Serrations, box locks and ratchets are the areas which are most difficult to clean. Special attention should be paid to their inspection and cleaning. Visual inspection of each item to detect visible soil is the most common method to verify cleanliness. You can use a magnifying glass to inspect micro-instruments and other hard-to-see areas on instruments. Cleaning verification indicators in the form of swabs can also be used to check hard to reach areas. They make use of proteins or ATP technology.

Woven wrappers are made of natural fibers of cotton (called linen) or blends of cotton and synthetic material such as polyester in various thread counts (number of threads per square inch) and thread weight. Pure linen does not have good barrier properties and these further diminish by repeated sterilization and laundering. Non-woven fabrics are made by methods other than weaving (eg SMS and Crepe Paper). In this case, fibers are pressure bonded to form sheets. They have excellent barrier properties. These are recommended instead of linen in modern CSSDs.

In some hospitals, especially larger ones, there are peripheral units where sterilization activities are carried out. It would be best if all items to be sterilized in the healthcare facility came to the CSSD. But sometimes this is not possible due to increased turnover time. These units should also be the responsibility of the central unit (CSSD). They should either be staffed by CSSD technicians or supervised by the CSSD manager. This will ensure that every patient gets standardized sterile material.

Every instrument that comes in contact with a patient is considered “contaminated”. This means it may have the presence of bacteria, fungi or viruses on it. Whereas an instrument used on an “infected” patient means the patient already has a disease (Eg. HIV, HBV, HCV or M. tuberculosis) All instruments and devices coming to the CSSD should be treated in the same way as if infected regardless of the whether the patient is known to be infected. There is no requirement for a separate soaking in disinfectant as the patient may not have disclosed his illness or not have full blown symptoms. Hence all instruments are potentially infected and should be treated alike. It is imperative to use appropriate PPE while receiving and washing used instruments and devices.

Ergonomics (or human factors) is the discipline concerned with the interactions among humans and other elements of a system like equipment or environment. It applies methods to improve the worker’s health and well-being without compromising the procedure or process being followed. Some examples are given below : Workbenches and chairs must be height adjustable, allowing staff to adjust to the right posture position when sitting or standing. Enough space must be available to allow for organization of the workspace. All materials, for example in the packing area should be located within easy reach of the workbench; packaging materials, indicators etc. There should be adequate space to manoeuvre, line up, and load and unload trolleys.