CSSD Central Sterile Supply Department

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CSSDCentral Sterile Supply Department
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• 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

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• 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.

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• 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
  

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• 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 .

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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.

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• 5. Conservation of trained staff.
• 6. Better quality control
• 7. Better good of material flow
• 8. Prolonged life by proper care of equipment

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ITEMS COMMONLY HANDLED BY CSSD STORES
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• 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

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• 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 .

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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.

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PHYSICAL PLNG

• 1. Location Grouping .
• 2. Lay Out Space Reqts.
• 3. Fixturtes Furniture .

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RULE OF THE THUMB ROUGHLY 10 SQFT / BED -
MCGIBONY
ADM STORAGE (UNSTERILE) AREA 21² M SCALES OF ACCN FOR ARMED FORCES HOSPITALS AH/CH/ SAY gt 700 BEDS
RECEPTION,CLEANING,CHECKING,ASSEMBLY PACKING AREA 35² M SCALES OF ACCN FOR ARMED FORCES HOSPITALS AH/CH/ SAY gt 700 BEDS
AUTOCLAVING AREA 28 ² M SCALES OF ACCN FOR ARMED FORCES HOSPITALS AH/CH/ SAY gt 700 BEDS
STERILE STORAGE ISSUE AREA 28 ² M SCALES OF ACCN FOR ARMED FORCES HOSPITALS AH/CH/ SAY gt 700 BEDS
TOTAL TOTAL 1,320 ² ft (COPP)
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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

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OTHERS

• 1.Maint Repair EQPT
• 2.Adequate number of cabins Furniture
• 3.Telephone or intercom.
• 4.Adequate no of syringes procedure sets.

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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
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• Methods Of Sterilization / Disinfection

Natural Chemical
Physical
Sun Light (UV) Air (Desiccation)
Solids Lime, Bleeching Powder, KMNO4 Liquids
Formalin, Phenol , Alcohol , Glutaraldehyde Gase
s Formaldehyde, Ethylene Oxide
Dry Heat Burning or Dry Air (160C for 60
Min) Moist Heat Boiling Steam Radiation Ionising
Radiation U V Rays
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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

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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

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• 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.

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STEAM STERILATION

• - Water ? Saturated ? Wet vapor ? Dry saturated
  Vapor ? Super Heated Vapor / Steam
• - Steam with lt0.95 Dryness Factor is not useful
  for Sterilization.
• - Superheated Steam acts like Dry Hot Air only .
  ( Strength Of Steam is its Latent Heat)

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• MODE OF ACTION.
• Dry Heat ? Oxidation
• Steam ? Denaturation Coagulation of Proteins

Sterilization Time (Holding Time Safety Time) Pressure (PSI) Temperature ( C )
2' 1' 3' 8' 2' 10' 12' 3' 15' 30 20 15 134 126 121
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• TYPES OF AUTO CLAVING MACHINES
• 1. Downward Displacement
• 2. Vacuum Assisted.
• 3. Pulsed Steam Dilution

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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)

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• 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 .

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ADVANTAGES OF STEAM STERILISATION

• 1. Rapid heating penetration of loads.
• 2. Destruction of all forms of microbial life
• 3. No residual toxicity.

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• 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

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• 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

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STAFFING CSSD

• BHATTA CHARJEE RECOMMENDS
• SUPERVISORS (sister/male ward masters) 4
• STAFF NURSES
  5
• TECHNICIANS (ORA)
  6
• ATTENDANTS
  24
• SWEEPER
  4
• CLERK
  1
• TOTAL
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CENTRALISED SUPPLY (RULE OF THUMD 2PER 100 BEDS)
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• 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)

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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

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A SUGGESTED LAYOUTOF CSSD
AUTOCLAVE
ROOM
ASSEMBLY (PARKING)
STERILE STORAGE
CLEANING WASHING
GLASS PARTITION
Supervisors office
disassembly
Clean storage
Verandah
STERILE ISSUE
Dirty reception
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clean reception
RAMP
INTRA MURAL COMMUNICATION LINE
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Thank You
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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

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Thermal Death Time ( cont.)

• Acidic or basic pHs decrease TDT
• Fats and oils slow penetration and increase TDT