Coming clean about sterility
STERILITY can mean the difference between life and death. It’s against this backdrop that Johannesburg will host Africa’s largest gathering of healthcare professionals and medical experts at the end of October for the Africa Health Congress at Gallagher Estate.
One of the topics at the event is Central Sterile Supply Departments (CSSDS) which are an integral, yet often overlooked component of the functioning of any healthcare facility. Clinical decontamination specialist Xana Jardine, a leading CSSD expert who has taught CSSD practice at Safmed for more than a decade, said CSSD representatives and unit heads in resource-constrained settings often struggle to effectively motivate and petition for an adequate share of scarce facility budgets.
“CSSD is not an income generator, and infection prevention actors need support to justify their department’s significant expenses,” she said.
Traditionally tasked with cleaning and decontamination, as well as packaging and distribution of medical equipment and devices, modern CSSDS in larger facilities must ensure continuous, efficient delivery of these services on a massive scale, with no margin for error. The roles of CSSDS are shifting as medical technology and practices continuously evolve. In some areas in SA, as with much of the global South, the requirements, and standards of good CSSD practice need to be maintained when balanced against severe resource, healthcare worker, and medical supply shortfalls.
An active medical community participant, Jardine has been instrumental in the development of SA’S CSSD sub-sector from the outset.
“CSSD in the country began with like-minded colleagues, passionate about hygiene and sterility – some three decades ago. This drove the evolution of autonomous regional CSSDS, which eventually gave rise to the national forum as we know it today,” she said.
Jardine says that the state of CSSD in SA varies widely and there is a diverse range of situations.
“Some private facilities in urban areas are now utilising sophisticated technologies like minimal invasive surgical techniques and robotic surgical assistance. In these contexts, there are sufficient CSSD equipment and personnel, and so the challenges tend to be around adapting to the new technologies, the new methods of decontaminating each new device, and the increasing emphasis on low-temperature sterilisation,” she explained.
Jardine said in other areas of SA, healthcare facilities contend with severe shortages of both staff and CSSD equipment, as well as basic medical supplies.
“In addition, staffing challenges mean that those running CSSD departments often lack training. Due to high unemployment rates and other factors, many of these individuals are eager to train, upskill and learn about CSSD best practices, but their efforts are often not adequately acknowledged by the healthcare system, in terms of their remuneration and employment status. Cleaning staff are sometimes being informally tasked with CSSD sterilisation and deployment duties, which is a higher level of specialisation,” she said.
She added that continuous learning and improvement and exposure to international best practices are driving the push towards greater standardisation, certification, and national core guidelines for the quality of CSSD. Technological changes; recycling innovations; the move towards automation; and new minimally invasive techniques and devices are among the factors driving the shifts in CSSD work, as technology changes require adapted methodologies. These days we’re also seeing a greater emphasis on design elements and work flows.
“The one thing we can work on is control the number of people who move in and out of operating theatres. We need to continue doing things correctly. No short-cuts,” she concluded.
Jardine will head a panel of experts who will deliver a series of interactive talk sessions at The Decontamination and Sterilisation (CSSD) Conference at this year’s Africa Health event.
The intensive one-day agenda is designed to equip delegates with in-depth knowledge of the standards, complexities and challenges associated with the CSSD function in Africa.
Doctors, nurses, unit heads and CSSD workers at all levels are encouraged to attend, as discussions will encompass an overview of working skills required to deliver a high standard of care for patients, as well as the latest developments surrounding the issues of sterilisation and infection control.