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
1,320 ² ft
TOTAL
(COPP)
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

(Desiccation) KMNO4
(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 ROOM
(PARKING)

STERILE
CLEANING&
WASHING
GLASS PARTITION STORAGE
Supervisors
Clean disasse office
storage mbly
Verandah
Dirty ° ° ° STERILE
clean 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