Cisa Campus

Worldwide learning and
training centre

Cisa Campus aims at establishing and promoting culture and knowledge to prevent the spread of infection in healthcare and life sciences settings. Cisa Campus informs and trains on procedures and technologies dedicated to the sterilization process.

Cisa Campus operates globally through its training programmes that reach healthcare operators and technicians all over the world.

Thanks to this centre of excellence, Cisa staff and distributors remain up-to-date and highly specialized on the solutions and technology currently present in the sterilization and infection control industry and gain insight into the impact they have on sector developments.

Cisa’s main headquarters are in Lucca, which allows Cisa Campus to offer specialised teaching to its entire staff and also to address local students and recent graduates. Many recent graduates from prestigious universities choose a subject related to Cisa Group and the sterilization process to carry out a curricular internship and prepare their degree thesis.

TRAINING HOURS
PER YEAR

1000+

CISA
STAFF

80%

TECHNICIANS
AND DISTRIBUTORS

20%

Cisa Campus provides scientific and technical knowledge through: Courses, Tech Tips and Indepth

Cisa Campus courses

Training can be based on specific requests by the distributor or healthcare facility and the research centre or laboratory. Courses are delivered both on-site or remotely, through e-learning and video conference. Teachers are generally Cisa Group staff or authoritative experts in the sterilisation procedures in healthcare or in the sterilisation process in life science.

info @cisacampus →

Operators, technicians and engineers undergo periodic training and refresher sessions on all company innovations and on the evolution of reference standards (e.g. DIN EN 285 – European Standards).

Following an annual refresher course, a specific certificate is issued to technical personnel, which allows them to use, install and maintain Cisa Group machinery and sterilizationsystems in Italy and elsewhere in the world.

Practical lessons at basic, intermediate and advanced level, provide all the information on the processes, technology and rules of use of the individual machines in the CSSD.

If special solutions are developed for a customer, usually in laboratory, research or pharmaceutical life science applications, the customer is often present to take part in functional verification testing and Cisa Campus can organise a specific training course.

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Cisa Campus Tech Tips

The Cisa Campus Tech Tips are short informative capsules, practical tips on the sterilization process. Technical recommendations for the proper use of sterilization autoclaves and advice for the maintenance of Cisa Group’s washer-disinfector technologies.

Power generator maintenance: replacing the safety valve

Power generator maintenance: replacing/cleaning the level probe

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The autoclave heating cycle. What it is, how often it is carried out and why it is essential.

The autoclave heating cycle. What it is, how often it is carried out and why it is essential.

The purpose of the heating test (or heating cycle) is to heat the chamber and the different hydraulic circuits so that only saturated steam passes through the machine. In addition, it can be useful to extract all the water in the equipment piping which has been produced by the cooling of the steam. Any preset programme for steam sterilisation can be used for the heating test. However, it is recommended to use the 134° sterilisation programme.
The heating cycle must be repeated daily and in any case whenever the equipment is switched off for a period of more than 4 hours.

Autoclave leak test, or vacuum test: what is it and why is it important?

Before starting the daily sterilisation activity, the operator must run some tests to ensure the proper operation of the equipment. These tests are carried out using the preset programmes in Cisa machines, namely Heating, Vacuum Test and Bowie & Dick Test.
Once the heating cycle has been completed and the steriliser is fully operational, the “chamber tightness” is assessed with the Vacuum Test cycle.

The autoclave vacuum test is the simplest test to perform. It is to be carried out daily, so as to be certain that the device correctly generates vacuum in the chamber and that there are no leaks in the sealing parts of the equipment (pump operation and achievement of the set vacuum limits, leaks in the door gasket or from the fittings in the piping of the vacuum circuit, good sealing of the mechanical components such as solenoid valves, etc.) and that it is able to maintain the vacuum in the chamber for a certain period of time. The test is performed by generating a controlled vacuum in the sterilisation chamber and maintaining it for a period of time of approximately 600”, i.e. 10 minutes.
If the vacuum test is successful, it shows that the leakage rate is within the normal range. The machine prints a paper report certifying that the test has been carried out.

How often should the Bowie & Dick autoclave test be carried out?

Bowie & Dick Test
Before starting the daily sterilisation activity, the operator must run some tests to ensure the proper operation of the equipment. These tests are carried out using the preset programmes in Cisa machines, namely Heating, Vacuum Test and Bowie & Dick Test.
Once the heating cycle has been completed, the steriliser is fully operational and the “chamber tightness” has been assessed with the Vacuum Test cycle, the operator must also carry out the Bowie & Dick Test every day.

The Bowie & Dick Test is the daily test that monitors the effectiveness of air removal and steam penetration in porous loads for fractionated vacuum sterilisers. During this test, the correct operation of the steriliser’s vacuum pump, the absence of air infiltration into the chamber and the absence of non-condensable gases dissolved in the steam feed are verified.
The Bowie & Dick test is of paramount importance. Indeed, what happens if air becomes trapped inside a package during a steam sterilisation cycle?
Let’s consider a heat-sealed sterilisation pouch containing a medical device, such as a scalpel. If air is trapped in the pouch, saturated steam penetrates the bag through its paper side, but fails to come into direct contact with the surface of the scalpel, as the trapped air forms a kind of ‘bubble’ around the scalpel itself.
As a result, the steam’s thermal energy will not be transferred to the scalpel, inactivating all microorganisms on the surface of the medical device, but will be released to the air, which will slowly heat up.

To carry out the test, you take a ready-made disposable or reusable B&D test pack and place it in the coldest point of the chamber or near the drain. Only the test pack must be present inside the chamber, because the test is carried out with the chamber empty. The test cycle is carried out following the time required by the specific regulations (half time). At the end of the cycle, the package is removed from the chamber.

The test will not be considered successful if the indicator sheet inside the test package presents an area that is not completely turned to colour.
The test will be considered passed if the indicator sheet presents a uniform colour over its entire surface.

Cisa Campus Indepth

These in-depth scientific studies deal with topics that may be related the sterilisation process, involving not only Cisa Group professionals but also authoritative personalities and experts from the scientific and medical world.

CONSUMPTION IN A HOSPITAL CSSD: HOW TO SAVE LARGE QUANTITIES OF WATER AND SIGNIFICANTLY REDUCE COSTS.

Water is considered to play a vital role in a hospital CSSD. Why?

Water is the essential fuel for the entire reprocessing process of reusable medical devices in every hospital CSSD.

The amount of water consumption within a CSSD serving ten operating theatres, fitted with equipment used medium intensively throughout the day, is approximately 2,500,000 litres per year.

The amount of water consumption within a CSSD serving ten operating theatres, fitted with equipment used medium intensively throughout the day, is approximately 2,500,000 litres per year.

This impressive number must be doubled if one also considers the consumption due to manual washing and the use of washer-disinfectors and other large devices for washing containers and trolleys.

It is said that the water used in a CSSD has three costs. What does this mean?

One must consider that in addition to the cost of water as a raw material, there are also all the technological costs associated with the reprocessing process and the treatment the water itself undergoes.

The different types of water used within CSSDs to meet both technical and regulatory requirements undergo treatments and these have a cost. A second cost is therefore that of pre-treatment and a third cost is that due to the discharge treatment from the devices at the end of the cycle, in simple words the disposal of the water itself.

Demineralised or osmotised water is a regulatory requirement for steam quality suitable for sterilisation
Osmotised water is needed for the thermal disinfection process in the final stage of every washer-disinfector
Softened water is used in vacuum pumps to generate the vacuum needed for the sterilization cycle
Softened water is also used in washer-disinfectors, especially in the washing phases
Softened water ensures a longer life for vacuum generation devices
Softened water also ensures a lower consumption of detergent in washer-disinfectors

Being acquainted with these aspects and the specific consequences in terms of sustainability is important in order to understand how to save costs, which technologies to choose and how to make the most of them, and also to reduce the impact on the environment.

Water consumption in the CSSD and sustainability

Water plays a leading role not only in the reprocessing process of a hospital CSSD but also in the Road Map 2030.

Water underlies at least 5 of the 17 sustainable goals that the United Nations have identified as targets to be achieved within the next decade.

What can be done to reduce water consumption in a CSSD?

Much can be done to actively participate in the UN 2030 agenda. Here are a couple of simple tips.

Address the concept of consumption and savings early on, when designing the reprocessing process in the CSSD.
Evaluate technologies that allow to save water all while performing the exact same process.

Esempio termodisnfettori

Cisa Group offers washer-disinfectors that reduce water consumption at every stage of the cycle and consequently guarantee significant savings in terms of the thermal and electrical power required to bring the water to the right temperature for the disinfection process.

It is like boiling water for pasta. By filling the pot only halfway one can save tap water, and less water can reach boiling temperature in less time, consuming less heat, saving gas.

Sterilizzatori a vapore con Aquazero

On the market there are systems and devices integrated into sterilisation equipment that can ensure water savings of over 95%, such as the patented Cisa Group Aquazero® system that generates vacuum without water.

Approaching the project of a new CSSD with greater awareness becomes essential.

Having clear objectives and choosing a partner with years of experience in designing smart and sustainable hospital CSSDs is the first step. Incorporating new technologies, innovative devices and specific measures is the second. Good teamwork can result in overall water savings of 60 to 70 per cent.

BACTERIAL CONTAMINATION AND THE “SEMMELWEIS REFLEX”.

“La Vie et l’Oeuvre de Philippe Ignace Semmelweis”. This is the title used by Louis Ferdinand Céline to discuss his thesis for his Degree in Medicine in 1924. The work would later be published in 1952 under the simpler title of “Semmelweis”.

Ma chi era il dottor Semmelweiss?

Nato in Ungheria, e laureatosi in Medicina presso la famosa Scuola Medica Viennese nel 1846 divenne dottore in chirurgia ed ostetricia. È ricordato per un’intuizione straordinaria, che individua nel mancato lavaggio accurato delle mani la causa del propagarsi della febbre puerperale.

Le morti per febbre puerperale

Semmelweiss infatti, aveva notato che nella clinica dove lui lavorava, ed in cui i giovani medici passavano direttamente dalla dissezione dei cadaveri alla visita delle donne che avevano appena partorito, l’incidenza delle morti per febbre puerperale si attestava a circa il 10%.
Semmelweis era ossessionato da queste morti così frequenti, ma la cosa che più lo disorientava era la constatazione che in un altro padiglione dello stesso ospedale, gestito non da medici ma esclusivamente da ostetriche, la mortalità per febbre puerperale era dieci volte più bassa.

Un collegamento patologico: le particelle cadaveriche

Lo studio della cartella clinica di un collega medico ed amico, morto a seguito di una breve malattia, lo colpì per due elementi:
• L’autopsia praticata sul cadavere dell’amico evidenziava lesioni simili a quelle che si riscontravano sulle donne morte per febbre puerperale
• Il giovane medico solo qualche giorno prima della morte si era ferito nel corso di una autopsia praticata sul cadavere di una di queste donne.

Gli fu chiaro che la febbre puerperale e la morte del giovane medico erano la stessa cosa dal punto di vista patologico perché entrambe presentavano gli stessi cambiamenti anatomici. Se nel caso del medico i cambiamenti nella sepsi derivavano dall’inoculazione di particelle cadaveriche allora la febbre puerperale doveva avere origine dalla stessa fonte. Ciò fu sufficiente a Semmelweis per giungere ad un’ipotesi, straordinaria per l’epoca: la febbre puerperale è una malattia che viene trasferita da un corpo all’altro a seguito del contatto che i medici e gli studenti presenti in reparto hanno prima con le donne decedute (su cui praticavano autopsia) ed immediatamente dopo con le partorienti che andavano a visitare in corsia.

Una banale disposizione: lavare le mani e biancheria pulita

Era una teoria sconvolgente per i tempi. Per dimostrarla il giovane Semmelweis mise in atto una banale disposizione: tutti coloro che entravano nel Padiglione di ostetricia, sarebbero stati obbligati a lavarsi le mani con una soluzione di cloruro di calce (ipoclorito di calcio). A questo aggiunse la disposizione che per tutte le partorienti si cambiassero le lenzuola sporche con altre pulite. I fatti gli diedero immediatamente ragione. Era il maggio 1847.

Nel 1846, su 4.010 puerpere ricoverate presso il Padiglione I, ne erano morte 459 (l’11,4%) per febbre puerperale. Nel 1847, dopo l’adozione del lavaggio delle mani con ipoclorito di calcio, su 3.490 pazienti ne morirono 176 (il 5%) e l’anno successivo la percentuale si attesterà tra l’1 e il 2%, all’incirca la stessa da sempre del Padiglione II
Questi dati avrebbero potuto suscitare se non entusiasmo almeno interesse o curiosità, invece gli attirarono gelosia, invidia e risentimenti vari. Il suo direttore, che sosteneva con forza la necessità per gli studenti di praticare molte autopsie, trovava irritanti le iniziative di questo straniero ungherese e che si arrogava il diritto di emanare disposizioni che non gli competevano, offensive per il personale (l’obbligo di lavarsi le mani) ed onerose per l’ospedale (cambio frequente delle lenzuola).

La prima intuizione sulla contaminazione batterica

Ci vollero molti anni prima che la scoperta di Semmelweis venisse accettata e applicata in modo generalizzato: la dimostrazione della contaminazione batterica fu data da Pasteur solo nel 1864, a quasi vent’anni di distanza. Prima di allora le scoperte di Semmelweis vennero screditate e, nonostante i risultati positivi, fu licenziato dall’ospedale di Vienna per aver dato disposizioni senza esserne autorizzato e di conseguenza le morti per infezione aumentarono nuovamente.
Le intuizioni di Semmelweis arrivarono quando i microscopi erano insufficienti per sapere dell’esistenza dei microbi, ben prima quindi che Pasteur gettasse le basi della moderna microbiologia, che rivaluterà l’operato e il genio di Semmelweis, dandogli postumo il merito che gli spettava in vita.

Ancora oggi, è chiamata “Riflesso di Semmelweis” la riluttanza o resistenza ad accettare una scoperta in campo scientifico o medico che contraddica norme, credenze o paradigmi stabiliti.

THE NEW FRONTIER FOR MEDICAL WASTE TREATMENT.

Medical waste represents an increasingly unsustainable economic and environmental cost. Cisa Group has the solution: an innovative approach to clinical waste management that is safe, economical and sustainable

Waste is a global emergency. It produces pollution that spreads into the air, alters water and makes the earth increasingly dirty and unlivable. Waste costs money: it takes up space and uses up human and economic resources to process it and to repair the environmental and health damage it produces.

Medical waste is particularly damaging: in addition to high management costs for institutions and facilities, it is a major source of CO₂, and is treated and disposed of in an obsolete and inefficient way.

Italian data before the pandemic showed an average annual production of around 144,000 tonnes (re. 2019). In 2020, the increase in hospitalisations and the widespread use of PPE led to an increase in consumption and a doubling of that figure (in Italy, 300 thousand tonnes were reached). Pollutant emissions due to an impressive number of trips to incinerators, landfills or recovery centres result in an unbearable logistical and financial burden.

Hospitals and healthcare facilities of all sizes have to deal with complex and hazardous procedures on a daily basis. The storage, transport and treatment of medical waste are considered high-risk operations and represent a high cost for the healthcare industry. These are huge figures on financial statements and shadows on sustainability budgets.

Sustainable development expands the concept of sustainability on the three pillars that focus even more on the responsibility of each actor and the importance of concrete choices and effective solutions. Economic sustainability means the ability to safeguard financial resources, efficiency for businesses and income and work for the livelihood of the population. Environmental sustainability is the ability to maintain the quality, reproducibility and availability of natural resources; this includes everything we can do to be more respectful of the planet. Social sustainability refers to the safeguard of human wellbeing: the ability to ensure living conditions and quality of life in terms of security, health, education, democracy, participation and justice. These three closely related pillars guide every social actor, outlining ethics and responsibility towards direct stakeholders, the surrounding communities and the world at large.

Most countries are developing new regulations to reduce the costs as well as the environmental and social impact of infectious waste, paying special attention to the UN Sustainable Development Guidelines and their related 17 Sustainable Development Goals (SDGs).

These regulations share similar objectives.

Simplification, introduced in Italy with Conversion Law 40/2020, was a significant innovation: hospital waste, properly sterilised at public and private healthcare facilities according to the dictates of Presidential Decree 254, is now subject to the legal regime of urban waste, and can therefore be disposed of through ordinary municipal waste collection without special handling. This means less transport and less costs, but also less risk for people and a decisive reduction of emissions into the atmosphere.

The legislator promotes on-site sterilisation of medical waste because it reduces health hazards and the impact on the environment

Cisa Group, which has been committed in the development of hospital sterilisation and infection control technologies for over 70 years, has been applying its expertise in medical waste treatment for more than 15 years with measurable benefits. The WSD® (Waste Sterilisation Department) medical waste treatment system enables compliance with new the legislation and ensures safe and environmentally friendly results. It delivers tangible economic, social and environmental benefits in line with at least 5 of the 17 SDGs (source: PWC).

WSD® is an end-to-end solution, a new frontier for waste management. [link alla pagina]

All tests carried out demonstrate the ability of Cisa’s system to comply with the provisions of Presidential Decree 254, without any air, ground, noise or olfactory pollution. The WSD® ensures respect for the health and safety of operators, communities and the surrounding environment.

The process takes place within the facility. Each step is monitored by Cisa's proprietary software. [link a pagina softtware]

Full control and simplification of the process ensure greater protection of personnel and safeguard the responsibility of the producer, who sometimes is not fully aware of the role that the law requires from him: to supervise the entire waste chain, up to its final disposal, which doesn’t occur when the waste is entrusted to a third party but only when it has actually completed its cycle. With the Cisa system, waste undergoes a treatment that reduces its volume by about 8 times, simplifying storage and handling. Landfilling, transport and emissions are also limited.

Internalising the entire waste chain can guarantee overall savings of up to 30-40% and a cut in emissions that could reach -according to a recent NHS study in England - up to 80%.

Making the process more efficient allows hospitals to focus on their sustainable development path and explore new end-of-waste opportunities such as alternative energy production, reuse and recycling, thus kick-starting an uninterrupted flow of innovation. With WSD®, the hospital of the future gives itself a great competitive advantage, just one step away from important milestones