Straight talk – Mallesan Vadivel, Founder & National President, Hospital Sterile Service Society of India, HSSSI

Discover how HSSSI is spearheading reform and setting resolutions to elevate CSSD standards, ensuring patient safety and infection control

​Mallesan Vadivel, Founder & National President, Hospital Sterile  Service Society of India, HSSSI

Q : What initiative has HSSSI taken to reform the CSSD industry in India?  What are the major resolutions of HSSSI to influence positive change in the  CSSD sector? 
Ans): HSSSI’s main initiatives are as follows:  
 -Re-evaluating & upgrading existing education in CSSD & networking programmes in order to provide students with optimum  opportunities for advancement in each area. 
– Establishing the organization as a stronger one that utilizes strategically focussed campaigns & techniques for the following activities viz: 
a) Advance technical knowledge & dissemination of information on the subject of sterile services in healthcare. 
b) Provide a common platform for people active in the field of CSSD to share knowledge, views & opinions. 
c) Offer information & assistance on setting up a CSSD to individuals & institutions who are interested. 
d) Conduct training courses, educational symposia & seminars on all aspects of CSSD & create an interface between suppliers & users. 

Major resolutions taken up by HSSSI are:
a) Aspire to share expertise & collaborate with like minded, passionate,  health care representatives whose knowledge & practical advice helps  implement sustainable changes to improve quality in CSSD. 
b) Encourage a strict code of ethics & moral behaviour i.e., principles of right & wrong are inculcated in CSSD personnel. 
c) Standardization of CSSD SOPs across Hospitals. 

Q :Emphasize the Critical nature of CSSD training & education for CSSD technicians & managers, highlighting the fact that HSSSI offers specialized programmes to help technicians & managers improve their skills &  knowledge. 
Ans) Understanding the need for a structured Training Programme in CSSD is very essential. Such a course is conducted by HSSSI, so that  quality CSSD technicians &  CSSD managers  walk out of the portals of HSSSI once they complete the training & course.  
HSSSI leaves no stone unturned by covering A to Z in its CSSD training program which covers  the responsibilities of Technicians as well as Managers. We train the personnel to: 
-Maintain record of effectiveness of cleaning, disinfection & sterilization. 
-Monitor & ensure controls necessary to prevent cross infection according to infection control policy. 
-Maintain proper supplies & equipment inventory records. 
-Know how to care for & operate all pieces of automated & mechanical equipment. 
-Issue sterile packs as per standard protocol.
 -Maintain stock levels of essential items at all times. 
– Conduct themselves with good interpersonal & communication skills. 
– Be people oriented, flexible & adaptable.
-Train to make them have good & prompt decision making ability.

Q :Describe the role of advanced technology in assisting the advancement of sterilization standards. Can you mention any recent trends you have noticed in the Indian context? 
There have been vast technological changes that has happened in the recent years which has indeed helped in carrying out almost zero/negligible error sterilization processes. 
Some of them are listed below: 
-Automation in sterilizers with provision for user identification for every cycle of sterilization. 
-Auto lock in mechanism which enables the technician to mandatorily execute full required cycle times & avoid shortcuts in the sterilization process. 
-Print out provided for each cycle which enables a fool proof documentation of each sterilization cycles. 
-Parameter settings in sterilizers are password protected thereby avoiding misuse and can be tracked easily the operator. 
-High quality packaging techniques which again enable standard sterilization. 
-Good quality indicators are available which makes the sterilization process more quality oriented. 
-Rapid Readout Tests are available enabling a fast TAT (Turnaround Time) for  the sterilization process. 
-High Technology transportation mechanism enables safe transportation techniques. 
-Compact & sturdy machinery available, thereby budgeting for good machines becomes possible. 
-Majority of the steps in the process has been switched over from manual to automatic thereby reducing human errors.
-High level awareness on the importance of proper functioning of CSSD is understood by the top management as well. 
-Quality & certified staff are being employed for the department to function smoothly & efficiently.

Q:Share your thoughts on the state of CSSD in Indian Hospitals. What  areas of improvement are necessary to maintain High levels of Infection  control? 
State of CSSD in Indian Hospitals have improved a lot compared to yester years. Today awareness and the importance of functioning of this department has been  felt by everyone using the services of this department. Adequate sterile supply plays an essential role in the attempt to reduce the  spread of disease within the healthcare services. A high quality reprocessing cycle is very necessary for the items that are used in an hospital, to  treat them in a way that can be used safely again. 
Having said that, compared to the number of hospitals existing in our country today, only a minimum percentage possess a full fledged CSSD and very few have a state of the art CSSD. 
The Areas of improvement that are required in CSSD even today are: 
-Following of standardised techniques in the CSSD. Processes are not uniform in many of the institutions even today due to lack of knowledge &  well trained staff
-Ownership of the department is lacking amongst the staff working therein. 
-Quality indicators are being sparsely used due to the cost factor involved.
-Lack of quality instrument maintenance policy available. 
-Many of the institutions still have been dependant on manually operated machines which attracts more human error in the process. 
-Formally educated & Certified CSSD Staff are not available in many hospitals.
-Poor water quality for cleaning of instruments used at many places.
-Outdated & old sterilizers still continue to be in use. 
-Proper packaging materials are not in use.

Q :Tell us about the CSSD Issues that small, medium & govt hospitals confront, as well as the essential guidelines that these institutions must follow if they lack a well equipped CSSD Unit. 
Today the small, medium & govt hospitals which are existing cannot be infrastructurally modified to the requirements. Due to this, adjustments & compromises in the process flow takes place. These should be avoided and irrespective of infrastructure constraint, process  flow should adhere to quality standards as per the requirements. 
-If there is any room for infrastructural modification,  it should be initiated & effected for the benefit of quality improvement.
-Modern washing machines and sterilisers should be purchased on war footing, if not existing 
-Also existing staff should be adequately certified & qualified to perform the required functions. 
-Written policies & procedures to be in place for every process. 
-Good quality cleaning agents to be procured and used as per manufacturer’s instructions for dilution &  temperature. 

-Monitoring of mechanical equipment to be done frequently. Complex instruments with lumen need to be prepared according to written  instructions from device manufacturer. 
-Implant loads to be necessarily monitored with a BI PCD containing Class 5 integrating indicator. 
-Documentation for each sterilizer to be maintained properly.
-Hand washing Sinks/Hand Hygiene facilities to be appropriately located in department. 
-Temperature & Humidity monitoring controls to be appropriately fixed in required areas. 
-Supervisors & all personnel to participate and conduct regular departmental continuing education. 

​CSSD in future will be more robust in its processes, user-friendly, secure, and uncompromised


Q :How can Hospitals reduce their overall infection rate while also increasing  patient safety? Which protocols must be followed? 
A Separate Corridor/dumb waiter should be available for used & sterile goods. 
– It should provide instruments, linen packs and other sterile items adequately for  proper patient care. 
-Monitor & ensure controls necessary to prevent cross infection according to infection control policy. 
-Stay updated with developments within the field to ensure the right process is taking place. 
Check physical, chemical & biological indicators are acceptable prior to issue of sterile packs. 
-Run diagnostic cycles as per the recommendations of the manufacturer.

-Confirm that the Sterile area sampling is done frequently and is negative for  growth of microorganisms. 
-Confirm the checklists of instruments in packs are followed & acknowledged. 
-Update the stock to the level of requirement on a daily basis.
-Staff hygiene need to be maintained with health checks at regular intervals.

Q : What changes do you anticipate in the near future that will impact CSSD  practice in a positive way. 
I am quite confident that in future, CSSD is going to have more robust  processes, which will be user friendly, safe, tamperproof,  uncompromisable with more trained & certified staff manning the department 
Equipment are going to have new advanced techniques enabling faster TAT without compromising on the process. 
The instruments used are going to be compatible with various modes of sterilization for faster and efficient reuse possibility. 
Documentation & recording of processes are going to be mandatory for all levels of the process. 
The space allocated for the department is going to be standard across  hospitals to accommodate proper demarcation of zones as required which will  enable to avoid cross contamination. 
Accountability for errors will play a prominent role for the process owners. 
Higher management will give more importance to the proper functioning of this  department. 
All the Technical staff working in this department will mandatorily possess adequate qualification & certification.
Automated inventory tracking mechanisms with instruments having Barcodes, QR Codes, RFID Tags or 2D Bar codes may be followed. Third party reprocessing facilities would be used for single use devices. 

Mallesan Vadivel
Founder & National President, Hospital Sterile Service Society of India, HSSSI | + posts