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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.

For Online Grading (www.iahcsmm.org):

IAHCSMM Members:

• Lesson Plans can be graded online using only your name and membership number
• Purchase a Single Lesson Plan, a Bundle of Six Lesson Plans, or choose one of our complete renewal packages (dues payment included with your lesson plan purchases) at www.iahcsmm.org/ecommerce/store.php
• Lesson Plans are worth 2 (two) points each and cost $10 per grading attempt or
  • Bundled Packages
    • Purchase 6 stand alone lesson plans as one package: $50 (worth 12 points if all quizzes are successfully passed with a score of 70% or higher) SAVE AN ADDITIONAL $10!
    • Purchase a CRCST renewal package: $80 (includes your dues payment, plus six lesson plans worth 12 points if all quizzes are successfully passed with a score of 70% or higher) A SAVINGS OF $20 (savings as a package versus purchasing individually)
    • Purchase a CRCST/CIS or CRCST/CHL renewal package: $100 (includes your dues payment plus nine lesson plans worth 18 points if all quizzes are successfully passed with a score of 70% or higher) A SAVINGS OF $30 (savings as a package versus purchasing individually)
    • Purchase a CRCST/CIS/CHL renewal package: $120 (includes your dues payment plus twelve lesson plans worth 24 points if all quizzes are successfully passed with a score of 70% or higher) A SAVINGS OF $40 (savings as a package versus purchasing individually)

Non-Members

• Lesson Plans can be graded online using an activation code provided during time of purchase
• Purchase a Single Lesson Plan or a Bundle of Six Lesson Plans at www.iahcsmm.org/ecommerce/store.php
• Lesson Plans are worth 2 (two) points each
• Costs are $15 per grading attempt or
  • Bundle of 6 stand alone lesson plans as one package:
    $75 SAVE AN ADDITIONAL $15!
  
  

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To activate a quiz:

Members:

• Click the Quiz icon for the appropriate quiz you wish to take and have graded
• Enter your first and last name plus your membership ID number
• The Quiz will open and you can proceed to answer all of the quizzes
• Choose Submit at the end of the quiz and it will be immediately graded (a score sheet will appear as soon as grading has been completed)

Non-Members:

• Click the Quiz icon for the appropriate quiz you wish to take and have graded
• Enter your first and last name plus an activation code provided at time of purchase (note: activation codes are only valid for one attempt; please retain your receipt for reference of which codes you have used)
• The Quiz will open and you can proceed to answer all of the quizzes
• Choose Submit at the end of the quiz and it will be immediately graded (a score sheet will appear as soon as grading has been completed)

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)

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Lesson Plan CIS 222
Safety in Central Sterile Supply Department Operations (Part I)
[Reprinted from Communiqué: November/December 2010]

LEARNING OBJECTIVES: Provide an overview of basic safety concerns including the three types of hazards most likely to impact Certified Instrument Specialist (CIS) technicians. Review safe work practices that can reduce risks in Central Sterile Supply Department (CSSD) areas.

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:

• Physical - including injuries from falls, electricity and fire.
• Chemical - including dangers from chemical sterilants and cleaning agents.
• Biological - including needlesticks and exposure from infectious waste and pathogenic (disease-causing) organisms.

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.

Soiled Receiving and Decontamination Areas

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:

• Use caution on wet floors. Check them for slippery surfaces and use mats or non-skid footwear, where appropriate.
• Follow the manufacturer’s recommendations for safe operation of cleaning and testing equipment.
• Visually inspect instrument sets received from user areas to determine that disposable sharps have not been inappropriately returned to the decontamination area.
• When loading/unloading carts from dumbwaiters or elevators, check the weight on the cart. Ensure that the wheels are straight and will roll over door spaces or uneven edges. Unload some items if the cart is too heavy to move easily.
• When cleaning instruments in a sink, always scrub below the surface of the water to avoid formation of biohazardous aerosols.
• Do not reach into unclear water/fluids in sinks, even to remove drain plugs.
• Use the concentration of detergents and water recommended by the manufacturer.

Scrub below the water’s surface to prevent aerosols.

Sterile Preparation and Sterilization Areas

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:

• Use thermal insulated gloves when handling sterilizer carts, washer baskets and other objects subjected to high temperatures.
• Park sterilizer carts in out-of-traffic areas so employees do not bump into them.
• Inspect all equipment for frayed electrical cords when servicing or placing them onto shelves or putting them into service.
• Use caution when using heat sealers. Do not insert your fingers inside a sealer to free packaging materials. Instead, ask for assistance and follow the packaging manufacturer’s recommendations.
• Be cautious when using a cutting edge to prepare paper/plastic packs.
• When lifting instrument sets, size up the load, and use the large muscles in your legs and arms. Hold the item as close to your body as possible. Also, remember that one end of the set may weigh more than the other end, and this can create a balance problem.
• Always check sterilizers for obvious damage to doors and door seals, hinges, and other parts. If damage is noticed, do not use the equipment. Instead, contact your supervisor about necessary repairs.
• Unauthorized hospital personnel, patients or visitors should not enter an area containing sterilization equipment.
• Only authorized, experienced service personnel should access control panels and inner parts of sterilization equipment to perform mechanical alterations and/or adjustments.
• Only trained and authorized personnel should operate sterilizers.
• Follow all procedures for using, reading, recording, and disposing of biological sterilizing indicators.
• Confirm that proper signs and labels are in place to warn personnel about hot surfaces and other hazards.

Supply Receiving, Breakout and Storage Areas

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.

• There are other safety concerns applicable to supply receiving, breakout and storage areas:
• Use caution when removing items from storage units or areas with sharp corners.
• Examine the workplace, allow ample time, and ensure that space is available to maneuver items being retrieved.
• When using a box cutter, ensure that fingers and other body parts are not in the path of the blade; cut away from the body or to the side. Retract the blade into the handle or sheath when it is not in use.
• Don’t use scalpel blades to open supply boxes or containers.
• Handle paper products with care; tiny skin lacerations can result from repetitious handling.
• Do not handle broken glass with your hands. Use a utensil to pick up large pieces and a broom and dust pan for smaller pieces, and put them in a puncture-resistant container.
• A secondary receptacle may be required for biohazardous contents.
• When lifting, pushing and pulling, use a back support device and proper body mechanics to relieve back strain.
• Inspect working areas for objects in pathways or equipment with parts that stick out in traffic paths. Keep aisles and doorways clear at all times.
• When working in small areas, know the traffic patterns in the entrances where doors can be a hazard.
• Avoid twisting and jerking movements when picking up/removing objects from tight spaces.

Supply and Equipment Distribution and Central Transport Areas

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:

• When transporting supply carts, patients or equipment, ensure that paths in front and on each side of the equipment are visible, with clearance on each side of the object being transported.
• Inspect floors for uneven parts or defective tiles/edges to ensure that items being transported will not fall off carts.
• Do not ride or sit on wheeled carts during transport or when they are not in motion.
• Use caution when approaching corners/intersections in hallways; use safety mirrors, if available.
• Be careful when pushing objects up or down hallway inclines. Push from behind (object goes first) when going up an incline. Pull from the front of the object (person goes first) when going down an incline.
• Use caution when approaching automatic doors/elevators. Know how they open and at what interval.

Clerical and Other Work Stations

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:

• Assembly work should be performed at heights that create the least fatigue and strain for employees.
• Use caution when opening file cabinets and do not leave drawers open when they are not being used.
• Work area floors where employees are required to stand should have fatigue mats to minimize leg strain.
• Appropriate chairs that support the employees’ backs should be used at computer, clerical and instrument work stations.
• Computer glare screens should be used to reduce eye strain.
• Items used frequently to perform routine tasks should be stored within easy reach to help prevent upper body strain from repetitive movements needed to retrieve them.

Surgical Service Areas

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.

In Conclusion

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.

Endnotes

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.

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