CIS Lesson Plans provide members with ongoing education in the complex and ever-changing area of surgical instrument care and handling. These lessons are designed for CIS technicians, but can be of value to any CRCST technician who works with surgical instrumentation.
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Each lesson plan graded online with a passing score of 70% or higher is worth two points (contact hour). You can use these points toward either your re-certification of CRCST (12 points) or CIS (6 points).
Mailed submissions to IAHCSMM will not be graded and will not be granted a point value (paper/pencil grading of the CIS Lesson Plans is not available through IAHCSMM or Purdue University; IAHCSMM accepts only online subscriptions of the CIS Lesson Plans)
There is a wide range of safety concerns with which CIS technicians must be familiar. Their work environment exposes them to numerous chemicals, hazardous materials, equipment generating high temperatures, and numerous other potential risks. This lesson, Part 1 in a three-part series, explains the importance of safety concerns and discusses basic precautions helpful in reducing accidents in specific Central Sterile Supply Department (CSSD) work areas.1
The safety of all healthcare employees and their patients deservedly receives significant attention from administrators, unions, trade associations, insurance carriers, governmental regulatory agencies, and allied organizations, among others. Employee safety is the responsibility of every staff member and facility administrator. In fact, it is everyone’s responsibility to ensure that safety is never compromised and is always at the forefront of the decision-making process.
The word “safe” means free from risk, danger or injury. There are many environmental hazards in the CSSD, and it is not possible for employees or patients to be completely free from all risks at all times. However, strategies to minimize these risks must be a goal of every CIS technician. Healthcare facility administrators and employees should work together to develop and maintain conditions that minimize opportunities to cause harm or injury.
There are three types of hazards of special concern to CIS technicians:
Knowing about and paying close attention to current and potential hazards can prevent most accidents. Unfortunately, the belief that “it can’t happen to me” creates a false sense of security that results in many injuries and exposures every year. Let’s tour common CSSD work areas and examine activities and safe working techniques to reduce risks in each area.
Injury, disease and even death can occur from exposure to blood and other body fluids and harsh chemicals. To prevent these occurrences, employees must receive thorough education regarding work place hazards. Employees working in soiled receiving and decontamination areas must wear personal protective equipment (PPE) to protect their skin surfaces and mucus membranes from chemical burns. This includes gloves, head and foot covers, fluid-resistant gowns or suits, masks, and eye goggles or face shields. A safety partnership must exist: employers must provide these items, and employees must use them.
Always wear personal protective equipment when working in the
soiled receiving and decontamination area.
CIS technicians must know the safety information in Material Safety Data Sheets (MSDSs) addressing the hazardous materials with which they work. Chemical manufacturers must develop and provide these to healthcare facilities, and managers should use them to prepare training programs.
Mishandling sharps (cutting instruments including knives, scalpels, blades, needles, and scissors) can create puncture wounds, lacerations and abrasions, and they must be handled correctly.2
Other examples of safe working practices in soiled receiving and decontamination areas include:
Scrub below the water’s surface to prevent aerosols.
Only employees thoroughly trained in principles of sterilization and the care and operation of all sterilization equipment should be assigned to this area. An effective new employee orientation process and ongoing training is essential, and a well-monitored preventive maintenance program is also required.
Injuries that can occur in sterile preparation and sterilization areas include skin and mucus membrane burns caused from misusing chemicals or being too close to a heat source, such as steam sterilizer or hot cart. Electrical burns from equipment can result if safe handling precautions are not consistently used. Splash exposure to chemicals, such as ethylene oxide (EtO), peracetic acid and instrument lubricant solutions and sprays, can cause eye injuries, so eye protection is required.
Other examples of safe work practices in sterile preparation and sterilization areas include:
Adequate storage space and traffic access is needed for supply breakout and storage areas. Shelving/supply storage units must be secure and steady, and they should be arranged to provide maximum space efficiency. Heavy and bulky materials and cases of glass containers should be on lower shelves. Then the most frequently used items can be stored on middle shelves, and lighter and less frequently used items should be placed on higher shelves.
Use approved equipment, such as steps, stands, and/or ladders, to safely reach upper shelves. Never stand or climb on shelves. CIS technicians must know and consistently follow the proper procedures for the safe operation of dollies, hand trucks, fork lifts, or carts when handling bulk materials. Also, use the correct tools to open and seal cases and crates.
Trash containers that securely close are needed to dispose of all unwanted materials, including hazardous and flammable substances. The disposal/removal of hazardous chemicals must consistently follow procedures described in applicable MSDSs.
Other hazards occur at the loading dock. Don’t climb onto or off of delivery trucks until they are secured. Be aware of the hazards associated with chemicals as they are loaded onto and off of trucks, and also of the fumes generated by trucks and fork lifts.
Much activity and, typically, inadequate space can cause problems where supplies and equipment are stored awaiting requests from patient care areas. Equipment in need of electrical charging requires multiple electrical outlets that comply with applicable electrical codes. Plugs must be three-wire and grounded, and electrical outlets must accommodate these plugs. CIS technicians must inspect electrical cords for frayed ends and bent prongs and notify appropriate personnel when they are found.
Safety tips when working in supply and equipment distribution and central transport areas include:
Poor work station design can cause chronic physical conditions for CIS technicians. Repetitive activities, such as bending over sinks or standing while assembling instruments, can create unnecessary stress and strains.
Tactics to reduce safety risks in clerical and other work stations include:
CIS technicians may have responsibilities in surgery centers or hospital surgery areas, and these locations have some of the hazards found in CSSDs. They should be familiar with applicable hazards such as those involving the use of lasers, X-ray equipment, and chemicals necessary for surgical procedures. It is important to observe safety policies, comply with safety signage, and follow all safety precautions provided by manufacturers of the potentially dangerous items.
This lesson has provided numerous examples of safety risks in CSSD areas. Experienced CIS technicians know there are many others, and they are always alert to the work environment and the risks that are present in it. Part II in this series will address government regulatory agencies and professional organizations that promote CSSD safety and concerns about the safe use of chemical sterilants. Part III will conclude the series with information about the safe use of chemical disinfectants, the reporting of employee accidents and injuries, and procedures to prevent patient injuries.
1. This lesson is adapted from: Central Service Technical Manual. Seventh Edition. Chicago, Il. International Association of Healthcare Central Service Materiel Management. 2007, and Managing Safety Hazards in Central Service. Module 6 in EXX CELL 2000 Plus: Strategies for Success. Chicago, Il. International Association of Healthcare Central Service Materiel Management. 2000.
2. See Care and Handling of Sharps. Certified Instrument Specialist Lesson #211. Communiqué. January/February, 2009.
Carla McDermott, RN, ACE
Morton Plant Mease Healthcare
Jack D. Ninemeier, Ph.D.
Michigan State University
East Lansing, MI