MICROBES ARE THE MOST NUMEROUS AND DIVERSE LIFE FORMS KNOWN. THEY HAVE EXISTED FOR OVER 3.5 BILLION YEARS ON EARTH.

1. ALL YOU NEED
TO KNOW ABOUT
CENTRAL
STERILE SUPPLY
DEPARTMENT

2. MICROBES AND PPE
TALAL ALBUDAYRI

3. MICROBES ARE THE MOST
NUMEROUS AND DIVERSE LIFE
FORMS KNOWN.
THEY HAVE EXISTED FOR OVER
3.5 BILLION YEARS ON EARTH.

4. THEY HAVE ADAPTED TO AND
COLONIZED THE BIOSPHERE—EVERY
ENVIRONMENT WE CAN THINK OF,
FROM SEVERAL KILOMETERS DEEP
WITHIN THE EARTH’S CRUST TO
THE UPPER REACHES OF OUR
ATMOSPHERE.

5. ARE ALL MICROBES DANGEROUS?
WHEN WE THINK OF MICROBES IN RELATION
TO CLINICAL ENVIRONMENTS, WHERE CLEANLINESS
AND STERILITY ARE PARAMOUNT, WE TREAT THE
PRESENCE OF ALL MICROBES THERE AS BEING
POTENTIALLY HARMFUL.
WE TRY TO ELIMINATE THEM ALL AND WE TAKE
WHAT ARE KNOWN AS STANDARD
PRECAUTIONS TO PREVENT THE SPREAD OF
INFECTION .

6. PLANTS, ANIMAL AND HUMANS ARE ALL DEPENDENT ON MICROBES FOR THEIR NORMAL FUNCTION
AND SURVIVAL.
SOME OF THE COMMENSAL SPECIES, THOUGH HELPFUL TO THE PERSON HOSTING THEM, MAY PROVE
PATHOGENIC OR HARMFUL IF TRANSFERRED TO SOMEONE ELSE.
IN A HOSPITAL OR HEALTHCARE SETTING WHERE PATIENTS ARE VULNERABLE TO INFECTION, WE
UNDERTAKE MANY METHODS OF INFECTION CONTROL TO PREVENT THE TRANSFER OF PATHOGENS OR
COMMENSALS.
EACH INDIVIDUAL HAS THEIR OWN PERSONAL MICROBIOME OR MICROBE COLLECTION CONSISTING OF
THOUSANDS OF DIFFERENT SPECIES THAT HELP PROTECT AGAINST DISEASE, STIMULATE THEIR IMMUNE SYSTEM
AND CARRY OUT MANY OTHER BENEFICIAL FUNCTIONS.
THESE HELPFUL MICROBES ARE KNOWN AS COMMENSALS WHEREAS DISEASE CAUSING
MICROBES ARE KNOWN AS PATHOGENS.

7. A HUMAN CAN THEREFORE ADD A LARGE NUMBER OF MICROBES TO THEIR ENVIRONMENT IN A NUMBER OF DIFFERENT
WAYS:
COUGHING,
SNEEZING
AND BODILY SECRETIONS
RECENT RESEARCH HAS SHOWN THAT ON AND IN THE AVERAGE HUMAN THERE ARE 1.3 TIMES MORE MICROBIA CELLS THAN
HUMAN CELLS!
CAN SPREAD MICROBES.

8. YOUR HANDS SPREAD
MICROBES WHEN YOU TOUCH
YOUR FACE,
BODY PARTS OR
CONTAMINATED ITEMS AND
THEN TOUCH OTHER ITEMS.

9. SKIN
SKIN COVERING OUR BODIES IS MULTILAYERED; THE TOP LAYER IS
COMPOSED OF DEAD CELLS.
THE TOP LAYER OF SKIN CONTAINS A LARGE AMOUNT OF COMMENSALS OF
OUR OWN, TOGETHER WITH TRANSIENT POPULATIONS PICKED UP FROM
CLOTHING, CONTACT WITH
OTHERS, AND OUR ENVIRONMENT.
OUR BODY DISCARDS THIS ENTIRE TOP LAYER OF DEAD SKIN CELLS AND
ASSOCIATED MICROBIAL BIOFILM OVER A PERIOD OF FIVE OR SIX WEEKS,
TO BE REPLACED BY A FRESH LAYER FROM UNDERNEATH.
THE FOREARM SHEDS APPROXIMATELY 1300 CELLS PER CM2 PER HOUR.

10. ALTHOUGH, STRICT
CLEANING AND
DECONTAMINATION
PROCEDURES MAY BE IN
PLACE, THE CLEAN ZONE
IS RARELY MICROBE-
FREE!

11. CSSD :
AS WE MOVE AROUND, WE LEAVE AN INVISIBLE TRAIL OF MICROBES
EVERYWHERE WE GO, AND ON EVERYTHING WE TOUCH.
ONCE WE UNDERSTAND THIS, WE CAN SEE HOW IMPORTANT IT IS TO
MINIMIZE THE AMOUNT OF CONTAMINATION WE BRING INTO CLEAN OR
STERILE ZONES IN THE CSSD.
WE TRY TO CONTAIN OUR DEAD SKIN CELLS AND MICROBES BY USING
HYGIENE PROCEDURES AND APPROPRIATE PPE TO PREVENT US FROM
RECONTAMINATING THE REUSABLE MEDICAL DEVICES OR THEIR
ENVIRONMENT.

12. VERY HIGH LEVELS OF CONTAMINATION PREVENTION AND
PPE ARE USED IN CLEAN ROOMS AND STERILE AREAS OF PHARMACEUTICAL
AND MICROELECTRONICS FACTORIES,
AND WHEN ASSEMBLING SPACECRAFT.
OFTEN, TWO
LAYERS OF CLOTHING ARE WORN, ONE TO ENTER SEMI-CRITICAL AREAS AND
THEN ANOTHER ON TOP OF THAT TO ENTER
THE CRITICAL AREAS.
DESPITE THE HIGHEST HYGIENE STANDARDS AND VIGOROUS CLEANING AND
DECONTAMINATION REGIMES IN
THESE PLACES, SOME MICROBES OCCASIONALLY SURVIVE (SEE FIGURE M2–29
NEWS ARTICLE, SCIENTIFIC AMERICAN). THIS IS ALSO THE CASE IN THE
CSSD CLEAN ZONES
NEW BACTERIAL LIFE-FORM
DISCOVERED IN NASA AND ESA
SPACECRAFT CLEAN ROOMS
HE PREVIOUSLY UNKNOWN
MICROBE WAS TOUGH ENOUGH
TO SURVIVE STRINGENT
STERILIZATION AT TWO
LOCATIONS. MIGHT IT SURVIVE
A TRIP TO MARS?

13. CSSD WORKWEAR AND PPE
THERE ARE THREE WORK ZONES WITHIN THE CSSD :
THE CONTAMINATION ZONE, THE INSPECTION, ASSEMBLY
AND PACKAGING ZONE AND THE STERILE STORAGE ZONE .
STAFF SHOULD NOT BE ABLE TO MOVE BETWEEN ZONES WITHOUT PASSING THROUGH GOWNING ROOMS,
CHANGING PPE AND UNDERGOING HYGIENE PROCEDURES.
THESE ARE SEPARATE ZONES WHICH SHOULD EACH HAVE THEIR OWN ENTRY AND EXIT POINTS.

14. WHEN YOU WORK IN THE DECONTAMINATION ZONE IN
THE CSSD, YOU ARE EXPOSED TO CONTAMINATED
REUSABLE MEDICAL DEVICES AND MATERIALS WHICH
WERE USED WITH PATIENTS WHO MAY HAVE BEEN
CARRYING PATHOGENIC MICROBES IN ADDITION TO
THEIR OWN NATURAL COMMENSALS.

15. DECONTAMINATION ZONE PPE REQUIREMENTS

16. GOWN WITH SLEEVES
WEAR FLUID RESISTANT GOWNS WITH LONG- CUFFED
SLEEVES THAT CAN BE TUCKED INSIDE GLOVES
DURING PROCEDURES THAT ARE LIKELY TO GENERATE
SPLASHES OF BLOOD OR BODY FLUIDS, OR DURING
ACTIVITIES THAT MAY CONTAMINATE IT WITH
INFECTIOUS MATERIAL. CHANGE THIS GOWN
WHENEVER IT BECOMES VISIBLY SOILED OR WET AND
DISCARD AFTER USE.

17. PLASTIC BIB OR APRON :
IN SOME CASES, YOU WEAR A BIB OR APRON OVER
THE GOWN FOR EXTRA PROTECTION FROM SPLASHES
DURING MANUAL CLEANING PROCESSES.

18. MASK & EYE PROTECTION :
WEAR FLUID REPELLENT MASKS WITH VISOR EYE SHIELDS TO
REDUCE THE RISK OF MICROBES BEING TRANSFERRED TO THE
EYES, NOSE AND MOUTH. THESE MUST BE FITTED PROPERLY AND
WORN TO COVER EYES, MOUTH AND NOSE, ACCORDING TO THE
MANUFACTURER’S IFU. DO NOT TOUCH THE MASK OR EYE SHIELD
WITH YOUR HANDS WHILE WORKING, REMOVE THEM
IMMEDIATELY IF THEY BECOME MOIST OR VISIBLY SOILED,
DISCARD THEM APPROPRIATELY AND REPLACE WITH CLEAN
EQUIPMENT.

19. SHOES OR SHOE COVERS
BEST PRACTICE SUGGESTS DEDICATED SHOES OR CLOGS THAT
ARE WORN ONLY IN THE
DECONTAMINATION ZONE. IDEALLY, THESE SHOULD BE
WASHABLE. DISPOSABLE SHOE COVERS COULD ALSO BE USED TO
PROTECT REGULAR SHOES FROM BECOMING WET AND
CONTAMINATED DURING CLEANING PROCEDURES HOWEVER,
THESE PUNCTURE EASILY AND MAY FALL OFF. THEY MUST BE
REPLACED IF THERE IS ANY SIGN OF DAMAGE AND THE OLD
ONES DISCARDED PROPERLY IN THE WASTE CONTAINER

20. OTHER WORKWEAR REQUIREMENTS :
WORKWEAR REQUIREMENTS FOR CSSD OTHER THAN THE DECONTAMINATION ZONE
WHEN YOU WORK IN THE IAP OR STERILE STORAGE ZONES IN CSSD, YOU WEAR DIFFERENT WORKWEAR. HERE THE EMPHASIS IS ON
PROTECTING THE REUSABLE MEDICAL DEVICES AND THEIR ENVIRONMENT.
PAY ATTENTION TO GENERAL HYGIENE AND WASH YOUR HANDS FREQUENTLY.
UNIFORM/SCRUB WEAR A FRESHLY LAUNDERED OR NEW, DISPOSABLE, LOW-LINT “SCRUB” UNIFORM THAT MINIMIZES BACTERIAL
SHEDDING AND IS COMFORTABLE FOR YOU. CHANGED SCRUBS DAILY OR WHENEVER THEY BECOME VISIBLY SOILED OR WET.
HEAD/HAIR COVER WEAR A CLEAN, SINGLE USE, LOW LINT SURGICAL HAT OR HOOD THAT FULLY COVERS AND CONFINES YOUR HAIR.
DISCARD THIS HEAD COVERING AND REPLACE IT WITH A NEW ONE WHEN RE-ENTERING THE ZONE.
FOOTWEAR WEAR DEDICATED NON-SLIP ENCLOSED FOOTWEAR THAT CAN PROTECT FROM INJURY OR CONTACT WITH ACCIDENTLY
DROPPED SHARP OBJECTS. FOOTWEAR MUST BE APPROPRIATE TO THE AREA AND REGULARLY CLEANED AND DISINFECTED. MAKE-
UP/JEWELRY DO NOT WEAR
MAKE-UP OR JEWELRY (EXCEPT A PLAIN WEDDING BAND) IN CSSD. YOU MAY WEAR STUD EARRINGS THAT ARE CONFINED WITHIN
THE HEAD COVER IN CASE THEY COME LOOSE.

21. GLOVES
USE GLOVES FOR ENVIRONMENTAL CLEANING ACTIVITIES, AND HANDLING CONTAMINATED REUSABLE MEDICAL DEVICES AND WASTE.
WEARING GLOVES DOES NOT REPLACE HAND WASHING AS GLOVES MAY HAVE BECOME DAMAGED DURING USE OR HAVE DEFECTS THAT ARE NOT
IMMEDIATELY OBVIOUS.
• WASH YOUR HANDS BEFORE AND AFTER USING GLOVES.
• WEAR THE CORRECT SIZE AND APPROPRIATE TYPE FOR THE TASK.
THEY SHOULD HAVE LONG ENOUGH CUFFS TO FIT OVER THE CUFFS OF THE GOWN.
• KEEP YOUR NAILS SHORT SO YOU DON’T PUNCTURE YOUR GLOVES.
• AVOID TOUCHING YOUR MASK, EYES OR FACE WITH YOUR GLOVES ONCE YOU HAVE STARTED WORK.
• LEARN HOW TO REMOVE GLOVES WITHOUT CONTAMINATING YOUR HANDS OR SNAPPING THE GLOVES WHICH MAY SPREAD CONTAMINATION
ACROSS THE ROOM.
• REMOVE USED GLOVES BEFORE TOUCHING ANYTHING THAT CAN BE CONTAMINATED THROUGH CONTACT SUCH AS SURFACES AND PENS.
• DISCARD THE GLOVES WHEN YOU ARE DONE, OR WHEN YOU SUSPECT THE GLOVES ARE TORN OR PERFORATED.

24. WHEN IT COMES TO WORKING IN CSSD YOU NATURALLY THINK OF PROTECTING YOURSELF, BUT IN THE IAP AND
STERILE ZONES YOU ALSO NEED TO THINK OF PROTECTING THE REUSABLE MEDICAL DEVICES FROM CONTAMINATION
BY YOU. IT IS IMPORTANT THAT YOU ARE FAMILIAR WITH MAINTENANCE OF PERSONAL HYGIENE APPROPRIATE TO THE
ZONE OF THE UNIT YOU ARE WORKING IN. IF YOU ARE ILL WITH ENTERITIS OR HAVE A SEVERE RESPIRATORY TRACT
INFECTION CAUSING A LOT OF COUGHING, SNEEZING, OR SKIN CONDITION, YOU SHOULD SEEK MEDICAL ADVICE AS
TO WHETHER YOU SHOULD BE HANDLING CLEAN OR STERILE GOODS.
HANDWASHING AND HAND CARE ARE EQUALLY IMPORTANT IN THE IAP AND STERILE ZONES, TO PROTECT THE
REUSABLE MEDICAL DEVICES FROM CONTAMINATION BY YOU.

25. thank you!
Keep it up