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

ADM & STORAGE

(UNSTERILE) AREA

- MCGIBONY

21 M

RECEPTION,CLEANING, 35 M
CHECKING,ASSEMBLY
& PACKING AREA
AUTOCLAVING AREA
STERILE STORAGE &
ISSUE AREA

28 M
28 M

SCALES OF
ACCN FOR
ARMED
FORCES
HOSPITALS
AH/CH/ SAY >
700 BEDS

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 - 1 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 1 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
(Desiccation)

Lime, Bleeching Powder,

KMNO4

Burning or Dry Air

Liquids
Formalin, Phenol , Alcohol ,
Glutaraldehyde
Gases
Formaldehyde, Ethylene
Oxide

(160C for 60 Min)

Moist Heat
Boiling Steam
Radiation
Ionising Radiation
U V Rays

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
cant 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
(Holding Time + Safety
Time)

2'
8'
12'

+
+
+

1
2'
3'

= 3'
= 10'
= 15'

Pressure Temperature
(PSI) ( C )
30
20
15

134
126
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
TECHNICIANS (ORA)
ATTENDANTS
SWEEPER
CLERK
TOTAL
CENTRALISED SUPPLY (RULE OF THUMD 2PER 100 BEDS)

5
6
24
4
1
44

DISTRIBUTION SYSTEMS :
1. Regular issue of one days 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
DIRTY RECEIPT

BULK STORES
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)
CLEANING&
WASHING

Clean
storage
clean
recepti
on

disasse
mbly
Dirty
recep
tion

GLASS PARTITION

STERILE
STORAGE

Supervisors
office
Verandah

0

STERILE
ISSUE

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