CSSD
Central Sterile
Supply Department
“ No Stronger Condemnation of
any hospital or ward could be
pronounced than the simple fact
that ZYMOTIC DISEASE has
originated in it or that such
disease attack other patients than
those brought-in with ”
- FLORENCE NIGHTINGALE
BHATTA CHARJEE DEFINES –
CSSD
as that service, with in the
hospital, catering for the sterile
supplies to all departments , both
to specialized units as well as
general wards and OPDs.
1928 – American College Of
Surgeons – CSSD.
1942 – World War II .Cairo, British
SDS Unit .
1955 – Cambridge Military Hospital
– Regular CSSD in UK.
1965 – First CSSD in India –
Safadarajan Hosptial
AIMS
To provide sterilized material from
a central department where
sterilizing process is carried out
under properly controlled conditions
To alleviate the burden of work of
the nursing personnel, there by
enabling them to devote more of
their time to patient 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
ITEMS COMMONLY HANDLED BY
CSSD STORES
1. Syringes
2. Procedure Sets
Lumbar puncture ; sternal puncture ; venesection ;
paracentesis ; aspiration ; catheterization ;
tracheotomy ; suturing ; dressing ; biopsy ;
incision & drainage ; aortography ; cardiac
resuscitation ; etc
3. Needles
4. Gloves
5. I.V.Fluids.
6. Treatment Trays.
7. O.T Instruments.
8. O.T. Linen
9. Infusion Fluids for Renal Dialysis.
10. At times LINEN. (other than O.T)
NB: Diet , drugs , bedpans & urinals are
not included by convention .
PLANNING A DEPT ; (COPP)
1. Physical Planning.
2. Functional Planning.
3. Personnel Planning.
4. Equipment Planning.
5. Financial Planning.
6.Quality Control.
7.Preventive Maintenance.
PHYSICAL PLNG
1. Location & Grouping .
2. Lay Out & Space Reqts.
3. Fixturtes & Furniture .
RULE OF THE THUMB
ROUGHLY – 10 SQFT / BED - MCGIBONY
ADM & STORAGE 21² M
(UNSTERILE) AREA SCALES OF
RECEPTION,CLEANING, 35² M ACCN FOR
CHECKING,ASSEMBLY ARMED
& PACKING AREA FORCES
AUTOCLAVING AREA 28 ² M HOSPITALS
AH/CH/ SAY >
STERILE STORAGE & 28 ² M
700 BEDS
ISSUE AREA
EQPT IN CSSD
1.Jet water cleaning gadgets.
2.Ultrasonic Washers
3.Glove sharpener
4.Needle sharpener.
5.Gas, Chemical or steam autoclaves.
6.Testing apparatus for efficiency of
sterilization
OTHERS
1.Maint & Repair EQPT
2.Adequate number of cabins &
Furniture
3.Telephone or intercom.
4.Adequate no of syringes &
procedure sets.
NUMBER OF SETS/SYRINGES
A - 1½ Daily requirement in use at wards /
Departments
B - 1 Daily requirement in sterile state at CSSD, ready
for issue
C - 1 Daily requirement being processed at CSSD
D – 1to 1½ Daily requirement held in reserve – dome
in CSSD, some in medical stores
Total: 4.5 to 5 times of the daily requirement
Methods Of Sterilization / Disinfection
Natural Chemical Physical
Sun Light (UV) Solids Dry Heat
Air Lime, Bleeching Powder, Burning or Dry Air
KMNO4
(Desiccation) (160°C for 60 Min)
Liquids
Moist Heat
Formalin, Phenol , Alcohol ,
Boiling Steam
Glutaraldehyde
Radiation
Gases
Ionising Radiation
Formaldehyde, Ethylene
U V Rays
Oxide
CHEMICAL
CIDEX – A Glutaraldehyde derivative is most
effective as it destroys spores too.
ETHYLENE OXIDE (ETO) ;
- Quite effective against spores too.
- Useful for delicate instruments and item which
can’t be immersed in liquids
- Low Boiling Point (10 degree C)
- Prolonged Aeration
- Highly Expensive / Explosive / Toxic
Types Of Sterilization Techniques
1.Dry Heat
2.Steam High Pressure Autoclaves operated by Gas, K.oil or
Electricity ( Flash, Pulse)
3. Ethylene Oxide Sterilization.
4. Chemical Sterilization.
5. Radiation Sterilization.
- Infra Red Radiation – Syringes
- Ultra Violet Radiation – Decontamination of Air
- Ionising Radiation / Gamma Radiation
ISOMED at BARC
STERILISATION .
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.
STEAM STERILATION
- 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)
MODE OF ACTION.
Dry Heat Oxidation
Steam Denaturation = Coagulation of Proteins
Sterilization Time Pressure Temperature
(Holding Time + Safety (PSI) ( C° )
Time)
2' + 1′ = 3' 30 134
8' + 2' = 10' 20 126
12' + 3' = 15' 15 121
TYPES OF AUTO CLAVING
MACHINES
1. Downward Displacement
2. Vacuum Assisted.
3. Pulsed Steam Dilution
TESTS FOR EFFICENCY OF
STERILISATION
1. Specially treated paper strip.
2. Pressure sensitive tape to be fixed to the
final fold
3. Brown indicator tubes - (very expensive)
4. Biological. Green strip containing bacteria
(Color must change to black)
5. Cellophane wrapped tablet containing
- Lactose - 75%
- Starch - 24%
- Magnesium Trisilicate – 1% (Tablet turns
brown during autoclaving)
6. Microbiological examination of finished
products.
7. Thermo - couples .
ADVANTAGES OF STEAM
STERILISATION
1. Rapid heating & penetration of
loads.
2. Destruction of all forms of
microbial life
3. No residual toxicity.
4. No damage to supplies being
sterilised.
5. Easy Quality Control
6. Economical & Reliable
This method is unsuitable for heat
sensitive and non- permeable material
RADIATION STERILISATION ;
‘ ISO MED ‘ at ‘BARC’ Trombay; dose - 2.5
Mega Rhontgen; Source – Cobalt-60 /Caesium
– 137/ Electron Beam (generated by linear
accelerator)
Reliable, can penetrate all types of packing.
Large & diverse shaped articles can be
sterilised. No residual radio activity at 2.5 mega
rhontgens.
Glass becomes dark, cotton looses tensile
property, food gets undesirable flavor. Not
practicable in hospitals
STAFFING :CSSD
BHATTA CHARJEE RECOMMENDS :
SUPERVISORS (sister/male ward masters) 4
STAFF NURSES 5
TECHNICIANS (ORA) 6
ATTENDANTS 24
SWEEPER 4
CLERK 1
TOTAL 44
CENTRALISED SUPPLY (RULE OF THUMD 2PER 100 BEDS)
DISTRIBUTION SYSTEMS :
1. Regular issue of one day’s requirement.
2. Clean for dirty exchange.
3. Milk round system (topping up
predetermined stock level)
4. As on required basis. (Grocery system)
FLOW PROCESS : CSSD
WARDS/DEPTS BULK STORES
DIRTY RECEIPT CLEAN RECEIPT COTTON & GAUGE
DISASSEMBLY
INSTRUMENT GLOVES RUBBERWARE
WASHING AREAS
ASSEMBLY
INSPECTION
PRE – STERILE STORAGE
STERILISATION STERILESTORAGE
DISTRIBUTION
A SUGGESTED LAYOUTOF
CSSD
AUTOCLAVE
ASSEMBLY
(PARKING) ROOM
STERILE
CLEANING&
WASHING
GLASS PARTITION STORAGE
Supervisors
Clean disasse office
storage mbly
Verandah
clean
Dirty ° ° ° STERILE
recep
recepti tion ° 0 ° ISSUE
on ° °
°
RAMP
INTRA MURAL COMMUNICATION LINE
Thermal Death Time (TDT)
TDT is the time required to kill a known
population of microorganisms in a specific
suspension at a particular temperature
Increasing temperature decreases TDT
Lowering the temperature increases TDT
Thermal Death Time ( cont.)
Acidic or basic pHs decrease TDT
Fats and oils slow penetration and increase
TDT
