Central sterile and supply department(CSSD)

BY : Ngayawon Raihing
MHA 1st year
 The central sterile supply department (cussed)
provides a service within a hospital which receives
stores processes distributes and controls both sterile
and unsterile from all departments for the care and
safety of patients
 modern concept of cussed was derived during kind
world war
 first CSSD in India was started in 1965 at
safdurjang hospital
 CSSD is the department which deals with receiving
cleaning packing disinfecting sterilizing storing
and distributing all surgical instruments and
equipment as per well-delineated protocols and
standardised procedures.
or
 A central sterile supply department is a hospital
support services , which is entrusted with
processing and issue of supplies including sterile
instrument and equipment used in various
department of hospital
 AIMS
 to provide an efficient ,economic continuous and
quality supply of sterilized materials to various areas
of the hospital to deliver quality and infection free
patient care.
 OBJECTIVES
 to provide adequate supply of sterile material on time.
 to reduce hospital acquired infection
 to supervise and provides facilities for the bulk
sterilization of materials.
 to undertake operational research techniques for
improving sterilization.
 to participate effectively in hospital infection control
committee.
 Receiving unsterile stores equipments / instruments from
medical store & various department.
 Sorting , washing , disinfecting , cleaning and drying.
 Checking labelling and packing of sets / trays /
instrument.
 Storage and issue of sterilized items in various
department.
 Maintaining records of the stores received processed and
issue.
 Validation of the effectiveness of sterilization technique.
 Training of staff in technique of sterilization .
 Location : should be ideally located at
ground floor
 Easy accessible to critical area( ICU , ITU,
HDU) and OT.
 Connected with two dumb waiter for sterile
and soiled material.
 Laundry near to boiler room.
 Space:
 It depends on total bed space availability
 It varies 0.7– 1msq / bed
 The layout must follow the zoning concept and
functional flow with receipt dirty counter on one
end and sterile on other end.
 There should not be backflow crossing and area
should be divided by partition into dirty clean and
sterile zone.
 Similarly gas and steam sterilization should be
separated
 Total functional Areas.
 Receiving and clean up area
 Clean work area including sterilization
 Unsterile storage area
 Sterile store area
 Glove processing area
 Gauze cutting area
 Office room/rest room/ dressing assembly.
 Trolley washing and packing Area
 Clean hot and cold water streams
 steamers
 Chemicals for washing
 Ultrasonic cleaner , jets ,
 Swabs cutting machine , scissors
 Sterilisers
 Autoclave
 ETO
 Plasmas
 UV radiation
 Dry air oven
 Supervisor of CSSD
 average 2 CSSD technician for 100 beds.
 Assistant or helper
 messenger
 stable and uninterrupted power supply 24/7 hrs
with backup.
 Running water of desired quality
 Temperature with comfort zone
 Ventilation with 10 air changes per hour
 Humidity level 50-60%
 200 lox electricity
 Quality management of services is extremely
important in view of its role.
 In Hospital infection control & the catastrophic
effects the poor quality services may have on
patients.
 However , quality of services can be judged from
level of satisfaction of the clientele.
 The client in case of CSSD are all internal.
 High quality of services to them means:
 100% reliability of sterility of stores by CSSD
 Timely supplies in right time
 Content of the trays/set are as per the standard list.
 Trays sets are labelled correctly
 The sterile supplied item remain sterile up to their
predetermined shelf life
 Quality of the item does not deteriorate by the
steriliser
 The quality of outcome however depends upon the
quality of infrastructure and process used in CSSD
QUALITY OF
STRUCTURE

QUALITY OF
PROCESS

QUALITY OF
OUTCOME
space , layout & surface
 The space requirement in CSSD is 7-10 safe/bed.
 The layout must follow zoning concept & functional
flow with receipt dirty counter on one end and sterile
issue on other end.
 There should be no criss crossing and area should be
divided by partition into dirty , clean and sterile.
 Gas and steam should be separated.
 The entrance lobby should have toilet and hand
washing facility.
 The flooring should be non slippery.
Organisation and staffing
 Department should be overall contrail of HOD of
OT/Nursing
 Should be headed by trained and experienced
manger.
 Should have trained staff( technicians attendants )on
each shift at each zone irrespective of volume.
Equipment quality availability
 Ultrasound cleaner
 Instrument washer
 Steel racks for storage of unsterile and sterile sets.
 Work tables.
 Gas sterilizers.
 ETO.
 Autoclave machines flitted with tetrameters for
temperature /time recording.
 Self recording pressure gauze for pressure /time
recording .
 Computer terminals .
Quality of materials
 Quality of disinfectants , detergents ,cotton –wool
gauze and other supplies should be of ensured.
Engineering support services
 Stable and uninterrupted power supply.
 Running water of desired quality.
 Temperature with comfort zone(15-20 degree Celsius)
.
 Ventilation with 10 air change per hour .
 Humidity level 50-60%
 Illumination level of 200 lux.
 Availability of a quality manual .
 Zoning concept to be implement ed.
 Schedule of timings .
 SOP for transfer of unsterile stores from user department
to CSSD and transfer of sterile stores from CSSD back to
user .
 standardized lists of the contents of sets /trays
 SOP for the sterilization of different categories of items
 SOP for complete process cycle
 SOP for internal validation of sterilization process.
 Bacterial ( bovine dick test )
External validation by random periodic culture of swabs from the
sterilized instrument /trays/stores
 Fixing the shelf life.
 A system of recall items.
 Policy regarding the return of sterile items issued.
 Effective scheduling of shifts.
 Ensuring availability of adequate number of
sets/trays.
 An SOP on infection control .
 Continuous training of staffed.
 Periodic surprise checks by the HOD.
 Incidence of incomplete sterilization as detected by
the periodic random testing of sterilized items by
culture of swabs taken.
 Incidence of incomplete sterilization as detected from
the colour of test strips inside the packs.
 Complaints from the users/clients about incorrectness
of packing /contents/damaged items packed or
improper cleaning.