Central Sterile Supply Services
Definition
The Central Sterile Supply Department (CSSR) is the one which
receives, processes, sterilizes, and distributes the medical supplies
and equipments to various departments of the Hospital clinics
like operation theatre (OT) and wards. The unit is centralized for
whole Hospital. The centralized unit is called as central Sterile
Supply Unit.
OBJECTIVES
• To process, maintain and dispense sterile supplies and equipment to
provide the most suitable material available for patient care.
• To be equipped with best known methods and techniques of
processing sterile material.
• To participate as an active member of the clinic’s infection control
program, etc.
• To impart knowledge and education inside the clinic about sterile
services.
FUNCTION
This department, also known as sterile processing
and distribution or central sterile services, is
responsible for the receiving of all used and / or
contaminated instruments, equipment and linen
from OT and OPD and the cleaning and
additional processing necessary for reuse.
This department may also include distribution of
supplies to patient units and other departments.
The main functions will include
Rinsing of articles should be permitted in
washing area by a trained member of the staff
Receiving and Counting of un-sterile equipments
Sorting of contaminated instruments, utensils and
equipments for appropriate cleaning.
If instruments are labelled ‘infected’ they should be put
through the disinfection cycle of the autoclave without
opening the packet.
Cleaning of instruments, utensils and equipments by hand.
Inspecting, assembling, wrapping and labelling of
procedure packs, trays and instruments sets.
Sterilization of procedure packs, trays, and /or instruments
sets. All sets need to have an indicator slip, which changes
colour on exposure to correct temperature, pressure and
time. The sets also have to be labelled with the name of the
set and expiry date.
Storage of sterilized supplies in sterile area.
Distribution of clean and/or sterilized supplies and
equipment to the appropriate user department
Inventory and charge control of supplies and
equipment delivered.
Working Flow Chart of CSSD
Receiving Unsterile Articles
Accounting and sorting
Washing, Cleaning & Drying
Packing
Linen processing and
assembling
Storage area for items awaiting
Sterilization
Sterilization Sterile Storage
Issue Sterile Products
The CSSD must be designed in such a way
that the flow of activities must be Uni-
Directional from unclean to clean area.
There should be minimum cross
movement to reduce the risk of cross
contamination.
Main areas of Sterilization Department
1. Decontamination Area:
All the user departments are to rinse the instruments prior to sending them to the
Sterilization Department.
Infected Instruments should be labelled “INFECTED”, by the user
department whereby a disinfection process would be carried out in the
washing area. The disinfection cycle of the instruments will be carried out by
autoclaving the instruments without opening the packet.
Dirty instruments will be received in the Decontamination Area or receiving area,
where they will be cleaned and dried. Any instrument with stains is to be washed
manually with detergent.
Decontamination area is considered a restricted area with increase potential
for contamination from blood or body fluid pathogens on the soiled utensils,
carts, and materials. So all the personnel dealing with dirty and infected
instruments should take safety measures. They should be strictly instructed to use
Personal Protective Equipment (PPE) such as gowns, aprons, masks, gloves,
head coverings and shoe covers.
Each item should be inspected for functionality, defects, and breakage then
appropriately assembled if required.
2. Preparation and Packing
Generally called “Prep and pack “, this is a clean area where items
processed in decontamination are received, inspected, reassembled, wrapped,
and sterilized.
Articles for sterilization should be packed in porous linen.
Labelling: Each pack should be marked with Date of Sterilization, Date of
Expiry, Pack Number, Procedure Name, and List of Contents (in a double
pack).
Sterilization equipment is a part of this area; storage also is required for supplies
used in assembling instrument sets and other sterilized items.
Strictly quality control policies and procedures must be followed in sterilization
processes.
Instructions regarding the operation of the machines should be explicitly
explained to all the personnel of the department.
Routine periodic inspection of all the machines will be done to ensure that the
outsourced agency is providing regular and periodic maintenance as per their
annual maintenance contract.
The temperature and the loads to be put into the machines are to be monitored,
to ensure optimum utilization of the equipment under given standards.
3. Issue of Sterile Supplies:
The issue system to be employed shall be as follows:
Each user department will be allocated a pre-determined number
of sets of instruments.
As and when the material / set is used the same will be sent to
the SSD periodically and deposited in credit.
This set will be rendered sterile and made available to the
user
department within a time period of 24-hours.
Emergency requisitions shall be treated accordingly.
The advantages of this system are:
The user department itself gauges the requirement of sterile
stock depending upon its experience.
Since each department will have it’s own stock of material
dedicated the management can assess the performance of the
user staff in handling of the material supplied by the SSD.
5. Shelf life
The shelf life of packaged sterile item depends upon:
Quality of wrapper material – Porous Linen
Storage condition
Conditions during transport
Amount of handling
A sterile tray packed in porous linen and stored under clean
conditions and not handled unnecessarily may be fit for use for 72
hrs.
6. Access:
Entry into the SSD would be restricted to authorized personnel
only, i.e. the Technicians and Nursing Aides working in the SSD
Other authorized persons will be as defined by the District Manager.
7. Equipment Maintenance
(i). In case of any wrong reading being detected or the equipment not
performing appropriately the District Manager should be
informed through the maintenance requisition slip, who would
initiate appropriate action.
(ii). All maintenance records would be maintained determining
the equipment down time and the repairs conducted for the
equipment –along with the party who have done
(iii). Any equipment to be scrapped will be done only under the
authorization of the DM and Technical Head.
(iv). Stock audit of the instruments will be carried out on a half
yearly basis and there will be special random checks of the Wards,
OPD and OT, under supervision of the District Manager.
8. Requisitioning for new item
Whenever any item is required, SSD will send requisition to
DM and will place the order for procuring items. Later
Main store will receive the item from supplier and issue to
SD department.
Store Purchase Department
SD DM
The SSD will keep disposable as well as reusable items.
(There are few items like catheters, tubing, which can be
reused from 3 to 5 times by resterilization. This concept is
used on the basis of specifications given by the manufacturer
of the item. ) Annexure -List of reusable items and the
number of uses Special consideration will be given to
linen packs and sterile instruments since their sterility can
become outdated and hence all stock will be dated and
rotated accordingly, on a “First in, First out” (FIFO) basis.
[Link] of Pack or set:
A set is basic grouping of all sterilizable instruments and
consumables that would be required for surgery.
These groups are made so that the transits of instrument to &
from the SSD are facilitated and no instruments are found
missing when the operations begin.
A set is specific to each operation (ex: Vasectomy set) and at times,
it is surgeon specific also. The compositions of the sets have to be
determined by the surgeons and data will have to be collected in
form of masters. An example is cited below:
Operation name:
Name of set:
Composition:
Usually these instruments are packed together in a tray and the set
also assumes name by the tray (ex: NSV tray).
Each tray is covered with linen and a label is marked on the linen.
10. QUALITY CONTROL
The parameters to be taken into consideration to maintain sterility of equipment:
Graphic recordings will be maintained. The daily graphic records of each cycle
will be maintained for a minimum period of one year.
Chemical parameters:
Bowie Dick tape [Steam indicator tape] is affixed on every pack before loading.
Once the required temperature is achieved in the chamber, the
colour of the tape changes [white to dark brown]
Material Method Duration of Treatment
OT Linen, Gauze Piece & Autoclave 121 C at 15 Pound/sq inch
Cotton pressure for 30 minutes.
Rubber goods (Gloves & Autoclave 121 C at 15 Pound/sq inch
Rubber sheet) pressure for 15 minutes.
Surgical Instruments – Autoclave 121 C at 15 Pound/sq inch
Metal pressure for 45 minutes.
Sharp Surgical Instruments Chemical 2% glutaraldehyde (Cidex)
Treatment solution for at least 8 to 10
hours.
Microbiological testing
Periodically, once in two weeks a capsule [biological indicator]
consisting of bacillus stereothermophilus is kept along with a load.
After the cycle is over, the capsule is sent to the Microbiology
Laboratory where the viability of the organisms is checked.
These organisms are supposed to be the most resistant to the heat. If
they are killed, it can be presumed that the packs are sterile.
In case of any aberrant results while testing any of the parameters,
the bio-medical engineers/equipment maintenance personnel would
be informed for performing an equipment check.
Besides the above three parameters, certain other factors
that will help in contributing towards the quality of the
department are:
Sterile area is to be fumigated once a week.
11. Record and Reports to be maintained in sterilization
department
The following records should be maintained:
Receipt Register: This option will allow user to receive all soiled, used
articles from different departments. Where user will enter the data like
department code, dept name, list of packs, items received with quantity, time of
receipt, name of the person who brought all items from department to SSD etc.
Issue item: This option will allow user to issue items to user dept’s
depending upon the issue system .
Replacement items: This option will allow SSD to replace damaged or unused
items and instruments with new articles for user department.
Equipment log book : This option will allow user to maintain a complete log
book of all equipment and contain the following features like equipment
breakdown time, period, engineer, type of service (AMC or any
other),performance, calibration reports data( periodic or randomly) etc. This
feature must be networked with maintenance department/ Biomedical
Engineering department.
Daily Activity recording equipment-wise e.g. daily recording of each
sterilization cycle with temperature, pressure, load, time period etc
• For Steam Sterilizer:
a. Sterilizer Instruction Manual
b. Record of each cycle
c. Record of thermographs of each cycle
d. Chemical Indicator
e. Daily Air Removal Indicator Test
f. Weekly Vacuum Leak Test
g. Weekly Spore Test or Biological Indicator Result
Random & Planned Micro-biological testing or infection control
auditing
Reports: To measure and check the degree of infection in SSD, random
and planned micro – biological tests are carried out. These tests should
also be recorded (Test no, Date, type of test, Name of the test, test done by,
Result, conclusion, recommendations, follow-up & post-follow-up testing)
13. MIS Reports
List of infection control tests and their result and recommendations
weekly/ monthly /yearly .