Keeping it Clean - Footscray Hospital CSSD Upgrade

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Footscray Hospital is one of four hospital facilities managed by Western Health in Melbourne, Victoria. The hospital provides around 290 beds, acute elective and emergency services and intensive and coronary care. Karen Tricker has been involved in four decontamination unit refurbishments with Western Health and she talked to AHHB about her role and lessons learnt from the recent upgrade to the Footscray Hospital, Central Sterile Services Department (CSSD).

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“In 2013/2014 the decontamination area of the CSSD at Footscray Hospital was refurbished as it was unable to continue meeting the demand of an increasing workload from theatre and wards,” Karen explains.
“The existing infrastructure was updated to maximise the usage of the space, reduce OH&S issues and ensure compliance to standards”, she says.
“We needed to update our equipment to pass-through thermal washers to decrease manual handling and to redesign the space to improve the flow of instrumentation as it came through theatre.”
I asked Karen about the redesign process and if staff were consulted about their wish-lists for the new space.
“Engaging the clinical staff in a redesign is critical and this is something Western Health is very good at. Bringing OH&S into the conversation is very important and in this case, the infection control department as well,” she says.
“Putting the tender together was quite a process. The OH&S representative from CSSD, my grade 4 instrument tech, myself and my manager were all part of the redesign committee,” Karen says.
While the work was being done, Karen needed to keep the decontamination area operational. She explained how this was achieved.
“The refurbishment was scheduled for the Christmas period which meant there was a reduced theatre load so that was helpful. We cordoned off areas where we were working and Atherton’s who won the tender for the redesign and installation, put in a small washer for us to use and the other washers were used one at a time as an existing was replaced with a new washer,” she says.
“It required a team effort to keep things running smoothly and we certainly needed to improvise in some circumstances. Putting on extra staff to manage the workload and the back-flow ensured that we were able to operate as normal,” she says.
How did the equipment upgrade impact on the staff?
“The upgrade to equipment included the installation of three automated thermal disinfectors, a new manual wash sink, relocation of the ultrasonic and installation of bulk chemistry,” Karen explains.
“A pass-through washer is loaded on one side and the item comes out thermally disinfected on the other. What we had previously was one pass-through washer and other single-fronted door washers. These washers mean staff are loading and unloading from the dirty side whereas the standards dictates pass-through items where you flow from dirty to clean,” she says.
“We are one of the first hospitals in Australia to install the largest Innova washer with an automated loading and unloading system. It has a conveyor on each side that allows us to load an instrument rack at working height,” she says.
“A conveyor belt moves the rack into the washer. An RFID on the washer inserts allows the machine to automatically select the correct l wash type. When the cycle is finished, the instrument rack moves out onto the conveyor and we then move the rack onto a wheelable trolley where it is decanted.”
“The ultrasonic has been lowered to comply with standards so it at staff waist level to prevent over-stretching when the lid is raised,” she says.
“One of the best components of the equipment upgrade”, Karen explains, “is the bulk chemistry.” This has eliminated OH&S concerns in relation to storage and handling of chemicals. We used to have 5litre bottles of chemical that were manually attached to the washers. Now we have a safer system for chemical management and more space since storage is no longer required.”
“The decontamination area is a heavy, busy department so reducing multi-handling of the same item and not having the chemistry to worry about has made a huge difference to the staff,” says Karen.
How has the redesign enhanced your work environment?
“I would have to say the work health and safety improvements of the redesign have made the biggest difference,” she admits. “There is no more loading and unloading and manually moving instruments from a dirty to a clean area”.
“And reducing the need for multiple manual handling tasks has improved the flowthrough. We now also meet the requirements of AS/NZ4187:2014 by ensuring the flow of instrumentation is always from dirty to clean with no risk of cross-contamination.”
“Repositioning our sinks has given us more bench space on either side of the sinks and better lighting has also improved the work area,” she says.
Delays occur frequently on projects like this. What are your tips for managing the unexpected?
“This refurbishment went to schedule but what I have learnt from past projects,” Karen advises, “is that an estimated time for completion is only an estimate.”
“There are usually hiccups along the way, especially when you are refurbishing areas and come across unexpected factors that are part of the existing infrastructure as opposed to a new build,” she says.
“Contingency plans are vital to ensure that a live work site is safe, Theatres keep running and the hospital can keep functioning. Meeting standards and keeping up staff enthusiasm for the project that may be running over-time also needs to be considered.”
“On this project we have kept our staff informed every step of the way so they feel engaged and invested in the changes that will improve their work day, improve patient outcomes and ultimately be worth the short term disruption of a refurbishment,” Karen says.
Fast Facts
Staff engagement was essential at all stages, including design.
Keeping the decontamination site live was a team effort requiring planning and innovation.
Pass-through washers reduced multi-handling.
Bulk chemistry eliminated OH&S concerns about storage and handling of chemicals.
A contingency plan is vital to manage delays.
Communication with staff throughout the project keeps enthusiasm high.
Karen Tricker
Karen Tricker has been the Nurse manager of the CSSD’s at Western health for the past 10 years. With over 30 years nursing experience Karen’s main areas of work have been in Operating theatres and teaching. Her focus has always been to deliver her patients the very best of care and Karen achieves this through CSSD by ensuring she has well educated and supported staff who strive to maintain best practice in the decontamination, sterilisation and tracking of medical devices.
What was on Karen’s wish-list for this refurbishment?
Pass through washers
Compliance to standards
Reduction in manual handling to improve the flow of the equipment