CSSD & OT - June.pptx

Central Sterile
Supply
Department
(CSSD) & OT
ASMA FIRDOUS
PG 1ST YEAR MICROBIOLOGY

Introduction
• An alarming rate of Hospital Acquired Infections (HAI) in Indian hospitals has
highlighted the importance of disinfection and sterilization.
• Achieving disinfection and sterilization through the use of disinfectants and sterilization
practices is essential for ensuring that medical and surgical instruments do not transmit
infectious pathogens to patients.
• One of the most accepted systems to achieve the prevention of transmitting infectious
pathogens is having a Centralized Sterile Supply Department (CSSD) supported by a
mechanized laundry.

Introduction
• Sterilization refers to any process that eliminates, removes, kills, or deactivates all
forms of life and other biological agents (such as fungi, bacteria, viruses, spore forms,
prions, unicellular eukaryotic organisms such as Plasmodium, etc.) present in a
specified region, such as a surface, a volume of fluid, medication, or in a compound
such as biological culture media.
• The various methods of sterilization include Physical Methods (Thermal (Heat),
Radiation, Filtration) and Chemical methods (Gaseous).
• The Central Sterile Services Department (CSSD), also called Sterile Processing
Department (SPD), or Central Supply Department (CSD), is an integrated place in
hospitals and other healthcare facilities that performs sterilization and other actions on
medical devices, equipment and consumables.

History & Development
• The development of concept of Sepsis was coined by Lister & Koch as a result of the
discovery of microorganisms. With this discovery, the need for an aseptic technique in
handling and sterilizing the equipment used in surgery and medicine was felt for the
care of the patient
• The modern concept of CSSD was derived during the second world war

History & Development
• 1928 – American College of Surgeons – CSSD
• 1942 – World War 2. Cairo, British SDS unit
• 1955 – Cambridge Military Hospital – Regular CSSD in the UK
• 1965 – First CSSD in India - Safdarjung Hospital, New Delhi

Objectives & Functions
• To provide sterilized material
• Contributing to a reduction in the incidence of hospital infection
• To avoid duplication of costly equipment
• To maintain a record of the effectiveness of the cleaning, disinfection and sterilization
process
• To monitor and enforce controls necessary to prevent cross-infection
• To maintain an inventory of supplies and equipment
• To stay updated regarding developments in the field
• To provide a safe environment for the patients and staff

CSSD
The Central Sterile Supply Department (CSSD) delivers sterile supplies of
surgical equipment, linen, dressing material and other such items which
can be reused in various departments of a hospital or health facility
(Operation Theatres, Labour Rooms, Minor OTs, HDUs, ICUs, Emergency
Units, Wards (IPDs), Day Care Units and Out Patient Departments
(OPDs)).

CSSD
• Laundry services form a critical component of service provision. Soiled and unsterile hospital
linen is known to be a source of microbial contamination
• It provides clean linen in an adequate and constant supply to all users
• Hospital linen includes all textiles used in the hospital, including mattress, pillow covers,
blankets, bed sheets, towels, screens, curtains, patient gowns, doctors’ coats, theatre cloths,
tablecloths, etc.

CSSD
• The purpose of cleaning is to remove contaminants such as micro-organisms or hazardous
materials, including chemicals, radioactive substances and infectious diseases
• the purpose of decontamination is to prevent the spread of micro-organisms and other noxious
contaminants that may threaten the health of human beings or animals or damage the
environment

General CSSD Concept Design
• Physical separation between soiled, clean and sterile zones
• The risk of cross-infection spread by staff is minimized

Planning for CSSD & Mechanized Laundry
• The Mechanized Laundry and CSSD should ideally be located at the ground floor
• They should have established linkages with other critical areas utilizing clean and sterilized
articles such as labor room, wards, OPD, store, etc.
• The type and capacity of equipment required in a CSSD and Mechanized Laundry will also
depend on the expected load being generated by the hospital.

Layout plan
The design and total area of CSSD is based on the following parameters
• The size of the institution
• Number of beds relying on the supply from CSSD
• Average number and type of surgical procedures per day
• Equipment type, size and number to be used

Organization and
Functioning of
Mechanised Laundry

Activities before the linen and equipment
are brought to CSSD and Mechanized
Laundry
Activities at Generation Points
Non-critical care areas:
1. Change of Linen
2. Sorting of used Linen
3. Disinfection of soiled/contaminated linen
Critical care areas:
1. Soiled and unsoiled linen
2. All used linen of OT is considered infectious
Decontamination of instruments:
1. Instruments used for major/minor surgeries in OT and other critical areas need to be
necessarily decontaminated and autoclaved before the next use
2. Two processes for packaging the instruments for decontamination are as follows:
 Decontaminate, dry and pack in OT or other service areas.
 Double wrap and send to CSSD for decontamination, wash, dry, pack and autoclave.

Activities before the linen and equipment are
brought to CSSD and Mechanized Laundry
Collection and transportation of Dirty Linen and instruments from Wards/ OTs/
other areas to Laundry and CSSD
• The pathways for delivery of clean and sterile equipment and linen and collection of dirty
equipment and linen should not cross each other.
• The transportation of materials should be done through a defined corridor/dumb waiter/ service
lift in a clean and covered trolley.
• The linen bag must be tied once 2/3rd full and taken to the appropriate area to store neatly.
• The laundry staff shall use gloves while handling the linen and check for any damage or tear, if
any.
• All the linen is transported in closed leak-proof bags, containers with lids or covered carts via
dumb waiters/ dedicated elevators or corridors to the washing area.
• Contaminated and noncontaminated linen is transported separately.

Activities at CSSD & Mechanized Laundry

Entry of Staff
• Entry of staff into Laundry and CSSD is maintained separately
• This consists of
Manager’s room
Male and Female changing room
Staff room and first aid area along with a pantry
Caretaker’s room and
Washrooms for staff
• The staff is supposed to change into clean and sterile uniforms in changing room before
entering the service area.
• CSSD in-charge will ensure adherence to Personal Protective Equipment (PPE) protocols
through CCTV cameras.

Activities in Mechanized Laundry
Receiving Area:
1. Separate window for receiving and dispatching of items
2. Two separate rooms for Soiled & Non-soiled linen
Disinfection Area:
1. Soiled linen is passed through the jet washer installed in the soiled linen room
2. Once the linen reaches laundry -> soaked in the tanks(0.5 % sodium hypochlorite) for 15 -20
minutes
Washing Area:
1. The disinfected linen should be washed with the detergent solution in washing machines.
2. The washed linen shall be put in the water extractor for 3-5 minutes

Normal White Linen (30 kg
capacity)

Coloured Linen (30 kg
capacity)

Heavy, Soiled and Infected White Bed Linen
(30 kg)

Heavy, Soiled and Infected Coloured Linen
(30 kg)

Activities at CSSD
Receiving Area:
• There should be a separate window for receiving and dispatching of items.
• The articles are sorted into different packs for different methods of cleaning.
Sub Store, Cotton and Gauze preparation area:
• used for gauze cutting and preparation
• Proper ventilation of this room shall be maintained to avoid suffocation
• Prepared gauze and cotton are then sent to receipt area for further action
Cleaning Area:
• Common automatic cleaners are
Ultrasonic cleaners
Washer decontaminators
Washer disinfectors
• Cleaning is done manually for fragile or difficult-to-clean instruments

Assembly and Packing Area :
• It includes checking of glass items for breakages, needles and instruments for sharpness and
breakages, assembling of the equipment after washing and drying
• Make appropriate sets for use by various departments and packaging along with sealing either
manually or using a machine before sterilization.
Labelling and Packing Area:
• Adequate documentation and labelling of each pack should be done and records should be
maintained
• The autoclave indicator is pasted in the packs by the CSSD technician and the packs are taken
to the cleaning area
• Bowie Dick test: It uses a thermo chromatic paper which is placed inside the pack and if it
shows a uniform dark black color pattern indicates a successful vacuum and full steam
penetration, whereas no or partial color change indicates an unsuccessful test cycle

Sterilization Area:
• Sterilization is achieved by steam sterilizers working at specified cycles of temperature and
duration
• Advantages of steam sterilizers are
 Rapid heating & penetration of loads
 Destruction of all forms of microbial life and
 No residual toxicity
ETO Process Room:
• An ethylene oxide sterilizer can be used to sterilize heat-sensitive
• instruments like various types of tubes. E.g. Catheter etc.
Storage Area:
• storage of sterilized materials where space is also provided for storing
• distribution trolleys
Issue and Distribution Area:
• Issue of the sterilized packages, dressings, linen, instruments and disposables to various
departments of the hospitals is done in this area.

HR Requirement
CSSD and Mechanized Laundry require dedicated and experienced staff for all shifts. Staffing should be
as per the IPHS 2022 laid down for each category of staff for District Hospitals as given under

Capacity Building: For Laundry & CSSD staff
Laundry
Objective: Participants should be able to acquire knowledge and skills for organizing the flow in
mechanized laundry and performing laundry services.
They should be able to supervise and maintain laundry equipment, take safety precautions and
monitor quality indicators.
Duration: One day
Participants: All available team members of Laundry.

Capacity Building: For Laundry & CSSD staff

Records & Registers :
Maintaining records and registers helps in analyzing and reviewing the performance, cleanliness,
adherence
to technical protocols, functionality and availability of equipment etc.

Quality Policy
The aim of the policy should be to provide patients with clean, disinfected and autoclaved
instruments/linen depending upon the requirement of various service areas (both critical and non-
critical), thereby supporting the hospitals in ensuring infection control
Quality Monitoring:
To check the validity of the sterilization process following points should be considered
a. ysical monitoring through the autoclave displayed screen or printout
b. Chemical monitoring with chemical indicators
c. Efficacy testing with biological indicators
d. Operations testing of the autoclave
CCTV Camera: All service areas, entry points inside CSSD complex should have CCTV camera
which should be linked with the Laundry In-charge for continuous monitoring, so that all the
technical protocols are monitored/supervised and adhered

Quality Assessment
• All the quality parameters will be as per the guidelines of the National Quality Assurance
Standards
• issued by GoI.
• Assessment shall be conducted as per prescribed QA checklist by the designated assessors.
• Before such assessment, the supervisor should use the checklist given in this guideline as part
of routine monitoring. This will help the CSSD and Laundry services to be in readiness for
quality certification.
• A Quality Management System procedure for Internal Assessment shall include the following:
 Selection of Internal Assessors.
 Criteria for Internal Assessors.
 Assessment Planning and methodologies.
 Assessment recording, non-conformance, and summary report preparation.
• Where assessment findings indicate deficiencies or the opportunity for improvement corrective
or preventive action should be promptly taken. This should be documented and carried out
within an agreed timeline.

Operational Management of CSSD &
Laundry
Policies and Procedures:
Administration: There should be a laid down Standard Operating Procedure (SOP) on the
functioning, duties and responsibilities of staff members, infection control measures, cleaning and
sterilization.
Scheduling: It is very important aspect of management of the CSSD complex. There is a need
for
planning of all activities. Punctuality needs to be adhered to for ensuring it.
Infection Control Measures: Since CSSD and laundry are the most sensitive support areas for
providing quality care services, high level of infection prevention and control practices are
adhered by all staff.
Some of the important activities are as follows:

Maintaining Hand hygiene
• Any staff handling linen must wear gloves and wash hands immediately following the handling
of
• any used linen.
• The In-charge should monitor
Handling Dirty Linen
• All dirty linen shall be handled with care, to minimize transmission of micro-organisms via dust
and skin scales.
• Proper PPE shall be worn
• All dirty linen shall be placed carefully in linen bins on removal from the bed.
• Care must be taken to remove any extraneous items from dirty linen before it is placed in
laundry bags.
• The infectious linen should be tied in a yellow bag and tagged to indicate the content being
infectious linen.

• To avoid spillage of dirty linen, linen bins must never be more than two thirds full
• Two trolleys should be maintained-one for transportation of dirty linen and other for
transportation of clean linen.
• “Soiled” & “Fresh” linen trolleys are to be marked separately.
• Laundry personnel shall always wear apron, mask and gloves while handling linen.
• All linen trolleys to be washed on daily or weekly basis.
Handling Dirty equipment
• All dirty equipment shall be handled with care, to minimize transmission of micro-organisms.
• Proper PPE shall be worn when there is potential for contamination through the instruments
• All dirty instruments shall be packed and labelled carefully after use.

Periodic Health check-up & Immunization of staff
• Periodic Medical Check-up and relevant Immunization of all staff shall be carried out and records
of the same shall be maintained with the Immunization Room In-charge.
• The Infection Control Nurse shall monitor the effective conduct of the process.
• A copy of the immunization status shall be maintained with the Laundry/ CSSD In-charge.

Flow process of CSSD
Common Area

List of Equipment
CSSD:
• Steam Steriliser
• ETO Steriliser
• Ultrasonic Cleaner
• Washer Disinfector
• Magnifying Lamp
• Sealing Machine
• Endoscope Washer

List of Equipment
Laundry:
Calculating Capacity of Laundry Equipment
• Depends on the requirement of individual hospital
• Various international and national studies have indicated 3-7 kgs of linen/bed to be washed
every day.
• Some of the states who have initiated mechanized laundry have proposed weight of 3 kgs per
hospital bed.
• So, for a 300 bedded hospital, we may expect cleaning of about 900 kgs of linen i.e., @ 3
kgs/bed/day.
• Such assumptions are based on daily changing of linen and periodic cleaning of blankets.

Biological monitoring of sterilization process (CSSD)
• Sterilisation process is monitored by physical (time, temperature, pressure), chemical (internal
and external indicators) and biological methods.
• Physical and chemical indicators must be used with every sterilisation cycle while biological
indicators must be run weekly.
• Biological indicators are the ideal monitors of sterilisation process because they measure the
efficacy of sterilization process
biological indicators are also required to be used in the following situations:
• installation of a new sterilizer
• after relocation of an existing sterilizer,
• after a sterilizer malfunction

Mechanical
Biological
Chemical

The details of the biological indicators for sterilization are given below:
*There are newer “enzyme” based methods of monitoring, where the results can be
achieved much
faster, in hours.

Interpretation
As per the CDC recommendations
• Objects, other than implantable objects, do not need to be recalled because of a single positive
spore test unless the steam sterilizer or the sterilization procedure is defective.
• If the mechanical and chemical indicators suggest that the sterilizer was functioning properly, a
single positive spore test probably does not indicate sterilizer malfunction but the spore test
should be repeated immediately.
• If the spore tests remain positive, use of the sterilizer should be discontinued until it is serviced.
• For ETO and H2O2 gas plasma, a single positive spore test may be considered significant. All
loads should be retrieved for re-processing.

CHECKLIST FOR CSSD & LAUNDRY : Structure

CHECKLIST FOR CSSD & LAUNDRY : Process

CHECKLIST FOR CSSD & LAUNDRY : Outcome

Operation Theatre - Discipline
1. Only people absolutely needed for an assigned work should be present.
2. People present in theatre should make minimal movements and curtail unnecessary movements in and out
of theatres, which will greatly reduce bacterial count.
3. Airborne contamination is usually affected by type of surgery, quality of air which in fact depends on rate
of air exchange.
All the persons including the least cadre of employers are partners in infection control and should be aware
to comply with infection control regulations
4 Prompt disposal of Theatre waste out of the theatre is of top priority. Any spillage of Body fluids including
Blood on the floors is highly hazardous and prompts the rapid multiplication of Nosocomial pathogens in
particular Pseudomonas spp

Surveillance of Operation Theatre
Role of Microbiological Surveillance
• The environments in the operation theatre are dynamic and subject to continuous change.
• Good infrastructures do not mean a safe environment as human make a greater difference in
making the environment unsafe.
• Microbiologists should be aware of organisms, sites and populations as surveillance cultures
should be chosen carefully to allow meaningful interpretation of results.
• Microbiologists should be familiar with the clinical techniques as those normally used for
culturing clinical specimens may not yield correct result when applied to environmental
specimens.
• Sites and cultured reports should not be chosen as etiological sources in the present infections.
Culturing unnecessary surface areas causes confusion and meaningful interpretation is lost.

Cleaning & Mopping in Operation Theatre
Large bacterial load (about 85-95%) can be reduced just by following regular/proper cleaning and
mopping procedures.
Before starting in the morning (every day)
1. Clean using vacuum cleaner (using broom increases bacterial counts in air which is highly
undesirable).
2. After 10min of cleaning, Mopping should be done using plain water with 10 grams of bleaching
powder per litre.
3. Let the floor dry after the first Mop, Second round of Mopping is done using 2-5% phenol
(carbolic acid 20ml-50ml per litre of water) or a good quality disinfectant like Lysol can be used
as per the manufacturer’s instructions.
4. Lower concentration of phenol acts as a perfume rather than a disinfectant.
5. Clean the Operation Theatre table, instruments coming in intimate contact with patient and
door handles with 70% Alcohol solution.
6. Don’t enter OT till the floor is completely dry.
7. After mopping, mops must be kept dry by exposure to sunlight. Continuous use of mops
without intermittent drying leads to contamination more than disinfection.

Cleaning & Mopping in Operation Theatre
Between two procedures in the same session.
Clean using vacuum cleaner (using broom increases bacterial counts in air which is highly
undesirable).
1. Clean the Operation Theatre table and instruments coming in intimate contact with patient with
70% Alcohol solution.
2. Discard waste immediately into respective plastic bags.
After concluding in the evening (every day)
1. Wait for at least 30min after all the OT Personnel are out of the room.
2. Mopping is to be done using 2% phenol solution.
3. Bathrooms and toilets should be disinfected with bleaching powder (10 grams per litre).

Microbiological Monitoring of Operation
Theatre
Between two procedures in the same session.
Swabbing and culture for bacterial and fungal organisms should be requested for once in every
three months and/or whenever an outbreak is suspected, whenever there is some renovation work
done in the OT complex.
Interpretation of Microbiological monitoring culture reports:
Most important parameters are:
• Bacterial/fungal spore counts in air.
• Surface bacterial / fungal counts on the OT table and its vicinity.
• Routine screening for Clostridium tetani has lost its relevance and should be done only when
suspected tetanus case is operated or whenever there is some renovation work done in the OT
complex.
1. Results of pre fumigation microbiological monitoring indicates the prevalent bacterial load to
which the patient could be exposed.
2. Results of post fumigation microbiological monitoring indicates the effectiveness of the
fumigation procedure.

Theatre
Air Samples
Average colony count per plate/30min
Interpretation - Action to be taken.
Less than 10 bacterial colonies- Acceptable > No special action. Maintain regular fumigation
and Mopping.
More than 10 bacterial colonies- Unacceptable > Repeat fumigation with microbiological
monitoring.
Isolation of any number of colonies of Staphylococcus aureus and Pseudomonas species.-
Unacceptable >
Repeat fumigation with microbiological monitoring. > Follow the precautions given under heading
IV
More than 2 Fungal colonies- Unacceptable > Repeat fumigation & thorough cleaning of all the
objects intimate with the patient using 70% Alcohol. See for any obvious fungal growth on walls
and ceiling.

Theatre
Surface Samples
Colony count per square feet.
Interpretation - Action to be taken.
Area (A) I.e. OT table and area adjacent to it.
Less than 5 colonies- Acceptable > No special action. Maintain regular fumigation and Mopping
5-9 Colonies- Undesirable > Follow the precautions given under heading IV. Maintain regular
fumigation and Mopping.
D10 colonies- Unacceptable > Repeat fumigation with microbiological monitoring.

Theatre
Surface Samples
Area (B) I.e. Area Away from the OT table.
<19colonies>No special action. Maintain regular fumigation and Mopping
>=20colonies- Unacceptable >Repeat fumigation with microbiological monitoring.

Theatre
Precautions taken to keep low bacterial counts in operation theatre
1. Allow only those who are absolutely needed to be in the operation theatre
2. Maintain in and out movements as minimum as possible
3. Prompt disposal of OT waste outside the OT complex.
4. Use of 10% sodium hypochlorite solution to clean blood and body fluid spillages.
5. Frequent and proper hand washing saves many lives.
6. Check for hand washing solution which should ideally have a combination of phenolic
compound and a surfactant ( alcohol with chlorhexidine, chlorlheximide 2% or 4%, povidone
iodine 7.5% or triclosan 1% etc).
7. Request for inspection/cleaning of A/C ducts should be made every 3rd month.
8. More than 2 consecutive Monitoring reports indicating the growth of Staphylococcus aureus
specially Methicillin resistant(MRSA) and Multidrug resistant strains of Pseudomonads, should
alert the screening for carriers amongst the regular OT Personnel.

How frequently we can do the Surveillance for Air borne Microbes.
Yet there is no definite answer to this question. Doing too frequent surveys are expensive
and will not correlate the existing infection rate in the Hospital.
But can indicate the circumstance we operate which can have bearing effect if the safety
standards fall Surveillance for Clostridia spores
The age old tradition of detection of anaerobic spores of C.tetani, and Gas gangrene
producing organisms are losing ground with onset of more awareness on theatre
sterilization. Routine testing for the Anaerobes is not essential except when there were
suspected cases of Tetanus or Gas gangrene attributed to operating in a particular Operation
theatre.
But it is ideal to survey the Operation theatres for anaerobes when newly constructed or any
remodeling or structural alterations are done. In such situations which will have trustworthy
safety of the theatre.

Sterilization & Disinfection of Operation
Theatres and Critical Care areas
General Instructions
1. Keep the floor dry when in use.
2. Use only vacuum cleaners (booming to be forbidden as it will dispense the infected
material all around and on the equipments.
3. Chemical disinfection of an operation room floor is probably unnecessary. The bacteria
carrying particles already on the floor are unlikely to reach an open wound in sufficient
numbers to cause an infection (Ayliffe et al 1967. Hombroeus et al 1978) Cleaning alone
followed by drying will considerably reduce bacterial population.
4. Wall and Ceilings- Wall and ceiling are rarely contaminated. The numbers of bacteria do
not appear to increase even if walls are not cleaned. Frequent cleaning is not necessary
and has little influence on bacterial counts. Routine disinfection is therefore unnecessary,
but only cleaned when dirty.

Environmental Cleaning of Operation Theatres
At the Beginning of the Day
1. Only remove the dust with cloth wetted with clean water. ( Mop theatre furniture lamps, sitting
tables, trolley tops, operation tables, procedure tables, Boyle's apparatus)
Note: Need not use chemicals/disinfectants unless contaminated with blood or body fluids
Between the procedures
Clean operation tables or contaminated surfaces with disinfectant solutions.
1. In case of spillages of blood/ body fluids decontaminate with bleaching solution/ chlorine
solution (10% available chlorine)
2. All discard waste in plastic bags (do not accumulate around surgical sites)
3. Do not discard soiled linen and gowns in the operation theatre floor.

At the end of the day
1. Clean all the table tops, sinks, door handles with detergent followed by low level disinfectant.
2. Clean the floors with detergents mixed with warm water.
3. Finally mop with disinfectant like phenol in the concentration of 1 in 10 (low concentrations of
phenol will not serve the purpose).
4. Keep the operation theatre dry for the next day's work

Fumigation
• Seal the room with adhesive tapes round the edges of the doors/windows and ventilators and
apertures.
• For Each 1000 cu.ft of space place 500ml formaldehyde (40% solution) and 1000ml of water in
an electric boiler. Switch on the boiler, leave the room and seal the door.
• Seal the room for 24 hrs
• Then open the door and neutralize any residual formaldehyde with ammonia by exposing
250ml of S.G 880 ammonia/ 1Lt of formaldehyde used. (Ref - Mackie and McCartney Practical
Medical Microbiology 13th Edition)
• Fumigation is obsolete in many developed nations in view of toxic nature of Formalin. Too
frequent use and inhalation is hazardous
• Several new safe chemicals are emerging but constrains of economy limit the use and several
hours of closure of operation theatres can be curtailed with Fumigation.

Precautions to reduce the rate of Infections
1. Every Hospital must constitute Infection control committee to monitor the events in the Hospital.
2. The entry of unnecessary personnel to be restricted into operation theatres.
3. A thorough washing with warm water and good detergent and carbolisation can bring overall
improvement
than mere fumigation.
4. Frequent monitoring and training of medical and paramedical staff must carry high priority than
mere
mechanical and chemical methods.
5. Thorough washing and carbolisation if done everyday after the surgeries will greatly enhance
the safety
standards and economize the repeated expenditure on fumigation.

Training of Paramedical Staff/Residents
1. The short solution to control infection lies with trained staff.
2. The principal and control of infection to all new comers and junior staff should be a goal of any
good Institution.
3. Formulate guidelines update as per the changing situation in control the infection.
4. Institute should formulate ideas on infection control to the need of circumstances, as there are
no fixed guidelines or formulae to control to suit all occasional.
5. Simple repeated hygienic hand wash is most cost effective method to reduce several infections
in Hospitals, in particular operation theatres

Conclusion
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 aninfection free environment of hospital and
save valuable life and money.

References
1. Guidelines for Central Sterile Supply Department (C.S.S.D.) & Mechanized Laundry
2. Surveillance and Sterilisation of Operation Theatres in the Developing World by - Dr. T.V. Rao
MD & Dr.Chithra.VN MD
3. www.ssmwdworld.com
4. Ananthanarayan and Paniker’s text book of microbiology,8th edition
5. Koneman’s color atlas and textbook of microbiology, 6th edition
6. Bailey and Scott’s textbook of microbiology, 12th edition
7. Jawetz, Mel nick and Adelberg’s medical microbiology, 23rd edition
8. Mackie and Mc Cartney’s textbook of practical microbiology, 14th edition

CSSD & OT - June.pptx

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