CSSD

Central Sterile Supply Department

MR. PRATIK TRIVEDI

OT MANAGER
 THE CENTRAL STERILIZATION &
SUPPLY DEPARTMENT (CSSD)

Mission of CSSD
Timely delivery of sterile goods
Quality (according to European Standards – EN)
Efficiency (line process)
Activities of the CSSD
Cleaning
Disinfection of semi- / non critical items
Sterilization of critical items (high risk for infection)
Supply of sterile materials
 DEFINITION

Service, with in the hospital, catering for the

sterile supplies to all departments , both to
specialized units as well as general wards and
OPDs.
 AIM

Centralizing the activities of receipt, cleaning, assembly,

sterilization, storage and distribution of sterilized
materials from a central department where safe
sterilization is done under controlled conditions with
adequate managerial and technical supervision at an
optimum cost.

To provide an efficient, economic, continuous and quality

supply of sterilized material to various areas of the
hospital to deliver quality and infection free patient care.

Contributes to reduction in hospital infection rate

To reduce the burden of work of the nursing personnel,

there by enabling them to devote more of their time to
patient care .
 Functions & Activity

Rinsing

Receipt cleaning

Issue &
Drying
Distribution
CSSD

Storage
checking

Labeling sterilization
 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.
 ADVANTAGES

Reduces Prevents
burden on cross-
nursing staff infection
Shortens
Maintains patient’s
standards stay

Economic Ensures safe

,Efficient and environment
uniform source

Infection free Inventory

atmosphere Maintenance

Processing, Quality
issue and Advantages
control care
 ADVANTAGES

1. Bacteriological safe sterilization.

2. Less expensive.
3. Elimination of unsound practices & establishment of
standard procedures.
4. Assurance of adequate supply of sterile products
immediately and constantly available for sometime as well
as emergency use.
5. Conservation of trained staff.
6. Better quality control
7. Better good of material flow
8. Prolonged life by proper care of equipment
 PLANNING OF CSSD DEPT

The CSSD can broadly be classified into two parts

Central Peripheral
unit unit

-Responsible for receiving dirty - Mainly responsible for distribution

Utilities cleaning, processing, to various areas of hospital.
Sterilization, storage and supply - TSSU (Theater Sterile Supply Unit)
PLANNING OF CSSD DEPT

QUALITY PHYSICAL

PREVENTIVE FUNCTIONAL

FINANCIAL PERSONNEL

EQUIPMENT
FLOW PROCESS
 LAYOUT DESIGNING PRINCIPLE

• There is no back tracking of sterile goods.

• One way movement from receiving counter to issue
counter.
• Sterile area should be prior to sterile storage and issue.
• The receiving counter must be away from the issue counter.
• Separate receiving and issuing counter

There should minimum six basic division in

CSSD

Cleaning Packaging Sterilization Issue

Drying Area Storage
Area Area Area counter
 STRUCTURAL DESIGN

• The Central Unit comprises of three zones, separated by two distinct

barriers.
One collection window
One supply window on the other end.
 EQUIPMENT IN CSSD

• Cleaning and decontamination devices

•Hot air Oven for drying & heat sterilization
•Glove processing unit for surgical gloves
•Instrument sharper e.g.. Needle sharper
•Testing apparatus for emergency sterilization
•Others :- trolleys, work surface, telephones
•Maintenance and repair of equipments
•Material : chemicals for washing and cleaning
•Steam Boiler
•Hot air ovens for drying instruments
•Autoclaves using dry heat, moist heat.
•Ethylene oxide sterilizers.
•Testing material to check effectiveness of sterilization.
•Sealing machine
•Ultrasonic Washer
 STERILIZATION

•It is a process of freeing an article from all living

organisms including bacteria ,fungal spores and
viruses.

•A material is pronounced sterile if it achieves

99.99% kill of bacterial spores.
 TYPES OF STERILIZATION

• Dry Heat
• Steam High Pressure-Autoclaves operated by Gas, K.oil or Electricity (
Flash, Pulse)
• Ethylene Oxide Sterilization.
• Chemical Sterilization.
• Radiation Sterilization.
• Infra Red Radiation – Syringes
• Ultra Violet Radiation – Decontamination of Air
• Ionizing Radiation / Gamma Radiation
 CHEMICAL STERILIZATION
CIDEX
•A Glutaraldehyde derivative is most effective as it destroys spores too.
•It is high level disinfectant. It kills spores within 12 hrs and viruses within 10
min.
•Widely used because of their excellent biocidal properties, activity in the
presence of organic matter, non corrosiveness and noncoagulation of
proteinaceous material

Hydrogen peroxide
•It is an effective bactericidal, fungicidal, viricidal and sporicidal.
•It is commercially available as 3% solution but can be used upto 25%
concentration.
•It is non corrosive and not inactivated by organic matter but irritant to skin and
eyes lutaraldehyde derivative is most effective as it destroys spores too.
 STEAM STERILATION

The equipments are first cleaned & the packaged in muslin, linen or paper
which are easily penetrated by steam & then placed on shelf in the chamber.

Water  Saturated  Wet vapor  Dry saturated Vapor  Super Heated

Vapor / Steam

- Steam with <0.95 Dryness Factor is not useful for Sterilization.

- Superheated Steam acts like Dry Hot Air only . ( Strength Of Steam is its
Latent Heat)

Total time Required

Autoclave – 45 to 50 min
ETO(Ethylene Oxide) sterilizer – 11 to 12 hours
 STERILIZATION INDICATORS
Mechanical Monitors:
 Devices that record time, temperature &
pressure.

Biological Indicators:
 They are standardized preparation of spores.
 A positive biological indicator is indicative of
possible sterilization process failure.
 They should be used atleast once a week but
 Time needed for incubation is long.
E.g. spores of Bacillus Sterothermophilus.
 STERILIZATION INDICATORS
Chemical Indicators:
These are more practical means & detect problems immediately.
The CDC & all major U.S organizations standards & guidelines advocate that a
chemical indicator be attached to every package that goes through a sterilization
cycle & within each package to be sterilized in what is expected to be the most
difficult-to-sterilize location.

These are divided into 6 classes, higher the class, more sensitive
the indicator
Class 1-
These are Internal & External Process Indicator
These inform that item has been exposed to sterilization process.
E.g. External Process Indicator – Autoclave Tape.
 STERILIZATION INDICATORS
Class 2
E.g. Bowie-Dick test for vacuum steam sterilizer.
They only access Vacuum Pump efficiency & detect the presence of air leaks
&/or gases in steam.

Class 3
E.g. Temperature Tube.
Contains chemicals that melts & sometimes changes color when the
appropriate temp is attained.

Class 4
Respond to one or more sterilization parameters.
Contains Ink that changes color when exposed to correct combination of
sterilization parameters.
 STERILIZATION INDICATORS

Class 5
Known as Integrating Indicators or Integrators
Respond to all parameters of sterilization over a specified range of
temperatures.

Class 6
These are emulating indicators.
These are designed to react to all critical parameters over a specified range of
sterilization cycles for which the stated values are based on the settings of the
selected sterilization cycles
 STORAGE

• After sterilization the sterilized items are kept in different racks as

per labeling.

• Supplied as per the demand of different area.

• To ensure continuous availability of sterile supply five times of

daily requirement should be available in storage.
 ROLE OF 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