A culture of patient safety involves: leadership, teamwork and collaboration, evidence-based practices, effective communication, learning, measurement, a just culture, systems thinking, human factors, and zero tolerance.Leaders in CSSD are responsible for establishing safety. Leaders set patient safety as priority and motivate staff to perform. They ensure all the standards are followed, and no short-cuts are taken. Leaders provide tools to ensure all steps are done seamlessly. Leadership is critical to the success of patient safety in CSSD.
Decontamination process in CSSD cannot be done by one person. Teamwork and collaboration combines the talents and skills of each member of a CSSD team and serve as a check and balance method, making sure every process is done the right way. CSSD must encourage thinking, suggestion and action from all staff. Teamwork and collaboration in the department also decrease risk to staff.
Also, communication is a vital aspect. Open communication between leaders and staff or between staff encourage sharing technological and environmental information. Communication is based on mutual trust and setting the best practices in CSSD. Communication includes written, verbal, or electronic, and can be used for sharing data, sharing policies and procedures, literature studies and also reporting systems.
Sterilisation should be used for evidence-based literature. Sterilisation cannot be done only as a habit; a generation-to-generation practice has shown that people don’t use evidence-based standard. Evidence based practice in CSSD is a basic element of patient safety. Evidence based guideline for CSSD best practice is available from World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), and Asia Pacific Society of Infection Control (APSIC). Adoption of best practices sometimes meets resistance. Leadership together with staff must increase awareness, improve the desire to change to meet the standard, and even ask for incentives.
All members of CSSD should learn. Learning together can improve the ability to create desired results. The department’s staff should encourage participating in learning the formulating policies and procedures. They can schedule monthly meetings when a group of staff presents one topic, while others pay attention and ask questions to the presenter group.
To monitor compliance with best practices and to identify gaps in care, CSSD must collect and report reliable data. The staff must collect any problem when reprocessing instrument, particularly in cleaning, disinfection or sterilisation. CSSD can also get information from users. Any report that shows lack of compliance from best practice should be analysed and managed to improve cleaning, disinfection or sterilisation practice.
All processes in healthcare facilities are systems, involving interconnected components, people, supplies and equipment. CSSD practice seems simple, however it is really complex. It needs trained technicians, facilities, supplies, and water. Systems change or system thinking should be done to achieve and sustain success in CSSD practices.
A CSSD practice is not only done using machine but needs staff; human factors should be considered. Some principles in human factors include simplifying the process, standardising the process, reducing dependence on memory, using forcing function, and working toward reliability.
To err is human and some will inevitably make errors. CSSD can review the systems and learn from errors. These errors can be addressed by providing feedback and encouraging productive conversation and critical analysis to prevent future errors. The no blame culture focuses on systems that led to the error rather than on the individual. Blaming personnel only creates anxiety and fear and does little to solve current problems or prevent them.
However, in a condition that shows purposeful disregard of the rules, zero tolerance culture is used. Leaders must not tolerate non-adherence. When best practices are known, these should be expected of all staff. If staff takes a short-cut in cleaning, disinfection or sterilisation process, these behaviours should be addressed and not ignored.