CSSD Central Sterile Supply Department. “ 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.
CSSDCentral Sterile Supply Department
“ 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 – SafadarajanHosptial
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
2. Procedure Sets
Lumbar puncture ; sternal puncture ; venesection ; paracentesis ; aspiration ; catheterization ; tracheotomy ; suturing ; dressing ; biopsy ; incision & drainage ; aortography ; cardiac resuscitation ; etc
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 .
1. Physical Planning.
2. Functional Planning.
3. Personnel Planning.
4. Equipment Planning.
5. Financial Planning.
1. Location & Grouping .
2. Lay Out & Space Reqts.
3. Fixturtes & Furniture .
RULE OF THE THUMB
ROUGHLY – 10 SQFT / BED - MCGIBONY
1.Jet water cleaning gadgets.
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.
Total: 4.5 to 5 times of the daily requirement
Methods Of Sterilization / Disinfection
Natural Chemical Physical
Sun Light (UV)
Lime, Bleeching Powder, KMNO4
Formalin, Phenol , Alcohol , Glutaraldehyde
Formaldehyde, Ethylene Oxide
Burning or Dry Air
(160°C for 60 Min)
Ionising Radiation U V Rays
CIDEX – A Glutaraldehyde derivative is most effective as it destroys spores too.
ETHYLENE OXIDE (ETO) ;
- Low Boiling Point (10 degree C)
- Prolonged Aeration
- Highly Expensive / Explosive / Toxic
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
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.
- 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
TYPES OF AUTO CLAVING MACHINES
1. Downward Displacement
2. Vacuum Assisted.
3. Pulsed Steam Dilution
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 .
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
BHATTA CHARJEE RECOMMENDS :
SUPERVISORS (sister/male ward masters) 4
STAFF NURSES 5
TECHNICIANS (ORA) 6
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
COTTON & GAUGE
INSTRUMENT GLOVES RUBBERWARE
PRE – STERILE STORAGE
A SUGGESTED LAYOUTOF
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INTRA MURAL COMMUNICATION LINE