CSSD

Colonel Zulfiquer Ahmed Amin

M Phil, MPH, PGD (Health Economics, MBBS
Armed Forces Medical Institute (AFMI)
The Central Sterile Supply Department (CSSD)
comprises that service within a hospital which
receives stores; processes, distributes and
controls professional supplies and equipment,
both sterile and non-sterile to and from all
departments of the hospital for the care and
safety of patients
Ideally, CSSD is an independent
department with facilities to
receive, clean, pack, disinfect,
sterilizes, store and distribute
instruments and supplies as per
well-delineated protocols.
By custom diets, medicines, laundry, supply
of blood and crystalloid are not included in
activities of CSSD.
BACKGROUND
 Objective and Functions
a. To provide sterilized material.

b. Contributing to a reduction in the incidence of hospital

infection.

c. To avoid duplication of costly equipment.

d. To maintain record of effectiveness of cleaning,

disinfection and sterilization process.
e. To monitor and enforce controls necessary to prevent
cross infection.

f. To maintain an inventory of supplies and equipment.

g. To stay updated regarding developments in the field.

h. To provide a safe environment for the patients and staff.

 Designing of a CSSD

• Size and location of CSSD varies

• 7 to 10 square feet per bed is recommended
• It should be located as close as possible to Operation
theatres, Accidents and Emergency department and
wards
• The CSSD layout should be designed for a unidirectional
flow
CSSD should have four zones for a smooth work flow:

a. The unclean and washing area

b. The assembly and packing area

c. The sterilization area

d. The sterile area

 PLANNING of CSSD

- The materials/ items from contaminated and sterile

areas should not get mixed.
- There should be physical barrier between clean and
dirty areas.
- The floor should be smooth, impervious, non skid and
robust.
- Relative humidity should be maintained at 45±5 %
- The clean area should be maintained at positive
pressures.

- The minimum ventilation rate should be 6-10 air

changes / hour.

- 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.
 Location

• 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.
 Floor Space

Serial Beds available Floor space required for CSSD

1 75-99 10 sq feet per bed
2 100-149 9 sq feet per bed
3 150-199 8.5 sq feet per bed
4 200-249 8 sq feet per bed
5 250-299 7.5 sq feet per bed
6 300 or More 7 sq feet per bed
LAYOUT OF CSSD
 Physical Facility and Equipment Availability at CSSD
Ser Rooms in the CSSD Nature of the work Provision of the Space (%)

1. Wash Rooms Dirty 10

2. Work Room (Packing Room) Clean 26

3. Syringe & Needle Processing Clean 9

4. Unsterile Pack Store Clean 4

5. Bulk Store Clean 11
6. Sterile Store Sterile 16

Miscellaneous (a)Gloves room

7. Clean 19
(b)Office room (c)Rest room

8. Autoclaves Clean 5
 WORK FLOW
 MAJOR ACTIVITIES IN A CSSD:

 RECEIVING THE USED ITEMS FROM USER DEPARTMENTS

 CLEANING

 PACKING

 STERILIZING

 STORING (TEMPORARY)

 DISTRIBUTING TO USER DEPARTMENTS

WORK FLOW OF CSSD
CSSD- Work Flow
FLOW PROCESS OF CSSD
 RECEIVING AREA
• Used item from various departments of the hospital are
shifted to CSSD for cleaning and sterilization.
• Ideally, the items that get soiled with blood or body fluid
should be decontaminated with Sodium Hypochloride
solution in the user department itself before sending to CSSD.
• The Receiving Area of CSSD should have access to
outside through a window with a counter.
• The items (Specially for instruments in trays) are
counted and Received.
• Thereafter, the instruments are inspected and
blunt/unsuitable Instruments are segregated/discarded.
• Necessary entries are made for records.
• Thereafter, the items are shifted to Cleaning area.
 CLEANING AREA
• HERE THE INSTRUMENTS ARE WASHED EITHER MANUALLY
OR IN MACHINES.
• FOR MANUAL WASHING, SINKS WITH WATER SUPPLY AND
WORKING COUNTERS ARE ORGANIZED. DETERGENTS AND
BRUSHES OF VARIOUS SIZES AND SHAPES ARE REQUIRED IN
THIS AREA.
• ULTRASONIC WASHER IS A MACHINE USED FOR CLEANING
SURGICAL INSTRUMENTS. IT CONVERTS HIGH FREQUENCY
SOUND WAVES INTO MECHANICAL VIBRATION THAT
PRODUCES SMALL BUBBLES THAT BURST ON THE INTERNAL
SURFACES OF INSTRUMENTS AND DISLODGE THE WASTE
PARTICLES.
- ‘TUNNEL WASHER’ IS HIGHLY SOPHISTICATED AND EXPENSIVE
MACHINE THAT ALLOWS TOTALLY HAND-OFF PROCESSING.
INSTRUMENTS IN PERFORATE OR MESH BOTTOM TRAYS COMING
FROM OPERATING ROOM OR OTHER DEPARTMENTS ARE PLACED INTO
THE TUNNEL WASHER WITHOUT ANY FURTHER HANDLING. THE
INSTRUMENTS ARE SUBJECTED TO CYCLES OF WASHING, RINSING,
ULTRASONIC CLEANING AND DRYING.

- AFTER THE INSTRUMENTS ARE WASHED, THEY ARE DRIED IN OVEN

DRYER AND SHIFTED TO PACKING AREA.
 PACKING AREA
- CLEAN AND DRY INSTRUMENTS ARE PACKED BEFORE
STERILIZATION, SO THAT THEY ARE NOT CONTAMINATED WHILE
HANDLING AFTER THEY ARE STERILIZED. MOST OF THE
INSTRUMENTS ARE PACKED IN TRAYS (TRAY ASSEMBLY) THAT ARE
WRAPPED WITH DOUBLE LAYER OF COTTON CLOTH. PAPER
ENVELOPES ARE ALSO AVAILABLE FOR PACKING THE INSTRUMENTS.
THESE ARE EQUALLY EFFECTIVE BUT EXPANSIVE. PLASTIC BAGS (ETO
BAGS) ARE USED FOR PACKING THE ITEMS FOR ETO STERILIZATION.
THE PACKS ARE LABELED INDICATING DATE OF STERILIZATION AND
DATE OF EXPIRY (WHEREVER POSSIBLE).

- SEALING MACHINE IS USED FOR THE SEALING THE PLASTIC BAGS IN

WHICH INSTRUMENTS ARE PACKED. AFTER PACKING AND SEALING,
THE INSTRUMENTS ARE SHIFTED FOR STERILIZATION.
STERILIZATION IS DONE BY EITHER OF THE TWO METHODS IN CSSD:

 STEAM STERILIZATION BY AUTOCLAVES

 GAS STERILIZATION BY ETO (ETHYLENE OXIDE) MACHINES
 AUTOCLAVE: STEAM UNDER PRESSURE IS THE MOST COST-
EFFECTIVE METHOD OF STERILIZATION, “AUTOCLAVE” GENERATES
STEAM AT A TEMPERATURE OF 121 DEGREE CENTIGRADE UNDER 15
POUNDS OF PRESSURE. AN EXPOSURE OF 20 MINUTES IS REQUIRED
FOR STERILIZATION.

 FLASH STERILIZER: THIS IS A SPECIAL TYPE OF AUTOCLAVE THAT

HAS A VERY SHORT STERILIZATION CYCLE OF ABOUT 3 - 5 MINUTES
BECAUSE OF ITS ABILITY TO RAISE THE TEMPERATURE TO 132
DEGREE CENTIGRADE.

STERILIZING AREA
 ETO STERILIZER: THE ITEMS LIKE CARDIAC CATHETERS ARE
THERMO SENSITIVE AND THEREFORE CANNOT BE STERILIZED BY
STEAM. SUCH ITEMS ARE STERILIZED BY ETHYLENE OXIDE (ETO)
GAS STERILIZATION. THE ETO IS AN EXPANSIVE AND TOXIC GAS. IT
IS ABSOLUTELY NECESSARY TO ENSURE THAT THESE ITEMS ARE
MADE FREE OF GAS MOLECULES BEFORE USING THEM ON A
PATIENT. THIS IS ACHIEVED BY SUBJECTING THE ITEMS TO FORCED
VENTILATION. THE ENTIRE CYCLE MAY TAKE ABOUT 8- 12 HRS.
 STORE

AFTER STERILIZATION, THE ITEMS ARE TEMPORARILY

STORED IN A CLEAN STORE (ON RACKS) FROM WHERE
THEY ARE DISTRIBUTED TO USER DEPARTMENTS
 DISTRIBUTION AREA

- IT SHOULD BE AWAY FROM THE RECEIVING AREA AND

MAY COMPRISE OF A WINDOW WITH COUNTER.

- IN MODERN HOSPITALS, THERE MAY BE A SEPARATE LIFT

FOR TRANSPORTING THE STERILE MATERIALS TO USER
DEPARTMENTS.
 TRANSPORT TO
OT

STERILE
USED
STORAGE
MATERIALS

TRANSPORT
STERILIZATION

CSSD
CLEANING
PACKAGING

TRAY
DISINFECTION
ASSEMBLY

INSPECTION
Staffing of CSSD
 STAFF
• CSSD IS USUALLY MANNED BY FOLLOWING STAFFS:

- CSSD IN CHARGE/ MANAGER: SUPERVISES ACTIVITIES OF CSSD.

- CSSD TECHNICIANS: OPERATE THE AUTOCLAVE AND ETO

MACHINES.

- CSSD ASSISTANTS: PERFORM THE CLEANING AND PACKING, GAUGE

CUTTING AND COTTON BALL MAKING.
- CLERK OR STOREKEEPER: TO MANAGE THE INVENTORY AND
STERILE STORES.

- HOUSEKEEPING STAFF.
Staffing should be planned based on the following
factors:-
– Average 02 technicians for 100 beds and one technical
supervisors.
– One clerk for keeping records, accounting and
supply per shift.
– Average 04 attendants per 100 beds in all shifts.
– Adequate number of cleaning attendants and
transporters.
– One technician and two attendants should be
stationed at each zone.
ORGANOGRAM
CSSD Supervisor.

CSSD Attendant.

CSSD Technician.

Messengers.

Boiler attendant.

Clerks.

Cleaners.
 Quality Assurance
• Mechanical Indicators:
MONITORING RECORD TIME, TEMPERATURE, HUMIDITY AND
PRESSURE DURING THE STERILIZATION CYCLE.
• Chemical Indicators:
DEVICES WITH A SENSITIVE CHEMICAL OR DYE TO MONITOR ONE
OR MORE PARAMETERS OF A STERILIZATION CYCLE.

• Biological Indicators:
EMPLOY THE PRINCIPLE OF INHIBITION OF GROWTH OF
MICROORGANISM OF HIGH RESISTANCE.
Mechanical:

Biological:

Chemical:
 ROLE OF CSSD MANAGER

• MAINTENANCE AND REPAIR OF • COST CONTROL MEASURE, TO

ANALYZE AND REDUCE THE NUMBER
EQUIPMENT OF CYCLE

• INVENTORY MANAGEMENT OF • RECORD KEEPING AND DATA ANALYSIS

SUPPLIES AND CONSUMABLE
• OPTIMAL UTILIZATION OF MANPOWER
AND EQUIPMENT
• ENSURE QUALITY OF
STERILIZATION • MOTIVATION OF STAFF AND TRAINING

• INTER DEPARTMENTAL COORDINATION

• ENSURE PROPER DISTRIBUTION
AND TRANSPORT
 Conclusion

In most healthcare facilities, the Central

Sterile Supply Department (CSSD) plays a key
role in providing the items required to deliver
quality patient care. A well planned, well
managed and well staffed CSSD can ensure an
infection free environment of hospital and save
valuable life and money.
THANK YOU