CSSD

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
receive, clean, pack, to disinfect
sterilizes stor and ,
,instrumentse and suppliesdistribut
as
e
per well-delineated protocols.
By custom diets, medicines, laundry, supply
of blood and crystalloid are not included in
activities of CSSD.
BACKGROUN
D
 Objective and
a. ToFunctions
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.
 Locatio
n
• 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 (Speciallyfor instrumentsin trays)
are
• Thereafter, instruments are inspected
counted and Received.
blunt/unsuitable
the Instruments
and are
segregated/discarded.
• Necessary entries are made for records.
• Thereafter, the items are shifted to Cleaning
area.
 CLEANING
• AREA ARE WASHED EITHER MANUALLY
HERE THE INSTRUMENTS
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
MACHINE ALLOWS TOTALLY EXPENSIVE
HAND-OFF PROCESSING.
INSTRUMENTS
THAT IN PERFORATE MESH BOTTOM TRAYS
FROM OPERATING
OR ROOM OR OTHER DEPARTMENTS
COMING 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 DRY INSTRUMENTS ARE BEFORE
AND
STERILIZATION, THAT THEY ARE NOT CONTAMINATED
SO PACKED
HANDLING AFTER THEY ARE STERILIZED. MOST OF WHILE 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.
 STOR
E

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
STORAG
MATERIAL
E
S

TRANSPORT
STERILIZATIO
N

CSSD
CLEANING
PACKAGING

TRAY
DISINFECTION
ASSEMBL
Y
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.
Staffi ng 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 TIME, TEMPERATURE, HUMIDITY
PRESSURE
RECORD DURING THEANDSTERILIZATION 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

SUPPLIES AND CONSUMABLE ANALYSIS

• OPTIMAL UTILIZATION OF MANPOWER

• ENSURE QUALITY OF AND EQUIPMENT
STERILIZATION
• MOTIVATION OF STAFF AND TRAINING

• ENSURE PROPER DISTRIBUTION • INTER DEPARTMENTAL COORDINATION

AND TRANSPORT
 Conclusio
n
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.