The Central Sterile Supply Department (CSSD) is responsible for receiving, processing, sterilizing, storing and distributing sterile supplies and equipment for hospitals. Key functions of the CSSD include cleaning, packaging, sterilizing items using autoclaves or ethylene oxide, storing sterile supplies, and issuing items to different hospital units. CSSDs aim to provide safe sterile supplies efficiently while standardizing equipment and assisting in infection control.
2. β The Central Sterile Supply Department
(CSSD) is the service responsible for
receiving, storing, processing, distributing and
controlling the professional supplies and
equipments (both sterile and non sterile) for
all user unit of hospital for the care and safety
of patient under strict quality control.
3. β The development of concept of sepsis was coined
by Lister and Koch as a result of discovery of
microorganism. With this discovery, the need for
aseptic technique in handling and sterilizing the
equipment used in surgery and medicine was felt
for the care of patient. The modern concept of
CSSD was derived during second world war.
β 1928 β’ American College of Surgeon first started
CSSD in their Hospital
β β’ 1965 β First CSSD in India β Safadarajung
Hospital
4. β Aims: To provide the safe and sterile supplies to all
the user unit of hospital.
β Objectives:
β’ To provide efficient, economic and uniform source of
sterile supply for the care and treatment of sick
β’ To assist purchase department for decision making and
selection of goods.
β’ To assist management of hospital in standardization of
good
β’ Cleaning ,Packaging ,labeling and dating of material
β’ To supply equipments to highly specialized units.
β’ To educate students, Nurse and ancillary persons
β’ To save nursing time at nursing station
β’ To participate effectively in Hospital infection control
committee.
5.
6. β Inputs for planning should be provided by a
committee which should include representatives from
administration, surgical staff, anaesthesiology,
pathology and nursing.
β This committee should develop a written programme
covering:
1. The overall scope of the department,
2. Departments to be served,
3. Extent of services to be rendered,
4. Process equipment to be procured,
5. Preparation of procedure manual, and
6. Organisational and administrative structure of the
department.
7. β The location of CSSD should be convenient
to its principal consumers. These are the
nursing units, labour suites and operation
theatres.
β It should be so located that supplies and
equipment are brought to and taken away by
the shortest route.
8. β A minimum of 7 sq ft on a per bed basis ( with
100 sq ft for the smallest hospital ) is
considered essential for planning a CSSD
with scope for future expansion.
β The area will be divided into:
β’ Receiving area
β’ Cleaning area
β’ Processing area
β’ Sterilisation
β’ Sterile storage
β’ Issuing area
9. Beds Space
Upto 100 beds 10 sq ft per bed
Upto 200 beds 9-10 sq ft per bed
Upto 300 beds 8-9 sq ft per bed
300 beds and above 7 sq ft per bed
10. 1. Receipt of used supplies
2. Accounting
3. Washing, cleaning and drying
4. Sorting
5. Gauze cutting and assembling
6. Packing
7. Sterilisation
8. Sterile storage
9. issue
11.
12. β The direction of work flow and economy of labour
determines the layout of the physical facilities.
β Articles should move only in one direction through
receipt, washing and cleaning, drying, sorting,
reassembling and packing, sterilisation and storage.
13.
14. β The number of workers will be influenced by the
following:
1. Method of collection and delivery
2. Quantum of work β one shift, two shifts or one shift
with only emergency issue counter after normal
working time
3. Hospitalβs philosophy on use of disposables
4. Availability of mechanical aids.
16. β’ Instruments
β’ Appliances
β’ Dressings
β’ Sponges
β’ OT linen
β’ Special packs
β’ Gauze and cotton material
β’ Gloves
β’ Bowls and trays
17. β Autoclaves
β Dry oven
β Gauze cutter
β Ultrasound washer
β Needle flushing device
β Ethylene oxide steriliser
β Work benches with marble or stainless steel top
β Storage cupboards and racks
β Linen folding table
β Soaking sinks
β High pressure water jets
18.
19. β’ Its one of the essential equipment of CSSD.
β’ Ultrasonic cleaner cleans by bombarding the item with
sound waves.
β’ These waves while passing through the detergent
solution produce submicroscopic bubbles which collapse
on themselves, generating tiny shock waves that knock
debris off nooks and corners of instruments that are not
easy to reach.
22. β’ Itβs the main equipment of CSSD
β’ At least one additional autoclave should be provided to
cater for failure or extra workload.
β’ Instructions for installation and operation must be clearly
understood
β’ They work on the principle of a pressure cooker.
autoclaves are used to sterilize equipment and supplies
by subjecting them to pressurized saturated steam at
121 Β°C (249 Β°F) for around 15β20 minutes. If temperature
is raised to 126 Β°C time can be reduced for 10 minutes.
At 134 Β°C it is 3 minutes. At 150 Β°C its only a minute
called flash sterilizers, for spot sterilisation in some
operation theatres.
β’ Use of saturated steam under pressure is the safest and
dependable method of sterilisation, in universal use for
destruction of all forms of microorganisms.
23.
24. β’ There are at least three stages in a typical EtO sterilization
cycle:
β’ Preconditioning
β’ Sterilization
β’ Aeration (Degassing)
Cycle time is usually more than 14 hours.
ο±Sterilization
β’ Itβs the second stage .The EtO enters the chamber via
evaporation with a certain amount of steam to keep the
humidity level up as well as to make sure the EtO is reaching
all parts of the load. When the required concentration in the
chamber and load is achieved the actual sterilization stage
starts. The lower the gas concentration in the chamber the
longer is the sterilization time.
25. β’ It is a colorless, poisonous gas that attacks the cellular
proteins and nucleic acids of microorganisms.
β’ It is most commonly used to sterilize instruments with long
lumens such as endoscopes, rubber, plastics, fibreglass and
all materials that have to be sterilized but cannot withstand
higher temperature.
β’ Effective sterilisation by EtO depends on the following:
1. Concentration of gas: 450 mg/litre or more is required for
effective sterilisation
2. Temperature: exposure time can be reduced by increasing
temperature. Two ranges of temperature is generally applied-
49 Β° to 63 Β°C and 30 to 37.8 Β°C
3. Humidity: it lowers exposure time. Steam is injected under
vacuum before admitting gas. In some wet gauze/ sponge is
placed
4. Packing: the type of wrapping should be penetrable to gas
and water vapour. Polyethylene is commonly used.
5. Period of exposure: in automatic- 110 to 260 minutes. In
others upto 12 hrs.
26. β’ Sterilisation process goes through following phases-
1. warming the chamber
2. Evacuating residual air to partial vacuum
3. Introduction of moisture to ensure that it penetrates the
wrappings of material
4. Introduction of EtO
5. Raising the temperature
6. Exposure for required time
7. Release of chamber pressure
8. Removal of gas under vacuum ( called purge cycle)
9. Reestablishment of atmospheric pressure by introduction of
filtered air into chamber
27. Advantages of EtO are:
β’ Low temperature
β’ High efficiency β destroys microorganisms including resistant
spores
β’ Large sterilizing volume/ chamber capacity
β’ Non corrosive to: plastic, metal and rubber materials
Disadvantages are:
β’ Excessively Long cycle
β’ Safety concerns - carcinogenic to humans
β’ Toxicity issues - toxic residues on surgical instruments and
tubing
β’ Not recommended for flexible scope
β’ EtO is flammable
β’ Requires special room conditions, safety equipment and
separate ventilation system
β’ Relatively high annual costs for maintenance, servicing and
31. Sterilisation checks:
β’ Colour index strips available for this purpose should be
kept in each pack being autoclaved.
β’ Manufacturers instructions must be followed scrupulously
regarding loading of autoclaves, temperature and
pressure levels and timings.
Sterility indicators:
Mechanical indicators- pressure, temperature, record time,
humidity and sterilisation cycle.
Chemical indicators- Colour index strips, tapes- attached or
implanted in packing material
Biological indicators- they should be placed in most
inaccessible location in the load and then cultured. Bacillus
stereothermophilus is used for this purpose
32. β’ Shelf life of sterilised packs i.e; the time for which it can
be stored safely before use, should be determined by a
committee of experts including bacteriologists.
β’ If the pack is not used, during its shelf life, it should be
again put through the autoclaving process without being
opened.
β’ A pack is considered to be sterile for upto 4 weeks but
experts opine that the pack should be reautoclaved
without opening after 1 week.
33. β’ The following 4 systems are in use:
1. Clean for dirty exchange : a sterilised article is issued at
the CSSD issue counter on return of a used one at any
time.
2. Requisition system : articles needed are issued on a
requisition given by the user department
3. Grocery system: each users requirements for all items
for a specific period are delivered at suitable interval
irrespective of whether the contents have been used or
not and previous basket or contents are withdrawn.
4. Quota system: predetermined stock levels(quota) of
various items for each user unit are maintained by a
delivery personnel from CSSD through regular
deliveries
34. β’ Responsibility: the Responsibility for supervision of
sterilising tasks should be clearly understood and vested
with one person.
β’ Segregation: Segregation of sterile and unsterile supplies
should never be carried on the same trolley or same
staff.
β’ Standardisation of packs: the aim is to have a standard
surgical pack containing all the items required for that
procedure by the operating surgeon.
β’ Packing procedures: step by step packing procedure for
each pack should be determined and should specify- i)
the quantities of materials required and their arrangement
ii) the sequence of packing operation.
35. β’ Manual of operations: a procedure manual listing all
procedures followed in the CSSD for each process and
their correct sequence is essential for effective operation
by the department.
β’ Packing material: linen, paper( kraft paper or news
paper), stainless steel containers, cardboard box can be
used.
