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CSSD Central 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 ; 2. Less expensive.
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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6. Better quality control 7. Better good of material flow
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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9. Infusion Fluids for Renal Dialysis.
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 2. Lay Out & Space Reqts. 3. Fixturtes & Furniture .
1. Location & Grouping . 2. Lay Out & Space Reqts. 3. Fixturtes & Furniture .
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ADM & STORAGE (UNSTERILE) AREA 21² M
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 > 700 BEDS RECEPTION,CLEANING,CHECKING,ASSEMBLY & PACKING AREA 35² M AUTOCLAVING AREA 28 ² M STERILE STORAGE & ISSUE AREA TOTAL 1,320 ² ft (COPP)
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EQPT IN CSSD 2.Ultrasonic Washers 3.Glove sharpener
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 2.Adequate number of cabins & Furniture
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 Gases Formaldehyde, Ethylene Oxide Dry Heat Burning or Dry Air (160°C 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 can’t 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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A material is pronounced sterile if it
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 <0.95 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' ′ = 3' 8' ' = 10' 12' ' = 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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- Magnesium Trisilicate – 1% (Tablet turns brown during autoclaving)
5. Cellophane wrapped tablet containing - Lactose - 75% - Starch % - 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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5. Easy Quality Control 6. Economical & Reliable
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 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 SUPERVISORS (sister/male ward masters) 4
BHATTA CHARJEE RECOMMENDS : SUPERVISORS (sister/male ward masters) STAFF NURSES TECHNICIANS (ORA) ATTENDANTS SWEEPER CLERK TOTAL CENTRALISED SUPPLY (RULE OF THUMD 2PER 100 BEDS)
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1. Regular issue of one day’s requirement.
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)
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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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INTRA MURAL COMMUNICATION LINE
A SUGGESTED LAYOUTOF CSSD AUTOCLAVE ROOM ASSEMBLY (PARKING) STERILE STORAGE CLEANING& WASHING GLASS PARTITION Supervisors office disassembly Clean storage Verandah STERILE ISSUE Dirty reception ° ° ° ° ° ° ° ° 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
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