Page 1 : CENTRAL STERILE SERVICE DEPARTMENT

Page 2 : It is a Service,, with in the hospital,, catering for the sterile supplies, to all departments ,, both to specialized units,, general wards and OPDs.

Page 3 : ƒMission of CSSD, ‰ Timely delivery of sterile goods, ‰ Quality, ‰ Efficiency (line process), , ƒActivities of the CSSD, ‰ Cleaning, ‰ Disinfection of semi- / non critical items, ‰ Sterilization of critical items (high risk for infection), ‰ Supply of sterile materials

Page 4 : a. Contributing to a reduction in the incidence of, hospital infection., b. To avoid duplication of costly equipment., c., , To, maintain, record of, effectiveness of, cleaning, disinfection, and sterilization process.

Page 5 : Rinsing, Receipt, , cleaning, , Issue &, Distribution, , Drying, CSSD, , Storage, , checking, , Labeling, , sterilization

Page 6 : •, , Receiving and sorting soiled materials used in the, hospital., , •, , Determining whether the item should be reused or, discarded., , •, , Carry out the process of decontamination or disinfection, prior to sterilization., , •, , Carry out specialized cleaning of equipments and, supplies., , •, , Inspecting and testing instruments, equipments and, linen., , •, , Assembling treatments trays, instrument sets, linen, packs, etc., , •, , Packing all materials for sterilization., , •, , Sterilizing., , •, , Labeling and dating materials., , •, , Storing and controlling inventory., , •, , Issuing and distributing.

Page 7 : •, •, •, , •, , •, , 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

Page 8 : 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

Page 11 : The CSSD can broadly be classified into two parts, , Centr, al, unit, -Responsible for receiving dirty, Utilities cleaning, processing,, Sterilization, storage and supply, , Peripher, al, unit, - Mainly responsible for, distribution, to various areas of hospital., - TSSU (Theater Sterile Supply, Unit)

Page 12 : - The materials/itemsfrom contaminated, and sterile areas should not get mixed., - There, should, be physical, barrier, between clean, and dirty areas., - The floor should be smooth, non skid &, robust., - Relative humidity should be maintained at, 45±5 %

Page 13 : - The clean area should, positive pressures., - The minimum, should, be, - The work, marble, , be maintained, , at, , ventilation rate, 6-10, air changes / hour., , area should be made, of, /, granite / stainless steel., , - The sterilization must, be planned, autoclaving by steam as well as by gas., , for

Page 14 : • 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, possible movement of the material., , quickest

Page 15 : •Cleaning and decontamination devices, •Hot air Oven for drying & heat sterilization, •Glove processing unit for surgical gloves, •Instrument sharper e.g.. Needle sharper, •Testing apparatus for emergency sterilization, •Others :- trolleys, work surface, telephones, •Maintenance and repair of equipments, •Material : chemicals for washing and, cleaning

Page 16 : •Steam Boiler, •Hot air ovens for drying instruments, •Autoclaves using dry heat, moist heat., •Ethylene oxide sterilizers., •Testing material to check effectiveness of, sterilization., •Sealing machine, •Ultrasonic Washer

Page 17 : •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.

Page 18 : • Dry Heat, • Steam High Pressure-Autoclaves operated, by Gas, K.oil or Electricity (Flash, Pulse), • Ethylene Oxide Sterilization., • Chemical Sterilization., • Radiation Sterilization., • Infra Red Radiation – Syringes, • Ultra Violet Radiation – Decontamination, of Air, • Ionizing Radiation / Gamma Radiation

Page 19 : CIDEX, •A Glutaraldehyde derivative is most effective as it destroys spores too., •It is high level disinfectant. It kills spores within 12 hrs and viruses, within 10min., •Widely used because of their excellent biocidal properties, activity in the, presence of organic matter,, •non corrosiveness and noncoagulation of proteinaceous material, Hydrogen peroxide, •It is an effective bacteriocidal, fungicidal, viricidal and sporicidal., •It is commercially available as 3% solution but can be used upto 25%, concentration., •It is non corrosive and not inactivated by organic matter but irritant to skin, and eyes lutaraldehyde derivative is most effective as it destroys spores too.

Page 20 : The equipments are first cleaned & the packaged in muslin,, linen or paper, , €, , which are easily penetrated by steam & then placed on shelf, in the chamber., , €, , Water Æ Saturated Æ Wet vapor Æ Dry saturated Vapor Æ, 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), , €, , €, , Total time Required, , ‰ Autoclave – 45 to 50 min, ‰ ETO(Ethylene Oxide) sterilizer – 11 to 12 hours

Page 21 : Chemical Indicators:, ‰These are more practical means & detect problems immediately., ‰The CDC & all major U.S organizations standards & guidelines advocate, that a chemical indicator be attached to every package that goes through, a sterilization cycle & within each package to be sterilized in what is, expected to be the most difficult-to-sterilize location., , These are divided into 6 classes, higher the class, more, sensitive, the indicator, Class 1These are Internal & External Process Indicator, These inform that item has been exposed to sterilization process., E.g. External Process Indicator – Autoclave Tape.

Page 22 : Class 2, ‰ E.g. Bowie-Dick test for vacuum steam sterilizer., ‰ They only access Vacuum Pump efficiency & detect the presence of, air leaks &/or gases in steam., , Class 3, ‰E.g. Temperature Tube., ‰Contains chemicals that melts & sometimes changes color when the, appropriate temp is attained., Class 4, ‰Respond to one or more sterilization parameters., ‰Contains Ink that changes color when exposed to correct combination of, sterilization parameters.

Page 23 : Class 5, ‰Known as Integrating Indicators or Integrators, ‰Respond to all parameters of sterilization over a specified range of, temperatures., Class 6, ‰These are emulating indicators., ‰These are designed to react to all critical parameters over a specified, range of sterilization cycles for which the stated values are based on the, settings of the selected sterilization cycles

Page 26 : ¾ MAJOR ACTIVITIES IN A CSSD:, ™ RECEIVING THE USED ITEMS FROM USER, DEPARTMENTS, ™ CLEANING, ™ PACKING, ™ STERILIZING, ™ STORING (TEMPORARY), ™ DISTRIBUTING TO USER DEPARTMENTS

Page 27 : 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, , 4, , 200-249, , 5, , 250-299, , 6, , 300 or More, , 8.5 sq feet per bed, 8 sq feet per bed, 7.5 sq feet per bed, 7 sq feet per bed

Page 30 : 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, , Clean, , 26, , 3. Syringe & Needle, , Clean, , 9, , Processing, 4. Unsterile Pack Store, , Clean, , 4, , 5. Bulk Store, , Clean, , 11, , 6. Sterile Store, , Sterile, , 16, , Clean, , 19, , Clean, , 5, , Room), , Miscellaneous (a)Gloves, 7., room (b)Office room, (c)Rest room, 8. Autoclaves

Page 31 : • After sterilization the sterilized items are, • kept in different racks as per labeling., • Supplied as per the demand of different, area., • To ensure continuous availability of sterile, supply five times of, daily requirement should be available in, storage.

Page 32 : Maintains, standards, , Reduces, burden on, nursing, staff, , Economic, ,Efficient and, uniform, source, , Shorten, s, patient’s, stay, Ensures, safe, environment, , Inventory, Maintenance, , Infection free, atmosphere, , Processin, g, issue, and, control, , Prevent, s crossinfection, , Advantages, , Quality, care

Page 33 : 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., 5. Conservation of trained staff., 6. Better quality control, 7. Better good of material flow, 8. Prolonged life by proper care of equipment