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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.

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Cssd central sterile supply department

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


AIMS

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 .


Advantages
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



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
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.


Physical plng
PHYSICAL PLNG

1. Location & Grouping .

2. Lay Out & Space Reqts.

3. Fixturtes & Furniture .


RULE OF THE THUMB

ROUGHLY – 10 SQFT / BED - MCGIBONY


Eqpt in cssd
EQPT IN CSSD

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


Others
OTHERS

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
NUMBER OF SETS/SYRINGES

Total: 4.5 to 5 times of the daily requirement


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


Chemical
CHEMICAL

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
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
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


TYPES OF AUTO CLAVING MACHINES

1. Downward Displacement

2. Vacuum Assisted.

3. Pulsed Steam Dilution


Tests for efficency of sterilisation
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
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
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

AUTOCLAVE ROOM

ASSEMBLY

(PARKING)

STERILE STORAGE

CLEANING&

WASHING

GLASS PARTITION

Supervisors office

disassembly

Clean storage

Verandah

STERILE ISSUE

Dirty reception

° ° °

° 0 ° ° ° °

clean reception

RAMP

INTRA MURAL COMMUNICATION LINE



Thermal death time tdt
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
Thermal Death Time ( cont.)

  • Acidic or basic pHs decrease TDT

  • Fats and oils slow penetration and increase TDT


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