1.Dr.Sharad H. Gajuryal Junior Resident MD(Hospital Administration) B.P Koirala Institute of Health Sciences,Nepal

2. Definition The Central Sterile Supply Department (CSSD) is the service responsible for receiving, storing, processing, distributing and controlling the professional supplies and equipments(both sterile and non sterile) for all user unit of hospital for the care and safety of patient under strict quality control. 3. It is an important facility of hospital that supplies sterile instruments and materials for dressing and procedures carried out in ward and other departments of hospital. CSSD has a great role in reducing Hospital Acquired Infection (HAI) 4. Normally the following types of article are entertained by CSSD: -Diagnostic sets like L.P set, Sternal Puncture set etc -Treatment sets like Cut down sets, aspiration set etc. -Dressing materials -OT linen & instruments -Rubber Gloves, Catheters, -IV sets & infusion sets 5. History & Development The development of concept of sepsis was coined by Lister and Koch as a result of discovery of microorganism. With this discovery, the need for aseptic technique in handling and sterilizing the equipment used in surgery and medicine was felt for the care of patient. The mordern concept of CSSD was derived during ssecond world war. 6. 1928 American College of Surgeon first started CSSD in their Hospital 1955 Cambridge Military Hospital 1958 Belfast -- Actual development took when Nuffield Provincial Hospital Trust (UK), a central Health council began to take interest Now CSSD is an integral part of every hospital 7. AIMS & OBECTIVES Aims: To provide the safe and sterile supplies to all the user unit of hospital. Objectives: To provide efficient, economic and uniform source of sterile supply for the care and treatment of sick To assist purchase department for decision making and selection of goods. To assist management of hospital in standardization of good Cleaning ,Packaging ,labeling and dating of material To supply equipments to highly specialized units. To educate students, Nurse and ancillary persons To save nursing time at nursing station To participate effectively in Hospital infection control committee. Applied research for improvement techniques. 8. Physical Facility Location: Should be ideally located in close proximity to Casualty, ward, OT and labor room for effectiveness and efficiency. The location should have adequate supply of water, both hot and cold, steam, compressed air and three phase electricity. 9. No. of Beds Space Requirement 75-99 Beds 10 sq. ft per bed 100-149 Beds 9 sq. ft per bed 150-200 8.5 sq ft. per bed 200-249 8 sq. ft. per bed 250-299 7.5 sq ft. per bed More than 300 7 sq. ft. per bed Space requirement: The minimum area in sq. ft required per bed as recommended (Giford, DL-1963) 10. Floor Space requirement: (Acc. To Committee on Plan Project) Facility Bed Strength 50 100 200 500 750 1000 GENERAL Space in Sq. Feet 1.Admin. Office 120 120 120 120 2.Store Room (unsterile) 120 240 160 240 240 240 STERILIZATION UNIT 1.Reception & Washup Area 120 120 180 180 240 240 2.Checkup & Assembly 180 180 240 240 320 320 3.Autoclave Room 80 80 120 120 160 160 4.Storage & Issue 120 120 180 180 240 240 Total: 620 740 1000 1080 1320 1320 11. Total space is functionally divided into foll0wing areas: Receiving and clean up area-10% Clean work area including area for sterilization-30% Unsterile storage area=15% Sterile storage area-16% Syringe needle and instrument processing and sterile area-12% Glove processing area-5% Office room/ rest room/gauze/dressing assembly-14% 12. Staffing Supervisor of CSSD CSSD Technician Clerks Assistant or Helper Messenger Staff strength varies from hospital to hospital depending upon bed strength and work load.For 30 bedded hospital 1 supervisor and CSSD worker is recommended(1961) 13. Work flow of CSSD The functional area should be clearly differentiated and there should be no cross by work flow, particularly the sterile and contaminated good. CSSD layout should be designed for unidirectional flow. and have four zone for smooth workflow i.e 1.Unclean and washing area, 2. Assembly and packing area, 3. Sterilization area 4 .The sterile area Arrangement of the work area may differ with each institution but flow of material will essentially be the same as given in the following chart. 14. Receiving Disassembling Area Issuing counter>> Distribution Storage Condemnation Cleaning Sterilization ICU,Labor Room,OT Processing Assembling( Drying and Packing) Ward, Emergency, OPD & other units Contaminated Area Clean Area Sterile Area 15. Operation 1.Rinsing 2.Cleaning:manually or ultrasound washer 3.Drying:manually or in natural way 4.Inspection and assembly: Damaged item should be condemned ,repairable should be repaired then assembled 5.Packaging: done with linen/draper after drying and assembling 6.Labeling:Done for identification. Date, contents, identification number, bar codes, initial of person who carried out sterilization, initial of packers are used 16. Sterilization Sterilization is the process of freeing any articles from living microorganisms including bacteria, Fungi, Virus etc. This process is carried out through sterilizers. 1.Heat Sterilization Dry Heat Sterilization Steam Sterilization 2.ETO (Ethylene Oxide Sterilization) 3.Chemical Sterilization 4.Radiation Sterilization (Gamma) 17. Heat Sterilization 1.Dry Heat Sterilization: In conventional Hot air oven, sterilization is carried out at 160 degree C for 1 hour. The most suitable article for DHS is glass wares, particularly glass syringe, But nowadays use of glass syringe has become obsolete. Another article is cutting edge instrument, Articles with oil, paraffins are also suitable for this sterilization as dry heat can penetrate all kind of materials. 18. Steam Sterilizer It is most commonly used sterilizer because it is safe ,inexpensive and time saving. There should be proper coordination between pressure, temperature and time . Articles are subjected to sterilize in 121 degree Celsius in 10- 15 minutes and 134 degree Celsius in 3 minutes in 20 PSI pressure. The outer layer of microorganism is softened by steam which coagulates internal portion of organism. In this way steam sterilization is effective against microorganism. Machine is operated either by supply of steam through a boiler or by inbuilt electrical steam generator. They are used for sterilization of glass wares, container, vessel, linen, rubber articles, OT instruments etc. 19. AIIMS Hospital 20. AIIMS Hospital 21. ETO Sterilization It is carried out by use of ethylene oxide as biocide to destroy bacteria , virus ,fungus and other microorganism. This method was developed by American army for sterilizing articles, which are damaged by high temperature, like plastic product and sensitive surgical materials. It is used for those materials that are heat and moisture sensitive. Since it is explosive, it is mixed with co2 or nitrogen and supplied in a cartridge. 22. Delicate surgical instrument like cystoscope, heart lung machine, bronchoscope, implants etc are sterilized by this method. Commonly used in tertiary level hospital for sterilization of costly and sensitive materials. The disadvantage of ETO is that it is expensive and takes a longer time and requires constant bacteriological testing of each load. 23. Chemical sterilization This is an absolute process where spores are also eliminated with microorganisms. Chemical sterilization is typically used for devices that would be sensitive to the high heat used in steam sterilization, and for devices that may be damaged by irradiation (rubbers and plastics can become more brittle after irradiation.) 24. Chemicals Used for Sterilization or Disinfection Glutaraldehyde and Formaldehyde Orthophtaldehyde Superoxide water Rapid read our ethylene Endo cleans (liquid sterilzers) Halogens 25. Gamma Radiation Sterilizer Gamma rays are used for sterilization of articles. Useful for sterilization of disposables. It has high reliability, high degree of penetration and diverse shape article can also be sterilized Its limitation of used is due to high cost. 26. Distribution from Sterile store Four major system of distribution 1.Topping up: Each department set predetermined stock level for each user and distributing routinely with record. 2.Clean for dirty exchange: one clean article for each dirty is exchanged 3.Regular complete stock issue: demand for box, trolley, basket containing article for need for specific period. 4.Ordinary order system :straight forward ordering system of user in order to keep their local store full. 27. Bacteriological Test Regular Culture of sterilizer should be done in time interval and must be sent to laboratory for bacteriological test.