Training Manual for Health Care Central Service Technicians / Edition 5

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The Training Manual is the premier reference and reviewpublication for individuals preparing for examinations given by TheCertification Board for Sterile Processing and Distribution. It isa concise, applicable tool that can be used for orientation,training, and instructional programs in health care facilities andin institutions for learning. The Fifth Edition of themanual is the largest and most comprehensive to date.

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Product Details

  • ISBN-13: 9780787982447
  • Publisher: Wiley
  • Publication date: 12/2/2005
  • Series: The Jossey-Bass/AHA Press Series
  • Edition description: Revised Edition
  • Edition number: 5
  • Pages: 304
  • Product dimensions: 8.50 (w) x 11.04 (h) x 0.90 (d)

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Training Manual for Health Care Central Service Technicians

John Wiley & Sons

ISBN: 0-7879-8244-X

Chapter One

Introduction to Central Service


At the completion of this assignment, the student will be able to

Describe the historical development of the central service department (CSD) within health care

Describe the organizational structure and objectives of the CSD

List the five major functional areas of a typical CSD

Describe the basic functions of each CSD area

Define the ethical responsibilities of the central service technician

List the categories of hazards associated with work in the CSD

List the means of preventing safety hazards

Describe proper attire to be worn in the CSD (how it varies within the department) and the importance of personal cleanliness

State the purpose and outline of the continuous quality improvement process

List agencies involved with the development of standards and their application to the CSD

Define and give reasons for work flow, people flow, and airflow patterns

Demonstrate an understanding of the purpose of a procedure manual and be able to differentiate between policies and procedures

Describe the relationship between CSD functions and written policies and procedures

Describe the four types of communication

List basic rules for telephone communications

Define medical terminology


(CSD) is the department within a health care facility in which medical/surgical supplies and equipment, both sterile and nonsterile, are cleaned, prepared, processed, sterilized, stored, and issued for patient care.

Until the 1940s, medical/surgical supplies were, for the most part, processed and maintained in the departments and patient care areas in which they were to be used. Under this system, there was considerable duplication of effort and equipment, and it was difficult to maintain consistently high standards of sterilization technique and product quality throughout the health care facility. Sterilization processing was "everybody's business but no one's responsibility" (Perkins, 1983).

As the number and variety of surgical procedures grew and the types of medical devices, equipment, and supplies proliferated, it became apparent that centralized processing was needed for efficiency, economy, and patient safety. The work of scientists W. B. Underwood and John J. Perkins was instrumental in encouraging health care facilities to establish a separate and distinct department, the central service department, with specialized expertise and direct responsibility for providing clean and sterile medical/surgical supplies and equipment to patient care areas.

This chapter provides an overview of the organizational structure, objectives, and functions of the CSD and an introduction to the responsibilities of CSD technicians.

Organizational Structure

The health care field of sterile processing and distribution has commonly been known as either central service or central supply, although neither of these names accurately reflects the functions or duties of the people who work in this field. A number of other names are also used to refer to the department that performs these functions. Among these names are central processing, central sterile, supply processing and distribution, and sterile processing and distribution. Whatever the department is called, the functions performed by the staff include the following: (1) cleaning, decontamination, processing (inspection, assembling, and packaging), and sterilization of reusable patient care supplies and equipment, and (2) distribution of these supplies and equipment to the units that use them.

Other logistical services may also be part of the CSD, such as mailroom, linen, and patient transport. Regardless of how the department is structured, any or all of these functions may be included in the services provided. Some of these functions may be performed by other departments.

Not only are the functions performed by the central service department different from one health care facility to another, but the organizational reporting structure varies also. For example, in many facilities the CSD reports to materials management, in others it reports to surgery, and in still others, to fiscal services, nursing, pharmacy, infection control, or administration. Some facilities have the cleaning, decontamination, processing, and sterilization functions report to one department and distribution to another department.

Every health care facility is organized into divisions and departments, each with a defined scope of activities and an organizational structure of its own. Managers are placed in charge of each of the departments, and their authority relationships are defined. Figure 1.1 shows one type of organizational structure for a health care facility. Figure 1.2 shows an example of an organizational structure for a large CSD.

Objectives and Functions

In general, central service provides the health care facility with services in the areas of supply processing and distribution. The distribution area is responsible for the delivery of supplies to designated customers. The decontamination processing areas are responsible for the cleaning, decontamination, inspection, assembly, packaging, and sterilization of all reusable patient care equipment and supplies. Sterile and nonsterile items must be separated and placed in defined and separate storage areas. This will help avoid confusion as to the items' sterile status.

The objectives of central service include the following:

Provide inventoried supplies and equipment to customer areas

Promote better patient care by providing prompt, accurate service

Provide supplies of sterile linen packs, basins, instruments, trays, and other sterile items

Maintain an accurate record of the effectiveness of the cleaning, disinfecting, and sterilizing processes

Strive for uniformity and simplicity in the trays and sets that the department provides

Maintain an adequate inventory of supplies and equipment

Monitor and enforce controls necessary to prevent cross-infection according to infection control policies

Establish and maintain sterile processing and distribution standards

Operate efficiently to reduce overhead expense

Stay abreast of developments in the field and to implement changes as needed to stay current with new regulations and recommended practices

Review current practice for possible improvements in quality or services provided

Provide consulting services to other departments in all areas of sterile processing and distribution, including in-service education programs, review of policies and procedures, and implementation of new processes

Other objectives may be included depending on the scope of the services provided by the individual department.

Major Areas in Central Service

The CSD is usually divided into five major areas: decontamination, processing (inspection, assembly, and packaging), sterilizing, sterile storage, and distribution.

Decontamination is the area where reusable patient care equipment and supplies are cleaned and rendered safe to handle. This can be done manually or with mechanical equipment depending on the item being decontaminated and the resources of the department. Whether manual or mechanical means are used, chemical detergents and disinfectants will be utilized as part of the process. Processing is the area where decontaminated or clean supplies, instruments, and trays are prepared for additional processing, storage, or distribution. There may be a linen room where packs of reusable linen are folded, assembled, and packaged. This is normally separate from the processing areas because of the large amount of lint that is generated. Lint can act as a vehicle for the movement of microorganisms, and can invade a patient wound and cause the body to attack it as a foreign object. Both of these possibilities can cause an infection to develop. For this reason the amount of lint (and other dust) must be minimized in the processing area. In addition to a linen room, many CSDs have an assembly area for house trays as well as single packaged items. Larger central service departments process operating room instruments through their CSD. Many CSDs also process reusable RT and anesthesia equipment. Clinics and other hospitals sometimes share processing services with one CSD to centralize processing and reduce costs.

The sterilizer area of the CSD is where packaged items are subjected to a process that destroys all microorganisms. This can be accomplished through a number of different methods, but most commonly through steam, ethylene oxide (EtO), gas plasma (Sterrad), or peracetic acid (Steris) sterilization. Other means of sterilization include dry heat and liquid chemicals (e.g., 2 percent glutaraldehyde).

Sterile storage is the area of the CSD where items are stored until distributed for use. There may be a separate area for the storage of clean, nonsterile items. The entire storage area must be subject to the principles of sterile storage. These principles include controlled temperature and humidity, limited traffic, ventilation requirements, and mechanisms that ensure that the environment remains as clean and dust-free as possible. Many times sterile trays are stored in this area until needed for surgery. Sterile storage is detailed in Chapter Eight.

Several major CSD functions are performed in the distribution area, including the preparation and delivery of exchange carts, case carts, orders, patient care equipment, and linens. In addition, CSD technicians are often responsible for replenishing stock (par level) of frequently used supplies on patient care units.

The CSD staff members are responsible for furthering the objectives of the department, while performing functions in a timely and conscientious manner and maintaining high standards of ethics, safety, and cleanliness. They must comply with all departmental rules and regulations.


In the normal course of their duties, CSD personnel often have access to patient information and have a responsibility to keep all such information confidential. Only the information necessary to perform CSD functions should be discussed within the health care facility, and patient information should never be communicated outside the institution. Not only do patients have a right to privacy, but also inappropriate discussions concerning patients may be overheard and misinterpreted by visitors, patient relatives, or other staff members.

Information or rumors regarding employees and physicians must also be considered confidential. Employees having tests or procedures have the same right to privacy as other patients. Inappropriate discussions concerning employees and physicians may be overheard and misinterpreted.

Central service department staff members have access to many items useful in the home. Just as shoplifting from department stores ultimately increases prices for all consumers, taking these supplies for personal use drives up costs. This action constitutes theft.

All tasks should be performed according to established procedures. Taking shortcuts or breaking protocol may appear to save time; however, supplies may not be prepared correctly and may not be usable. Not following established procedures may also have serious consequences that jeopardize the safety of both patients and staff. Additional time and money may be needed to correct errors or treat injuries resulting from improper work performance. So please check with a supervisor before attempting to make a change.


Safety is a major concern of the CSD. The primary areas of safety hazards include environmental, electrical, mechanical, chemical, biological, fire, and physical. The work performed in the CSD is complex and requires attention to detail to avoid injury to both patients and employees. Most workplace injuries and accidents are caused by neglect, carelessness, thoughtlessness, or a lack of understanding of the principles of safety. Safety is every employee's responsibility. An understanding and application of basic safety standards will enable the employee to ensure that injuries, accidents, and damage are kept to a minimum.

Environmental Hazards

Workers may suffer cuts or "sticks" from needles, scalpels, other sharp instruments, and glassware in the decontamination area. At all times, be alert for these hazards and never reach into any liquid to retrieve items. Always use a forceps or other grasping tool to retrieve items immersed in liquid. The floor may be wet and slippery and can cause falls. Soiled, reusable medical/surgical items are considered to be contaminated with bacteria and other microorganisms, which can cause illness to the staff. Wearing the proper protective equipment as described in Chapter Four helps to prevent this from happening. In the processing and sterilization areas, personnel can be burned when operating steam sterilizers or heat sealers. Be aware that many areas of a steam sterilizer are hot. Use insulated gloves to move carriages and know where hot areas are located on your sterilizers. Employees can be exposed to high levels of EtO. EtO is a known carcinogen and a possible mutagen, but when used properly prevents employee infection. Receiving staff have to contend with heavy boxes, splinters, and large carts, which require the use of proper body mechanics and ergonomically correct equipment. Distribution technicians work with elevators and lifts, bulky patient care equipment, and traction apparatus. All these items pose potential safety problems and require careful, precise use and handling. If workers follow protocols as defined by their department's policies and procedures, these environmental concerns can be minimized. If you have any concerns, be sure to ask your department manager how you can best be protected.

It is important to keep the workplace clean and free of clutter. Work surfaces and equipment must be cleaned and disinfected routinely to retard the growth of microorganisms. Clutter provides fuel for fires and a breeding ground for insects, vermin, and the microorganisms they carry. Passageways must be kept free of boxes and carts, both to prevent injuries and to keep escape routes open in the event of fire or other emergencies. In a health care facility, escape routes must not only accommodate people, but also large transport vehicles such as stretchers and carts. A separate breakout or decasing area should be maintained to hold deliveries until the exterior shipping cartons can be opened and the contents removed in a safe and controlled manner. Exterior shipping cartons have been exposed to many environments (in warehouses, on docks, in trucks), are usually made of corrugated porous material, and must be considered heavily contaminated and should not be brought into the CSD. These procedures all serve to minimize contamination and prevent accidents.

If workers follow the proper protocol as set up by their department these environmental concerns can be minimized. Be sure to ask your department manager how you are protected if you have any concerns.

Electrical Hazards

All electrical devices should be inspected upon arrival in the health care facility to ensure proper grounding and electrical safety, including electrical devices for personal use such as radios, if permitted in the workplace. Routine preventive maintenance of equipment is essential. The health care facility's biomedical or plant engineering staff usually perform these tasks. All maintenance and repairs of equipment issued by the CSD and used in the CSD should be documented and records maintained.

Electrical cords should be kept behind equipment and away from walkways so that personnel will not trip on them. Extension cords should never be used. All cords should have a grounded, three-prong, hospital-grade plug. If a cord is cracked or cut, it must be replaced. Water should never be allowed to collect near an electrical outlet.

For other electrical safety rules, the facility's safety regulations can be consulted.

Mechanical Hazards

Equipment operational safety is very important in the CSD. Large, automated pieces of equipment are used, including several types of washer/decontaminators, ultrasonic washers, scope washers, and sterilizers. To prevent injury (and to avoid damaging expensive equipment), CSD staff must understand and practice the proper operating procedure for each piece of equipment. The equipment manufacturers' written operation and maintenance procedures must be reviewed and followed. As with all in-service education conducted in the department, training on equipment operation should be documented and maintained in each employee's file in the CSD.


Excerpted from Training Manual for Health Care Central Service Technicians Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents

Foreword to the Fifth Edition.

Foreword to the Fourth Edition.

Foreword to the Third Edition.

Foreword to the Second Edition.

Foreword to the First Edition.

1 Introduction to Central Service.

Educational Objectives.

Organizational Structure.

Objectives and Functions.

Major Areas in Central Service.



Personal Cleanliness.

Continuous Quality Improvement.

Rules and Regulations.



2 Human Anatomy and Physiology.

Educational Objectives.

Cell Biology.

The Skeletal System.

The Muscular System.

The Nervous System.

The Circulatory System.

The Respiratory System.

The Digestive System.

The Urinary System.

The Reproductive System.

The Endocrine System.

The Sensory System.


3 Microbiology and Infection Control.

Educational Objectives.

Basic Microbiology.

Disease Transmission.

Disease Prevention.

Nosocomial Infections and Cross-Contamination.

Disinfection Principles.

Sterilization Principles.



4 Decontamination.

Educational Objectives.

Collection and Transport of Used Supplies and Equipment.

Decontamination Area.

Standard Precautions.

Detergents and Cleaning Agents.


Cleaning and Processing Equipment.

Cleaning, Disinfection, and Preparation Procedures.


5 Instrumentation.

Educational Objectives.

Handheld Surgical Instruments.

Powered Instruments.

Endoscopic Instruments.


6 Preparation and Packaging for Sterilization.

Educational Objectives.

Preparation of Instruments.

Pack Construction.

Basin Set Preparation.

Miscellaneous Preparation.

Principles of Packaging.

Types of Packaging Materials.

Wrapping Techniques.


Containerized Packaging.

Labeling Packages.

Shelf Life.


7 Sterilization.

Educational Objectives.

Factors Affecting Sterilization.

Monitoring the Sterilization Process.

Steam Sterilization.

EtO Sterilization.

Dry-Heat Sterilization.

Liquid Chemical Sterilization.

Gas Plasma Sterilization.

Ozone Sterilization.


8 Sterile Storage.

Educational Objectives.

Maintaining Product Sterility.

Stock Arrangement, Rotation, and Shelf Life.


9 Distribution.

Educational Objectives.

Types of Distribution Systems.

Delivery Methods and Equipment.

Distribution Work Practices.


10 Inventory Control.

Educational Objectives.

Measuring Inventory Performance.

Managing Inventory.


Appendix A: Central Service Terminology.

Appendix B: Medical Terminology for Central ServiceDepartment Employees.

Appendix C: Symbols Used by Device Manufacturers.


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