Central Sterile Services in Hospitals Sterilisation Support Services Nosocomial Infection

1. Central Sterile
Services in a Hospital
Dr. Syed Amin Tabish
FRCP, FACP, FAMS, MD (AIIMS)
Postdoc Fellowship, Bristol University (England)
Doctorate in Educational Leadership (USA)

2.  The Central Sterile Supply
Department is responsible
for preparing medical/
surgical supplies and
equipment so that they are
sterile and ready for use in
patient care

3.  The Sterile Processing
Department (Central Supply, or
Sterile Supply as it is also
known), comprises that service
within the hospital in which
medical/surgical supplies and
equipment, both sterile and
nonsterile, are cleaned,
prepared, processed, stored,
and issued for patient care

4. The work of scientists W.B. Underwood
and J.J. Perkins was instrumental in
encouraging health care facilities to
establish a separate and distinct
department, the Sterile Processing
Department, with specialized expertise
and direct responsibility for providing
clean and sterile medical/surgical
supplies and equipment to patient care
areas.

5.  1928 – American College Of
Surgeons – CSSD
 1942 – World War II .Cairo, British
SDS Unit
 1955 – Cambridge Military Hospital
– Regular CSSD in UK
 1965 – First CSSD in India –
Safadarajan Hosptial

6. CSSD
• Sterile Processing Departments are
typically divided into four major areas to
accomplish the functions of
decontamination, assembly and sterile
processing, sterile storage, and
distribution.
• In the decontamination area, reusable
equipment, instruments, and supplies are
cleaned and decontaminated by means of
manual or mechanical cleaning processes
and chemical disinfection.

7. CSSD (contd)
• Clean items are received in the assembly and
packaging area from the decontamination area
and are then assembled and prepared for
issue, storage, or further processing (like
sterilization).
• After assembly or sterilization, items are
transferred to the sterile storage area until its
time for them to be issued.
• Several major functions are carried out in the
distribution area: case cart preparation and
delivery; exchange cart inventory,
replenishment and delivery

8. Steps in the Decontamination Process
• Transport
• Attire
• Sorting
• Soaking
• Washing [Detergent, Equipment, Ultrasonic, Inspection]
Types of Packaging
• Textiles
• Nonwovens
• Pouch packaging
• Rigid container systems

9. Sterilisation Process
• Bacterial spores are the most resistant of
all living organisms because of their
capacity to withstand external destructive
agents. Although the physical or chemical
process by which all pathogenic and
nonpathogenic microorganisms, including
spores, are destroyed is not absolute,
supplies and equipment are considered
sterile when necessary conditions have
been met during a sterilization process.

10. Objective
 To provide sterilized material
from a central department where
sterilizing process is carried out
under properly controlled
conditions
To alleviate the burden of work of
the nursing personnel, there by
enabling them to devote more of
their time to patient care .

11. Advantages
1. Bacteriological safe sterilization.
2. Less expensive.
3. Elimination of unsound practices &
establishment of standard procedures.
4. Assurance of adequate supply of sterile
products immediately and constantly available
for sometime as well as emergency use
5. Conservation of trained staff.
6. Better quality control
7. Better good of material flow
8. Prolonged life by proper care of equipment

12. Items Commonly handled by CSSD:
1. Syringes
2. Procedure Sets
Lumbar puncture ; sternal puncture ; venesection ;
paracentesis ; aspiration ; catheterization ;
tracheotomy ; suturing ; dressing ; biopsy ; incision &
drainage ; aortography ; cardiac resuscitation ; etc
3. Needles
4. Gloves
5. I.V.Fluids.
6. Treatment Trays.
7. O.T Instruments.
8. O.T. Linen
9. Infusion Fluids for Renal Dialysis

13. PLANNING a CSSD
1. Physical Planning
2. Functional Planning
3. Personnel Planning
4. Equipment Planning
5. Financial Planning
6.Quality Control
7.Preventive Maintenance

14. ADM & STORAGE
(UNSTERILE) AREA
21² M
SCALES OF
ACCN FOR
ARMED
FORCES
HOSPITALS
AH/CH/ SAY >
700 BEDS
RECEPTION,CLEANING,
CHECKING,ASSEMBLY
& PACKING AREA
35² M
AUTOCLAVING AREA 28 ² M
STERILE STORAGE &
ISSUE AREA
28 ² M
TOTAL 1,320 ² ft
(COPP)
Physical Facilities
Average – 10 SQFT / BED

15. CSSD Equipment

16. OTHERS
1.Maint & Repair EQPT
2.Adequate number of cabins &
Furniture
3.Telephone or intercom.
4.Adequate no of syringes &
procedure sets.

17. Methods Of Sterilization / Disinfection
Natural Chemical Physical
Sun Light (UV)
Air
(Desiccation)
Solids
Lime, Bleeching Powder,
KMNO4
Liquids
Formalin, Phenol , Alcohol ,
Glutaraldehyde
Gases
Formaldehyde, Ethylene
Oxide
Dry Heat
Burning or Dry Air
(160°C for 60 Min)
Moist Heat
Boiling Steam
Radiation
Ionising Radiation
U V Rays

18. CIDEX – A Glutaraldehyde derivative is most
effective as it destroys spores too.
ETHYLENE OXIDE (ETO) ;
- Quite effective against spores too.
- Useful for delicate instruments and item
which can’t be immersed in liquids
- Low Boiling Point (10 degree C)
- Prolonged Aeration
- Highly Expensive / Explosive / Toxic

19. Sterilization Techniques
1.Dry Heat
2.Steam High Pressure Autoclaves operated by
Gas, K.oil or Electricity ( Flash, Pulse)
3. Ethylene Oxide Sterilization.
4. Chemical Sterilization.
5. Radiation Sterilization.
- Infra Red Radiation – Syringes
- Ultra Violet Radiation – Decontamination of Air
- Ionising Radiation / Gamma Radiation
ISOMED at BARC

20. STERILISATION
It is a process of freeing an article
from all living organisms including
bacteria ,fungal spores and viruses.
A material is pronounced sterile if it
achieves 99.99% kill of bacterial
spores.

21. STEAM STERILATION
- Water  Saturated  Wet vapor  Dry
saturated Vapor  Super Heated Vapor /
Steam
- Steam with <0.95 Dryness Factor is not
useful for Sterilization.
- Superheated Steam acts like Dry Hot Air
only . ( Strength Of Steam is its Latent
Heat)

22. MODE OF ACTION.
Dry Heat  Oxidation
Steam  Denaturation = Coagulation of
Proteins
Sterilization Time
(Holding Time + Safety
Time)
Pressure
(PSI)
Temperature
( C° )
2' + 1′ = 3'
8' + 2' = 10'
12' + 3' = 15'
30
20
15
134
126
121

23. TYPES OF AUTO CLAVING MACHINES
1. Downward Displacement
2. Vacuum Assisted.
3. Pulsed Steam Dilution

24. TESTS FOR EFFICENCY OF STERILISATION
1. Specially treated paper strip.
2. Pressure sensitive tape to be fixed to the
final fold
3. Brown indicator tubes - (very expensive)
4. Biological. Green strip containing bacteria
(Color must change to black)

25. 5. Cellophane wrapped tablet
containing
- Lactose - 75%
- Starch - 24%
- Magnesium Trisilicate – 1% (Tablet
turns brown during autoclaving)
6. Microbiological examination of finished
products.
7. Thermo - couples .

26. ADVANTAGES OF STEAM STERILISATION
1. Rapid heating & penetration of
loads
2. Destruction of all forms of
microbial life
3. No residual toxicity
4. No damage to supplies being
sterilised
5. Easy Quality Control
6. Economical & Reliable
This method is unsuitable for heat sensitive and
non- permeable material

27. RADIATION STERILISATION ;
‘ ISO MED ‘ at ‘BARC’ Trombay; dose -
2.5 Mega Rhontgen; Source – Cobalt-
60 /Caesium – 137/ Electron Beam
(generated by linear accelerator)
Reliable, can penetrate all types of
packing. Large & diverse shaped
articles can be sterilised. No residual
radio activity at 2.5 mega rhontgens.
Glass becomes dark, cotton looses
tensile property, food gets undesirable
flavor. Not practicable in hospitals

28. DISTRIBUTION SYSTEMS :
1. Regular issue of one day’s
requirement.
2. Clean for dirty exchange.
3. Milk round system (topping up
predetermined stock level)
4. As on required basis. (Grocery
system)

29. FLOW PROCESS : CSSD
WARDS/DEPTS BULK STORES
DIRTY RECEIPT CLEAN RECEIPT COTTON & GAUGE
DISASSEMBLY
INSTRUMENT GLOVES RUBBERWARE
WASHING AREAS
ASSEMBLY
PRE – STERILE STORAGE
INSPECTION
STERILISATION STERILESTORAGE
DISTRIBUTION

30. A SUGGESTED LAYOUTOF
CSSD
INTRA MURAL COMMUNICATION LINE
RAMP
ASSEMBLY
(PARKING)
CLEANING&
WASHING
AUTOCLAVE
ROOM
GLASS PARTITION
STERILE
STORAGE
STERILE
ISSUE
clean
recepti
on
Clean
storage
Supervisors
office
Verandah
disasse
mbly
Dirty
recep
tion
° °
°
° 0
° °
° °

31. Thermal Death Time (TDT)
 TDT is the time required to kill a known
population of microorganisms in a
specific suspension at a particular
temperature
 Increasing temperature decreases TDT
 Lowering the temperature increases
TDT
 Acidic or basic pHs decrease TDT
 Fats and oils slow penetration and
increase TDT

32. Administrative Monitoring
• Decontaminating, terminally sterilizing, and cleaning
all reusable items; disposing of disposable items.
• Packaging and labeling of items.
• Loading and unloading the sterilizer.
• Operating the sterilizer.
• Monitoring and maintaining records of each cycle.
• Adhering to safety precautions and preventive
maintenance protocol.
• Storing of sterile items.
• Handling sterile items ready for use.
• Making sterile transfer to a sterile field.