CSSD

Central Sterile Supply

Department

Definition
The CSSD is a service catering to the needs of
a hospital or a group of hospitals for the
supply of sterilized articles to all the
departments including the wards, OPDs, other
special units and the operation theatre.
Earlier decentralized sterilization system was followed and generally
sterilization was done by nurses.

Aim and Objectives

The CSSD is to provide centrally an efficient, economic,
continuous and quality supply of sterilized material to
various areas of the hospital to deliver quality and infection
free patient care.

The sterilization process is conducted under controlled conditions at

minimum cost to reduce the incidence of hospital associated
infections (Pressure zones are created)
supervise and provide facilities for the bulk-sterilization of the
materials.
Provide facilities for in-service teaching and training of nursing and
ancillary personnel in the sterilization practices.
provide the most suitable material for the patient care, play an
effective role in hospital infection control activities.
To ensure quality control for infection free patient care

Scope

Diet, drugs, linen (cleaning), bedding, bedpan, urinals are not

included in the scope of CSSD.
Surgical instruments:
OTs are usually provided with the facilities for sterilizing for
emergency situations but that is not much reliable
OTs staff are trained to observe a high standard of aseptic
techniques.
Sterilizing facilities are readily available for the dropped or
forgotten instruments
Bed Pans:
Disposable bed pans are preferred. The unpleasantness and
bulkiness of transporting such articles about a hospital creates
an unrealistic situation to undertake the processing of
bedpans and urinals centrally.

Zonal Divisions

CSSD have 3
zones
Soiled area
Clean area
Sterile area

Sterile
Zone

AutoclaveClean
Zone

STOCK
PACK

STERILIZATION

DISINFECTION
RETURN

Functions

Receiving and sorting of soiled instruments

Determining what to reuse and what to
discard
Disinfecting/decontaminating
the
instruments before sterilization:
fumigation or manual cleaning
Specialized cleaning treatment:
This function means cleaning of the used
equipments/materials, rubber and plastic
goods either by machines e.g., ultrasonic
cleaner, jet glove washing machines,
washer disinfectors, anesthetic tubing
washers and dryers. This function may
also include cleaning of the delivery
trolleys
Inspecting and checking of supplies
Assembling treatment trays and instrument
packs
Packing all for sterilization
Sterilization process

Planning

On an Average area of 0.75 to 1.2 sq.m per bed is taken for supporting
services like CSSD, Kitchen, Laundry
An area of 185 sq.m for a 500 bedded and 750 sq.m for 1000 bedded
hospital will be adequate for Indian conditions.
The CSSD should be close to the casualty, operation theatre and wards
which are the largest consumer of the sterilized material.
In
multistoried
buildings
CSSD may be planned in the
lower floor right under the
operation
theatre
where
vertical movement will be the
quickest possible movement
of the material. Should at
easy
reach
from
OT,
Emergency and ICUs
Service Lift should be in close
proximity and provisions of
dumbwaiters should be there
in CSSD
It should have ready access
to Supply Unit and Linen

Establish what is
Critical
Plan Adequate
space
Control flow
Adequate lighting
Comfortable work environment

Control Flow
Closely monitor and manage flow
Work and Material: Dirty Clean
Staf: Clean to Dirty
Air: Clean to Dirty
Cleaning Area
Pressure: Positive to Negative clean to dirty

Internal Designing

Manual and segregation areas needs supervision areas.

All three zones should be physically segregated
Separated entries and exits for soiled, clean and sterile goods
Strict separation of the staff working in the 3 different areas
The floor should be smooth, impervious, non skid and strong.
Light fittings should be recessed.
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 items such as rubber, plastic or
delicate instruments can not be autoclaved.
Space should also be provided for storing distribution trolleys

Functional Areas

The Central Sterile Supply Unit will include the following functional
areas or zones:
Receiving Area where soiled articles for recycling are received on
trolleys from Units
throughout the facility
Decontamination Area where all articles are sorted, rinsed,
ultrasonically cleaned or mechanically washed then mechanically
dried; this area may also include cleaning of the delivery trolleys
Packing Area (Clean Workroom) where the clean instruments,
equipment and other articles are sorted, counted and packaged for
sterilizing
Sterilizing and Cooling Area where sterilizers are loaded, set into
operation and unloaded following completion of the sterilizing cycle
Storage Area where sterile stock for Operating Unit and wards and
general unit stock are stored separately
Dispatch Area where sterile stock is held prior to dispatch to Units
in the facility; distribution trolleys may also be located in this area
Administrative Areas including Offices or Workstations

Flow of Functions
Disposable
/
Discarded
Receivin
g

Distributio
n
Issue
Counte
r

Segregatio
n (Sorting)

Trolley Wash
and trolley
store
Reusabl
e

Packing for
Autoclavin
g

Existing
Equipments
that expires

Sterile
Store

Manual
Cleaning/Washi
ng

Autoclavi
ng
Labeling
and
packing

Labeling
and
Packing

Spaces

Entrance lobby
Reception and Cleaning room
Glove room
Work room (Preparation and
assembling of packs)
Sterilization room
Store room
Nurses room
Staf changing room
Cloak room

Receiving Area:
A lobby or holding area provided for return of used items & trolleys.
The Receiving Area should be located with ready access to Trolley
Wash and Decontamination area.
The Receiving Area will require:
Smooth, impervious and easily cleanable surfaces , walls and
ceiling
Impervious and non-slip finishes to the floor
Hot and cold water outlets
Staff hand washing basin
Decontamination Areas
The Decontamination area is where instruments are rinsed,
ultrasonically cleaned if appropriate, washed/ decontaminated and
dried.
The Decontamination area shall contain work space and equipment for
sorting, decontamination and cleaning medical and surgical
equipment, and for disposal of used/soiled material.
The Decontamination area should be located between the Receiving
area and the Clean Workroom/ Packing area.

Trolley/ Cart Wash

An area shall be provided for stripping, washing and disinfecting of trolleys
and carts.
The Trolley Wash area should be located with ready access to Receiving
Area.
The trolley washing area will require:
Hot and cold water outlets.
An automated trolley wash unit may be used

Clean Workroom/ Packing

The Clean Workroom/ Packing area is where cleaned and dried
instruments are removed from the decontaminating/ drying
equipment, sorted, assembled into sets and packaged, ready for
sterilizing
The Clean Workroom/ Packing area will be located between the
Decontamination area and the Sterilizing area, with a unidirectional
workflow from contaminated to clean areas.
Linen folding, where required, shall be carried out in a separate room,
preferably the laundry.
The air handling system shall be filtered or discharged direct to the
outside.

Sterilizing and Cooling

The Sterilizing and Cooling Area provides accommodation for
sterilizers and parking space for sterilizer and cooling trolleys.
Following unloading of the sterilizer, packs should not be handled
until cool.
The size of the area will be dependent on the number and type of
sterilizers installed.
Staf Amenities
Showers, toilets and secure lockers for staff employed in this area
shall be provided. These facilities shall be conveniently located a
A lunch room can be a shared central facility outside the Sterile
Supply Department.
Access to a training room in close proximity to CSSD for formal
training activities is recommended.
Facilities shall also be provided in the Change Room to store caps,
overalls and footwear protection.
'Barrier' principles are observed when entering the unit.

Storage
A room shall be provided for the storage of processed sterile packs
etc. Ventilation, humidity and temperature control is required.
Supply air pressure shall be positive with respect to surrounding
areas and the level of filtration shall equal or exceed that of the
Operating Room.
A separate room shall be provided to store stock that is 'clean' but
not sterile. Access to this room shall be provided from outside the
unit for stocking, and from within the unit for drawing stock to
process.
Space shall also be provided for storing trolleys as required.

Functional Relationship diagram ( Base

Model)

Functional Relationship diagram ( Base

Model)

CSSD design example

The Soiled arrival area - different solutions

Area should be able to hold arriving goods volume.

If the space is limited, try to arrange one side wider than the
other to accommodate big trolleys on one side and small
trolleys on the other side.

Soiled Good Flows

Soiled sorting area

Washer-disinfectors
of pass-through
design

Dedicated
instrument
preparation area for
delicate and heat
sensitive items.
(Ultrasonic support)

Hatch for clean

goods transfer to
packing area

Clean supply/linen goods flow

Caretaker can supply goods to a reception without
entering clean area
When linen is inspected, folded and packed in a
CSSD, a separate room should be dedicated for
that purpose.
Linen packing table can be used by 2 persons,
working together standing on each side.

Solutions for the Linen room

Drawing shows minimal recommended dimensions to fulfill the work tasks
in the linen inspection, folding and packing area.
If space is limited consider inspection, folding and packing at the
laundry and only pre-storage, assembly, labeling and sterilization at the
CSSD.

Control & Packing

A minimum distance of 1500mm

between packing tables and minimum
900mm, side facing against a wall, as a
good recommendation.

Packing table located sideways from

window avoiding light reflexes on
instruments and work surface.

Loading trolleys can also be designed

as height adjustable units, to support
and ease work conditions

Sterilizer area

Air lock with a recommended minimum 1400mm width and including

hand washbasin.

Air lock can also be used as service area at narrow installations.

Return transfer hatch for racks

Sterile Store

Mobile or stationary storage for

sterile goods in baskets and/or
containers.

An over-pressure shall be kept

in sterile store creating an
airflow from sterile store to the
surrounding areas.

Open storage units, allowing

good ventilation of stored
goods as well as a good
overview of the content.

Inspection and recording of

sterilized goods to have a
tracing function!

 Try to achieve corridors width min 1200mm between Basket racks

and/or Wire shelf.
If space is limited, there are questions to be raised:
Will goods be sent out directly to the users?
Can goods be stored at the users site?
Lockable Pass-through cabinets for pickup of goods.
Shelving to be 250 mm above the floor and 440 mm from the ceiling

Issue area

Sterile goods meets clean trolley in the issue area, where the
caretaker can collect sterile goods without entering sterile store.

Goods further protected by use of

external transports.

Issue to OT through direct connected elevator.

box or trolley cover during

Environmental
Considerations

Relative humidity should be maintained at 455 per cent

The clean area should be provided with air locks and maintained at positive
pressures relative to the adjoining spaces.
The minimum ventilation rate should be six to 10 air changes per hour.
Light levels shall be not less than 400 lux.
HEPA (High-efficiency particulate air) filters should be used
Storage : temperature range to be between 18C to 22C with a relative humidity
ranging from 35% to 68%

Air and Pressure Flow

Dirty

Workflow Dirty to
Clean

Sterile

Airflow Clean to Dirty

Pressure Flow Positive

to Negative

EQUIPMENTS
CLEANING AREA

High capacity pass through washer

disinfector at 800C to 900 C having
various shapes and sizes.
Cold and hot water streams.
Detergent Solution.
Steam
Hot air ovens for drying instruments.
Wall fixtures for drying.
STERILIZATION AREA

Autoclaves using dry heat, moist heat.

Ethylene oxide sterilizers.
Testing material to check effectiveness of
sterilization.
STORAGE AND DISTRIBUTION

Cup boards, selves, tables, chairs, racks.

Trolleys, instrument trays, wire baskets and containers.

Autoclave

Pass Boxes

Flash
Sterilization

Sterilization of an unwrapped object at 132oC for 3 minutes at 27-28

lbs
Flash sterilization is considered acceptable for processing cleaned
patient-care items that cannot be packaged, sterilized, and stored
before use. It also is used when there is insufficient time to sterilize
an item by the preferred package method. Flash sterilization should
not be used for reasons of convenience, as an alternative to
purchasing additional instrument sets, or to save time

Distribution
One For One
System
Milk Round System
The Grocery
System

Pneumatic Chutes/PTS (Pneumatic

Transfer System
Pneumatic tube system also known as pneumatic post system is a
system in which carriers are propelled through network of tubes by air
or vacuum.
Hospital
pneumatic
tube
systems
transport
small
materials
to
and
from
pharmacies, laboratories, blood
banks,
surgery
centers,
emergency departments and
nursing stations, as well as
other locations throughout a
hospital campus.

Specifications

Piping- Outside diameter of the tubing is typically 150mm

to 750 mm
Capacity - 1.7 kg
Speed of transfer- 2.8m/sec - 7.6 m/sec

Material transferred
Equipments
X-rays
Pharmaceuticals
Reports etc

Examples
India

in

Sir Ganga Ram hospital, Delhi

Artemis health institute, Gurgaon
Pushpanjali Crosslay Hospital, Ghaziabad
Ganga Hospital, Coimbatore
Kokila Dirubhai Ambai Hospital, Mumbai
Global Hospitals, Chennai