
“
No Stronger Condemnation of any hospital or ward could be pronounced than the simple fact that ZYMOTIC DISEASE has originated in it or that such disease attack other patients than those brought-in with
FLORENCE NIGHTINGALE

 BHATTA CHARJEE DEFINES –
CSSD as that service, with in the hospital, catering for the sterile supplies to all departments , both to specialized units as well as general wards and OPDs.

 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


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 .

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

ITEMS COMMONLY HANDLED
BY
CSSD STORES

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.
10. At times LINEN. (other than O.T)
NB: Diet , drugs , bedpans & urinals are not included by convention .

PLANNING A DEPT ; (COPP)
1. Physical Planning.
2. Functional Planning.
3. Personnel Planning.
4. Equipment Planning.
5. Financial Planning.
6.Quality Control.
7.Preventive Maintenance.

1. Location & Grouping .
2. Lay Out & Space Reqts.
3. Fixturtes & Furniture .

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

1.Jet water cleaning gadgets.
2.Ultrasonic Washers
3.Glove sharpener
4.Needle sharpener.
5.Gas, Chemical or steam autoclaves.
6.Testing apparatus for efficiency of sterilization

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

NUMBER OF SETS/SYRINGES
A - 1½ Daily requirement in use at wards / Departments
B - 1 Daily requirement in sterile state at CSSD, ready for issue
C - 1 Daily requirement being processed at CSSD
D – 1to 1½ Daily requirement held in reserve – dome in CSSD, some in medical stores
Total: 4.5 to 5 times of the daily requirement

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

-
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

Types Of 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

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.

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)

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

1. Downward Displacement
2. Vacuum Assisted.
3. Pulsed Steam Dilution

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)

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 .

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

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

STAFFING :CSSD
BHATTA CHARJEE RECOMMENDS :
SUPERVISORS (sister/male ward masters) 4
STAFF NURSES 5
TECHNICIANS (ORA) 6
ATTENDANTS 24
SWEEPER 4
CLERK 1
TOTAL 44
CENTRALISED SUPPLY (RULE OF THUMD 2PER 100 BEDS)

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)

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

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

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

Thermal Death Time ( cont.)

Acidic or basic pHs decrease TDT

Fats and oils slow penetration and increase
TDT