workload for staff

BASICS FOR A GETINGE CSSD DESIGN
T-DOC
Management
• Designed, supporting work
areas and assisting equipment
optimize the work flow under
controlled conditions:
- ‘Barrier’ design
- Equipment designed for it’s

actual purpose and an optimal
utilization
- Reduced workload for staff
- Assisted Management

INFECTION CONTROL
TRENDS & DEVELOPMENTS
NEW TRENDS AND DEVELOPMENTS!

Trends and Development
Basic design concept for the CSSD/TSSU
• Controlled room ventilation (air flow) to get

good production conditions:
- Soiled zone – negative pressure (-)
versus adjoining areas
- Clean (-)
zone – positive pressure (++) (++) (+)
versus to all adjoining areas
- Sterile zone – positive pressure (+)
New demands:
- Clean zone – positive pressure (++)

Trends and Development
Basic design concept for the CSSD/TSSU
• Controlled room ventilation (air flow) to get

good production conditions:
- Clean (-)
zone – positive pressure (++) (++) (+)
∆+10 Pa
• Less sterile storage capacity requirement
Background
- Requirement for cost reduction of the department (Area savings)
Consequences:
- More efficient work flow is required
- Demand for reduced processing time

Goods carriers
• Increased usage of solid instrument

containers, used as goods carrier for the
surgical trays
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

Washer-Disinfectors
• Transition from house steam supply to

electrically heated equipment
Background:
- Big investment and maintenance costs.
- Energy loss during steam transport.
• Transition from external drying to washer-

disinfectors with integrated drying.
(An interpretation of SS-EN ISO 15883)
• ”Air-tight” installation by pass-through
installations.
• Non-vented units (No conn. to ventilation)
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
• Integrated drying extends the processing time

• 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.
Linen reprocessing
• Reduced usage of reusable sterilized

dressing sets for surgeon, patient and
equipment.
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

Sterilizers
• Reduced processing time

• Automation increase
• ”Air-tight” installation by pass-through
installations
• Service access from unloading side by
pass-through installations
• Sound level reduction
• Increased water and energy
consumption awareness (”Green”)
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
• Separated vacuumpumps - on site adapted equipment.
• ”Green” concept already by competitors! ?
• Adaptation of automation units and options to actual conditions to be observed – increase

awareness by sales force.

The processing environment
• Improved working environment within

CSSD
• The CSSD work getting a higher
“status”
• ”Green concept”
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”
• Less energy, water consumption required.

Centralization (”Super CSSD’s”)
• Outsourced processing by a Super CSSD

provides ”factory like” sterile services
outside hospitals (UK, NL, FR, Singapore)
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.
Reprocessing time
• Speed-up reprocessing time including the

return and distribution transports.
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!
• Inspection and packaging process have to be more efficient.
• Queue of goods before Washer-disinfectors and Sterilizers as well as before Inspection and
Packaging have to be heavely reduced.
• Logistic assistance must be implemented.

Reprocessing cost
• Bring investment, running cost and

processing area down on reprocessing
equipment.
• Reduce staff
• Separate purchase of reprocessing
equipment to get optimal benefits?
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?

Optimize = Customer Value
• Adaptation of an optimal work flow to

each customer requirements.
• Production area reduction
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.
• Requirement of compact interior design proposal and the installed equipment.
• Easy used, staff reducing work flow
• Easy used, ”self-explaining”, guiding, presentation material required for the sales force.


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Design of CSSD and New Trends

9/28/2010 I Anuradha Desai I Getinge Academy I [CLASSIFICATION Public] 2

SOLUTIONS FOR WARDS AND OUTPATIENT CLINICS

9/28/2010 I Anuradha Desai I Getinge Academy I [CLASSIFICATION Public]

9/28/2010 I Anuradha Desai I Getinge Academy I [CLASSIFICATION Public]

9/28/2010 I Anuradha Desai I Getinge Academy I [CLASSIFICATION Public]

SOLUTIONS FOR MANAGEMENT AND QUALITY ASSURANCE - TDOC

9/28/2010 I Anuradha Desai I Getinge Academy I [CLASSIFICATION Public]

GENERAL CSSD DESIGN CONCEPT - 1

• Physical separation between soiled, clean and sterile zone

• The risk of cross-infection spread by staff is minimized

9/28/2010 I Anuradha Desai I Getinge Academy I [CLASSIFICATION Public]

GENERAL CSSD DESIGN CONCEPT - 2

• Separated entries and exits for

• Strict separation of the staff

• Room ventilation separated -

• Straight workflows - for simple,

9/28/2010 I Anuradha Desai I Getinge Academy I [CLASSIFICATION Public]

GENERAL CSSD DESIGN CONCEPT - 3

9/28/2010 I Anuradha Desai I Getinge Academy I [CLASSIFICATION Public]

GUIDELINES FOR CSSD DESIGN

9/28/2010 I Anuradha Desai I Getinge Academy I [CLASSIFICATION Public]

GUIDELINES FOR CSSD DESIGN

TYPICAL CSSD DESIGN

• Try to locate the

9/28/2010 I Anuradha Desai I Getinge Academy I [CLASSIFICATION Public]

Sterile supply corridor

9/28/2010 I Anuradha Desai I Getinge Academy I [CLASSIFICATION Public]

• Ongoing project! Cart

9/28/2010 I Anuradha Desai I Getinge Academy I [CLASSIFICATION Public]

9/28/2010 I Anuradha Desai I Getinge Academy I [CLASSIFICATION Public]

9/28/2010 I Anuradha Desai I Getinge Academy I [CLASSIFICATION Public]

TYPICAL CSSD DESIGN

9/28/2010 I Anuradha Desai I Getinge Academy I [CLASSIFICATION Public]

TYPICAL CSSD DESIGN

• Porter can return goods

• One way workflow

• Special instrument preparation

9/28/2010 I Anuradha Desai I Getinge Academy I [CLASSIFICATION Public]

TYPICAL CSSD DESIGN

• Soiled sorting area

• Hatch for clean

9/28/2010 I Anuradha Desai I Getinge Academy I [CLASSIFICATION Public]

TYPICAL CSSD DESIGN

• Porter can supply goods to a

• One way workflow

• When linen is inspected, folded

• Linen packing table can be used

9/28/2010 I Anuradha Desai I Getinge Academy I [CLASSIFICATION Public]

Solutions for the Linen room

• Example – calculated demand of

• Drawing shows minimal

• The linen trolley can accommodate

• If space is limited – consider

9/28/2010 I Anuradha Desai I Getinge Academy I [CLASSIFICATION Public]

TYPICAL CSSD DESIGN

• Staff change for male /

• Staff rest area

• Office for supervisor

9/28/2010 I Anuradha Desai I Getinge Academy I [CLASSIFICATION Public]

TYPICAL CSSD DESIGN

•Local requirements should be followed.

9/28/2010 I Anuradha Desai I Getinge Academy I [CLASSIFICATION Public]

TYPICAL CSSD DESIGN