Straight Talk – Captain Baban Rai, President Indian Sterilization Healthcare Association, ISHA

Modern technologies, educational initiatives, and shifting perspectives are shaping the future of CSSD, ensuring sterilization excellence and elevating healthcare standards

Q :How would you rate the state of CSSD practice in India.  According to you what are the bottlenecks that is affecting the growth of segment.

In fact, Central sterile services are in very pathetic state in most of the Indian hospitals, barring some corporate and private hospitals.  Though in most of the corporate hospitals and some private hospitals, US and European standards/guidelines are followed but large number of general hospitals, governments hospitals and nursing homes do not follow any. They follow protocols made by themselves locally, which are far below acceptable standards. In such hospitals, real numbers of HAI (on account of inadequate reprocessing of instruments & equipment) are under reported due to various reasons. Though IPC teams have developed systems to capture HAI data, but most of the Indian hospitals are unable to follow these, leading to under reporting.

In my view, inadequate knowledge & education in technicians, managers and administrators are the main bottlenecks that is affecting the growth of the segment. Due to these inadequacies in knowledge and practices, most of the CSSD professionals are not able to convince their administrators to allocate adequate funds for the purchase of quality instruments and equipment and, implementation of other quality services. Hospital administrators under-rate the importance and are not willing to provide adequate funds for the growth of CSSD services including qualified man power. Recognized diploma and degree for sterilization services is another bottleneck for the segment.

Q :Are there any statutory guidelines for sterilization services in a hospital to prevent hospital acquired infections? Have these guidelines been made obligatory for the hospitals? 

Actually, there is no guidelines for CSSD or sterilization services separately for Indian Hospitals, but these services have been covered in the national guidelines for Infection Prevention and Control in healthcare facilities and also in Indian Public Health Standards (IPHS) guidelines for district hospitals. However, these guidelines are not sufficient and are silent on many CSSD procedures and services. They don’t elaborate about standardization of manpower, educational qualifications, purchase of quality equipment and services etc (like sterilizers, washer disinfectors, packaging materials, monitoring tools). Unless these factors are not well addressed, delivery of quality services can’t be assured. Moreover, whatever guidelines we have, these are not obligatory for hospitals, and this is the reason that most hospital don’t comply to the general standards and norms of CSSD practices.

Q3- ISHA is a voluntary organization that works to eliminate healthcare related infections and strengthen CSSD practices in India. What concrete initiatives have been taken so far by the body?

Indian Sterilization Healthcare Association (ISHA) dedicates itself to the promotion and harmonization of sterilization departments and decontamination practices. We make a contribution not only to ensure that the quality of reprocessing is at the highest possible level across the country but also to make it the basic right of every patient to be treated with a medical device of a good quality. It is said knowledge is power, so we empower the CSSD professionals by imparting knowledge through various means. The followings initiatives have been taken by ISHA to raise the bar of Indian CSSDs and bring them at par with international standards. 

  • Organizing seminars, workshops and conferences at regular intervals.
  • Sharing knowledge and bringing awareness through daily questions and answers vide various WhatsApp and Telegram groups.
  • Organizing and conducting online ISHA competency test series and issuing certificates to the scorers of 70% marks and more. 
  • Approaching state and central government agencies for the recognition of CSSD professions separately.
  • Approaching National Commission for Allied and healthcare professions for inclusion of CSSD technologists in the list.
  • Preparing ISHA guidelines for Indian Sterile Services.
  • Working on standardization and certification of CSSD.

Q :What are the core areas of the CSSD that any hospital must focus to ensure patient’s safety? From CSSD point of view, what are the key learning from the pandemic?

Central Sterile Services are responsible to ensure patient safety by providing efficient, economic and germ free patient care items at the point of use and, also to provide a safe environment for the patients and staff. CSSD is broadly divided in four areas, Decontamination/soil area, Assembly & Packaging area, Sterilization area and Sterile storage area. Though every area of the CSSD is a core area because it directly affects the patient’s safety but the most important area is decontamination. Adequate cleaning and disinfection of instruments makes these safe to handle, hence ensuring safety of handling staff and preventing spread of infection. Adequate cleaning and disinfection is the most important pre-requisite for sterilization. Without adequate cleaning, sterilization can’t be achieved. Next core area is assembly & packaging because quality of packaging materials and methods of packaging directly affects the sterilization. Sterilization area is also important because way of loading the packages into the sterilizers affects the outcome. Monitoring of sterilization services instils the confidence that highest level of sterilization has been achieved.

Q :What advice would you give to small and medium hospital, government hospitals and nursing homes that are not presently adhering to CSSD Best practices? What can be done to address their problems?

ISHA acknowledges that sterile services are one of the most neglected services in small and medium hospitals, government hospitals and nursing homes. Generally, change is resisted everywhere whether it is home, office, factory or any department of a hospital. Whenever you suggest any change/step for improvement, you will get back the typical reply, “We have been doing this since last 10 or 20 years and did not face any issue.” Hospitals do not agree to accept any change easily. I will appeal to the administrators and sterile professionals of such hospitals to keep them updated with modern practices which ensures patient’s safety. To ensure infection prevention, the CSSD professionals must be well versed, well trained, efficient and committed. They should have knowledge about standard protocols, complexities, challenges, risks and techniques associated with the functioning of CSSD. These hospitals should allow their staff to participate in various learning/knowledge sharing programs and ensure the implementation of new learnings in the department. Never compromise the safety of patients. Good CSSD protocols will help to minimize the SSIs (surgical site infections) in hospitals. This will bring a good name to the hospital or nursing home and, of course to the surgeon also.

Q :Discuss the importance and value of CSSD practice and academic orientation. Do technicians and managers who choose to work in this industry have a bright future? What is the potential for growth?

CSSD functions are so important that they are compared with the functions of heart and lungs of the body. As a heart, it receives the soiled goods and supplies sterile goods to various departments of the hospitals. Similarly, as lungs it does cleaning, disinfection and sterilization of the patients care items. If heart and lungs do not function properly, there is a threat to individual life. In the same way, if proper protocols are not followed in reprocessing of instruments and equipment, rate of HAI may go very high and may lead to loss of life in some cases. Academic orientation of sterile professionals ensures implementation of CSSD best practices. 

Recently the Union Government has constituted the National Commission for Allied and Healthcare professions, seeking regulation and standardization of education and practices of these. Unfortunately, (as per listed professions in this commission), the functions of CSSD are carried out by OT technologists. ISHA has  written a letter to the commission to include CSSD Technologists in the list of allied healthcare professionals. If this request is accepted, education and many other things related to CSSD professionals will be recognized, standardized and regulated. As I have earlier said, CSSD practices need to improve a lot, so there is tremendous potential for growth of this industry once CSSD best practices are applied across the country.

Q :Do you believe that Indian hospitals are adopting modern CSSD Technology in order to raise quality standards and achieve excellence in sterilization?

Most of the Corporate hospitals and big private hospitals follow AAMI/CDC guidelines. These hospitals have taken the lead in adopting modern CSSD technologies. Since last 8-10 years, there is a spurt in  CSSD growth. Lot of seminars, conferences, educational and awareness programs have been launched in these years and change is clearly can be felt. But as I have earlier said that most of the times, “change” is resisted. Speed of adaptation of modern technologies, is very slow in small and medium hospitals, particularly in government hospitals. But as we know, “Rome was not built in a day”. Good things will continue to happen and one day, majority of the hospitals will achieve excellence in sterilization.

Q :How do you see the CSSD market in India evolving and how bright is the outlook for CSSD in India? 

There is tremendous scope for growth of CSSD market and the scenario is changing fast. In our country, health tourism is rapidly growing in comparison to other countries. Patients from across the world, are choosing India specially for different surgical procedures. The reason for this increased health tourism is, the availability of skilled healthcare givers and low treatment cost compared to western developed countries. More surgical procedures mean more load on CSSD that is directly proportional to growth of CSSD market. So, we can say that outlook for CSSD is very bright in coming years.  

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