CSSD.

Central sterile supply department.

consideration.

Central sterile supply department Is a service whereby Medical /surgical

Supplies and instruments both sterile and non-sterile Or clean, prepared,

processed, stored and issued for patient care. Hospital acquired infection

remains a serious problem in health care today. The purpose of sterile

service department is to concentrate the skill and their responsibility for the

supply of sterile material and to reduce the risk of errors.

The primary activities to be undertaken within the CSSD are.

1. Cleaning and disinfecting process for instruments, trays, utensils,

containers and other reprocess able items.

2. Receiving of clean linen from various sites of the Hospital.

3. Segregation, storage and dispatch of various sterile sets to user

departments.

4. Prepare and packaging contents of trays and packs and, where

appropriate, single use items and other materials as supplementary

packs.

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 5. Sterilising trays and packs and disinfecting those items acceptable for

patient use in this condition.

6. Storing non sterile materials components.

7. Monitoring of the temperature and relative humidity inside the CSSD.

8. Distributing processed and purchased goods to users.

The department is divided into 3 zones to accomplish the functions of

decontamination, assembly and sterile processing, and sterile storage and

distribution. These zones include the following.

1. Decontamination zone.

2. Assembly /sterilization zone.

3. Storage and distribution zone.

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 GENERAL CSSD DESIGN CONCEPT -1.

Distinct separation must be maintained between the soiled and sterile

areas. The technical staff works on either the soiled side or the sterile

side and cannot cross from one side to other.

The risk of cross infection spread by the staff is minimised.

New demands:

 Solid zone- Negative pressure.(-)

 Clean Zone-Positive pressure.(++)

 Sterile zone-Positive pressure.(+)

Controlled room ventilation (Airflow.) to get good production conditions.

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 WORK FLOW
Major activities in CSD.
1. Receiving the used items from user departments.
2. Cleaning.
3. Packing.
4. Sterilizing.
5. Storing.
6. Distributing to user departments.

Rinsing.
receipt

Cleaning.
distributi
on

CSSD
drying

storage

checking
labeling sterilizati
on

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 RECEIVING AREA /

DECONTAMINATION ZONE

 Used items from various departments of the hospital are shifted to

CSSD for cleaning and sterilization.

 Ideally the items that get soiled with blood or body fluid should be

decontaminated with sodium hypochlorite solution in the user

department itself before sending to CSSD.

 The receiving area of CSSD should have acces to outside through a

window with the counter.

 The items specially for instruments in trays are counted and received.

 Therefore, the instruments are inspected and blunt / suitable

instruments are segregated and discarded.

 Necessary entries are made for records.

 Therefore, the items are shifted to cleaning area.

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 CLEANING AREA

 Here the instruments are washed either manually or in machines.

 For manual washing, sinks with water supply and working counters

are organised. Detergents and brushes of various sizes and shapes are

required in this area.

 Ultrasonic washer is a machine used for cleaning surgical

instruments. It converts high frequency sound waves into mechanical

vibration that produces small bubbles that burst on the internal

surfaces of instruments and dislodge the waste particles.

 After the instruments are washed they are dried in oven dryer and

shifted to packing area.

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 Automatic washer disinfector.

The preferred method of cleaning is an Automatic washing machine

with an integrated disinfection step. For thermostable medical

devices, thermal disinfection is preferred to. Chemical disinfection.

PACKING AREA

 Cleaning and dry instruments are packed before sterilization. So

that they are not contaminated while handling after they are

sterilized. Most of the instruments are packed in trays. The are

wrapped with double layer of cotton cloth. Paper envelopes are

also available for packing the instruments. These are equally

effective but expansive. Plastic bags are used for packing the

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 items for Eto sterilization. The packs are labelled Indicating date

of sterilization and date of expiry.

 By the inspection of the cleaning results, functional test and

packing height adjustable tables can be used for optimal

ergonomic work conditions. Loading trolleys can also be designed

as height adjustable units to support an ease work conditions.

 After packing and sealing, the instruments are shifted for

sterilization.

Sterilization area.

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  Sterilization is done by Steam. Eto, and plasma steriliser.

 It is better to have 2 sterilizers in case of breakdowns.

 The material is pronounced sterile if it achieves 99.99% kill of

bacterial spores.

 Steam under pressure is the most cost effective method of

sterilization. Autoclave generates steam at a temperature of 121

and 134 degree centigrade under 15 pounds of pressure. An

exposure of 20 minutes. Is required for sterilization.

 ETO steriliser. The items like cardiac catheters thermosensitive

and therefore cannot be sterilised by this team. Such items are

sterilised by ethylene oxide gas sterilization. The ETO is an

expensive and toxic gas. It is absolutely necessary to ensure that

these items are made free of gas molecules before using them on a

percent. This is achieved by subjecting the items to forced

ventilation. The entire cycle may take about 8 to 12 hours.

 Ensure that all instruments sets are complete and safely packed

before sterilization.

 At the end of the sterilization. The packs are removed from the

sterilising units from the other end of well fitted double door

autoclave. The autoclave indicators are checked to confirm

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 adequate sterilisation of the packs and in case the sterilization is

not adequate, the process is to be repeated.

STORAGE AREA

 Packs which are adequately sterilized or stored in this sterile zones. If

this sterile packs are torn, if it is has been opened, they are wet, etc,

and then the whole process is to be repeated again.

 This is a clean area and should kept clean and tidy at all times with

limited access.

 Temperature and relative humidity should be maintained.

 Only the member working in the packing area will issue out packs to

customer's following all the formalities.

 There should be enough shelves and baskets available to store all

sterile goods without having to stack them tightly or on top of one

another.

 Cupboards can be used to store small, delicate or expensive items. All

Cupboards must have doors, Preferably with the lock.

 Trolley’s should be cleaned and dried after each use because even

though they are used with sterile items. Contamination can occur

during transport outside the cssd.

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  After sterilization the items are temporarily stored in the clean store

from where they are distributed to under departments.

 Before releasing items For delivery, check the packaging for damage.

 Reject any suspect packs and unpack them before sending to the wash

area for reprocessing.

 Check the external chemical indicator type 1 to ensure that the pack

has been subjected to the sterilization process.

DISTRIBUTION AREA

 Issue of the sterilised packages, dressings, linen instruments and

disposable to various departments of the hospitals is done in this area.

 Transportation of instruments needs to be undertaken as per

protocols. Does sterilized instruments, once packed, should be sent to

various departments on stainless steel trolleys via Waiters, dedicated

elevators or corridors.

 To ensure customers receive appropriate sterile items in the safe

condition and ready to use.

 All items need to be checked for sterility before they are released

from CSSD.

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  Holds or tears, Wetness or stains, Broken seals, dust, evidence of

crushing Etc, should be checked when deciding if the package still

sterile.

 All damaged items must be returned to the decontamination area.

 Trolleys. must not be overloaded.

 All items issued have to be recorded so that a tracking system

remains effective.

 Sterile supplies should be transported in green colour coded, covered

or enclosed trolleys.

STAFF

CSSD manned by following Staffs.

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  CSSD in charge/Manager: Supervises activities of CSSD.

 CSSD Technicians.: Operate the autoclave and ETO machines.

 CSSD Assistants: Perform the cleaning and packing, Gauge cutting

and cotton ball making.

 Clerk/Store keeper: To manage the inventory and sterile stores.

 Housekeeping staff.

 Average 2 technicians for 100 beds and one technician supervisor.

 One clerk for keeping records, accounting and supply per shift.

 Average 4 attendance per 100 beds in all shifts.

 Adequate number of cleaning attendants and transporters.

 One technician and 2 attendants should be stationed at each zones.

QUALITY ASSURANCE

 Mechanical indicators:

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 Monitoring record time. Temperature and humidity and pressure

during the sterilization cycle.

 Chemical indicators:

Devices with sensitive chemical or dye to monitor one or more

parameters of sterilization cycle.

 Biological indicators:

Employee The principle of inhibition of growth of microorganisms of

high resistance.

CONCLUSION.

In most healthcare facilities, the central sterile supply department

plays a key role in providing the items record to deliver quality

patient care. A well planned well managed and well-staffed CSSD

can ensure an effective free environment of hospital and save

valuable life and money.

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