Sterile Supply Room

Pharmacy sterile service

Designing a CSSD
Sterile Supply Room

 The Central Sterile Supply Room prepares,

sterilizes, stores and issues medical-surgical
supplies for patient care. The CSSR is divided
into two main sections to accomplish the
functions of assembly & sterile processing,
storage and distribution
 The other name for this unit may be
CSSD central sterile supply department
Introduction

 Initially , the facility of CSSR was started as

an equipment washroom with autoclaving
facility

 Currently , a sterile room utilizes the modern

production line techniques with automatic
control recording devices to ensure sterility
Cont.

 In Pakistan this service is not included under

management scope of Pharmacist

 Here we pinpoint the potential role of the

Pharmacist , which he can be assumed to do
for the management of this service if
delegated
Objective of central sterile supply

Purpose of CSSD to provide a centralized

system for total decontamination , professional
support and service for improve patient care by
performing:
Cleaning and sterilization of hospital items
Packaging of sterilized items
Preparation of procedural trays and sets used in
the care and treatment of patient
Maintain inventory
Cont.

 Maintain record of the effectiveness of

various process for cleaning and sterilization
 Develop a cost effective program by cost
analysis of
personnel
supplies and
equipment
Participation in research programs
Organization and Management

 One of specialized hospital operations may or

may not function under the pharmacy
 Normally not operating under pharmacy and
has a broader scope of services
 Involved in cleaning , storage and dispensing
of specialized equipment such as suction
pumps , cardiac catheters , surgical dressing
carts , special kits and trays, etc.
Cont.

 The management of sterile room varies

widely in various hospital , in some
institutions it is considered as sub
department
 In some institution this units operate under
the control of surgical department
 Most widely use of this service required in
operation theatres
Management control of CSSD

 Pharmacist control
 Nurse control
 Pharmacist nurse dual control
 Operating supervisor control
 Designing a CSSD

 Designing a CSSD is not straight forward.

if something is worth doing
it is worth doing well enough to meet your goals
this applies to designing a CSSD

One size does NOT fit all, units should be individually

designed to meet the needs of the hospital

 A cheap quick solution is generally a shortcut to Chaos

 Introduction
CSSD - Central Sterile Service Department
 An Independent department
 Dedicated to the decontamination and sterilization of sterile
supplies
 A controlled area
 Should be designed and constructed in a way that will provide
effective segregation of clean and dirty areas

The Decontamination Process implies proper workflow

between 3 Areas;
Dirty Area
Clean Area
Sterile Area
Decontamination Process
Decontamination Process
 The CSSD Design
 A U-shaped modular unit is preferable

 This allows progressive work flow from the" dirty” area to a

progressively cleaner, inspection, packaging, sterilization and
cooling area, to finish with sterile storage and distribution
It is critical that these areas are sequentially
linked in a uni-directional flow to prevent ‘zig-zagging
How can we achieve the Ideal
CSSD 
 Create an Expert Team?

Teamwork is Key, establish what information you need

to accomplish the plan and where to find it

CSSD Manager Support

Staff
Engineers
Quality/ housekeepi
Architects legal ng

Infection Control
Theatre
Procurement Finance/
purchasing
nursing
Finance
Pharmacist reprocessing

Facility
manageme laundry
nt

Engineerin
Medical & g/a
surgical maintenan
Infection ce
control
prevention

One size does NOT fit all, units should be individually designed to meet the
needs of the hospital
 Establish Your Goal and Prioritize

•Plan big, Plan right and work in stages

•Don’t settle for second best
•Prioritize sufficient inventory
•Prioritize separating clean and dirty

A Dirty Item cannot become a Sterile Item

 How to plan Your Space

Calculate the area according to individual hospital needs

• Number of operating theatres

• No. + Type of Surgical procedures
• Anticipated workload
• Operating hours
• Available Inventory
• Method of cleaning i.e. manual/automated
• Number and capacity of washer disinfectors
• Extent of storage available in the theatres and other service
areas

The minimum effective operating size is 260 m²

 Establish what is Critical

Controlled access
Adequate space
Controlled flow
 Adequate lighting
 Comfortable work environment
 Controlled Access

Automatic/semi-automatic doors make it easier to open/close

doors when pushing trolleys
 At least 2 doors are required for uni-directional flow
 One into the dirty area another out of the clean area
The area must be contained i.e. no openings without doors
Doors must be wide enough to accommodate trolleys and
should have vision panels to prevent injuries
 Adequate Space

Space is needed to;

Manoeuvre trolleys
Allow for unilateral movement
Separation of clean and dirty
Reduce lifting and carrying excessively heavy
items
 Reduce awkward movements
Allow for a tidier safer area

Insufficient space creates difficult working conditions compromising

sterility 
 Controlled Flow


Closely monitor and manage flow

Work and Material: Dirty – Clean

Staff: Clean to Dirty NEVER both
simultaneously
Air: Clean to Dirty
Pressure: Positive to Negative – clean to dirty

Items must move from the dirtiest to the cleanest area to minimize the
risks of contamination
 Work Flow
Follow the principle of forward movement from dirtiest to
cleanest area

Areas should be directly linked to each other and progress

according to activities

Backtracking should not be possible

Workflow
Material Flow
Staff Flow
 Air and Pressure Flow

Workflow – Dirty to Clean

Airflow – Clean - Dirty

Pressure Flow – Positive to Negative

Air Flow
Adequate Lighting
Natural daylight if possible
Windows are good, its nice to
see the outside world
Adequate lighting is crucial for
safety
Low-luminance devices must
be used for artificial lighting

 Comfortable work environment

Units tend to be hot, noisy and stuffy 

Below ceiling height of at least 2.8m

recommended
Allows optimum air circulation
Reduces temperature build up
Reduces noise
Enhances light

Noise must be controlled

Do not exceed 60 dB SPL
Use absorbent materials
Insulate equipment in technical walls
The Ideal Layout
 Decontamination Area – 35%

SUPPORT ZONE
waste female male dispatch
kitchenette staff rest room
disposal change change area

sluice CSSD DEPARTMENTAL CORRIDOR sterile

pack
store
receiving &
trolley

textile
store

room

office
store
PPE
PPE
bay
sorting
area

STERILE ZONE
cooling

manual automated washing inspection & packing area

washing sterilization
area (IAP area)
area area

plant room

DECONTAMINATION ZONE INSPECTION & PACKING ZONE (IAP)

 IAP Area – 35%

SUPPORT ZONE
waste female male dispatch
kitchenette staff rest room
disposal change change area

sluice CSSD DEPARTMENTAL CORRIDOR sterile

pack
store
receiving & trolley

textile
store

room

office
store
PPE
PPE
sorting bay
area

STERILE ZONE
cooling

manual automated washing inspection & packing area

washing sterilization
area (IAP area)
area area

plant room

DECONTAMINATION ZONE INSPECTION & PACKING ZONE (IAP)

 Sterilization Area – 20%

SUPPORT ZONE
waste female male dispatch
kitchenette staff rest room
disposal change change area

sluice CSSD DEPARTMENTAL CORRIDOR sterile

pack
store
receiving &
trolley

textile
store

room

office
store
PPE
PPE
bay

sorting
area

STERILE ZONE
cooling

manual automated washing inspection & packing area

washing sterilization
area (IAP area)
area area

plant room

DECONTAMINATION ZONE INSPECTION & PACKING ZONE (IAP)

 Support Areas – 10%

SUPPORT ZONE
waste female male dispatch
kitchenette staff rest room
disposal change change area

sluice CSSD DEPARTMENTAL CORRIDOR sterile

pack
store
receiving &
trolley

textile
store

room

office
store
PPE
PPE
bay
sorting
area

STERILE ZONE
cooling

manual automated washing inspection & packing area

washing sterilization
area (IAP area)
area area

plant room

DECONTAMINATION ZONE INSPECTION & PACKING ZONE (IAP)

Receive/check/
Sort

Transported
Dirty instruments
arrive

REALITY
Dirty Area
 Storage

Autoclave
Clean Area Inspection Instrument Packing
 In Conclusion

Designing a CSSD is not simple, one size

does not fit all

Understanding the CSSD process is critical to

design

Plan for the future when designing

Listen to the experts when designing

Education is the passport to the future ,

tomorrow belongs to those who prepare for
it today – Malcolm X(Al Haj Malik
Shahbaz)