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Recommendations by the Quality Task Group
[5] Cooperation with the OR and other Departments

The ideal scenario in any Central Sterile Supply Department would be to have the items to be sterilised arrive in a condition that would allow them to be placed directly into the machines without having to resort to any further handling, dismantling, pre-treatment measures or repacking. This would also be desirable in respect of personnel protection. But the reality is somewhat different and hence there remains much to be desired. Having described in Part 2 of the Recommendations by the Quality Task Group (Central Service 1998; 6 (6): 423 ff) the importance of quick transport, the means of transportation and cooperation with the OR, the wards as well as other departments will now be discussed.

In general a distinction is made between two types of transportation, which are briefly described here:

• Dry transportation
  In the case of DRY TRANSPORTATION all used items are transported dry, i.e. without placing them in a disinfectant solution, in closed containers to the CSSD. The used instruments are placed on mesh trays (with jointed instruments opened), labelled and transported together with the unused instruments. Dry transportation is recommended for many reasons and is carried out in most establishments. The fear that adhering residues as well as blood will dry too firmly and that the machines will not be able to master cleaning has not been borne out. The advantages reside in the lower weight of the containers, in the reduced consumption of disinfectant solution, which cannot be used anymore, and in avoidance of coagulation processes, problems with foam as well as corrosion if instruments are left too long in the solution.

• Wet transportation
  In the case of WET TRANSPORTATION the used items are arranged on mesh trays, then placed in the disinfectant solution and transported in this manner. Disinfection takes place during the wait and transportation time. Based on the manufacturer's instructions, the disinfectant solution must be freshly prepared using in each case the concentration tailored to the desired purpose, e.g. efficacy against HBV. It is important that residues of the disinfectant solution should not get into the washer-disinfector, as this would induce foam formation. A cleaning enhancer should be added in accordance with the respective recommendation of the manufacturer. Mixing substances at one's own discretion can lead to a loss in efficacy and to other problems.

Described below are the problems most commonly encountered in the interaction between the CSSD and other departments:

• The mesh trays are overfilled so that other mesh trays have to be used to accommodate them.
• It is not assured that jointed instruments have been placed on the trays in a properly opened condition.
• The mesh trays contain single-use items and waste, i.e. items that should have been consigned to the waste already in the OR.
• Residues of skin disinfectants are poured over the instruments, leading to discolorations and to hardening of blood residues.
• Items are all placed pell-mell on the mesh trays, hence they must be properly arranged in the CSSD.
• Parts are missing, and a search for them must be launched.
• Identification of the associated mesh trays ("used/unused") is not successful.
• New medical devices appear on the scene without any explanation given as to how they are processed.

To resolve these issues the Quality Task Group proposes the following measures:

• Provide training for OR personnel.
• Improve goodwill. Arrange joint training courses for OR and CSSD personnel so as to achieve a joint goal: quality.
• Influential persons e.g. the nursing management or infection control nurse can play a coordinating role and help to overcome disagreements and excuses ("we've no time for that type of thing!"; "we've always done that in this way!").
• Record agreed working procedures in the quality manual.
• Deploy OR personnel temporarily to the CSSD so that they also see this side of the coin and experience what problems can arise for the CSSD staff from an inconsiderate approach to disposal in the OR.
• Overcome anonymity by getting to know and understand each other.
• Employ special disposal assistants in the CSSD
• Label the disposal mesh trays with the code or name of the person effecting disposal so that selective corrective and retraining measures can be taken.
• Compile a list for special items, such as e.g. for syringes or sharp instruments.
• Provide information or instructions for OR personnel as regards placement of special items.