KEEPING IT CLEAN AND SAFE

Macquarie University Hospital’s sterilisation department has an outstanding practice that embraces advanced technology, robust systems for patient safety and, most importantly, a focus on staff engagement.


Macquarie University Hospital’s Central Sterile Services Department (CSSD) is part of the peri-operative team working across the Hospital’s 12 operating theatres. It provides services for a number of surgical disciplines, including orthopaedic, neurosurgical, urology, plastic, ENT, ophthalmic, general, cardio-vascular and robotic surgery. It also supports endoscopy, angiography, ICU/CCU, wards and clinics.

CSSD is a smart team of 21 technicians working with the most advanced sterilisation equipment available, improving their processes constantly and taking their innovations to international conferences.

They sterilise close to 5000 items every day, using a range of high-end equipment and mapping each item in a complex process designed to ensure quality control of the highest level.

“We are a support department and deal with anything related to medical devices,” explained Roel Castillo, CSSD Manager who joined the Department three years ago after working as a sterilisation technician at POWH and as a sterilisation supervisor/theatre CSSD Coordinator at RPAH. Roel also set up Chris O’Brien Lifehouse CSSD.

“We are an ISO hospital so infection control needs to be to these standards, which can be pretty complex and which change all the time. Working in a hospital where advanced technology and innovative practice is embraced, we go above and beyond basic requirements.”

Last year, the Department added to its suite of equipment and became one of the first hospitals – if not the first – in Australia to use, operationally, a high-end electronic monitoring system that can cater to monitoring requirements in all areas of CSSD. This includes medical devices, surface cleanliness, environmental surfaces, reprocessing equipment and hand hygiene – all accomplished with ease and outstanding precision.

The electronic system works by assessing the level of microbial contamination utilising an adenosine triphosphate (ATP) Bioluminescence Assay.

3M Clean–TraceTM is a small handheld device. The operator swabs a surface with something akin to a cotton bud. Samples are inserted into a small vessel that fits into the handheld ‘reader’. The machine produces a reading of contamination in Relative Light Units (RLUs) and can be downloaded to its software application for reporting, data and analysis if required. This can be reviewed if trends or issues need to be corrected from a safety reprocessing perspective.

“This is a quantitative reading, measured in RLU and corresponding to the level of microbial or organic contamination present on the sampled surface,” said Roel. “Any capture above the acceptable limit of 50RLU on a medical device surface is considered as an infection risk, so a decision to act is clear.

“It also gives you an affirmation of what CSSD does well – expectations of a correctly cleaned and reprocessed (sterilised or high-level disinfected) medical device worthy of patient reuse.”

Roel says that the real key to success of Macquarie University Hospital’s sterilisation services lies in the people who work there. As Manager, he places significant emphasis on all staff being fully engaged and creating what he calls a ‘culture of ownership’.

“If you look at employee engagement around the world, it’s generally very low,” said Roel. “Only around 23 per cent of the global workforce is highly engaged in their work, according to a Gallup Global poll taken in 2015. Around 40 per cent are actively disengaged or passively engaged.

“In our work, that kind of statistic would be really problematic. We need 100 per cent staff commitment in a context where excellence in patient care is your mandate. Technology alone doesn’t do that job. We have to have a team who is well-trained, committed to their work and personally accountable.

“We have put systems in place for staff success. Our technicians can confidently know they are well-trained in sterilisation but they also access a detailed system that tracks every piece of a Reusable Medical Device (RMD) and its place in the process. New technology such as 3M Clean–TraceTM is one of the important ‘enablers’ of the staff engagement we achieve.

“We have moved from medical device only to whole CSSD monitoring using the ATP Bioluminescence Assay, with Macquarie University Hospital’s CSSD at the forefront of its utilisation in the global reprocessing context.”

CSSD is actively involved in research, including on-site investigations of how best to meet ISO standards and improve practice. One recent on-site investigation on the credibility of ISO 17665-3 looked at RMDs and the need to establish unique penetration times based on product families. The work showed that reprocessing RMDs correctly – by ensuring sufficient ‘lethality’ of sterilisation according to their family groupings – is critical in ensuring integrity of sterility.

Roel presented findings from this study at the 17th World Federation of Hospital Sterilisation Sciences earlier this year. The group has presented at several international conferences held in Australia, Germany, Switzerland, New Zealand, Czech Republic and Thailand.