1. CSSD Central Sterile Supply Department

2. “ 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

3. 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.

4. 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

5. 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 .

6. 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.

7. 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

8. ITEMS COMMONLY HANDLED BY CSSD STORES

9. 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

10. 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 .

11. 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.

12. PHYSICAL PLNG 2. Lay Out & Space Reqts. 3. Fixturtes & Furniture .
1. Location & Grouping .
2. Lay Out & Space Reqts.
3. Fixturtes & Furniture .

13. 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)

14. 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

15. 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.

16. 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

17. 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

18. 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

19. 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

20. 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.

21. 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)

22. 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

23. TYPES OF AUTO CLAVING MACHINES
1. Downward Displacement
2. Vacuum Assisted.
3. Pulsed Steam Dilution

24. 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)

25. - 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 .

26. ADVANTAGES OF STEAM STERILISATION
1. Rapid heating & penetration of loads.
2. Destruction of all forms of microbial life
3. No residual toxicity.

27. 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

28. 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

29. 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)

30. 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)

31. 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

32. 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

33. Thank You

34. 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

35. Thermal Death Time ( cont.)
Acidic or basic pHs decrease TDT
Fats and oils slow penetration and increase TDT