This document provides information about the Central Sterile Supply Department (CSSD) at Shri Krishna Hrudayalaya & Critical Care Hospital in Nagpur, India. It discusses the aims, objectives and methodology of the internship project. It introduces the CSSD and describes its functions like processing, sterilizing and distributing sterile equipment and supplies to different hospital departments. It outlines the various areas within the CSSD including receiving, cleaning, packing, sterilizing, storage and distribution. The goal of the CSSD is to reliably provide sterilized items when and where needed in the hospital in a cost-effective manner.

1. INTERNSHIP PROJECT ON
DEPARTMENT OF CENTRAL STERILE
SUPPLY DEPARTMENT
DEPARTMENT OF MHA & M, DMIMS, SAWANGI
WARDHA
PREPARED BY
DR MANJIT RAMESH
BARSAGADE
MHA & M 1ST YEAR

2. TABLE OF CONTENT
SR NO PARTICULARS PAGE NO
1 INFORMATION ABOUT SHRI
KRISHNA HRUDALAYA & CRITICAL
CARE HOSPITAL
2 AIMS & OBJECTIVES
3 METHODOLOGY
4 INTRODUCTION OF CSSD
5 FUNCTION OF CSSD
6 LOCATION OF CSSD
7 STAFF
8 WORK FLOW AND SPACE PLANING
9 RECEVING AREA

3. TABLE OF CONTENT
SR NO PARTICULARS PAGE NO
10 CLEANING AREA
11 PACKING AREA
12 STERILIZING AREA
13 STORE
14 DISTRUBATION AREA
15 SUPPORT AREA IN CSSD
16 CSSD AT SHRI KRISHNA HRUDALAYA
AND CRITICAL CARE
17
18

4. INFORMATION ABOUT SHRI KRISHNA
HRUDALAYA & CRITICAL CARE HOSPITAL
 INTRODUCTION
 PATIENT CARE
EVERY YEAR NEARLY 6,000 PATIENTS VISIT THE CLINICS FROM MAHARASHTRA, MADHYA
PRADESH, CHHATTISGARH, AND ANDHRA PRADESH AND FROM NEIGHBORING COUNTRIES. MANY
PATIENTS ARE REFERRED TO US AFTER RECEIVING TREATMENT INITIALLY AT THEIR NATIVE
PLACE. THIS GROUP OF PATIENTS IS REFERRED FOR VARIOUS INVESTIGATIONS LIKE 2D
ECHOCARDIOGRAM, TREAD MILL TEST, HEMATOLOGICAL AND BIOCHEMICAL INVESTIGATIONS,
CARDIAC CATHETERIZATION (FOR CORONARY, VASCULAR AND VALVULAR INTERVENTIONS).
EQUAL NUMBER OF SUCH PATIENTS ARRIVES DIRECTLY TO US. WE HAVE BEEN DOING
INTERVENTIONS FOR ALL ACUTE CORONARY EVENTS LIKE UNSTABLE ANGINA AND MYOCARDIAL
INFARCTION (HEART ATTACK). WE PERFORM MORE THAN 100 CORONARY ANGIOGRAPHIES
EVERY MONTH. SIGNIFICANT POPULATION UNDERGOES PRIMARY ANGIOPLASTY FOR HEART
ATTACK AND WE HAVE A SIZABLE NUMBER OF PATIENTS COMING TO US FOR PLANNED PCI
(PERCUTANEOUS INTERVENTIONS). WE HAVE INFRASTRUCTURE, EQUIPMENTS AND STAFF TO
MANAGE ALL TYPE OF CARDIAC EMERGENCIES LIKE HEART FAILURE, PULMONARY EDEMA,
PULMONARY EMBOLISM, ETC. OUR SURGICAL UNIT HAS TEAM O CARDIOVASCULAR SURGEON,
PERFUSIONIST, CARDIAC ANESTHETIST AND SUPPORTIVE STAFF. AT SHRIKRISHNA
HRUDAYALAYA, EVIDENCE BASED MEDICINE IS THE KEYSTONE OF OUR ENDEAVOUR. APART
FROM THE PATIENT CARE AND SERVICE, CLINICAL RESEARCH PROGRAMMES AND RANDOMIZED
TRIALS CONTRIBUTE INCREASINGLY TO IMPROVED DELIVERY OF CARE AND HIGHEST
STANDARDS OF WORK ETHICS. THE STRATEGIES FOR PREVENTION, EARLY DIAGNOSIS,
TREATMENT MANAGEMENT AND REHABILITATION HAVE BEEN ESTABLISHED IN A
COMPREHENSIVE AND MULTIDISCIPLINARY APPROACH FOR A TOTAL CARDIAC CARE
PROGRAMME.

5. INFORMATION ABOUT SHRI KRISHNA
HRUDALAYA & CRITICAL CARE
HOSPITAL
 PATIENT CARE
 MANY ADVANCES HAVE TAKEN PLACE IN EVERY SPECIALTY. IN CARDIOVASCULAR
SURGERY, CONCEPTS HAVE CHANGED TAKING INTO ACCOUNT THE ADVANCES
AND AVAILABILITY OF NEWER TECHNIQUES. WE HAVE TRAINED AND
EXPERIENCED CVTS TO TACKLE CHALLENGING AND COMPLEX CARDIOVASCULAR
SURGERIES. THERE IS SPECIALIZED UNIT FOR INTERVENTIONAL RADIOLOGY FOR
PATIENTS WITH STROKE, ARTERIAL AND VENOUS THROMBO EMBOLISM AND
DISEASES OF THE VESSELS LIKE VARICOSE VEINS. SUPPORTIVE CARE IN THE
FORM OF TOTAL REHABILITATION AND COUNSELING OF PATIENTS IS WIDELY
RECOGNIZED TO BE VERY IMPORTANT ASPECTS OF THERAPY. EXCELLENT WORK
HAS BEEN CARRIED OUT IN AREAS OF REHABILITATION, PHYSIOTHERAPY,
OCCUPATIONAL THERAPY, PSYCHOLOGY AND MEDICAL SOCIAL WORK.

6. INFORMATION ABOUT SHRI KRISHNA
HRUDALAYA & CRITICAL CARE
HOSPITAL
 ABOUT HOSPITAL
 SHRIKRISHNA HRUDAYALAYA AND CRITICAL CARE CENTRE WAS STARTED BY DR. MAHESH
FULWANI IN 1998, WITH THE VISION OF SERVING THE SUFFERING MANKIND AND TO BRING
THE LATEST MEDICAL TECHNOLOGY AVAILABLE TO CATER THE CHALLENGES IN THE FIELD
OF CARDIOVASCULAR DISEASES. INITIALLY IT WAS RELATIVELY SMALL UNIT PROVIDING
SERVICES IN CARDIOLOGY. IT FLOURISHED IN FEBRUARY 2008 AND TOOK A SHAPE OF
HUGE CENTRE PROVIDING TERTIARY CARE FOR ‘EVERY ALIMENT IN CARDIOLOGY AND
CRITICAL CARE’ UNDER ONE ROOF.
 THE HOSPITAL IS WELL EQUIPPED WITH ROUND THE CLOCK CARDIAC CATHETERIZATION
LAB. IN ADDITION, 24 HOURS’ AVAILABILITY OF SKILLED STAFF AND INTERVENTIONAL
CARDIOLOGISTS. THE CRITICAL CARE UNIT HAS FULL TIME INTENSIVISTS AND CRITICAL
CARE PHYSICIANS TO TAKE CARE OF CRITICALLY ILL PATIENTS. WE ARE RECOGNIZED BY,
EMPANELLED ON VARIOUS LEADING CORPORATE, SEMI-GOVERNMENT AND GOVERNMENT
ORGANIZATIONS, AND ARE ENGAGED IN PROVIDING ROUND THE CLOCK SERVICE AT MUCH
AFFORDABLE COST TO EVERYONE.

7. INFORMATION ABOUT SHRI KRISHNA
HRUDALAYA & CRITICAL CARE HOSPITAL
 SERVICES
 KEEPING PACE WITH RECENT ADVANCES IN INFORMATION
TECHNOLOGY, SHRIKRISHNA HRUDAYALAYA AND CRITICAL
CARE CENTRE IS ALSO A TECHNO-SAVVY AND HAS
ESTABLISHED A COMPREHENSIVE COMPUTERIZATION OF
MEDICAL PRESCRIPTIONS, RECORDS, MATERIAL MANAGEMENT
AND ADMINISTRATION. THE PATIENTS CAN COMMUNICATE ON
TELEPHONE ROUND THE CLOCK AND QUALIFIED DOCTORS TO
GET THEIR QUERIES ANSWERED WILL ATTEND THEM. THERE IS
FACILITY OF SENDING THE REPORTS/ DATA VIA FAX OR E MAIL IF
YOU WISH TO REVIEW YOUR RECORDS PRIOR TO VISIT HOSPITAL
OR ANYTIME YOU FEEL IT IS URGENT TO MAKE A DECISION
ABOUT THE TREATMENT MANAGEMENT.

8. INFORMATION ABOUT SHRI KRISHNA
HRUDALAYA & CRITICAL CARE HOSPITAL
 SPECALITY SERVICES
 ECHOCARDIOGRAPHY
 INTERVENTIONAL CARDIOLOGY
 CARDIAC CATHETERIZATION AND
INTERVENTIONAL CARDIOLOGY
 CARDIAC AND VASCULAR SURGERY
 PREVENTION AND REHABILITATION

9. INFORMATION ABOUT SHRI KRISHNA
HRUDALAYA & CRITICAL CARE HOSPITAL
 CORONARY ANGIOGRAPHY & ANGIOPLASTY
 BYPASS OPERATION
 2D ECHO AND COLOUR DOPPLER
 BALOON VALVE TREATMENT
 FETAL ECHO
 ARRYTHMIA CLINIC
 ICCU
 COMPUTERISED TMT
 PACEMAKER HUT TEST
 24 HOURS EMERGENCY
 CRITICAL CARE UNIT
 NEURO SURGERY
 ORTHO SURGERY
 TRAUMA CARE
 GENERAL SURGERY
 DIALYSIS
 24 HOURS AMBULANCE

10. INFORMATION ABOUT SHRI KRISHNA
HRUDALAYA & CRITICAL CARE HOSPITAL
 CLINICAL RESEARCH
 EVERY MOLECULE HAS TO BE EXTENSIVELY SUBJECTED TO RESEARCH BEFORE IT ENTERS
INTO THE MARKET ANY PARTICULAR DISEASE. CENTRAL ETHICS COMMITTEE CRITICALLY
REVIEWS THE PROPOSED RESEARCH PROGRAMMES AND PROJECTS IN DETAIL AND
ENSURES THAT THE RESEARCH EFFORTS ARE AT PAR WITH ICH-GCP GUIDELINES. ETHICS
COMMITTEE CONSISTING OF DOCTORS AND SCIENTIFIC OFFICERS, EXPERT MEMBERS IN
THE FIELD OF MEDICINE, LAW AND SOCIAL SCIENCE CRITICALLY EVALUATE THE RESEARCH
AND MEDICAL PRACTICES FOLLOWED IN THE HOSPITAL. A SEPARATE DATA MONITORING
AND SAFETY COMMITTEE, IN ADDITION, EVALUATE AND MONITORS ALL OFFICIALLY
SANCTIONED INTRAMURAL RESEARCH PROGRAMMES. PATIENT’S SAFETY IS OF PRIME
CONCERN FOR US WHILE CONDUCTING BIOMEDICAL RESEARCH.
 COMPLETED PROJECTS:
 PHASE III CLINICAL STUDY ENTITLED EFFICACY AND SAFETY OF INTRAVENOUS
ADMINISTRATION OF CONIVAPTAN HYDROCHLORIDE IN THE TREATMENT OF EUVOLEMIC
HYPONATREMIA - A MULTICENTRE, OPEN LABEL, NON-COMPARATIVE, PHASE III STUDY.
 A PHASE III, ACTIVE (WARFARIN) CONTROLLED, RANDOMIZED, DOUBLE-BLIND, PARALLEL
ARM STUDY TO EVALUATE EFFICACY AND SAFETY OF APIXABAN IN PREVENTING STROKE
AND SYSTEMIC EMBOLISM IN SUBJECTS WITH NONVALVULAR ATRIAL FIBRILLATION
(ARISTOTLE: APIXABAN FOR REDUCTION IN STROKE AND OTHER THROMBOEMBOLIC
EVENTS IN ATRIAL FIBRILLATION)

11. LOCATION
 SHRIKRISHNA HRUDAYALAYA AND CRITICAL CARE CENTER
 TIKEKAR ROAD, CONGRESS NAGAR SQUARE,
 OPP. NEW ENGLISH HIGH SCHOOL,
 DHANTOLI,
 NAGPUR - 440 012.
 TEL. NO. : +91-712-2444434, 2442136
 FAX: +91-712-2440120
 E-MAIL: INFO@SHRIKRISHNAHRUDAYALAYA.COM

12. AIM
TO STUDY THE PLANNING, ORGANISATIONAL STRUCTURE, MANAGEMENT,
EVALUATION AND GIVE RECOMMENDATIONS IF ANY OF CENTRAL STERILE
SUPPLY DEPARTMENT
OBJECTIVES
•TO STUDY ORGANISATION AND WORKING OF CENTRAL
STERILE SUPPLY DEPARTMENT.
•TO SEE THE FACILITY AND SERVICES PROVIDED BY CENTRAL
STERILE SUPPLY DEPARTMENT.
•TO FIND OUT ANY NEED TO IMPROVE BASIC SERVICES
PROVIDED BY CENTRAL STERILE SUPPLY DEPARTMENT.

13. METHODOLOGY
•AN OBSERVATIONAL STUDY WAS
CARRIED OUT IN CENTRAL STERILE
SUPPLY DEPARTMENT AT SHRI KRISHNA
HRUDALAYA & CRITICAL CARE NAGPUR.
•THE DATA HAS BEEN COLLETED
THROUGH OBSERVATIONAL AND
INFORMAL DISCUSSION WITH DOCTORS,
NURSES, PATIENTS & OTHER STAFFS.

14. INTRODUCTION OF CSSD
 ENSURING A HIGH STANDARD OF STERILIZATION AND DISINFECTION TO MINIMIZE THE INCIDENCE OF
HOSPITAL INFECTION HAS BEEN UPPERMOST IN THE MINDS OF CLINICIANS AS WELL AS HOSPITAL
ADMINISTRATORS. STANDARDIZATION OF SURGICAL DRESSINGS, AND CENTRALIZING ALL SURGICAL
SUPPLIES FROM ONE POINT OF ORIGIN WERE NECESSITATED DURING THE SECOND WORD WAR BECAUSE
OF THE REQUIREMENT OF A LARGE NUMBER OF CASUALTIES IN DIFFERENT THEATERS OF WAR. THE
CONCEPT OF A STERILE SUPPLY ORGANIZATION, IN THE FORM OF AN INDEPENDENT UNIT OR ONE
ATTACHED TO LARGE BASE HOSPITALS CAME INTO BEING. STERILIZATION ACTIVITIES IN A HOSPITAL ARE
BETTER CENTRALIZED IN ONE SINGLE DEPARTMENT FOR EFFICIENCY AND EFFECTIVENESS. THIS
DEPARTMENT, CALLED THE CENTRAL STERILE SUPPLY DEPARTMENT (CSSD) BECOMES RESPONSIBLE FOR
PROCESSING, STERILIZING AND DISPENSING OF ALMOST ALL ITEMS OF STERILE EQUIPMENT, SETS AND
DRESSINGS IN THE HOSPITAL. CENTRALIZATION OF STERILIZING ACTIVITIES IN ONE DEPARTMENT HAS
RESULTED IN MANY ADVANTAGES, THE CHIEF AMONG THESE ARE (I) IMPROVED EFFICIENCY, (II) STERILE
SUPPLIES AVAILABLE AT ALL TIMES OF THE DAY OR NIGHT, (III) ECONOMY OF TRAINED MANPOWER, (IV)
STERILIZATION SAFETY AND (V) QUALITY CONTROL.
 THE OBJECTIVE OF ESTABLISHING A CENTRAL STERILE SUPPLY DEPARTMENT IS TO MAKE RELIABLY
STERILIZED ARTICLES AVAILABLE AT THE REQUIRED TIME AND PLACE FOR ANY AGREED PURPOSE IN THE
HOSPITAL AS ECONOMICALLY AS POSSIBLE, HAVING REGARD TO THE NEED TO CONSERVE THE TIME OF
USERS [ESPECIALLY DOCTORS AND NURSES]. THE STERILE SUPPLY DEPARTMENT WITHIN A HOSPITAL
RECEIVES STORES, STERILIZES AND DISTRIBUTES TO ALL DEPARTMENTS INCLUDING THE WARDS,
OUTPATIENT DEPARTMENT [OPD] AND OTHER SPECIAL UNITS SUCH AS OPERATING THEATRE [OT]. MAJOR
RESPONSIBILITIES OF CSSD INCLUDE PROCESSING AND STERILIZATION OF SYRINGES, RUBBER GOODS
[CATHETERS, TUBING], SURGICAL INSTRUMENTS, TREATMENT TRAYS AND SETS, DRESSINGS ETC. IT IS
RESPONSIBLE FOR ECONOMIC AND EFFECTIVE UTILIZATION OF EQUIPMENT RESOURCES OF THE HOSPITAL
UNDER CONTROLLED SUPERVISION.
 THE CSSD ALSO AIMS AT ASSUMING TOTAL RESPONSIBILITY FOR PROCESSING HOSPITAL ITEMS THEREBY
ASSURING THAT ALL OF THEM RECEIVE THE SAME DEGREE OF CLEANING AND STERILIZATION. IT ALSO
CONTRIBUTES TO THE EDUCATIONAL PROGRAM WITHIN THE HOSPITAL RELATING TO INFECTION CONTROL
AND DEVELOPS A COST-EFFECTIVE PROGRAM BY COST ANALYSIS OF PERSONNEL, SUPPLIES AND
EQUIPMENT.


15. FUNCTIONS OF CSSD
 RECEIVING AND SORTING SOILED MATERIALS USED IN THE HOSPITAL.
 DETERMINING WHETHER THE ITEM SHOULD BE REUSED OR DISCARDED.
 CARRY OUT THE PROCESS OF DECONTAMINATION OR DISINFECTION PRIOR TO
STERILIZATION.
 CARRY OUT SPECIALIZED CLEANING OF EQUIPMENTS AND SUPPLIES.
 INSPECTING AND TESTING INSTRUMENTS, EQUIPMENTS AND LINEN.
 ASSEMBLING TREATMENTS TRAYS, INSTRUMENT SETS, LINEN PACKS, ETC.
 PACKING ALL MATERIALS FOR STERILIZATION.
 STERILIZING.
 LABELING AND DATING MATERIALS.
 STORING AND CONTROLLING INVENTORY.
 ISSUING AND DISTRIBUTING.

16. LOCATION
 IN HOSPITALS WITH WELL-UTILIZED SURGICAL SERVICES, THE
OPERATION THEATERS (OT) REQUIRES HUGE SUPPLIES OF
STERILE SURGICAL INSTRUMENTS AND STERILE LINEN AND
THEY ARE THE MAJOR USERS OF CSSD. THE OTHER USERS OF
CSSD INCLUDE WARDS, ICUS, EMERGENCY AND LABOR ROOM
ETC. THEREFORE THE LOCATION OF CSSD SHOULD
PREFERABLY BE IN PROXIMITY TO OT AND SHOULD HAVE EASY
ACCESS TO OTHER USER DEPARTMENTS. IN SOME HOSPITALS,
THE OT COMPLEX HAS ITS OWN STERILE SUPPLY UNIT WITHIN
OR JUST ADJACENT TO IT. THIS IS KNOWN AS THEATER STERILE
SUPPLY UNIT (TSSU). THE AUTOCLAVE MACHINES IN THE CSSD
EMIT LOT OF HEAT SO THE FACILITY SHOULD HAVE AT LEAST
ONE SIDE EXPOSED TO OPEN SPACE. BECAUSE OF SHORTAGE
OF SPACE, NOW A DAY’S MANY HOSPITALS ESTABLISH THE
CSSD IN THE BASEMENT. THE CSSD CAN BE CONNECTED TO OT
COMPLEX THROUGH SMALL ELEVATORS.

17. STAFF
 THE STAFF IN CSSD COMPRISE OF TECHNICIANS WHO OPERATE THE
AUTOCLAVE AND ETO MACHINES. ASSISTANTS WHO PERFORM THE
CLEANING AND PACKING, GAUGE CUTTING AND COTTON BALL MAKING
ASSIST THEM. THERE MAY BE CLERKS OR STOREKEEPERS TO MANAGE
THE INVENTORY AND STERILE STORES. ONE OR MORE HOUSEKEEPING
STAFFS MAY BE REQUIRED. A MANAGER SUPERVISES THEM ALL.
 CSSD IN CHARGE/ MANAGER
 CSSD TECHNICIANS
 CSSD ASSISTANTS
 HOUSEKEEPING STAFF

18. WORK FLOW AND SPACE PLANNING
 MAJOR ACTIVITIES IN A CSSD ARE:
 RECEIVING THE USED ITEMS FROM USER DEPARTMENTS
 CLEANING
 PACKING
 STERILIZING
 STORING (TEMPORARY)
 DISTRIBUTING TO USER DEPARTMENTS
 THESE ACTIVITIES ARE CARRIED OUT IN ABOVE SEQUENCE AND
EFFORTS ARE MADE TO MAINTAIN A UNI-DIRECTIONAL FLOW OF
ACTIVITIES SO THAT STERILE AND UNSTERILE ITEMS REMAIN
SEPARATE. ACCORDINGLY THE SPACE PROGRAMMING IS DONE. EACH
AREA IS DESCRIBED BELOW:

19. RECEIVING AREA
 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 FLUIDS SHOULD BE
DECONTAMINATED WITH SODIUM HYPOCHLORITE SOLUTION IN THE
USER DEPARTMENTS ITSELF SO THAT THE STAFFS WHO HANDLE
THESE ITEMS FOR TRANSPORTATION OR CLEANING ARE NOT EXPOSED
TO THE RISK OF CONTACTING INFECTIONS. AFTER DECONTAMINATION,
THEY ARE SHIFTED TO CSSD. THE STAFF OF THE USER DEPARTMENT
OR THROUGH CENTRALIZED STAFF CAN TRANSPORT THESE ITEMS TO
CSSD EITHER.
 THE RECEIVING AREA OF CSSD SHOULD HAVE ACCESS TO OUTSIDE
THROUGH A WINDOW WITH A COUNTER. THE ITEMS (ESPECIALLY FOR
INSTRUMENTS IN TRAYS) ARE COUNTED AND RECEIVED. THEREAFTER
THE INSTRUMENTS ARE INSPECTED AND BLUNT/ UNSUITABLE
INSTRUMENTS ARE SEGREGATED/ DISCARDED. NECESSARY ENTRIES
ARE MADE FOR RECORDS. THEREAFTER THE ITEMS ARE SHIFTED TO
CLEANING AREA.

20. CLEANING AREA
 HERE THE INSTRUMENTS ARE WASHED EITHER MANUALLY OR IN MACHINES. FOR MANUAL,
WASHING SINKS WITH WATER SUPPLY AND WORKING COUNTERS ARE ORGANIZED.
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.
 TUNNEL WASHER IS HIGHLY SOPHISTICATED AND EXPANSIVE MACHINE THAT ALLOWS
TOTALLY HAND-OFF PROCESSING. INSTRUMENTS IN PERFORATE OR MESH BOTTOM TRAYS
COMING FROM OPERATING ROOM OR OTHER DEPARTMENTS ARE PLACED INTO THE TUNNEL
WASHER WITHOUT ANY FURTHER HANDLING. THE INSTRUMENTS ARE SUBJECTED TO
CYCLES WASHING, RINSING, ULTRASONIC CLEANING AND DRYING. MOST OF THE HOSPITALS
CANNOT AFFORD THESE WASHERS.
 AFTER THE INSTRUMENTS ARE WASHED, THEY ARE DRIED IN OVEN DRYER AND SHIFTED TO
PACKING AREA.
 IF USED ITEMS ARE NOT DECONTAMINATED IN USER DEPARTMENT THAN BLOOD/ BODY
FLUID SOILED SHOULD BE DECONTAMINATED WITH SODIUM HYPOCHLORITE BEFORE
HANDLING FURTHER.

21. PACKING AREA
 CLEAN AND DRY INSTRUMENTS ARE PACKED BEFORE STERILIZATION SO THAT THEY ARE
NOT CONTAMINATED WHILE HANDLING AFTER THEY ARE STERILIZED. WORKING COUNTERS
ARE REQUIRED IN THIS AREA. MOST OF THE INSTRUMENTS ARE PACKED IN TRAYS (TRAY
ASSEMBLY) THAT 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 (ETO BAGS) ARE USED FOR PACKING THE
ITEMS FOR ETO STERILIZATION. THE PACKS ARE LABELED INDICATING DATE OF
STERILIZATION AND DATE OF EXPIRY (WHEREVER POSSIBLE).
 SEALING MACHINE IS USED FOR THE SEALING THE PLASTIC BAGS IN WHICH INSTRUMENTS
ARE PACKED. AFTER PACKING AND SEALING, THE INSTRUMENTS ARE SHIFTED FOR
STERILIZATION.
 A LARGE QUANTITY OF COTTON BALLS AND GAUGE PIECES ARE USED IN VARIOUS PATIENT
CARE AREAS AND ARE REQUIRED TO BE STERILIZED BEFORE USING THEM. TRADITIONALLY
THESE ARE PREPARED IN THE CSSD. CUTTING THE GAUGE IS VERY ARDUOUS JOB AND IS
DONE WITH THE HELP OF GAUZE CUTTING MACHINE. DURING THE PROCESS OF GAUGE
CUTTING, THE COTTON FIBERS ARE DISPERSED IN THE AIR AND MAY GET SETTLED ON THE
STERILIZED ITEMS SPOILING THEM. THEREFORE, A SEPARATE ROOM IS REQUIRED FOR
CUTTING THE GAUGE AND PREPARING COTTON BALLS ADJACENT TO THE PACKING AREA.

22. STERILIZING AREA
 STERILIZATION IS DONE BY EITHER OF THE TWO METHODS IN CSSD:
 STEAM STERILIZATION BY AUTOCLAVES
 GAS STERILIZATION BY ETO (ETHYLENE OXIDE) MACHINES
 AUTOCLAVE: STEAM UNDER PRESSURE IS THE MOST COST-EFFECTIVE METHOD OF STERILIZATION, THEREFORE, MOST
COMMONLY USED FOR STERILIZATION OF INSTRUMENTS AND LINEN IN HOSPITALS. “AUTOCLAVE” IS THE NAME OF THE MACHINE
THAT GENERATES STEAM AT A TEMPERATURE OF 121 DEGREE CENTIGRADE UNDER 15 POUNDS OF PRESSURE. AN EXPOSURE OF
20 MINUTES IS REQUIRED FOR STERILIZATION. BEFORE FEEDING THE STEAM, VACUUM IS GENERATED IN THE CHAMBER OF THE
AUTOCLAVE SO THAT NO AIR POCKET REMAINS IN THE FOLDS OF LINEN AND THE STEAM IS DISTRIBUTED UNIFORMLY IN THE
CHAMBER.
1. AUTOCLAVE IS AVAILABLE WITH SINGLE DOOR OR DOUBLE DOORS. DOUBLE DOOR AUTOCLAVES HAVE TWO DOORS ON TWO
OPPOSITE SIDES AND HAVE THE ADVANTAGE OF MAINTAINING UNI-DIRECTIONAL MOVEMENT OF MATERIALS. THE UNSTERILE
ITEMS ARE FED INTO THE CHAMBER THROUGH ONE DOOR AND THE STERILIZED ITEMS ARE TAKEN OUT FROM THE OTHER DOOR
OF THE AUTOCLAVE.
2. THE AUTOCLAVES OF DIFFERENT CAPACITIES ARE AVAILABLE- 1/2, 1, 2 TON ETC. AND CAN BE SELECTED DEPENDING ON THE
WORK LOAD.
 ETO STERILIZER: THE ITEMS LIKE CARDIAC CATHETERS ARE THERMO SENSITIVE (DAMAGED BY HEAT) AND THEREFORE CANNOT
BE STERILIZED BY STEAM. SUCH ITEMS ARE STERILIZED BY ETHYLENE OXIDE (ETO) GAS STERILIZATION. THE ETO IS AN
EXPANSIVE AND TOXIC GAS. THE ITEMS THAT ARE TO BE STERILIZED ARE PLACED IN A CHAMBER THAT IS FILLED WITH ETO. AS A
RESULT OF THE EXPOSURE TO THE GAS ALL ORGANISMS ATTACHED TO THE ITEM GET KILLED BUT THE ITEM GETS COATED
WITH GAS MOLECULES. IT IS ABSOLUTELY NECESSARY TO ENSURE THAT THESE ITEMS ARE MADE FREE OF GAS MOLECULES
BEFORE USING THEM ON A PATIENT. THIS IS ACHIEVED BY SUBJECTING THE ITEMS TO FORCED VENTILATION. THE ENTIRE CYCLE
OF STERILIZATION AND VENTILATION IS LONG AND MAY TAKE ABOUT 8- 12 HRS. FOR EACH CYCLE OF GAS STERILIZATION ONE
ETO CARTRIDGE IS REQUIRED THAT IS FIXED WITH THE MACHINE BEFORE STARTING THE CYCLE.
 FLASH STERILIZER: THIS IS A SPECIAL TYPE OF AUTOCLAVE THAT HAS A VERY SHORT STERILIZATION CYCLE OF ABOUT 3 - 5
MINUTES BECAUSE OF ITS ABILITY TO RAISE THE TEMPERATURE TO 132 DEGREE CENTIGRADE. THE MACHINE IS GENERALLY
KEPT IN THE OT. DURING THE OPERATIONS IF THERE IS URGENT A REQUIREMENT OF STERILIZING AN INSTRUMENT, IT IS DONE
ON FLASH STERILIZER.

23. STORE
 AFTER STERILIZATION, THE ITEMS ARE
TEMPORARILY STORED IN A CLEAN
STORE (ON RACKS) FROM WHERE THEY
ARE DISTRIBUTED TO USER
DEPARTMENTS

24. DISTRIBUTION AREA
 IT SHOULD BE AWAY FROM THE
RECEIVING AREA AND MAY COMPRISE OF A
WINDOW WITH COUNTER. IN MODERN
HOSPITALS, THERE MAY BE A SEPARATE LIFT
FOR TRANSPORTING THE STERILE MATERIALS
TO USER DEPARTMENTS.

25. SUPPORT AREAS IN CSSD
 THE FOLLOWING SUPPORT AREAS WOULD BE
REQUIRED IN A CSSD
1. CSSD MANAGERS OFFICE
2. WORKERS REST ROOM WITH LOCKERS AND TOILET
FACILITY
3. UNSTERILE STORES FOR COTTON, GAUGE, LINEN AND
INSTRUMENTS

26. QUALITY ASSURANCE
 IN ORDER TO ENSURE THE QUALITY OF STERILIZATION THE FOLLOWING MEASURES ARE TAKEN:
 ENSURE THE EQUIPMENT IS FIT I.E. IN AUTOCLAVE THE TEMPERATURE IS MAINTAINED AT 121 DEGREES
CENTIGRADE, 15-POUND PRESSURE AND HOLDING TIME IS MINIMUM 20 MINUTES. MODERN MACHINES
ASSURE THAT AND ARE FITTED WITH GOOD QUALITY MONITORS. THEY PROVIDE PRINT OUTS OF READINGS.
THE DOORS OF THE AUTOCLAVE DO NOT OPEN UNLESS THE CYCLE IS COMPLETE.
 BOWIE DICK’S TAPES ARE FIXED WITH EVERY PACK OF ITEMS TO BE STERILIZED. THIS TAPS CHANGES THE
COLOR WHENEVER THE REQUIRED TEMPERATURE IS ATTAINED. AFTER A CYCLE, THE TAPES ARE
CHECKED FOR CHANGE OF COLOR. HOWEVER, THE CHANGE IN COLOR ONLY INDICATES THAT THE
SPECIFIC TEMPERATURE HAS BEEN ACHIEVED DURING THE CYCLE BUT CANNOT GUARANTEE THAT THE
ITEMS ARE STERILIZED. INDICATORS ARE ALSO AVAILABLE FOR CHECKING THE QUALITY OF ETO
STERILIZATION.
 PERIODICALLY BACTERIOLOGICAL TESTS ARE TO BE DONE. A CAPSULE CONTAINING BACILLUS
STEREOTHERMOPHILUS (FOR AUTOCLAVE) AND BACILLUS SUBTILIS (FOR ETO) ARE PUT ALONG WITH THE
LOAD. THESE BACTERIA ARE CONSIDERED MOST RESISTANT TO STEAM OR GAS RESPECTIVELY. AFTER
THE CYCLE IS OVER THESE CAPSULES ARE TESTED IN MICROBIOLOGY LAB FOR PRESENCE OF LIVE
ORGANISMS. IF THERE ARE NO LIVE ORGANISMS IN THE CAPSULES, IT INDICATES THE STERILIZATION
PROCESS WAS EFFECTIVE.
 THE STAFFS WHO WORK ESPECIALLY IN STERILIZATION AREA, STERILE STORE AND DISTRIBUTION AREA
SHOULD CHANGE SLIPPERS AND THEIR DRESS, AND WASH THEIR HANDS BEFORE RESUMING WORK.

27. LIFE OF STERILIZED ITEMS
THE LIFE OF THE STERILE MATERIALS DEPENDS ON
THE QUALITY OF PACKING MATERIALS USED AND THE
STATUS OF CLEANLINESS OF STORING AREA.
GENERALLY, THE ITEMS STERILIZED BY STEAM
AUTOCLAVE CAN BE USED FOR ONE WEEK AND ETO
PACKS CAN BE USED FOR 6 MONTHS.

28. HOSPITAL MANAGEMENT
INFORMATION SYSTEM

NO OF CYCLE PER EQUIPMENT

WORKLOAD PER EQUIPMENT- NO OF PACKS PER
CYCLE

DEPARTMENT WISE UTILIZATION

COST INCURRED ON STERILIZING ONE PACK ON
AUTOCLAVE AND ETO

NO OF PACKS EXPIRED AND RE-STERILIZED

29. ROLE OF CSSD MANAGER
 MAINTENANCE AND REPAIR OF EQUIPMENT
 INVENTORY MANAGEMENT OF SUPPLIES AND CONSUMABLE
 ENSURE QUALITY OF STERILIZATION
 ENSURE PROPER DISTRIBUTION AND TRANSPORT
 COST CONTROL MEASURE, TO ANALYZE AND REDUCE THE NUMBER OF CYCLE
 RECORD KEEPING AND DATA ANALYSIS
 OPTIMAL UTILIZATION OF MANPOWER AND EQUIPMENT
 MOTIVATION OF STAFF AND TRAINING
 INTER DEPARTMENTAL COORDINATION

30. MATERIALS TO BE STERILIZED
 SOME OF THE TRAYS/ INSTRUMENTS USED FOR DIFFERENT PROCEDURES IN DIFFERENT AREA OF THE HOSPITAL ARE:
 OT INSTRUMENTS AND DRAPES
 GLOVES
 DRESSING SET/ TRAY
 SUTURE REMOVAL SET
 SUTURING SET
 CUT DOWN TRAY
 TRACHEOTOMY SET
 LUMBAR PUNCTURE SET
 BONE MARROW/ LIVER/ KIDNEY BIOPSY SET
 CVP SET
 BURN PACK
 INTRA COSTAL DRAINAGE (ICD) PROCEDURE SET
 OP SUPPLIES- SIMS SPECULUM, SPATULA, ENT SETS, PROCTOSCOPES, DENTAL INSTRUMENTS

31. CSSD AT SHRI KRISHNA HRUDALAYA &
CRITICAL CARE
LOCATION OF CSSD
•CENTRAL STERILE SUPPLY DEPARTMENT IS SITUATED ON TERRACE OF THE HOSPITAL
STAFF IN CSSD
•CSSD INCHARGE - 1
•CSSD TECHNICIAN - 1
•INCHARGE OF CSSD – DR PIYUSH NAIDU
INSTRUMENTS USED IN CSSD
•AUTOCLAVE MACHINE – 2
•ETO SERILIZER (ETHYLENE OXIDE STERILIZER) – 2
•SEALING / PACKING MACHINE
•WATER FILTER – 2

32. LAYOUT OF CENTRAL STERILE SUPPLY
DEPARTMENT
ENTRANCE
ETHYLENE OXIDE STERALIZER 1
ENTRANCE
AUTOCLAVE
MACHINE 2
AUTOCLAVE
MACHINE 1
ETHYLENE OXIDE
STERALIZER 2
SEALING
MACHINE
WASHING AREA
STERILE + PACKING AREA
WASHING ROOM
OPEN AREA OF TERRACE HAVING
ROOF OF PLASTIC SHED

33. CSSD CONSIST OF
•CSSD CONSIST OF 2 ROOMS
OPEN AREA OF TERRACE HAVING ROOF OF PLASTIC SHED
STERILE + PACKING AREA
WASHING ROOM
OPEN AREA OF TERRACE HAVING
ROOF OF PLASTIC SHED
•IT CONSIST OF 2 AUTOCLAVE MACHINES
•THESE AUTOCLAVE MACHINES ARE KEPT UNDER PLASTIC
SHED.

34. STERILE AREA + PACKING
AREA
•IT CONSIT OF
ETO STERILIZER MACHINE.
SEALING MACHINE.
RACKS FOR MAINTANANCE OF CSSD REGISTER.
PACKING IS ALSO DONE IN THIS AREA.

35. WASHING ROOM
 IT CONSIST OF
 ETO STERALIZER MACHINE
 WATER TAPS FOR CLEANING OF INSTRUMENTS, FOR
FLUSHING OF CATHERATER ETC
 TWO WATER FILTERS WHICH ARE CONNECTED TO
TWO SEPARATE TANKS WHICH IS USED FOR
CATHERATER FLUSHING

36. SHIFT OF CSSD STAFF
 CSSD INCHARGE – 2PM TO 11PM
 CSSD TECHNICIAN – 11AM TO 11PM

37. LIST OF ITEMS & SPECIAL TRAY COMMONLY PROCESSED IN
CSSD
 INSTRUMENTS
 APPLIANCES
 DRESSINGS
 SPONGES
 OT LINEN
 SPECIAL PACKS
 GAUZE AND COTTON MATERIALS
 GLOVES
 BOWLS AND TRAYS

38. REGISTERED MAINTAINED IN
CSSD AUTOCLAVE IN TIME – OUT TIME REGISTER
 ETHYLENE OXIDE STERILIZER IN TIME - OUT TIME REGISTER
 OT REGISTER
 CARDIAC OT REGISTER
 CCU + ICU REGISTER
 WARD REGISTER
 DUTY ROOSTER REGISTER

39. PROCEDURE
 COLLECTION OF MATERIALS FROM VARIOUS
DEPARTMENTS
CSSD
NURSING
UNIT
CAT LAB
OT
OPD
IPD
LABOUR
ROOM

40. PROCEDURE
 RINSING: RINSING OF ARTICLES AFTER USE SHOULD NOT BE PERMITTED IN PATIENT CARE AREAS UNLESS
CARRIED OUT BY A TRAINED MEMBER OF THE STAFF
 INSPECTION AND ASSEMBLY: EACH ITEM SHOULD BE INSPECTED FOR FUNCTIONALITY, DEFECTS, BREAKAGE AND
THEN APPROPRIATELY ASSEMBLED
 CLEANING: ALL REUSABLE MEDICAL DEVICES SHOULD BE THOROUGHLY CLEANED PRIOR TO DISINFECTION OR
STERILIZATION.
 DRYING: ALL ARTICLES SHOULD BE DRIED APPROPRIATELY.
 PACKAGING: ARTICLES SHOULD PREFERABLY BE PACKED IN POROUS MATERIAL.
 LABELLING: EACH PACK SHOULD BE MARKED WITH NOMENCLATURE OF THE ARTICLE, CONTENTS OF THE PACK,
INITIALS OF THE PERSON WHO PACKED IT, DATE AND INITIALS OF THE PERSON WHO CARRIED OUT THE
STERILIZATION.
 STERILIZATION: THE OPERATION OF THE STERILIZER SHOULD BE ENTRUSTED TO A RESPONSIBLE AND FULLY
TRAINED PERSON. IT SHOULD BE KEPT IN A STATE OF GOOD MAINTENANCE AND REPAIR.
 AFTER STERILIZATION, STERILE MATERIALE IS TAKEN TO STORES
 STORAGE: SHOULD BE PROPERLY MANAGED SEPARATELY FOR STERILE AND NON-STERILE STORES. FOR
STERILE GOODS, CLEAN ROOM CONDITIONS SHOULD BE FOLLOWED.
 DISTRIBUTION: REFERS TO CLEAN AND DIRTY ARTICLES EXCHANGE SYSTEM. A PROGRAM SHOULD BE
ESTABLISHED FOR THE COLLECTION OF USED ITEMS FROM PATIENT CARE AREAS AND DISTRIBUTION OF
STERILIZED GOODS.

41. STERILITY INDICATORS
 MECHANICAL INDICATORS: ARE MONITORING INSTRUMENTS WHICH RECORD TIME, TEMPERATURE,
HUMIDITY AND PRESSURE DURING THE STERILIZATION CYCLE.
 CHEMICAL INDICATORS: ARE DEVICES WITH A SENSITIVE CHEMICAL OR DYE TO MONITOR ONE OR MORE
PARAMETERS OF A STERILIZATION CYCLE.
 BIOLOGICAL INDICATORS: EMPLOY THE PRINCIPLE OF INHIBITION OF GROWTH OF MICROORGANISM OF HIGH
RESISTANCE TO THE MODE OF STERILIZATION. SUBSEQUENT FAILURE OF GROWTH OF MICRO-ORGANISMS
INDICATES ADEQUACY OF STERILIZATION.
 NO SINGLE METHOD IS CAPABLE OF MONITORING COMPLETELY ALL PARAMETERS NECESSARY FOR A
FOOLPROOF STERILIZATION.
 RECORDING INSTRUMENTS ON THE AUTOCLAVE THAT GIVE A GRAPHIC RECORD OF TEMPERATURE,
PRESSURE, ETC. CAN BE INSPECTED IMMEDIATELY AFTER A LOAD HAS BEEN AUTOCLAVED.
 IN ADDITION, CHEMICAL INDICATORS PLACED INSIDE CHANGE COLOR WHEN CONDITIONS NECESSARY FOR
STERILIZATION HAVE BEEN MET. THESE ARE AVAILABLE AS TAPES AND STRIPES, AND ARE ATTACHED OR
IMPLANTED INSIDE THE PACKING MATERIAL.
 THIS SHOULD BE SUPPLEMENTED WITH PERIODICAL USE OF BIOLOGICAL INDICATORS TO DETECT (WHICH
MAY TAKE SEVERAL DAYS) FAILURE OF THE AUTOCLAVE. BIOLOGICAL INDICATORS SHOULD BE PLACED IN
THE MOST INACCESSIBLE LOCATION IN THE LOAD AND THEN CULTURED. THEY PROVIDE POSITIVE
ASSURANCE, ALBEIT RETROSPECTIVELY, THAT EACH PACKAGE HAS BEEN SUBJECTED TO PROPER
STERILIZING CONDITIONS.

42. TOTAL TIME REQUIRED
 AUTOCLAVE – 45 TO 50 MIN
 ETO STERILIZER – 11 TO 12 HOURS

43. OBSERVATION
 CSSD IS SITUATED ON TERRACE OF HOSPITAL.
 CSSD HAS TWO ROOMS STERILE + PACKING ROOM AND WASHING ROOM
 PLASTIC BAGS ARE USED TO BRING THE UNSTERILED MATERIAL
 FIRE EXTINGUISHERS ARE NOT INSTALLED.
 ONLY 1 STAFF WORKING IN CSSD
 STERILE + PACKING ROOM AREA 13*13 SQ FT
 WASHING ROOM AREA 13*10 SQ FT
 AUTO CLAVE SIGNAL LOCK & ETO SIGNAL LOCK USED TO INDICATE THAT MATERIAL IS
STERILISED
 MASK, HEAD CAP ARE USED BY CSSD TECHNISIAN FOR SAFTEY
 AFTER STERILISATION STERILE MATERIAL IS TAKEN TO STORE

44. RECOMMANDATION
 PACKING ROOM, STERILE ROOM SHOULD BE SEPRATE.
 AN ETO IS A TOXIC GAS. BREATHING APPARATUS FOR EMERGENCIES MUST BE STORED IN
AN,
EASILY ACCESSIBLE PLACE NEAR ETO AREA.
 USE OF EXHAUST SYSTEM TO EXHAUST GAS TO OUTSIDE,
 ALARMS TO ALERT IN CASE OF LEAK SPILL OF GAS.
 FIRE EXTINGUISHER SHOULD BE INSTALLED
 STAFF SHOULD BE INCREASED IN CSSD
 STERILE SUPPLIES AND PACKS AND CONTAMINATED ARTICLES SHOULD NEVER BE CARRIED
ON THE SAME TROLLEY OR BY THE SAME STAFF.
 ELECTRICAL WIRES SHOULD BE PROPERLY INSTALLED AND ELECTRICAL MAIN SWITCH
SHOULD BE INSTALLED OUTSIDE CSSD

45. RECOMMANDATION
 THERE SHOULD BE SEPRATE ROOM FOR GAUGE CUTTING & MAKING COTTON
BALLS.
 SEPRATE SLIPPERS SHOULD BE USED IN CSSD
 CSSD SHOULD BE SHIFTED FROM TERRACE
 CLEANING SHOULD BE PROPER IN CSSD
 ONE ATTENDANT SHOULD BE THERE IN CSSD TO BRING UNSTERILISED
MATERIAL FROM ALL DEPARTMENT
 TROLLEY SHOULD BE USED TO BRING UNSTERILISED MATERIAL

46. THANK
YOU