CENTRAL STERILE SUPPLY DEPARTMENT DEFINITION: CSSD is a service unit in a hospital that processes, issues, and controls the

sterile stores supply to all departments of the hospital. FUNCTION: i. Receipt: Receiving unsterile stores, instruments, equipment and linen from various consumer departments of the hospital for processing. ii. Cleaning: Cleaning of used equipment, rubber and plastic goods either manually or by machines. iii. Checking, assembling and packaging: Checking of glass items for breakages, needles and instruments for sharpness and breakages, assembling of the equipment after washing and drying, making sets and packaging for sterilization. iv. Sterilization: Sterilization of all the items received, by using the appropriate techniques as applicable to the items. v. Labeling vi. Storage: Storage of sterilized packs, dressing materials. vii.Issue and distribution: Issue of sterilized packages, dressings, linen instruments and disposables to various departments of the hospital. LOCATION: The location of CSSD should be such that it is as close as possible to the major user areas, such as A & E dept, O.T. and wards. In a multistory building, the CSSD may be situated in the lowest floor. PHYSICAL LAYOUT: The following areas should be planned: - Area for receipt of material/ items - Areas for storing sterilized material/ items. - Cleaning, washing and decontamination area. - Assembling area - Glove processing area. - Gauze cutting area. - Area for storage of packed sets - Sterilizers rooms: this should be equipped with double door pass through autoclaves which are built into the wall between the clean and sterile areas. - Sterile store - Supervisors room - Issue counter - CSSD Manager Office - Changing rooms - Trolley washing and packing area. - Area for storage and supply of steam, hot and cold water.

KEY PLANNING &DESIGNING PARAMETERS: There should be separate receipt and dispatch areas. The clean and dirty areas should be separated by a physical barrier. The floor surface should be smooth, impervious, non-skid and robust. The clean area should be provided with air locks and maintained at positive pressure relative to the adjoining spaces. Facilities must be planned for at least one high speed autoclave preferably in OT. In order to minimize the spread of lint, the preparation and assembling of gauze packs should be confined to a separate enclosed ventilated work area. The work area should be made of marble/granite/ stainless steel. The sterilization must be planned for autoclaving by steam as well as by gas since certain item such as rubber cannot be autoclaved. EQUIPMENT PLANNING: A. CLEANING AREA i. High capacity pass through washer disinfector at 800C to 900 C having various shapes and sizes. ii. Cold and hot water streams. iii. Detergent Solution. iv. Steam when available. v. Hot air ovens for drying instruments. vi. Wall fixtures for drying. B. STERILIZATION AREA i. Autoclaves using dry heat, moist heat. ii. Ethylene oxide sterilizers. iii. Testing material to check effectiveness of sterilization. C. STORAGE AND DISTRIBUTION i. Cup boards, selves, tables, chairs, racks. ii. Trolleys, instrument trays, wire baskets and containers. D. OTHER EQUIPMENTS -Cleaning and decontamination devices -Hot air Oven for drying & heat sterilization -Glove processing unit for surgical gloves -Instrument sharper eg. 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 STAFFING PATTERN: Staffing should be planned based on following factors:1. Three shift working

2. Messenger service 3. Maintenance service. 4. Staff for 6 areas. 5. Leave and off duty Different categories of staff. CSSD Supervisor. CSSD Attendant. CSSD Technician. Messengers. Boiler attendant. Clerks. Housekeeping boys STAFFING REQUIRMENTS: MEDICAL SUPERINTENDENT I/C CSSD (Microbiologist) TECH. SUPERVISOR CSSD TECHNICIANS CLEANING ATTENDANTS TRANSPORTERS SAFAIWALA

Average 02 technicians for 100 beds and one technical supervisors. One clerk for keeping records, accounting and supply/ shift. Average 04 attendants per 100 beds in all shifts. Adequate number of cleaning attendants and transporters. One technician and two attendants should be stationed at each zone.

CSSD MATERIAL DISTRIBUTION SYSTEM: i. The one for one or basket system: Wards send their requisition to CSSD from which deliveries are made in accordance with the demand. ii. The milk round system: daily topping up of each ward stock to an agreed level. iii. The grocery system: a load of standard composition is delivered daily to each ward and unused stock from the previous days issue is returned.

iv. The clean for dirty exchange system: one clean article is issued for each dirty article returned to CSSD under arrangement by the user. METHOD OF STERILIZATION: Sterilization processes can be classified as under: i. Steam/ Moist Heat sterilization: These are used in various size Autoclaves. The principle is based on right combination of steam, pressure and temperature for fixed time. If the pressure is increased the duration of sterilization reduced. It destroys the micros by irreversible denaturation or heat coagulation of cell protein. Steam must have less than 3% moisture. And dryness 92-95% Steam at 1340C -03 mins at 32.5 lbs pressure and 1210C for 10 mins. at 20lbs DRY HEAT STERILIZATION: It is used for sterilization of oils, powders, small instruments. At 1600C to 1800C for 40 mins. Infra red is one method of dry heat sterilization. Gas Sterilization: ETO Sterilization: ETO may be used in combination with CO2 or nitrogen. Sterilization by ETO is done for items which cannot stand high temperature such as rubber goods, drip sets, canulas, delicate surgical instruments sharp instruments etc. Kills micro organism by altering DNA of micro organism by process of alkylation. To be used undiluted or diluted with carbon dioxide or nitrogen Items susceptible for heat, delicate costly instruments like cystoscope, heart lung machine, electrical instrument, catheter and implant are sterilized. Low Temperature Steam Formaldehyde: this combination of dry saturated steam and formaldehyde kills vegetative bacteria, bacterial spores and most viruses. Gas Plasma Sterilization: is a dry, low temperature process combining a chemical vapor phase with a gas plasma phase repeated multiple times under vacuum to ensure sterility. Sterilizing by Ionizing radiation: Two accepted methods of sterilization are Gamma radiation and electron beam radiation. POLICIES & PROCEDURES: QUALITY OF PROCESSES USED IN CSSD:

1. Schedule of timings for receipt of unsterile stores and issue of sterile stores so that the department gets adequate tie for processing the stores. 2. Sop for transfer of unsterile stores from user departments to CSSD and transfer of sterile stores from CSSD back to users including the mode of transfer. 3. Standardized lists of the contents of sets/ trays for various procedures. 4. SOP for sterilization of different categories of items by different techniques. 5. SOP for complete process cycle category/ technique wise from start to finish. 6. Fixing the shelf life of various sterile items after proper microbiological testing in the lab. 7. A procedure for labeling of the packs so that labels should have the packing/sterilization date/expiry date and the signature of the staff involved in packing/ sterilization. 8. An SOP for planned preventive and breakdown maintenance and regular periodic recalibration of equipment to ensure minimum down time and optimum efficiency of equipment. 9. An SOP for disposal of waste as per the biomedical waste management rules.