"Get me one of those long clamps Dr. Magilligan uses—STAT! You know what they are—you got one for me last time."

Phrases like this are heard every day in hospitals across America. Somebody needs an item, and needs it now. In most cases someone from Central Service gets the job done. So exactly who and what is this department called Central Service?

Central Service suffers from a name recognition problem. Depending on the facility, the department may be referred to as CS (central service or central supply), CPD (central processing and distribution), or SPD (sterile processing and distribution), just to name a few. For the sake of this article, the term central will be used to encompass all names used to describe this department. With Healthcare Purchasing News recognizing its 2004 Central Service Department of the Year in the December issue (story available at www.hpnonline.com/inside/december
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now is the perfect time to reintroduce central to hospital administrators and to explain the vital role this department plays in institutions of every size and type.

Paradigm busting
Most healthcare professionals think of central as a department in the hospital basement, staffed primarily by entry-level employees. Central is known basically for cleaning instruments in a dishwasher; it is not considered a department that requires much technical knowledge. This could not be farther from the truth.

Central is one of the few departments that could bring an institution to a halt, because all sterilization and decontamination takes place in this area. If staff is not available, there are no "Kelly Service" type replacements that can fill in on short notice. Due to the increased technicality of cleaning machines and procedures over the past 10 years (which includes an increase in computerization), central staff employees must be highly trained in proper procedures.

Central has become more technical in part because organizations such as JCAHO, AAMI, OSHA, EPA, and the FDA have implemented very specific regulations for cleaning and sterilizing instruments. Central is responsible for monitoring the sterilization process throughout the institution, and for ensuring the sterility of instruments used in all procedures and surgeries. Instruments must be sterile to protect both the patients on which they are used and the employees who handle and process them. The current minimally invasive surgical procedures require intricate and delicate instruments that require technical knowledge for cleaning and assembly. Central employees must know how to get these instruments clean because, as we all know, "it can’t be sterile if it isn’t clean."

As a department, central can have a significant impact on a hospital’s bottom line. Central is generally responsible for equipment rentals. It also takes care of daily patient charges for blood pumps, ventilators, and other devices, and gathers charge tickets for patient charge items. Central also inventories the nursing unit supplies, restocks them when necessary, and retrieves them STAT when needed in an emergency.

Central is responsible for one of a hospital’s biggest assets—its instrument inventory. The value of this inventory can range from approximately $50,000 at a small hospital to more than $2 million at a large institution. Proper care and control of this inventory by central is crucial to an institution’s bottom line.

The central department requires constant capital improvement in order to provide proper quality product and service. It is one area of the hospital where "quality doesn’t cost; it pays." Likewise, central employees must be highly trained to keep up with the new procedures and instruments being used by doctors, surgeons, and nursing staff. Central staff must understand how new equipment is used in order to properly clean, assemble, wrap, and sterilize it. The success of any procedure depends on the availability of clean, sterile, and properly packaged and arranged instruments.

Central is a department that can help keep a hospital out of the headlines: "Dirty Instruments Stop Surgery" London Times 2/31/03. Having a staff well trained and certified along with proper equipment central can help prevent headlines like this and help show that a hospital has great quality.

Central is a constantly evolving, dynamic department. Quality of product and service is constantly checked and improved, and new, such as advanced methods of monitoring the cleaning process are becoming standard. Central plays a key role in reducing a hospital’s surgical infection rate. In fact, central can be considered the "heart of the hospital" because so many other departments depend on the service it provides.

Central is not just a department; it is a group of unique professionals certified through various programs. In June 2004 the New Jersey Department of Health and Senior Services passed a law requiring all personnel who are responsible for reprocessing of medical/surgical devices to pass a certification and exam and to maintain certification by obtaining continuing education credits. The NJDHSS press release states: "Since reprocessing of medical devices is an important link in the chain of infection, the Department feels that education and testing the competency levels of managers and technicians will protect the public and ultimately lead to lower healthcare costs." The importance of central’s role in controlling hospital infections is beginning to be recognized.