CSSD Workflow Automation: Need of the Hour

By Neeta Amit Ghugare

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Centralized Sterile Supply Department is ripe for technology and, technology is ripe for CSSD, explains Neeta Amit Ghugare.


Healthcare and hospitals in general are passing through challenging as well as exciting times. Different departments in a hospital are being treated as either profit or cost centres. One such department – Centralized Sterile Supply Department (CSSD), which is the heart of the hospital, is required to consistently deliver quality patient care and support infection control within the hospital.


CSSD has come a long way from being relegated to the basement of the hospital to a well-planned facility. With patient safety and infection control becoming buzz words, CSSD is beginning to get more focus, understanding and investment. CSSD managers and staff are facing newer demands; there is increasing pressure on cost control, transparency and efficiency. CSSD probably deals with more line items than some retail outlets. Each line item has its own SOP, its own assembling instruction, its own care instructions. And yet, all of this is handled manually.

Coming to regulation, audits are a never-ending part of life in a hospital and each audit requires reconstruction of events, opening sterile packs, answering questions about where instruments or sets are, measuring processes. By some estimates, annual audits take upwards of 2-3 months in some cases.

To talk about environment – all of us know how much time any department spends in coordination, talking to OT, rushing instruments because surgeon is not happy. Stressful and unpredictable would be one way to describe it.

At the core of it all, the departments are as good as the people manning them. In CSSD especially, because of hardly any adoption of systems, processes are very person-dependent creating further issues. By one estimate, new employees are only 25% as productive as the average CSSD technician even six months after being hired and turnover is a given in the Industry.

With such a situation there is no doubt that CSSD is ripe for technology and, technology is ripe for CSSD. Overall, if we think about the challenges and needs of CSSD, there are certain core objectives of technology adoption:

  1. While making the process more accurate and efficient, it should take away human fatigue, allow staff to concentrate on more value-added tasks such as inspection and quality checks

  2. It should bring measurability and accountability to the process

  3. It should help save costs and time

  4. It should make processes easier and more intuitive.

At the basic level, most modern CSSDs have software that document sterilization processes and allow for printing of sterilization records. It also serves as an inventory control system with packing and assembly instructions for technicians. But the need of the hour is an Integrated enterprise-wide workflow automation solution that encompasses the full gamut of activities starting from the CSSD department to the various end users in the hospital.

No doubt that this workflow is complex, but if these six key principles are incorporated into a system, it might just make life easier for all stakeholders.

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  1. A comprehensive and end to end system– covering all facets so that one system does the job making the process seamless.

  2. Simple to understand and use.

  3. Creates an audit trail and makes audits simpler.

  4. Allows to fill in knowledge gaps for the users.

  5. Takes care of all regulatory and compliance documentation.

  6. Makes inter-departmental communication more transparent, easy and stress-free.

Now the system must allow for decision making based on actual data rather than personal hunches. Data points like:

  • Are instruments and sets meeting cycle requirements?

  • What is the proportion of our slow- moving inventory?

  • What are the % rejections in our processes?

  • Are staff properly trained or are there gaps? Are we staffing adequately or are we short?

  • What is the frequency of damages / pilferage?

  • At what stage do we need replacements? Are we condemning instruments too early or too late?

Moving ahead you would also need this system to simply Track & Trace your entire Instrumentation.

Traceability is a major requirement and different marking systems have been created over the years to help identify at least high value instruments. Let us look at technologies that allow traceability and identification. They are called AIDC technologies – Automatic Identification and Data Capture (AIDC) technologies. In CSSD applications, 3 types of AIDC technologies are in use.

Barcode technology has been most widely used for instrument and inventory identification. Its simplicity, accuracy and pricing are what makes it an attractive solution. But for fast processing, one by one scan becomes a bottleneck. Also, in soiled condition, codes are difficult to read and must be entered manually as you may have experienced even in retail environments.

QR code is another form of a matrix barcode and can hold more data for more versatile applications. It is used very extensively as a marketing tool since it can quickly point audiences to websites or open-up information and images. However, in the CSSD environment again, it suffers from similar disadvantages as barcode.

RFID technology itself is old, and like most technologies had its origin in war conditions. RFID at vehicle toll booths enables quick identification of any vehicle from a distance without any human intervention. RFID helps retailers check shoplifting. RFID has made rapid strides in the last few years with miniaturization of tags. Several RFID tags can be read at a time, they do not need line of sight and do not have issues under soiled conditions.

RFID identifiers are unique worldwide, which means the object that it is attached to or associated with becomes unique. This is one reason why this technology is an important one for UDI guidelines issued by US Food & Drug Administration. There are 2 types of RFID technologies – Active (battery powered) and Passive (no battery). In the case of CSSD applications, due to sterilization processes, the passive technology is used. Tag sizes begin at about 3 mm width and weigh less than 1 gm.

RFID can help simplify tasks of the pack sets workflow where RFID helps to match instruments to sets, highlight any missing instruments or any mismatched instruments that have got into the pack by mistake. A set packed properly and completely can mean precious surgical time saved in the OT, no need for opening other packs to get the required instruments and improving the productivity of all users.

A full-fledged implementation of RFID based instrument tracking workflow for a small hospital with 4-5 operating rooms will pay for itself in 2 years and here is how.

  • 18-25% savings in inventory costs

  • 21-27% savings in processing costs

  • 20-25% savings in manpower costs

The big gains you make in patient safety, accountability, quality of processes is priceless. When the department is looked at as a professionally run, quality conscious, energetic environment, even staff outlook towards work will change. When you can remove the drudgery and mundaneness from a technician’s job and focus on quality instead, it will bring in immense pride at the work he does!

That, by itself, will lead to better outcomes for patients, hospital managements and other stake holders.



Neeta Amit Ghugare

Process Lead – Healthtech Pivot LLP