Presentation
HE21 - The War Against the Scalpels – Hospital Safety at the Central Sterile Supply Department (CSSD)
SessionPoster Session 2
DescriptionHospitals have two faces. One face deals with clinical activities of physicians and nurses with patients, and the other less familiar face, deals with the interface between clinical staff and logistical support teams - technicians, maintenance workers, food service workers, cleaning staff, and many others. The hospital's safety approach must address both patient safety and staff safety, as all hospital workers come into contact with patients, even if this contact is not direct but occurs through products and tools used in patient care.
The activities of Occupational Safety and Health Administration (OSHA) units can teach us about the range of health hazards facing medical workers. For example, needle sticks pose an immediate and clear risk as the needle may have been contaminated. A needle stick requires the affected person to undergo a series of blood tests and even immunization program depending on the biological source of the stick. This procedure, beyond the health risk, also results in lost workdays. Reducing the likelihood of needle sticks should be done in several ways, from reducing needle usage to using needles with safety devices that cover the tip after use, to developing work methods ensuring proper disposal of needles or scalpels in designated waste bins in operating rooms, inpatient departments, clinics, and throughout the hospital. However, despite educational programs and enforcement, we witness a high rate of needle sticks among both clinical teams and support staff.
This work focuses on one aspect of logistical support for clinical staff activities – the Central Sterile Supply Department (CSSD) – where more than a million injuries from sharp objects arriving at sterile supply occur worldwide annually. Workers in this department are exposed to numerous risks, as detailed in Occupational Safety and Health Administration (OSHA) assessments. One risk that is rarely mentioned was observed as part of the activity presented in this work. Operating rooms use many instruments that must be sterile as soon as possible to enable flow of surgeries. At the end of an operation these instruments are transferred to a department hidden from users' view – the CSSD. Few in the hospital know what happens in this department and how they reliably transform non-sterile instruments to 100% sterile. However, the risk of sticks from sharp objects among cleaning and disinfection workers handling contaminated materials from operating rooms is particularly high, due to surgical needles and scalpels that aren't disposed of in designated bins potentially arriving with instrument trays from the operating room to sterile supply workers who might get stuck.
This work presents the scope of the problem and the effects of intervention on the rate of sharp materials arriving at the department.
Hadassah Hebrew University Medical Center is a tertiary referral hospital with 900 inpatient beds that conduct more than 30,000 operations every year. The hospital's sterile supply department has 36 employees, including operating room nurses and workers trained in sterilization equipment operation. More than 80,000 trays of post-operational materials arrive via a special elevator from the operating room, and sterilized materials are sent to "consumers" after rigorous control. Trays and instruments are marked with QR codes, allowing trace-back in case of a needle stick to determine the source of a tray containing an exposed scalpel or needle.
In early 2021, the number of sharp objects arriving at the hospital's sterile supply department increased. Hospital management perceived the number of incidents of sharp materials arriving at the department as problematic and began recording incidents and implementing intervention programs. During that year, 93 incidents were recorded where sharp objects arrived at the sterile supply department. Four workers were stuck and had to undergo tests and take leave for several days. It's important to note that even though the number of those stuck was low, having several people from a staff of 36 absent for days, and sometimes longer periods, severely impacts the department's ability to quickly meet operating room needs.
To reduce the rate of sharp materials arriving at central supply, several intervention programs were prepared by human factors engineers in collaboration with hospital management and central supply department management. The first intervention program was based on involving employees from the operating rooms and hospital units with the CSSD activities. Teams including department heads and head nurses were invited for guided tours of the CSSD. To our amazement, veteran nurses and physician departments heads didn't know where the department was located and following the tours they were willingly cooperated. The second program included observations in the operating rooms where it was found that there weren't enough designated sharps containers, and existing containers were out of reach for some staff members. The third program was based on previous research dealing with "gentle enforcement" - non-offensive and productive comments to the departments that were the source of materials that arrived to the CSSD. The "gentle enforcement" included photographs of the objects that arrived from the departments, requests to these departments to come to the CSSD and collect these objects, and a letter signed by hospital management with reminders about work procedures. The combination of all these led to reduced risk for workers.
The intervention programs resulted in a decrease to 23 incidents in 2022 and only 19 incidents in the following year where sharp objects arrived at the sterile supply department, with only one worker getting stuck. Analysis of sources from which sharp objects arrived shows that all surgical departments and catheterization rooms contributed between 5 to 16 sharp objects. However, the clear impact of having no sharp objects came from the operating room for the entire year, demonstrates that the phenomenon can indeed be prevented. Results for 2024 were not summarized in this article and can be added by the time of conference presentation.
A drug with a short half-life is one that, when given by infusion, continues to have an effect as long as the infusion drips, but the effect quickly dissipates when the infusion stops. Cook and colleagues presented the idea that safety is similar in nature to such a drug - as long as proper educational activities are conducted, the result is a decrease in adverse events. Therefore, we must continue to perform various actions that will enhance caregiver and patient safety over time.
The activities of Occupational Safety and Health Administration (OSHA) units can teach us about the range of health hazards facing medical workers. For example, needle sticks pose an immediate and clear risk as the needle may have been contaminated. A needle stick requires the affected person to undergo a series of blood tests and even immunization program depending on the biological source of the stick. This procedure, beyond the health risk, also results in lost workdays. Reducing the likelihood of needle sticks should be done in several ways, from reducing needle usage to using needles with safety devices that cover the tip after use, to developing work methods ensuring proper disposal of needles or scalpels in designated waste bins in operating rooms, inpatient departments, clinics, and throughout the hospital. However, despite educational programs and enforcement, we witness a high rate of needle sticks among both clinical teams and support staff.
This work focuses on one aspect of logistical support for clinical staff activities – the Central Sterile Supply Department (CSSD) – where more than a million injuries from sharp objects arriving at sterile supply occur worldwide annually. Workers in this department are exposed to numerous risks, as detailed in Occupational Safety and Health Administration (OSHA) assessments. One risk that is rarely mentioned was observed as part of the activity presented in this work. Operating rooms use many instruments that must be sterile as soon as possible to enable flow of surgeries. At the end of an operation these instruments are transferred to a department hidden from users' view – the CSSD. Few in the hospital know what happens in this department and how they reliably transform non-sterile instruments to 100% sterile. However, the risk of sticks from sharp objects among cleaning and disinfection workers handling contaminated materials from operating rooms is particularly high, due to surgical needles and scalpels that aren't disposed of in designated bins potentially arriving with instrument trays from the operating room to sterile supply workers who might get stuck.
This work presents the scope of the problem and the effects of intervention on the rate of sharp materials arriving at the department.
Hadassah Hebrew University Medical Center is a tertiary referral hospital with 900 inpatient beds that conduct more than 30,000 operations every year. The hospital's sterile supply department has 36 employees, including operating room nurses and workers trained in sterilization equipment operation. More than 80,000 trays of post-operational materials arrive via a special elevator from the operating room, and sterilized materials are sent to "consumers" after rigorous control. Trays and instruments are marked with QR codes, allowing trace-back in case of a needle stick to determine the source of a tray containing an exposed scalpel or needle.
In early 2021, the number of sharp objects arriving at the hospital's sterile supply department increased. Hospital management perceived the number of incidents of sharp materials arriving at the department as problematic and began recording incidents and implementing intervention programs. During that year, 93 incidents were recorded where sharp objects arrived at the sterile supply department. Four workers were stuck and had to undergo tests and take leave for several days. It's important to note that even though the number of those stuck was low, having several people from a staff of 36 absent for days, and sometimes longer periods, severely impacts the department's ability to quickly meet operating room needs.
To reduce the rate of sharp materials arriving at central supply, several intervention programs were prepared by human factors engineers in collaboration with hospital management and central supply department management. The first intervention program was based on involving employees from the operating rooms and hospital units with the CSSD activities. Teams including department heads and head nurses were invited for guided tours of the CSSD. To our amazement, veteran nurses and physician departments heads didn't know where the department was located and following the tours they were willingly cooperated. The second program included observations in the operating rooms where it was found that there weren't enough designated sharps containers, and existing containers were out of reach for some staff members. The third program was based on previous research dealing with "gentle enforcement" - non-offensive and productive comments to the departments that were the source of materials that arrived to the CSSD. The "gentle enforcement" included photographs of the objects that arrived from the departments, requests to these departments to come to the CSSD and collect these objects, and a letter signed by hospital management with reminders about work procedures. The combination of all these led to reduced risk for workers.
The intervention programs resulted in a decrease to 23 incidents in 2022 and only 19 incidents in the following year where sharp objects arrived at the sterile supply department, with only one worker getting stuck. Analysis of sources from which sharp objects arrived shows that all surgical departments and catheterization rooms contributed between 5 to 16 sharp objects. However, the clear impact of having no sharp objects came from the operating room for the entire year, demonstrates that the phenomenon can indeed be prevented. Results for 2024 were not summarized in this article and can be added by the time of conference presentation.
A drug with a short half-life is one that, when given by infusion, continues to have an effect as long as the infusion drips, but the effect quickly dissipates when the infusion stops. Cook and colleagues presented the idea that safety is similar in nature to such a drug - as long as proper educational activities are conducted, the result is a decrease in adverse events. Therefore, we must continue to perform various actions that will enhance caregiver and patient safety over time.
Event Type
Poster Presentation
TimeTuesday, April 14:45pm - 6:15pm EDT
LocationFrontenac Foyer