The Central Sterile Supply Department (CSSD) manages cleaning, disinfection, sterilization and distribution of reusable instruments and sterile items, supporting clinical care and preventing nosocomial infections. Because CSSD nursing content is limited in standard nursing curricula, structured on-the-job training is needed to raise professionalism and standardized practice. This study aimed to investigate the effect of problem-based learning (PBL) on CSSD nurses’ knowledge, skills, self-directed learning, teamwork and satisfaction with training.
This single-center randomized study was conducted from April to October 2024. The protocol received ethics approval from the Medical Research Ethics Committee of West China Second University Hospital, Sichuan University, and written informed consent was obtained from all participants. Assessments were single-blind: assessors remained unaware of group allocation during scoring.
Forty CSSD nurses meeting inclusion criteria (valid nursing practice certificate and voluntary consent) were enrolled. Exclusion criteria included nursing interns, rotating or visiting nurses, and those on leave for six months or more. Nurses were numbered in chronological employment order and randomly assigned using a random number table: odd numbers to the control group (n = 20) and even numbers to the observation/PBL group (n = 20). Demographic characteristics (gender, age, education, professional title, years of experience) did not differ significantly between groups according to the source.
A training team of one researcher, two head nurses and two instructors—each with mid-level or senior titles and relevant CSSD experience—divided responsibilities between instructional and assessment roles. The instructional group designed the training plan, developed case materials for PBL and supervised training, while an independent assessment group conducted blinded evaluations. Case materials and training content were aligned with national CSSD standards and the 2022 Central Sterile Supply Department training manual.
The observation group received PBL every two weeks over six months. Each case spanned two sessions (each ≤ 1 hour); six cases were completed across 12 sessions. Key preparation steps included instructor selection and training in PBL methods, subgroup formation (two subgroups of 10 nurses), trainee orientation to PBL procedures and provision of an equipped training venue.
Case development focused on real CSSD problems—examples included instrument surface rust, instrument-cleaning quality failures, assembly/packaging errors, sterilization monitoring abnormalities and wet packs. Cases incorporated uncertain or challenging elements to stimulate critical thinking and were intentionally concise given sterile supply knowledge characteristics.
PBL was delivered in three phases:
Initial phase: subgroups received case information, brainstormed, identified unresolved problems and set individual learning goals. Instructors monitored participation and guided thinking.
Facilitation phase: in the second session members shared independently gathered information, discussed unresolved issues, received instructor mediation as needed and determined whether to enter a new learning cycle or proceed.
Ending phase: learners summarized solutions and consolidated knowledge through iterative cycles of application, knowledge-gap identification, targeted learning and reapplication.
The control group received traditional on-the-job training with the same overall content, frequency and duration as the PBL group. Sessions (≤ 30 minutes) combined face-to-face lectures, practical demonstrations, instructional videos and brief live Q&A. Nurses practiced practical skills independently after demonstrations and video viewings.
Assessments occurred after the six-month training period and included:
Theoretical knowledge: closed-book examination (maximum 100 points) drawn from a CSSD question bank developed from national CSSD standards and the 2022 training manual; the question bank showed good internal consistency (Cronbach’s alpha 0.911).
Practical skills: scored against Standard Operating Procedures for On-the-job Training in the CSSD (maximum 100 points); assessors were blinded to group allocation.
Teamwork skills: assessed with the Clinical Teamwork Scale (maximum 120 points); source reports a Cronbach’s alpha of 0.858 for the scale.
Self-directed learning competence: assessed using a 34-item scale (score range 34–170) with strong reliability and validity metrics reported in the source (Cronbach’s alpha 0.944).
Satisfaction with training: evaluated via an anonymous questionnaire. The source indicates satisfaction scores were compared between groups but does not provide the questionnaire items or scoring range in the provided text.
After six months of training, the PBL (observation) group had higher scores than the control group across all reported outcomes: theoretical knowledge, practical skills, self-directed learning competence, teamwork skills and satisfaction with training. Differences were reported as statistically significant (P < 0.05). The source text reports these comparative outcomes but does not provide the absolute mean scores, standard deviations or effect sizes within the provided excerpt.
The source describes methodology, instruments and that PBL outperformed traditional training, but the provided text did not include specific numerical results (means, SDs), sample-size justification beyond feasibility, long-term follow-up data, or subgroup and sensitivity analyses. The study was conducted at a single hospital, which may affect generalizability; this limitation is implicit from the design but detailed external validity assessments were not reported in the excerpt.
The authors conclude that implementing problem-based learning in on-the-job CSSD nurse training improved professional theoretical knowledge, practical skills, self-directed learning, teamwork and trainee satisfaction compared with traditional methods. The study supports PBL as a feasible model for regular CSSD training, with training materials and case-based activities linked to national standards. Further reporting of absolute outcome values, replication across multiple centers and longer-term evaluation would be needed to fully assess generalizability and sustained impact.