INTERNSHIP PROJECT ON

DEPARTMENT OF CENTRAL STERILE SUPPLY

DEPARTMENT

PREPARED BY
RIYA SAJJAN
MBA HEALTHCARE 1ST YEAR
 TABLE OF CONTENT
SR NO PARTICULARS PAGE NO
1 INFORMATION ABOUT
INDRAPRASTHA APOLLO
HOSPITAL

2 AIMS & OBJECTIVES

3 METHODOLOGY

4 INTRODUCTION OF CSSD

5 FUNCTION OF CSSD

6 LOCATION OF CSSD

7 STAFF

8 WORK FLOW AND SPACE PLANING

9 RECEVING AREA
 TABLE OF CONTENT
SR NO PARTICULARS PAGE NO

10 CLEANING AREA

11 PACKING AREA

12 STERILIZING AREA

13 STORE

14 DISTRUBATION AREA

15 SUPPORT AREA IN CSSD

16 CSSD AT SHRI KRISHNA HRUDALAYA

AND CRITICAL CARE

17

18
 INFORMATION INDRAPRASTHA APOLLO HOSPITAL

 INTRODUCTION
 PATIENT CARE
Established by Dr Prathap C Reddy in 1983, Apollo Healthcare has a robust
presence across the healthcare ecosystem. From routine wellness &
preventive health care to innovative life-saving treatments and diagnostic
services, Apollo Hospitals has touched more than 120 million lives from over
120 countries, offering the best clinical outcomes. Indraprastha Apollo Hospital
Delhi is Best Hospital in Delhi.
11,000+ Healing Hands - Largest network of the world’s finest and
brightest medical experts who provide compassionate care using
outstanding expertise and advanced technology.

4,500+ Pharmacies - Apollo Pharmacy is India’s first, largest and most

trusted branded pharmacy network, with over 4500 plus outlets
covering the entire nation

Most Advanced Healthcare Technology - Apollo Hospitals has been the

pioneer in bringing ground-breaking healthcare technologies to India.

Best Clinical Outcomes - Leveraging its vast medical expertise &

technological advantage, Apollo Hospitals has consistently delivered
best in class clinical outcomes.
 INFORMATION ABOUT INDRAPRASTHA APOLLO
HOSPITAL
 SPECALITY SERVICES
 HEART
 SPINE
 ORTHOPAEDICS
 CANCER CARE
 NEUROSCIENCES
 GASTROENTEROLOGY
 TRANSPLANTS
 CRITICAL CARE
 BARIATRIC SURGERY
 ROBOTICS
 PREVENTIVE HEALTH CHECK
 INFORMATION ABOUT INDRAPRASTHA APOLLO
HOSPITAL
 CORONARY ANGIOGRAPHY & ANGIOPLASTY
 BYPASS OPERATION
 2D ECHO AND COLOUR DOPPLER
 BALOON VALVE TREATMENT
 FETAL ECHO
 ARRYTHMIA CLINIC
 ICCU
 COMPUTERISED TMT
 PACEMAKER HUT TEST
 24 HOURS EMERGENCY
 CRITICAL CARE UNIT
 NEURO SURGERY
 ORTHO SURGERY
 TRAUMA CARE
 GENERAL SURGERY
 DIALYSIS
 24 HOURS AMBULANCE
 LOCATION
 INDRAPRASTHA APOLLO HOSPITAL, MATHURA RD, NEW DELHI,
DELHI 110076
 HOURS: OPEN 24 HOURS
 TEL. NO. : 1860 500 1066
 Consult Apollo 24×7 for 24 hour services.
 AIM
TO STUDY THE PLANNING, ORGANISATIONAL STRUCTURE, MANAGEMENT,
EVALUATION AND GIVE RECOMMENDATIONS IF ANY OF CENTRAL STERILE
SUPPLY DEPARTMENT

OBJECTIVES
•TO STUDY ORGANISATION AND WORKING OF CENTRAL STERILE
SUPPLY DEPARTMENT.

•TO SEE THE FACILITY AND SERVICES PROVIDED BY CENTRAL

STERILE SUPPLY DEPARTMENT.

•TO FIND OUT ANY NEED TO IMPROVE BASIC SERVICES

PROVIDED BY CENTRAL STERILE SUPPLY DEPARTMENT.
 METHODOLOGY
AN OBSERVATIONAL STUDY WAS
CARRIED OUT IN CENTRAL STERILE
SUPPLY DEPARTMENT AT INDRAPRASTHA
APOLLO HOSPITAL, DELHI.

THE DATA HAS BEEN COLLETED

THROUGH OBSERVATIONAL AND
INFORMAL DISCUSSION WITH DOCTORS,
NURSES, PATIENTS & OTHER STAFFS.
 INTRODUCTION OF CSSD
 ENSURING A HIGH STANDARD OF STERILIZATION AND
DISINFECTION TO MINIMIZE THE INCIDENCE OF HOSPITAL
INFECTION HAS BEEN UPPERMOST IN THE MINDS OF
CLINICIANS AS WELL AS HOSPITAL ADMINISTRATORS.
STANDARDIZATION OF SURGICAL DRESSINGS, AND
CENTRALIZING ALL SURGICAL SUPPLIES FROM ONE POINT
OF ORIGIN WERE NECESSITATED DURING THE SECOND
WORD WAR BECAUSE OF THE REQUIREMENT OF A LARGE
NUMBER OF CASUALTIES IN DIFFERENT THEATERS OF WAR.
THE CONCEPT OF A STERILE SUPPLY ORGANIZATION, IN
THE FORM OF AN INDEPENDENT UNIT OR ONE ATTACHED
TO LARGE BASE HOSPITALS CAME INTO BEING.
 STERILIZATION ACTIVITIES IN A HOSPITAL ARE BETTER
CENTRALIZED IN ONE SINGLE DEPARTMENT FOR
EFFICIENCY AND EFFECTIVENESS. THIS DEPARTMENT,
CALLED THE CENTRAL STERILE SUPPLY DEPARTMENT
(CSSD) BECOMES RESPONSIBLE FOR PROCESSING,
STERILIZING AND DISPENSING OF ALMOST ALL ITEMS
OF STERILE EQUIPMENT, SETS AND DRESSINGS IN THE
HOSPITAL. CENTRALIZATION OF STERILIZING
ACTIVITIES IN ONE DEPARTMENT HAS RESULTED IN
MANY ADVANTAGES, THE CHIEF AMONG THESE ARE (I)
IMPROVED EFFICIENCY, (II) STERILE SUPPLIES
AVAILABLE AT ALL TIMES OF THE DAY OR NIGHT, (III)
ECONOMY OF TRAINED MANPOWER, (IV) STERILIZATION
SAFETY AND (V) QUALITY CONTROL.
 THE OBJECTIVE OF ESTABLISHING A CENTRAL STERILE
SUPPLY DEPARTMENT IS TO MAKE RELIABLY STERILIZED
ARTICLES AVAILABLE AT THE REQUIRED TIME AND PLACE
FOR ANY AGREED PURPOSE IN THE HOSPITAL AS
ECONOMICALLY AS POSSIBLE, HAVING REGARD TO THE
NEED TO CONSERVE THE TIME OF USERS [ESPECIALLY
DOCTORS AND NURSES]. THE STERILE SUPPLY DEPARTMENT
WITHIN A HOSPITAL RECEIVES STORES, STERILIZES AND
DISTRIBUTES TO ALL DEPARTMENTS INCLUDING THE WARDS,
OUTPATIENT DEPARTMENT [OPD] AND OTHER SPECIAL UNITS
SUCH AS OPERATING THEATRE [OT]. MAJOR
RESPONSIBILITIES OF CSSD INCLUDE PROCESSING AND
STERILIZATION OF SYRINGES, RUBBER GOODS [CATHETERS,
TUBING], SURGICAL INSTRUMENTS, TREATMENT TRAYS AND
SETS, DRESSINGS ETC. IT IS RESPONSIBLE FOR ECONOMIC
AND EFFECTIVE UTILIZATION OF EQUIPMENT RESOURCES
OF THE HOSPITAL UNDER CONTROLLED SUPERVISION.
 THE CSSD ALSO AIMS AT ASSUMING TOTAL
RESPONSIBILITY FOR PROCESSING HOSPITAL ITEMS
THEREBY ASSURING THAT ALL OF THEM RECEIVE THE
SAME DEGREE OF CLEANING AND STERILIZATION. IT
ALSO CONTRIBUTES TO THE EDUCATIONAL PROGRAM
WITHIN THE HOSPITAL RELATING TO INFECTION
CONTROL AND DEVELOPS A COST-EFFECTIVE
PROGRAM BY COST ANALYSIS OF PERSONNEL,
SUPPLIES AND EQUIPMENT.
 FUNCTIONS OF CSSD
 RECEIVING AND SORTING SOILED MATERIALS USED IN THE HOSPITAL.

 DETERMINING WHETHER THE ITEM SHOULD BE REUSED OR DISCARDED.

 CARRY OUT THE PROCESS OF DECONTAMINATION OR DISINFECTION PRIOR TO STERILIZATION.

 CARRY OUT SPECIALIZED CLEANING OF EQUIPMENTS AND SUPPLIES.

 INSPECTING AND TESTING INSTRUMENTS, EQUIPMENTS AND LINEN.

 ASSEMBLING TREATMENTS TRAYS, INSTRUMENT SETS, LINEN PACKS, ETC.

 PACKING ALL MATERIALS FOR STERILIZATION.

 STERILIZING.

 LABELING AND DATING MATERIALS.

 STORING AND CONTROLLING INVENTORY.

 ISSUING AND DISTRIBUTING.

 LOCATION
 IN HOSPITALS WITH WELL-UTILIZED SURGICAL SERVICES, THE
OPERATION THEATERS (OT) REQUIRES HUGE SUPPLIES OF
STERILE SURGICAL INSTRUMENTS AND STERILE LINEN AND
THEY ARE THE MAJOR USERS OF CSSD. THE OTHER USERS OF
CSSD INCLUDE WARDS, ICUS, EMERGENCY AND LABOR ROOM
ETC. THEREFORE THE LOCATION OF CSSD SHOULD PREFERABLY
BE IN PROXIMITY TO OT AND SHOULD HAVE EASY ACCESS TO
OTHER USER DEPARTMENTS. IN SOME HOSPITALS, THE OT
COMPLEX HAS ITS OWN STERILE SUPPLY UNIT WITHIN OR JUST
ADJACENT TO IT. THIS IS KNOWN AS THEATER STERILE SUPPLY
UNIT (TSSU). THE AUTOCLAVE MACHINES IN THE CSSD EMIT LOT
OF HEAT SO THE FACILITY SHOULD HAVE AT LEAST ONE SIDE
EXPOSED TO OPEN SPACE. BECAUSE OF SHORTAGE OF SPACE,
NOW A DAY’S MANY HOSPITALS ESTABLISH THE CSSD IN THE
BASEMENT. THE CSSD CAN BE CONNECTED TO OT COMPLEX
THROUGH SMALL ELEVATORS.
 STAFF
 THE STAFF IN CSSD COMPRISE OF TECHNICIANS WHO OPERATE THE
AUTOCLAVE AND ETO MACHINES. ASSISTANTS WHO PERFORM THE
CLEANING AND PACKING, GAUGE CUTTING AND COTTON BALL MAKING
ASSIST THEM. THERE MAY BE CLERKS OR STOREKEEPERS TO MANAGE
THE INVENTORY AND STERILE STORES. ONE OR MORE HOUSEKEEPING
STAFFS MAY BE REQUIRED. A MANAGER SUPERVISES THEM ALL.

 CSSD IN CHARGE/ MANAGER

 CSSD TECHNICIANS

 CSSD ASSISTANTS

 HOUSEKEEPING STAFF
 WORK FLOW AND SPACE PLANNING
 MAJOR ACTIVITIES IN A CSSD ARE:

 RECEIVING THE USED ITEMS FROM USER DEPARTMENTS

 CLEANING

 PACKING

 STERILIZING

 STORING (TEMPORARY)

 DISTRIBUTING TO USER DEPARTMENTS

 THESE ACTIVITIES ARE CARRIED OUT IN ABOVE SEQUENCE AND

EFFORTS ARE MADE TO MAINTAIN A UNI-DIRECTIONAL FLOW OF
ACTIVITIES SO THAT STERILE AND UNSTERILE ITEMS REMAIN
SEPARATE. ACCORDINGLY THE SPACE PROGRAMMING IS DONE. EACH
AREA IS DESCRIBED BELOW:
 RECEIVING AREA
 USED ITEMS FROM VARIOUS DEPARTMENTS OF THE HOSPITAL ARE
SHIFTED TO CSSD FOR CLEANING AND STERILIZATION. IDEALLY THE
ITEMS THAT GET SOILED WITH BLOOD OR BODY FLUIDS SHOULD BE
DECONTAMINATED WITH SODIUM HYPOCHLORITE SOLUTION IN THE
USER DEPARTMENTS ITSELF SO THAT THE STAFFS WHO HANDLE
THESE ITEMS FOR TRANSPORTATION OR CLEANING ARE NOT EXPOSED
TO THE RISK OF CONTACTING INFECTIONS. AFTER DECONTAMINATION,
THEY ARE SHIFTED TO CSSD. THE STAFF OF THE USER DEPARTMENT
OR THROUGH CENTRALIZED STAFF CAN TRANSPORT THESE ITEMS TO
CSSD EITHER.

 THE RECEIVING AREA OF CSSD SHOULD HAVE ACCESS TO OUTSIDE

THROUGH A WINDOW WITH A COUNTER. THE ITEMS (ESPECIALLY FOR
INSTRUMENTS IN TRAYS) ARE COUNTED AND RECEIVED. THEREAFTER
THE INSTRUMENTS ARE INSPECTED AND BLUNT/ UNSUITABLE
INSTRUMENTS ARE SEGREGATED/ DISCARDED. NECESSARY ENTRIES
ARE MADE FOR RECORDS. THEREAFTER THE ITEMS ARE SHIFTED TO
CLEANING AREA.
 CLEANING AREA
 HERE THE INSTRUMENTS ARE WASHED EITHER MANUALLY OR IN MACHINES. FOR MANUAL,
WASHING SINKS WITH WATER SUPPLY AND WORKING COUNTERS ARE ORGANIZED.
DETERGENTS AND BRUSHES OF VARIOUS SIZES AND SHAPES ARE REQUIRED IN THIS AREA.
ULTRASONIC WASHER IS A MACHINE USED FOR CLEANING SURGICAL INSTRUMENTS. IT
CONVERTS HIGH FREQUENCY SOUND WAVES INTO MECHANICAL VIBRATION THAT
PRODUCES SMALL BUBBLES THAT BURST ON THE INTERNAL SURFACES OF INSTRUMENTS
AND DISLODGE THE WASTE PARTICLES.

 TUNNEL WASHER IS HIGHLY SOPHISTICATED AND EXPANSIVE MACHINE THAT ALLOWS

TOTALLY HAND-OFF PROCESSING. INSTRUMENTS IN PERFORATE OR MESH BOTTOM TRAYS
COMING FROM OPERATING ROOM OR OTHER DEPARTMENTS ARE PLACED INTO THE TUNNEL
WASHER WITHOUT ANY FURTHER HANDLING. THE INSTRUMENTS ARE SUBJECTED TO
CYCLES WASHING, RINSING, ULTRASONIC CLEANING AND DRYING. MOST OF THE HOSPITALS
CANNOT AFFORD THESE WASHERS.

  AFTER THE INSTRUMENTS ARE WASHED, THEY ARE DRIED IN OVEN DRYER AND SHIFTED TO
PACKING AREA.

 IF USED ITEMS ARE NOT DECONTAMINATED IN USER DEPARTMENT THAN BLOOD/ BODY
FLUID SOILED SHOULD BE DECONTAMINATED WITH SODIUM HYPOCHLORITE BEFORE
HANDLING FURTHER.
 PACKING AREA
 CLEAN AND DRY INSTRUMENTS ARE PACKED BEFORE STERILIZATION SO THAT THEY ARE
NOT CONTAMINATED WHILE HANDLING AFTER THEY ARE STERILIZED. WORKING COUNTERS
ARE REQUIRED IN THIS AREA. MOST OF THE INSTRUMENTS ARE PACKED IN TRAYS (TRAY
ASSEMBLY) THAT ARE WRAPPED WITH DOUBLE LAYER OF COTTON CLOTH. PAPER
ENVELOPES ARE ALSO AVAILABLE FOR PACKING THE INSTRUMENTS. THESE ARE EQUALLY
EFFECTIVE BUT EXPANSIVE. PLASTIC BAGS (ETO BAGS) ARE USED FOR PACKING THE ITEMS
FOR ETO STERILIZATION. THE PACKS ARE LABELED INDICATING DATE OF STERILIZATION
AND DATE OF EXPIRY (WHEREVER POSSIBLE).

 SEALING MACHINE IS USED FOR THE SEALING THE PLASTIC BAGS IN WHICH INSTRUMENTS
ARE PACKED. AFTER PACKING AND SEALING, THE INSTRUMENTS ARE SHIFTED FOR
STERILIZATION.

 A LARGE QUANTITY OF COTTON BALLS AND GAUGE PIECES ARE USED IN VARIOUS PATIENT
CARE AREAS AND ARE REQUIRED TO BE STERILIZED BEFORE USING THEM. TRADITIONALLY
THESE ARE PREPARED IN THE CSSD. CUTTING THE GAUGE IS VERY ARDUOUS JOB AND IS
DONE WITH THE HELP OF GAUZE CUTTING MACHINE. DURING THE PROCESS OF GAUGE
CUTTING, THE COTTON FIBERS ARE DISPERSED IN THE AIR AND MAY GET SETTLED ON THE
STERILIZED ITEMS SPOILING THEM. THEREFORE, A SEPARATE ROOM IS REQUIRED FOR
CUTTING THE GAUGE AND PREPARING COTTON BALLS ADJACENT TO THE PACKING AREA.
 STERILIZING AREA
 STERILIZATION IS DONE BY EITHER OF THE TWO METHODS IN CSSD:

 STEAM STERILIZATION BY AUTOCLAVES

 GAS STERILIZATION BY ETO (ETHYLENE OXIDE) MACHINES

 AUTOCLAVE: STEAM UNDER PRESSURE IS THE MOST COST-EFFECTIVE METHOD OF

STERILIZATION, THEREFORE, MOST COMMONLY USED FOR STERILIZATION OF INSTRUMENTS
AND LINEN IN HOSPITALS.  “AUTOCLAVE” IS THE NAME OF THE MACHINE THAT GENERATES
STEAM AT A TEMPERATURE OF 121 DEGREE CENTIGRADE UNDER 15 POUNDS OF PRESSURE.
AN EXPOSURE OF 20 MINUTES IS REQUIRED FOR STERILIZATION. BEFORE FEEDING THE
STEAM, VACUUM IS GENERATED IN THE CHAMBER OF THE AUTOCLAVE SO THAT NO AIR
POCKET REMAINS IN THE FOLDS OF LINEN AND THE STEAM IS DISTRIBUTED UNIFORMLY IN
THE CHAMBER.

1. AUTOCLAVE IS AVAILABLE WITH SINGLE DOOR OR DOUBLE DOORS. DOUBLE DOOR

AUTOCLAVES HAVE TWO DOORS ON TWO OPPOSITE SIDES AND HAVE THE ADVANTAGE OF
MAINTAINING UNI-DIRECTIONAL MOVEMENT OF MATERIALS. THE UNSTERILE ITEMS ARE FED
INTO THE CHAMBER THROUGH ONE DOOR AND THE STERILIZED ITEMS ARE TAKEN OUT
FROM THE OTHER DOOR OF THE AUTOCLAVE.
2.  THE AUTOCLAVES OF DIFFERENT CAPACITIES ARE AVAILABLE- 1/2, 1, 2 TON ETC. AND CAN BE
SELECTED DEPENDING ON THE WORK LOAD.
 ETO STERILIZER: THE ITEMS LIKE CARDIAC CATHETERS ARE THERMO SENSITIVE
(DAMAGED BY HEAT) AND THEREFORE CANNOT BE STERILIZED BY STEAM. SUCH
ITEMS ARE STERILIZED BY ETHYLENE OXIDE (ETO) GAS STERILIZATION. THE ETO
IS AN EXPANSIVE AND TOXIC GAS. THE ITEMS THAT ARE TO BE STERILIZED ARE
PLACED IN A CHAMBER THAT IS FILLED WITH ETO. AS A RESULT OF THE
EXPOSURE TO THE GAS ALL ORGANISMS ATTACHED TO THE ITEM GET KILLED BUT
THE ITEM GETS COATED WITH GAS MOLECULES. IT IS ABSOLUTELY NECESSARY
TO ENSURE THAT THESE ITEMS ARE MADE FREE OF GAS MOLECULES BEFORE
USING THEM ON A PATIENT. THIS IS ACHIEVED BY SUBJECTING THE ITEMS TO
FORCED VENTILATION. THE ENTIRE CYCLE OF STERILIZATION AND VENTILATION
IS LONG AND MAY TAKE ABOUT 8- 12 HRS. FOR EACH CYCLE OF GAS
STERILIZATION ONE ETO CARTRIDGE IS REQUIRED THAT IS FIXED WITH THE
MACHINE BEFORE STARTING THE CYCLE.

 FLASH STERILIZER: THIS IS A SPECIAL TYPE OF AUTOCLAVE THAT HAS A VERY

SHORT STERILIZATION CYCLE OF ABOUT 3 - 5 MINUTES BECAUSE OF ITS ABILITY
TO RAISE THE TEMPERATURE TO 132 DEGREE CENTIGRADE.  THE MACHINE IS
GENERALLY KEPT IN THE OT. DURING THE OPERATIONS IF THERE IS URGENT A
REQUIREMENT OF STERILIZING AN INSTRUMENT, IT IS DONE ON FLASH
STERILIZER.
  STORE
 AFTER STERILIZATION, THE ITEMS ARE
TEMPORARILY STORED IN A CLEAN
STORAGE ROOM FROM WHERE THEY
ARE DISTRIBUTED TO USER
DEPARTMENTS THROUGH A PASSING
WINDOW.
 DISTRIBUTION AREA
ITSHOULD BE AWAY FROM THE
RECEIVING AREA AND MAY COMPRISE OF A
WINDOW WITH COUNTER. IN MODERN
HOSPITALS, THERE MAY BE A SEPARATE LIFT
FOR TRANSPORTING THE STERILE MATERIALS
TO USER DEPARTMENTS.
  SUPPORT AREAS IN CSSD
 THE FOLLOWING SUPPORT AREAS WOULD BE
REQUIRED IN A CSSD

1. CSSD MANAGERS OFFICE

2. WORKERS REST ROOM WITH LOCKERS AND TOILET

FACILITY

3. UNSTERILE STORES FOR COTTON, GAUGE, LINEN AND

INSTRUMENTS
  QUALITY ASSURANCE
 IN ORDER TO ENSURE THE QUALITY OF STERILIZATION THE FOLLOWING MEASURES ARE TAKEN:

 ENSURE THE EQUIPMENT IS FIT I.E. IN AUTOCLAVE THE TEMPERATURE IS MAINTAINED AT 121 DEGREES
CENTIGRADE, 15-POUND PRESSURE AND HOLDING TIME IS MINIMUM 20 MINUTES. MODERN MACHINES
ASSURE THAT AND ARE FITTED WITH GOOD QUALITY MONITORS. THEY PROVIDE PRINT OUTS OF READINGS.
THE DOORS OF THE AUTOCLAVE DO NOT OPEN UNLESS THE CYCLE IS COMPLETE.

 BOWIE DICK’S TAPES ARE FIXED WITH EVERY PACK OF ITEMS TO BE STERILIZED. THIS TAPS CHANGES THE
COLOR WHENEVER THE REQUIRED TEMPERATURE IS ATTAINED. AFTER A CYCLE, THE TAPES ARE CHECKED
FOR CHANGE OF COLOR. HOWEVER, THE CHANGE IN COLOR ONLY INDICATES THAT THE SPECIFIC
TEMPERATURE HAS BEEN ACHIEVED DURING THE CYCLE BUT CANNOT GUARANTEE THAT THE ITEMS ARE
STERILIZED. INDICATORS ARE ALSO AVAILABLE FOR CHECKING THE QUALITY OF ETO STERILIZATION.

 PERIODICALLY BACTERIOLOGICAL TESTS ARE TO BE DONE. A CAPSULE CONTAINING BACILLUS

STEREOTHERMOPHILUS (FOR AUTOCLAVE) AND BACILLUS SUBTILIS (FOR ETO) ARE PUT ALONG WITH THE
LOAD. THESE BACTERIA ARE CONSIDERED MOST RESISTANT TO STEAM OR GAS RESPECTIVELY. AFTER THE
CYCLE IS OVER THESE CAPSULES ARE TESTED IN MICROBIOLOGY LAB FOR PRESENCE OF LIVE
ORGANISMS. IF THERE ARE NO LIVE ORGANISMS IN THE CAPSULES, IT INDICATES THE STERILIZATION
PROCESS WAS EFFECTIVE.

 THE STAFFS WHO WORK ESPECIALLY IN STERILIZATION AREA, STERILE STORE AND DISTRIBUTION AREA
SHOULD CHANGE SLIPPERS AND THEIR DRESS, AND WASH THEIR HANDS BEFORE RESUMING WORK.
 LIFE OF STERILIZED ITEMS

THE LIFE OF THE STERILE MATERIALS DEPENDS ON

THE QUALITY OF PACKING MATERIALS USED AND THE
STATUS OF CLEANLINESS OF STORING AREA.
GENERALLY, THE ITEMS STERILIZED BY AUTOCLAVE &
ETO CAN BE USED FOR 6 MONTHS AND PLASMA PACKS
CAN BE USED FOR 12 MONTHS.
 HOSPITAL MANAGEMENT INFORMATION
SYSTEM
 NO OF CYCLE PER EQUIPMENT

 WORKLOAD PER EQUIPMENT- NO OF PACKS PER

CYCLE

 DEPARTMENT WISE UTILIZATION

 COST INCURRED ON STERILIZING ONE PACK ON

AUTOCLAVE AND ETO

 NO OF PACKS EXPIRED AND RE-STERILIZED

 ROLE OF CSSD MANAGER
 MAINTENANCE AND REPAIR OF EQUIPMENT

 INVENTORY MANAGEMENT OF SUPPLIES AND CONSUMABLE

 ENSURE QUALITY OF STERILIZATION

 ENSURE PROPER DISTRIBUTION AND TRANSPORT

 COST CONTROL MEASURE, TO ANALYZE AND REDUCE THE NUMBER OF CYCLE

 RECORD KEEPING AND DATA ANALYSIS

 OPTIMAL UTILIZATION OF MANPOWER AND EQUIPMENT

 MOTIVATION OF STAFF AND TRAINING

 INTER DEPARTMENTAL COORDINATION

 MATERIALS TO BE STERILIZED
 SOME OF THE TRAYS/ INSTRUMENTS USED FOR DIFFERENT PROCEDURES IN DIFFERENT AREA OF THE HOSPITAL ARE:

 OT INSTRUMENTS AND DRAPES

 GLOVES

 DRESSING SET/ TRAY

 SUTURE REMOVAL SET

 SUTURING SET

 CUT DOWN TRAY

 TRACHEOTOMY SET

 LUMBAR PUNCTURE SET

 BONE MARROW/ LIVER/ KIDNEY BIOPSY SET

 CVP SET

 BURN PACK

 INTRA COSTAL DRAINAGE (ICD) PROCEDURE SET

 OP SUPPLIES- SIMS SPECULUM, SPATULA, ENT SETS, PROCTOSCOPES, DENTAL INSTRUMENTS

 STERILE AREA + PACKING
AREA
•IT CONSIT OF

ETO STERILIZER MACHINE.

SEALING MACHINE.

RACKS FOR MAINTANANCE OF CSSD REGISTER.

PACKING IS ALSO DONE IN THIS AREA.

 WASHING ROOM
 IT CONSIST OF

 ETO STERALIZER MACHINE

 WATER TAPS FOR CLEANING OF INSTRUMENTS, FOR

FLUSHING OF CATHERATER ETC

 TWO WATER FILTERS WHICH ARE CONNECTED TO

TWO SEPARATE TANKS WHICH IS USED FOR
CATHERATER FLUSHING
 SHIFT OF CSSD STAFF
 CSSD INCHARGE – 2PM TO 11PM

 CSSD TECHNICIAN – 11AM TO 11PM

LIST OF ITEMS & SPECIAL TRAY COMMONLY PROCESSED IN

CSSD
 INSTRUMENTS
 APPLIANCES
 DRESSINGS
 SPONGES
 OT LINEN
 SPECIAL PACKS
 GAUZE AND COTTON MATERIALS
 GLOVES
 BOWLS AND TRAYS
 REGISTERED MAINTAINED IN CSSD
 AUTOCLAVE IN TIME – OUT TIME REGISTER

 ETHYLENE OXIDE STERILIZER IN TIME - OUT TIME REGISTER

 OT REGISTER

 CARDIAC OT REGISTER

 CCU + ICU REGISTER

 WARD REGISTER

 DUTY ROOSTER REGISTER

 PROCEDURE
 COLLECTION OF MATERIALS FROM VARIOUS
DEPARTMENTS
NURSING
OPD UNIT

IPD CSSD CAT LAB

LABOUR OT
ROOM
 PROCEDURE
 RINSING: RINSING OF ARTICLES AFTER USE SHOULD NOT BE PERMITTED IN PATIENT CARE AREAS UNLESS
CARRIED OUT BY A TRAINED MEMBER OF THE STAFF

 INSPECTION AND ASSEMBLY: EACH ITEM SHOULD BE INSPECTED FOR FUNCTIONALITY, DEFECTS, BREAKAGE AND
THEN APPROPRIATELY ASSEMBLED

 CLEANING: ALL REUSABLE MEDICAL DEVICES SHOULD BE THOROUGHLY CLEANED PRIOR TO DISINFECTION OR
STERILIZATION.

 DRYING: ALL ARTICLES SHOULD BE DRIED APPROPRIATELY.

 PACKAGING: ARTICLES SHOULD PREFERABLY BE PACKED IN POROUS MATERIAL.

 LABELLING: EACH PACK SHOULD BE MARKED WITH NOMENCLATURE OF THE ARTICLE, CONTENTS OF THE PACK,
INITIALS OF THE PERSON WHO PACKED IT, DATE AND INITIALS OF THE PERSON WHO CARRIED OUT THE
STERILIZATION.

 STERILIZATION: THE OPERATION OF THE STERILIZER SHOULD BE ENTRUSTED TO A RESPONSIBLE AND FULLY
TRAINED PERSON. IT SHOULD BE KEPT IN A STATE OF GOOD MAINTENANCE AND REPAIR.

 AFTER STERILIZATION, STERILE MATERIALE IS TAKEN TO STORES

 STORAGE: SHOULD BE PROPERLY MANAGED SEPARATELY FOR STERILE AND NON-STERILE STORES. FOR
STERILE GOODS, CLEAN ROOM CONDITIONS SHOULD BE FOLLOWED.

 DISTRIBUTION: REFERS TO CLEAN AND DIRTY ARTICLES EXCHANGE SYSTEM. A PROGRAM SHOULD BE
ESTABLISHED FOR THE COLLECTION OF USED ITEMS FROM PATIENT CARE AREAS AND DISTRIBUTION OF
STERILIZED GOODS.
 STERILITY INDICATORS
 MECHANICAL INDICATORS: ARE MONITORING INSTRUMENTS WHICH RECORD TIME, TEMPERATURE, HUMIDITY
AND PRESSURE DURING THE STERILIZATION CYCLE.

 CHEMICAL INDICATORS: ARE DEVICES WITH A SENSITIVE CHEMICAL OR DYE TO MONITOR ONE OR MORE
PARAMETERS OF A STERILIZATION CYCLE.

 BIOLOGICAL INDICATORS: EMPLOY THE PRINCIPLE OF INHIBITION OF GROWTH OF MICROORGANISM OF HIGH

RESISTANCE TO THE MODE OF STERILIZATION. SUBSEQUENT FAILURE OF GROWTH OF MICRO-ORGANISMS
INDICATES ADEQUACY OF STERILIZATION.

 NO SINGLE METHOD IS CAPABLE OF MONITORING COMPLETELY ALL PARAMETERS NECESSARY FOR A

FOOLPROOF STERILIZATION.

 RECORDING INSTRUMENTS ON THE AUTOCLAVE THAT GIVE A GRAPHIC RECORD OF TEMPERATURE,

PRESSURE, ETC. CAN BE INSPECTED IMMEDIATELY AFTER A LOAD HAS BEEN AUTOCLAVED.

 IN ADDITION, CHEMICAL INDICATORS PLACED INSIDE CHANGE COLOR WHEN CONDITIONS NECESSARY FOR
STERILIZATION HAVE BEEN MET. THESE ARE AVAILABLE AS TAPES AND STRIPES, AND ARE ATTACHED OR
IMPLANTED INSIDE THE PACKING MATERIAL.

 THIS SHOULD BE SUPPLEMENTED WITH PERIODICAL USE OF BIOLOGICAL INDICATORS TO DETECT (WHICH
MAY TAKE SEVERAL DAYS) FAILURE OF THE AUTOCLAVE. BIOLOGICAL INDICATORS SHOULD BE PLACED IN
THE MOST INACCESSIBLE LOCATION IN THE LOAD AND THEN CULTURED. THEY PROVIDE POSITIVE
ASSURANCE, ALBEIT RETROSPECTIVELY, THAT EACH PACKAGE HAS BEEN SUBJECTED TO PROPER
STERILIZING CONDITIONS.
 TOTAL TIME REQUIRED
 AUTOCLAVE – 45 TO 50 MIN

 ETO STERILIZER – 11 TO 12 HOURS

 OBSERVATION
 CSSD IS SITUATED ON TERRACE OF HOSPITAL.

 CSSD HAS TWO ROOMS STERILE + PACKING ROOM AND WASHING ROOM

 PLASTIC BAGS ARE USED TO BRING THE UNSTERILED MATERIAL

 FIRE EXTINGUISHERS ARE NOT INSTALLED.

 ONLY 1 STAFF WORKING IN CSSD

 STERILE + PACKING ROOM AREA 13*13 SQ FT

 WASHING ROOM AREA 13*10 SQ FT

 AUTO CLAVE SIGNAL LOCK & ETO SIGNAL LOCK USED TO INDICATE THAT MATERIAL IS
STERILISED

 MASK, HEAD CAP ARE USED BY CSSD TECHNISIAN FOR SAFTEY

 AFTER STERILISATION STERILE MATERIAL IS TAKEN TO STORE

 RECOMMANDATION
 PACKING ROOM, STERILE ROOM SHOULD BE SEPRATE.

 AN ETO IS A TOXIC GAS. BREATHING APPARATUS FOR EMERGENCIES MUST BE STORED IN

AN,
EASILY ACCESSIBLE PLACE NEAR ETO AREA.

 USE OF EXHAUST SYSTEM TO EXHAUST GAS TO OUTSIDE,

 ALARMS TO ALERT IN CASE OF LEAK SPILL OF GAS.

 FIRE EXTINGUISHER SHOULD BE INSTALLED

 STAFF SHOULD BE INCREASED IN CSSD

 STERILE SUPPLIES AND PACKS AND CONTAMINATED ARTICLES SHOULD NEVER BE CARRIED
ON THE SAME TROLLEY OR BY THE SAME STAFF.

 ELECTRICAL WIRES SHOULD BE PROPERLY INSTALLED AND ELECTRICAL MAIN SWITCH

SHOULD BE INSTALLED OUTSIDE CSSD
 RECOMMANDATION
 THERE SHOULD BE SEPRATE ROOM FOR GAUGE CUTTING & MAKING COTTON
BALLS.

 SEPRATE SLIPPERS SHOULD BE USED IN CSSD

 CSSD SHOULD BE SHIFTED FROM TERRACE

 CLEANING SHOULD BE PROPER IN CSSD

 ONE ATTENDANT SHOULD BE THERE IN CSSD TO BRING UNSTERILISED

MATERIAL FROM ALL DEPARTMENT

 TROLLEY SHOULD BE USED TO BRING UNSTERILISED MATERIAL

THANK YOU