Management of

Central Sterile Supply Department (CSSD)

• Central sterile supply department (CSSD) is that department of the hospital that process, sterilize, and
distributes sterile equipment, sets, and dressings.

• The consolidation of sterilizing operations into a single department offers various benefits. The most
important of these are

- increased productivity,

- sterile supplies that are always available,

- sterilization safety, and

- quality control.
FIG 1 – General Floor Plan of a CSSD
CSSD Process Flow:-
FIG 2 – Flow of articles in CSSD
Planning of CSSD –

The planning of CSSD conforms to the sequence of work starting from the reception of materials to their dispatch
from the department. The following is the order of the events.

1. The department receives materials from OTs, wards, labour suite, nursery, etc.
2. All used materials are cleansed; users should have done preliminary cleaning to remove blood, pus, and other
difficult-to-remove materials before sending the articles to CSSD.
3. Clean materials are examined, put together, and packaged in preparation for sterilization.
4. They are either distributed directly from the issue counter or kept in a sterile storage facility after sterilization.

Physical facilities –

The flow of articles in the CSSD is unidirectional through receipt, washing and cleaning, drying, sorting,
reassembling and packing, sterilization and storage as shown in Fig. 2.
The following areas are essentially required in the CSSD –
Location –

The CSSD's location ought to be convenient for its main consumers. These are the operating rooms,
labour suites, and nursing units. It is situated such that supplies and equipment may be delivered to it
and removed using the quickest path. The hospital's major service core is where the department is
conveniently situated.

Space –

A minimum of 7 sq ft on a per bed basis (with 100 sq ft for the smallest hospital) is essential for
planning a CSSD with scope for future expansion and growth. The area is divided into receiving and
cleaning, clean work and processing, sterilization, syringes and glove processing, sterile storage, and
issue.
Staffing in CSSD –

A large hospital should have at least the following staff members –

Equipments – The main item of equipment in the CSSD is the autoclave. Most of these modern electric autoclaves are
designed to achieve a vacuum in the sterilization chamber followed by injection of steam under controlled pressure to
achieve desired temperatures for varying periods. Other equipment in the CSSD includes the following.
Packing Procedures

Step by step packing procedure for each pack is determined, and specifies:
i. the quantities of materials required and their arrangement on the workbench, and
ii. the sequence of the packing operation. Workbenches should be so designed to keep packing
movements to minimum, with storage of materials either on shelves or above the bench within easy
reach of the packer.

Manual of Operations

For the efficient functioning of the department, there is a procedure manual in place that details every
procedure used in the CSSD for every process and their proper order. It must be understood that the
more expensive and advanced the technology, the more skill and accuracy are needed to operate it.

Packing Material

When using an autoclave or hot air oven to sterilize items, several packing materials are deployed as
wraps. Because it provides a superior bacterial barrier, linen is frequently used to pack sterilizing loads.
For efficient sterilization, a double linen wrapping is preferred. It should be simple to open the wrap
without leaking the contents.
 Recieving and Sorting: -
Receiving
Project analysis slide 5
• Used supplies and equipments should be collected and taken to the
receiving area without contamination of personnel or any area of the
hospital.

• Equipments should be covered and supplies should be moved in

Sorting
It basically concentrates on separating the equipments based on the type of treatment to be given, i.e
whether they are to be disinfected in Washer disinfectors/ Ultrasonic washers or to be directly sent for
Steam/ ETO sterilization
 Decontamination: -

Project analysis
Reusable equipments, slide
instruments 5 are
and supplies
cleaned and decontaminated by means of manual or
mechanical cleaning processes and chemical
disinfections.

Soaking - It is necessary only if devices are very bloody

Washer Disinfectors -
- It is used to clean heat tolerant items.
- Several washes and rinses.

Ultrasonic Washer - It is used to remove fine soils from

Project
Inspection - analysis slide 5

1) Cleanliness - Bar locks, serrations and crevices

2) Sharpness - Scissors, rongeurs, chisels, curettes, etc.

3) Stiffness and Alignment of jaws and teeth - for hinged instruments like clamps and forceps.

Standardization of packs - The purpose of standardization is to create a standard surgical kit that includes all
the supplies needed for a procedure by the operating surgeon. This technique has the benefit of having
standardized sets on available, regardless of an individual surgeon's preferences, even for emergency
procedures. In addition to these, the following are other frequently used sets (or packs) of sterile tools and
supplies in many other operations that are generally standardized -
 Assembly and Packing:-

Project analysis slide 5

• Sternal puncture set 

• Lumbar puncture set 

• Catheterisation set 

• Bladder wash set 

• Liver biopsy set 

• Tracheostomy set.
Packing Material

When using an autoclave or hot air oven to sterilize items, several packing materials are deployed as wraps.
Because it provides a superior bacterial barrier, linen is frequently used to pack sterilizing loads. For efficient
sterilization, a double linen wrapping is preferred. It should be simple to open the wrap without leaking the
contents.
 Sterilization
Project analysis slide 4
• The most dependable and secure method of sterilization, used worldwide to eliminate all types of bacteria, is saturated
steam under pressure (Autoclaving). The higher the temperature the more rapidly is sterilization accomplished.

• The autoclaving method requires 121 °C at 15 lbs/psi for 15 minutes as the minimum time and pressure for sterilization.
The time can be shortened to 10 minutes if the temperature is raised to 126°C.

• It takes three minutes at 134°C and just one minute at 150°C.

• Incomplete penetration of steam can occur because of overloading the autoclave or incorrect positioning of packages
inside the autoclave.
 Sterile Storage

Project analysis
• Monitoring and slide 5
Maintaing the records of each cycle.

• Adhering to the safety precautions and preventive maintenance control (296-298 K , 57% humidity.)

• Storing of Sterile items.

• Issuing Sterilized loads.

Quality Control: Sterilization Checks –

Despite the autoclaves' process instruments, which provide a graphic record of temperature and pressure, standard
methods of sterility testing are included. Each load being autoclaved contains colour index strips that can be used for
this purpose. Autoclave loading, temperature, pressure, and time must all be done according to the manufacturer's
recommendations.
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