Dr.Sharad H.

Gajuryal
Junior Resident
MD(Hospital Administration)
B.P Koirala Institute of Health Sciences,Nepal
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.
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)
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
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.
 • American College of Surgeon first started CSSD in their
1928 Hospital

• Cambridge Military Hospital

1955

• Belfast
1958

• Actual development took when Nuffield Provincial Hospital

-- Trust (UK), a central Health council began to take interest

• CSSD is an integral part of every hospital

Now
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.
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.
Space requirement: The minimum area in sq. ft required
per bed as recommended (Giford, DL-1963)

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

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 120 240 160 240 240 240
(unsterile)
STERILIZATION
UNIT
1.Reception & 120 120 180 180 240 240
Washup Area
2.Checkup & 180 180 240 240 320 320
Assembly
3.Autoclave 80 80 120 120 160 160
Room
4.Storage & Issue 120 120 180 180 240 240
Total: 620 740 1000 1080 1320 1320
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%
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)
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.
 Receiving

Contaminated
Disassembling
Area
Area
Condemnation

Cleaning Processing

Clean Area
Assembling(
Drying and
Sterilization Packing)

Sterile Area
Storage

Issuing Ward,
ICU,Labor counter>> Emergency,
Room,OT Distribution OPD & other
units
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
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)
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.
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.
AIIMS Hospital
AIIMS Hospital
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.
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.
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.)
Chemicals Used for Sterilization or Disinfection

Glutaraldehyde and Formaldehyde

Orthophtaldehyde
Superoxide water
Rapid read our ethylene
Endo cleans (liquid sterilzers)
Halogens
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.

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.
Bacteriological Test
Regular Culture of sterilizer should be done in time
interval and must be sent to laboratory for
bacteriological test.