The Central Sterile Supply Department (CSSD) is responsible for receiving, processing, sterilizing, storing and distributing sterile surgical instruments and supplies. The document outlines the various processes involved in CSSD such as decontamination, packaging, sterilization and storage. It provides guidelines on CSSD work flow, cleaning and sterilization methods, packaging, load monitoring, and sterile storage area requirements to ensure sterility of supplies.
The Central Sterile Supply Department (CSSD) is the service responsible for receiving, storing, processing, distributing and controlling the professional supplies and equipment (both sterile and non-sterile) for all user unit of hospital for the care and safety of patient under strict quality control
You will be able to have a brief idea about CSSD from this ppt
Thanks
The Central Sterile Supply Department (CSSD) is the service responsible for receiving, storing, processing, distributing and controlling the professional supplies and equipment (both sterile and non-sterile) for all user unit of hospital for the care and safety of patient under strict quality control
You will be able to have a brief idea about CSSD from this ppt
Thanks
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THE CENTRAL STERILIZATION & SUPPLY
DEPARTMENT (CSSD)
MISSION OF CSSD (CUSTOMER ORIENTED)
Timely delivery of sterile goods
Quality (according to European Standards – EN)
Efficiency (line process)
ACTIVITIES OF THE CSSD (SPAULDING)
Cleaning
Disinfection of semi- / non critical items (mucosa – non intact
skin contact)
Sterilization of critical items (high risk for infection)
Supply of sterile materials
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3. The Central Sterile Supply Department (CSSD) is the service responsible
for receiving, sorting, processing, distributing and controlling the
professional supplies of sterile items for all users unit of hospital for the
care and safety of patient under strict quality control
4. 10sft/bed
There is no international guidelines regarding space requirements for CSSD.
For 600 bedded hospitals 6 or 7 sft per bed around 4000sft space
100 bedded hospital, we may need 1000 sft space
Number of operation theaters and number of surgical procedures to be done or being
done also taken into consideration. A CSSD of 300 bedded hospital having 7 operation
theaters may need lesser space than a CSSD of 250 bedded hospital having 10
operation theaters.
ISHA- Indian Sterilization Healthcare Association 2017
5. Used Articles Rinsing Assembling
Temporary storage in
user dept
Collection by
CSSD Staff
Transport to
CSSD
Transport to user
dept
Documentation Loading Place Indicators Packing & Labelling Trays Tray setting with
checklist
Decontamination
Manual / Machine
CSSD WORK FLOW
Drying
Unload & Storage in
sterial area
Sterilization
Handover items into
CSSD
7. LOCATION PRESSURE TOTAL ACH ALL ROOMS AIR
EXHAUSTED
OUTSIDE
RELATIVE
HUMIDITY
TEMPERATURE
Decontamination Negative 6 Yes No requirement 22 -26°C
Pre pack/ packing Positive 4 No No requirement 22-26°C
Sterile storage Positive 4 No Max 60%
WHO 40-50%
22-26°C
Sterilizer equipment Negative 10 Yes No requirement No requirement
8. 8
3M Health Care Academy
SM
Clotted Blood
Open Trolleys for
Instruments
transportation
Instruments transportation
through common usage
equipments
9. :
1) Instruments to be transported in dedicated
Closed trolleys
2) Count the number of instruments per set and
record in the Issue register in OT/wards also in
Issue register
3) Sort sharp items/ micro-instruments
4) Inspect for any damage/ dried blood stains
5) If damaged-report to the Manager & remove
from usage
6) Primary wash is to be done by the user
department to prevent organic matter from drying
on it
7) Possibly in a dedicated lift or by other means
10.
11.
12. Cleaning: The physical removal of body materials, dust or foreign
material. Cleaning will reduce the number of microorganisms as well as
the soil, and reducing the risk of soil being fixed to the surface. Removal of
soil will reduce also the risk of inactivation of a chemical disinfectant and the
multiplication of microorganisms. The removal of contamination from
an item to the extent necessary for further processing or for
intended use. [ISO/TS 11139]
13. The destruction or removal of microorganisms at a
level that is not harmful to health and safe to handle.
This process does not necessarily include the destruction
of bacterial spores.
15. A. Cleaning & Decontamination Process
Brushes for Cleaning
Instrument Sorting & Disassembly Manual Drying & Drying Cabinet
Compatible Cleaning Agent IFU
Instrument Checklist
Multiple Sinks for Cleaning
16. B. Methods of cleaning
Ultra-sonic Cleaning
• Use after gross soil is removed
• Usually used for Micro-instruments to
avoid their damage
• Conduct Aluminum foil test to check
the efficacy of the ultra-sonicator
Manual Cleaning
• Use brushes recommended for
washing medical devices
• Disinfect the brushes in the
Multi-enzyme cleaner after
every use or at least end of
the day
Washer Disinfector
• Do not overload
• Daily and preventive
• Correct chemical & lubricants
• Review and initial mechanical washer
cycle printouts
• Document results
Final rinse
by RO Water
17. FACTORS WHICH AFFECT CLEANING
Effective cleaning and pre-cleaning of devices often requires chemicals, combined with
mechanical action and heat.
It can be performed manually and/or with machines.
• Type and amount of soil
• Quality of water
• Type of detergent
• Concentration of detergent
• Type of instrument or device
• Amount of time permitted for the detergent to act
18. P
ASS
T
HROUGH
W
INDOW
A pass through window is
used to move clean items
into prep and pack area and
items that need to be
reprocessed back to
decontaminated area.
19. C. Instrumentation Inspection, Preparation & Packaging
Internal Pack Control CI
Cleaning Verification using
ATP
Instrument Checklist
Double Wrapping
Lubrication
Magnifying Lens Verification
20. Test Method0 Soil Component Tested Limitations
Length
of test
ATP
Swab device, extract ATP
from swab, and determine
ATP
ATP (present in
eukaryotic cells and live
bacteria)
- Need instrumentation
to read test
30 seconds
Protein
Swab device, immerse in
reagent and assess for color
development
Protein Not applicable to lumens minutes
21. Equipment control -Bowie-Dick type(Autoclave)-class 2
Exposure control- external indicator class 1
Pack control- internal indicator class 4 or 5 or 6
Load control- internal indicator class 4 or 5 or 6 or BI
22. Equipment Monitoring is a way to find out whether or not your vacuum assisted
steam sterilizer is doing its job properly.
To monitor dynamic air- removal steam sterilizers, you begin each day with a
Bowie-Dick type test to detect air leaks, inadequate air removal, inadequate
steam penetration and the presence of non-condensable gases, any of which can
compromise sterility.
26. Sterilization
Pre-vacuum Steam Sterilizer – High Speed ( Temperature 121 – 134 deg. C /
Pressure 1.1 to 2.1 Bar)
16 Towel BI PCD Pack
16 Towel Challenge Pack using
for Loaner and Implant load
Biological Indicator(BI) Challenge Pack
Steam sterilization loading
techniques
Following IFU
27. S.no Sterilization method Biological indicator Incubation
1. Steam Geobacillus stearothermophilus 60°C for 3hrs
2. EO B. Atrophaeus 37o C -4hrs
3. Plasma sterilisation Geobacillus stearothermophilus 58o C-24hrs
28.
29. An internal indicator preferably class 5 (every pack)
External class 1 indicator (every pack)
Bowie dick-class 2 indicator-pre vacuum autoclave (every day empty load)
Every load sterilized by EO
Every load containing implantable devices in autoclave
Every day for autoclave
Every day for plasma sterilization
30. Autoclave: run 3 empty cycles with BI PCD and subsequently 3
empty cycles with Bowie-dick
Other sterilizers: run 3 empty cycles with BI PCD
31. Advantages
Cost and environment
If chemically treated are resistant to
moisture and dust
Disadvantages
More labor (laundry, inspect, delint
between each use and may need to repair)
Not lint free
If chemically treated may require
extended dry times
IAHCSMM Central Service Technical Manual, 7th edition, Chapter 13
Sterile Processing University, LLC The Basics of Sterile Processing, 3rd edition, Chapter 7
Central Services Association of Ontario, The Manual for Reprocessing Medical Devices, 1st Edition, 2009
32. )
Best wrap barrier
Water-repellent
No linting
Wrapped basin sets should not exceed 3 Kg
Containerized instrument sets do not
exceed 11kg
Tears easier than woven textiles
Has memory
Advantages Disadvantages
IAHCSMM Central Service Technical Manual, 7th edition, Chapter 13
Sterile Processing University, LLC The Basics of Sterile Processing, 3rd edition, Chapter 7
Central Services Association of Ontario, The Manual for Reprocessing Medical Devices, 1st Edition, 2009
33. Good to use for small, lightweight
instruments or single items
Contents easily visible
Paper/Plastic Pouches: labeling is done
on plastic side only
Must select the correct size for contents so
air can be expelled but not so large that the
contents can move around and damage the
seals
Seal rupture possible
Requires a heat seal
Advantages Disadvantages
IAHCSMM Central Service Technical Manual, 7th edition, Chapter 13
Sterile Processing University, LLC The Basics of Sterile Processing, 3rd edition, Chapter 7
Central Services Association of Ontario, The Manual for Reprocessing Medical Devices, 1st Edition, 2009
34. Excellent barrier to microorganisms
Water repellent
Easy-to-use
Eliminates torn wrappers
No linting
Protects instruments from damage
during processing, storage, and
transport
Ergonomics - adds weight to instruments
May need additional dry time
Additional space needed to store
containers but may be able to stack for
sterile storage
Additional labor for cleaning in between
use and inspection of gaskets, latches,
valves, etc
Advantages Disadvantages
IAHCSMM Central Service Technical Manual, 7th edition, Chapter 13
Sterile Processing University, LLC The Basics of Sterile Processing, 3rd edition, Chapter 7
Central Services Association of Ontario, The Manual for Reprocessing Medical Devices, 1st Edition, 2009
40. Maintain items on sterilizer cart until adequately cooled
Do not touch during the cooling process
Could wick bacteria from hands into packaging
Place sterilizer cart in a low traffic area, no air-conditioning or cold-air-vents
Do not transfer warm items to a cool cart which could result in condensate forming and
contamination
May open door slightly at end of cycle to reduce the potential for condensation
formation
ANSI/AAMI ST79:2010 & A1:2010 & A2:2011 & A3:2012, Section 8.8
41. Is event related and depends on
• Quality of packaging material
• Storage conditions
• Conditions during transportation
• Amount of handling
Label each product
• Expiration date or statement such as: “contents sterile unless package is open or
damaged. Please check before using.”
ANSI/AAMI ST79:2010 & A1:2010 & A2:2011 & A3:2012, Section 8.9.3 and 10.3.3
46. Type of sterilizer Advantages Disadvantages
Autoclave Inexpensive
Fast
Effective, with a wide margin of safety
Penetrates medical packing, device lumens
Non-toxic – low environmental impact
Readily available
Sterilizers are available in many sizes for
many applications
Cycle easy to control and monitor
Unsuitable for anhydrous materials and for heat-
and moisture-sensitive materials
May leave instruments wet, causing them to rust
Expertise
Deleterious for heat-sensitive instruments
Microsurgical instruments damaged by repeated
exposure
Potential for burns
Hydrogen
Peroxide (Plasma)
Fast
Safe for the environment
Compatible with heat- and
moisture-sensitive
Absence of toxic waste
Easy installation and operation
No staff monitoring currently required
No aeration required
No chemical residues
Cannot sterilize materials that absorb hydrogen
peroxide (e.g. linen, gauze, cellulose/paper, wood)
Low penetration power
Medical devices must be dry before processing
Cellulose (paper), linens and liquids cannot be
processed
Limitations to length of lumens of medical
devices that can be effectively sterilized
47. Type of sterilizer Advantages Disadvantages
ETO Non-corrosive
Penetrates packaging materials, device
lumens
Has some ability to penetrate some synthetic
materials
Excellent material compatibility
Simple to operate and monitor
Toxic/carcinogenic to humans
Lengthy cycle due to aeration requirements
Requires monitoring of the work areas
Requires control and monitoring of discharge into
the environment
Flammable and explosive.
Expensive
48. Implantable devices till the BI testing is satisfactory
Non implantable devices BI/ class 5or 6/specific cycle physical
parameters in the load control
49. RAPID CYCLE OR FLASH STERILIZATION
“Unwrapped” steam sterilization
Should only be used when necessary
Do not flash whole trays of instruments
Items must be used immediately
Avoid by keeping adequate supply of frequently dropped items
Maintain records or “flash logs”
Use to support need for additional instruments
50. Nurse from OT calls the CSSD to inform the Arthroplasty set is wet.
What to perform next?
1. Receive the wet set process sterilize and return
2. Receive all the sets sterilized in the same load
3. CSSD technician observes the external indicator is working and
tells to use the instrument
4. Its an issue between CSSD technician and the OT nurses, no
need to inform others
51. Load contains positive BI- failed load and also all loads sterilized in that
sterilizer till last successfully sterilized load
Incorrect reprocessing of device
Print out of reprocessing equipment failure to reach correct parameters
CI has not changed colour
Doubt about sterility of equipment(torn, wet)
Notification to all concerned departments
52.
53. Controlled temperature 24°C
≥ four air exchanges/hour
Relative humidity not to exceed
60%
Controlled traffic
Positive air flow (out)
Sterile items are stored at least 20-25cm (8-10”) above the floor, at least
45cm (18”) below the ceiling or sprinkler heads, and at least 5cm (2”) from
outside walls.
It should be located near a dock for the receiving of materials.
