Felipe Mejia - MOHH CASE

Designing a CSSD to Maximize

Efficiency

Felipe Mejia Mechanical Engineer – CSSD Planner

Director of Planning and Design Belimed

PHOTO

4

Designing a CSSD to Maximize Efficiency

Staff

Administration

Decontam

Prep & Pack

Clean

Sterile Stores

Dispatch

What is a CSSD?


What is a CSSD?

5


First and foremost ...

Design Objective

8

Our purpose and

number one

priority, is safety for

patients and staff.

...Prevent Infections


Resources

• Space

– Equipment

– Rooms and Area Required

• Staff

– Clinicians & Support Staff

– Working Environment

– Automation

– Instrument Tracking

– Safety Net

• Utilities

10


Assessment of Space Needed

11

Number & Type of Cases Soiled Instrument Load Processing Equipment

Staff Support Infrastructure Space


Optimizing Space

12

Number & Type

of Cases No Change

Soiled

Instrument Load No Change

Processing

Equipment

Minimize

Footprint

Reduce Holding Areas

Reduce

Cycle Time

Reduce Service Area

(Smart Access)

Increase

Usable-to-Total

Volume Ratio

Warning!!

Reduce Amount of Equipment

$200 to $400 USD per square foot


Optimizing Equipment Cycle Time

13

Our Ammunition

Against Infection

causing Agents Temperature

Equipment Cycle Time

Time Needed to Accomplish Objective Safety Factor

Chemicals

Mechanical Force

Time

We do not want to

reduce our

Arsenal


Optimizing Equipment Cycle time

14

Run Processes Simultaneously

Capture and reuse Energy

Optimize Fluid Mechanics

Reduce Mechanical Time

So, how can we do it?


Equipment Automation

16

– No need to monitor Equipment Cycle times

– Reduction of idle time in between equipment cycles

– Reduction in equipment failure


Equipment Automation

17

– Staff works on critical tasks instead of manual labor

– Reduction of human error


Utilities • Water

– Indicator of total utility

consumption

– Consider the entire hospital

infrastructure when planning

o Example: Water consumption

can drop from from 950

Litre/Cycle to 10 Litre/Cycle

• Electricity

– Proper electrical wiring reduces

consumption

– Plan for the future

22


Utilities

• Energy

– Most of the energy used

goes into heating and

cooling

– Insulate utilities and buy

equipment with good

insulation

– Capture dissipated

energy and reuse

• Reclamation

– Water

– Steam Condensate

23


A Design Approach

24

Define

Measure

Analyze

Improve

Control

Lean Six Sigma DMAIC Methodology in the Design Process

Clearly define the scope, parameters and functions of

the CSSD

Processing load ▪ Space ▪ Time ▪ Equipment needs

▪ Cost ▪ Sustainability

Compare ideal designed CSSD with reality

Model your solution either manually or with modeling

software

Modify variables to reconcile ideal with reality. Revisit

project definition


Issues: EBD

• Deficient data for Evidence Based Design

– Deficient at the Hospital level

– Deficient at Industry level

– Deficient at Global level

– Mostly anecdotic

– At all levels data collection must be improved

– Stanford University Good example of data collection and

result analysis.

https://practicegreenhealth.org/sites/default/files/upload-

files/stanford_spd_and_water_savings.pdf

29


Issues: Funding for Healthcare

• Funding

– Is healthcare a right or a privilege?

– If it is a right, who pays for it?

– Who manages it?

– The Swiss healthcare system answered those questions with

an approach that resulted in a system yielding remarkable

health results.

30


Case Study: The Swiss Healthcare System

• History

– Came into effect under the implementation of “The Health Insurance

law”, in 1996. It has undergone only a couple of changes since.

• Essence

– It is mandatory for all individuals residing in Switzerland to purchase

the “Basic Healthcare Package” in a Private Market Place regulated

by the government.

– The government provides temporary financial assistance to those

who can’t afford it.

65% of Health Spending in Switzerland is Public

72% is the OECD* Average

83 % is the UK

*(OECD) Organization for Economic Co-operation and Development 31



• Essence

– The Swiss health care system is highly decentralized.

– Each of the 26 cantons is responsible for providing healthcare and

regulating the insurers.

– All applicants must be accepted regardless of health condition.

– Insurers make money on Premium Services and higher costs on

Packages in exchange for better service. D = 89%

– Competition between insurers drive up standards and lowers costs.

– Consumers get up to 45 % discounts for “No-Claims” bonus. This

has resulted in a clear incentive to adopt a healthier lifestyle.

32



• Price

– It is expensive!! But the Swiss value healthcare

Swiss 11.5% of GDP (GDP/c ~ US 84k)

OECD Average 9.5% of GDP (GDP/c ~ US 39k)

USA 17.6% of GDP (GDP/c ~ US 54k)

Singapore 4.6% of GDP (GDP/c ~ US 56k)

Colombia 6.8% of GDP (GDP/c ~ US 8k)

• Cost

– Regulated by Hospitals based on Competition

• Quality

– Professional self regulation

– Monitored by Regional Governments

33



• Negatives

– Expensive

– Discourages Preventive Healthcare

– Adult Dental Care not Included

– Weak or no Doctor/Patient Relation

– Weak Coverage Abroad

– Risk of Healthcare Cartels

– Coverage for Undocumented Immigrants is mandatory

– Mandatory

35


A Glimpse of the Future CSSD

• Equipment design will be heavily influenced by resource

consumption.

• Equipment will be smaller due to the demand for specific

processing.

• Automation will become prevalent

• Equipment will be replaced not because it reached its

lifetime but because of technology advances.

• Instrument Tracking System will evolve into an all inclusive

software, controlling the entire operation of the CSSD

• Level of knowledge required by a CSSD Clinician will

drastically increase. We will se more a more structured

Academic education.

36


A Glimpse of the Future CSSD

37

Thank You

Documents

Felipe Mejia - MOHH CASE