1. Review safety practices important when handling chemical disinfectants.
2. Explain the benefits of Material Safety Data Sheets.
3. Highlight the importance of reporting employee injuries and accidents.
4. Discuss basic procedures to prevent patient injuries.
CSSD Safety Practices: Part III
Sponsored by:
Handle Disinfectants Safely
Disinfectants are chemicals that kill most
pathogenic (disease-causing) microorganisms,
but not spores. Therefore, they are not
sterilants like ethylene oxide, hydrogen
peroxide or ozone, which were discussed
in Part II of this series. They are widely used
to kill organisms on medical devices
that do not need to be sterilized before
reuse. Commonly-used disinfectants in
healthcare facilities include quaternary
ammonium compounds (“quats”), phenolics,
alcohol, halogens (chlorine and iodophors),
glutaraldehyde, ortho-phthaladehyde (“OPA”),
and formaldehyde.
Processing recommendations issued by
the disinfectant and medical device
manufacturers should always be carefully
followed to best ensure that the disinfection
procedures used are effective and safe. All
MSDSs for the chemicals should be available
for easy reference, their instructions
should be consistently followed, and
the information they contain should be
integrated into safety training programs.
Applicable guidelines issued by national,
state and local governmental agencies
regarding these chemicals must be complied
with, as well. Any guidelines published
by voluntary associations should also be
followed to ensure worker and patient safety.
CIS technicians should follow general safety
precautions when handling and working
with disinfectants. Examples are:
• Wearing necessary personal protective
equipment (PPE), including general
purpose utility gloves, a fluid-resistant
gown or other covering with sleeves, full-
face protection, and shoe covers.
• Using an exhaust hood because some
disinfectants produce fumes that irritate
the respiratory tract.
• Following previously developed spill plans
and disposal procedures for each solution.
• Knowing where eye wash towers/stations
and other first aid supplies are located
and how to use them.
Material Safety Data Sheets
CIS technicians and other healthcare
personnel must be adequately informed
about the risks associated with the
hazardous materials with which they work
or to which they are exposed. To this
end, the Occupational Safety and Health
Administration (OSHA), an agency within
the U.S. Department of Labor, requires
(Instrument Continuing Education-ICE)
Instrument Continuing Education (ICE)
lessons provide members with ongoing
education in the complex and ever-changing
area of surgical instrument care and handling.
These lessons are designed for CIS technicians,
but can be of value to any CRCST technician
who works with surgical instrumentation.
You can use these lessons as an in-service
with your staff, or visit www.iahcsmm.org
for online grading at a nominal fee.
Each lesson plan graded online with a passing
score of 70% or higher is worth two points
(2 contact hours). You can use these points
toward either your re-certification of CRCST
(12 points) or CIS (6 points).
Mailed submissions to IAHCSMM will not be
graded and will not be granted a point value
(paper/pencil grading of the ICE Lesson Plans
is not available through IAHCSMM or Purdue
University; IAHCSMM accepts only online

Certified Instrument Specialist (CIS) technicians must consistently use safe work practices
to protect themselves, their employee peers and the patients they serve. Unfortunately,
this is much easier to say (and to insist upon) than it is to practice. Those working in
Central Sterile Supply Departments (CSSDs) are confronted with a wide array of risks that
require a great deal of knowledge to avoid.
This lesson is the last of a three-part series examining some of the most important safety
issues of concern to CIS technicians. In the first lesson, we presented an overview of
safety issues, and we took a “tour” through the CSSD to note specific risks in each
work area. In the second lesson, we explained the role of governmental agencies and
allied professional organizations in shaping safety practices, and we also discussed safety
concerns applicable to chemical sterilants. In this lesson, we will discuss safety practices
that should be used when working with chemical disinfectants, note the purposes of
Material Safety Data Sheets (MSDSs), explain protocols for reporting employee injuries
and accidents, and review practices to reduce patient injuries.
Series Writer/Editor
Jack D. Ninemeier, Ph.D.
Michigan State University
East Lansing, MI

CIS Self-Study Lesson Plan
manufacturers of the materials to develop
and supply MSDSs with their products.
MSDSs are documents specific to each
hazardous material that provide important
information that employees must know
to work safely with the material. This
information is more detailed than that
normally included on product labels or
on other precautionary statements, and
• Product name and manufacturer’s name
and contact information
• List of hazardous ingredients
• Physical information, such as vapor
pressure and density, evaporation rate,
solubility in water, freezing and boiling
points, specific gravity, acidity (pH),
appearance, and odor
• Fire and explosion information, including
flash point, flammable units, extinguishing
media, special fire fighting procedures,
and unusual fire and explosion hazards
• Reactivity information, such as
stability, incompatibility, and hazardous
decomposition products
• Health hazard data, including effects of
over-exposure to the material
• Storage recommendations
• Emergency and first aid procedures
• Spill or leak procedures, spill management,
and waste disposal recommendations
• Protection information and control
• Special precautions
While not every chemical is potentially
hazardous, MSDSs should still be available
for all products used in the CSSD. Employees
should know about the chemicals they
handle. Some staff members could have
special health concerns, such as allergies,
and will be alerted to potential problems by
this information.
Employers are responsible to ensure that
MSDSs are available and, in turn, CIS
technicians must become familiar with
the information and comply with the
instructions provided. Employers may
ask staff members to review MSDSs on a
regular basis.
Safe practices suggested by MSDSs should
be incorporated into work procedures to
help reduce chemical accidents and injuries.
Practice drills relating to chemical exposure,
fires and explosions may be helpful.
Knowledge about first aid and procedures to
seek proper treatment is also important. This
and other related emergency information is
provided by MSDSs that should be sent with
exposed or injured employees as they seek
medical assistance.
Reporting Employee Accidents and
Even with significant efforts to increase work
safety awareness and prevent accidents,
CIS technicians can still be involved in
accidents, and injuries can still occur. Then
it is necessary to document and report the
incident to the appropriate administrative
personnel to comply with OSHA healthcare
facility regulations.
An investigation must be conducted to
provide information about the cause, the
situation, and/or the behaviors involved.
This will help identify the factors, hazards
or unsafe practices that contributed to the
incident. Then corrective actions can be
taken to improve the systems, behaviors or
physical conditions that caused the injury
and will help prevent future injuries to other
CIS technicians should remember that no
matter how insignificant an injury seems
they should inform their supervisor, manager
or director immediately. Time, place, tasks
being performed, and a description of the
incident must be recorded on the appropriate
form. It should then be submitted to
the safety officer, personnel department,
employee health or other administrators,
and risk management personnel must also
be informed about potential problems.
Preventing Patient Injuries
CIS technicians have a responsibility to
help prevent patient injuries, accidents
and infections. They do so as they
correctly perform the important tasks of
decontaminating, disinfecting, inspecting,
testing, assembling, packaging, sterilizing,
and aseptically handling sterile items
according to established procedures. If
these tasks are done correctly, the chance
of a patient being injured or involved in
an accident related to sterile processing
procedures is greatly reduced. A check
and balance system should be used to
ensure that these important functions are
performed correctly. For example, sterilizers
must be inspected while in use, they should
be monitored with biological monitoring
tests, and these results must be recorded
and reviewed.
Potential hazards can exist when CIS
technicians have not correctly performed
their jobs. Some examples include:
• Patient Care Equipment — Patients
receiving equipment that has not been
tested for proper operation and function
can be subjected to complications arising
from malfunctioning equipment or
delayed treatment. All equipment must
be tested and documented according
to manufacturers’ recommendations
and guidelines before leaving the CSS
department. All equipment must be
properly decontaminated, and it should
be free from soil, damage, defects, or
hazards that could affect its use. Patient
equipment must also be included in
a scheduled preventive maintenance
• Contaminated Supplies or Reusable
Medical Devices — Contaminated
supplies, equipment, and unsterile
reusable medical devices, such as surgical
instruments, are a hazard to patients
undergoing surgical procedures or
treatment because nosocomial (hospital-
Picture courtesy of KEM Medical
Exhaust hoods protect CIS technicians from
potentially dangerous fumes.
acquired) infections can occur. Also,
complications resulting from delayed
surgical procedures may result from having
to flash sterilize an item that was not
properly decontaminated and sterilized.
All items must be properly processed from
initial transport after use until they are
stored and redistributed. CIS technicians
must use correct processing procedures,
sterilization equipment must operate
properly and be carefully monitored,
and sterilized items must be handled,
transported and stored properly.
• Chemical Residues — Patients coming
in contact with items having chemical
residues can receive chemical burns or
other complications. Items sterilized
with ethylene oxide (EtO) must be fully
aerated to ensure that no EtO residue
or its byproducts will remain and harm
patients, and devices should be dry when
sterilized to avoid ineffective sterilization.
All items soaked in glutaraldehyde or other
chemicals must also be completely rinsed
to ensure that no residues or byproducts
• Patient and Supply Transport — Patients
being moved are at risk from collision
injuries resulting from poor transportation
techniques. Often there is traffic in patient
care areas caused by foodservice and
supply carts and patient transportation
devices such as gurneys/stretchers and
wheelchairs. Hallways, corners and
elevators can present hazards if the proper
techniques are not used as employees
transport patients. Safety tips include
using caution at all times, not using a
transport vehicle to push or prop open
automatic doors, and never parking mobile
equipment in hallways where it can block
traffic or door access.
When there is a patient accident/injury, it
should be investigated, and a record of the
incident should be developed. Practices and
physical conditions within the facility that
might cause a patient accident or injury must
also be investigated and reported, and it is
the responsibility of all healthcare workers to
report unsafe practices or hazards.
If a malfunction in the sterilization process
has occurred (or appears to have occurred),
all items in any loads thought to be unsterile
must be recalled. Then they must be
quarantined until biological and chemical
indicators are read. CSSDs must have a
recall procedure, and its basic tactics should
• Obtaining a list of all supplies known to be
in the load.
• Verifying the sterilization controls.
• Notifying the CSSD supervisor, manager or
director and those in the areas throughout
the facility where any affected supplies
could be stored.
• Retrieving as many affected items as
• Notifying the Infection Control and
Operating Room supervisor or coordinator
and other personnel according to the
facility’s policies and procedures.
• Notifying physicians if items known to be
unsterile were used in any of their surgical
• Documenting all steps taken.
• Notifying risk management personnel
about any possibility that unsterile devices
were used on a patient.
• Ensuring that the malfunctioning sterilizer
is removed from service if it caused the
• Inspecting malfunctioning sterilization
equipment by qualified service personnel.
A comprehensive report must be developed
and, after the equipment is repaired, a
negative biological test must be verified
before the equipment’s next use.
In Conclusion
Each of the three lessons in this series has
addressed important safety concerns. While
many topics and extensive information
have been presented, CIS technicians are
confronted by numerous other safety hazards
in their work areas. CSSD professionals must
have extensive knowledge about and require
skills in a wide range of very important
disciplines, and the ability to work safely is
among their most important responsibilities.
1. This lesson is adapted from: Central
Service Technical Manual. Seventh
Edition. Chicago, Il. International
Association of Healthcare Central Service
Materiel Management. 2007, and
Managing Safety Hazards in Central
Service. Module 6 in EXX CELL 2000
Plus: Strategies for Success. Chicago, Il.
International Association of Healthcare
Central Service Materiel Management.
2. See chapter 10 in the Central Service
Technical Manual referenced above for
detailed information about disinfectants.
CIS Self-Study Lesson Plan
Technical Editor
Carla McDermott, RN, ACE, CRCST
Clinical Nurse III
South Florida Baptist Hospital,
Plant City, FL
Series Writer/Editor
Jack D. Ninemeier, Ph.D.
Michigan State University
East Lansing, MI
IAHCSMM is looking for volunteers to write or
contribute information for our CIS Self-Study
Lessons. Doing so is a great way to contribute to your
own professional development, to your Association,
and to your Central Sterile Supply Department peers.
Our team will provide guidelines and help you
with the lesson to assure it will be an enjoyable
process. For more information, please contact
Elizabeth Berrios (elizabeth@iahcsmm.org).
Keep hallways clear for the free flow of traffic.
CIS Self-Study Lesson Plan Quiz
(Instrument Continuing Education-ICE)
Lesson No. CIS 224: CSSD Safety Practices: Part III
Questions (circle correct answer):
1. Which is true about disinfectants?
a. They kill spores
b. They are sterilants
c. They kill most disease-causing
d. They are not used in healthcare facilities
2. Which of the following is not a
commonly used disinfectant in
healthcare facilities?
a. Citric acid
b. Alcohol
c. Glutaraldehyde
d. Formaldehyde
3. Guidelines by voluntary associations
________ followed to best ensure
worker and patient safety when
handling disinfectants.
a. Should be
b. Do not need to be
4. Which of the following is not part of
personal protective equipment (PPE)?
a. Fluid-resistant gown
b. Shoe covers
c. Full-face protection
d. All the above are part of personal
protective equipment
5. Material safety data sheets (MSDSs)
are required by which federal
government agency?
a. FDA
c. EPA
d. CDC
6. Material safety data sheets are
developed by:
a. Healthcare facilities
b. U.S. Department of Labor
c. Manufacturers of chemicals to which
they apply
d. Independent testing laboratories
7. Information that must be included on
a material safety data sheet includes
all of the following except:
a. List of hazardous ingredients
b. Health hazard data
c. Purchase container size
d. Reactivity information
8. Which of the following statements
is true?
a. Not every chemical is potentially hazardous
b. Every chemical is potentially hazardous
c. Material safety data sheets need only be
available for hazardous products
d. The FDA is responsible to ensure that
MSDSs are available in each healthcare
9. Which type of employee accident/injury
must be investigated?
a. Only those that cause an injury or death
b. Only those that occur when instruments
are being processed
c. All injuries and accidents, regardless
of significance
d. Only those covered by each specific
healthcare facility’s policies
10. Patient care equipment must be free
from which of the following before
it is issued for patient use?
a. Soil
b. Damage
c. Defects
d. A and C above
e. All the above
11. Which is true about flash sterilization?
a. It can delay surgical procedures
b. It may be necessary when an item was not
properly decontaminated
c. It minimizes the need for careful
sterilization in CSS departments
d. A and B above
e. All the above
12. Chemical residues on patient-contact
equipment ________ cause chemical
burns for the patients on which it is used.
a. Can
b. Cannot
13. Who should be contacted if a process
load is thought to be unsterile and must
be recalled?
a. The CSSD supervisor, manager or director
b. Infection control supervisor or coordinator
c. Operating room supervisor or coordinator
d. A and C above
e. All the above
14. Malfunctioning sterilization equipment
should be inspected by:
a. The Central Sterile Supply Department’s
b. Qualified service personnel
c. Infection control personnel
d. All the above
15. Who is responsible to report unsafe
practices or hazards?
a. Only managers in the departments in
which the practices or hazards occur
b. Only risk management personnel
c. All healthcare workers
d. Only OSHA inspectors
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