CSSD (Central Sterile Supply Department)

Presented by: Dr Nirali Sheth

What is CSSD?

CSSD can be defined as that services, within the hospital catering for sterile supplies to all departments, both to specialized unit as well as General Wards and OPDs.

Mission: to have the right item, at the right place, at the right time, in the right condition and always render services.
Receives, stores, sterilizes and distributes

Objectives of CSSD

To provide optimum services to all departments that requires sterile supplies of instruments To train all employees in order to assure optimal sterile techniques and aseptic handling of all sterile items. To avoid duplication of costly equipments, which may be infrequently used. To record the effectiveness of cleaning, disinfection and sterilization process.

To monitor and enforce controls necessary to prevent

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To maintain an inventory of supplies and equipments To stay updated regarding developments in the field. To provide safe environment for patients and staff. Staff: CSSD head senior manager- Alphonsa NP Technicians - 7 Attendants - 6

Location: Central part of hospital 'L' floor and connected to all the floors by a lift. Area: 1. Unsterile window to receive unsterile items 2. Packaging area 3. Sealing area 4. Loading area 5. A autoclave room, a ETO chamber and plasma sterilizer called STERRAD 100S 6. Sterile storage area

Personal Hygiene

Personal protective Attire and equipments (PPE- heatproof gloves, face shield, apron) Full attire/gown Head cap and mask Rubber footwear/gumboots Goggles Steam gloves and examination gloves Handwashing technique (Bacterorub sterilium)

CLEANING AND DISINFECTING

Two types: 1.Manual 2. Machine

Manual- Rinse instruments in running cold water - Wash in detergent solution with stiff Bristle brush - Inspection and drying Machine- 1. Washer Disinfector 2. Ultrasonic Cleanser

Hand washing protective Technique

Personal Equipment

STERILIZATION

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 bacterial spores.

3 types of sterilizers are available in CSSD department of this hospital. 1. Steam Sterilizer 2. ETO (Ethylene oxide gas sterilizer) 3. Hydrogen peroxide plasma gas sterilizer.

STEAM STERILIZER (AUTOCLAVE)

3 machines are available in this department 2 manual and1 semi automatic

Autoclaved instruments can be valid for 7 days.

Operation: Preparation of load Loading the chamber Autoclave cycle

A)Preparation of Loads:

The cleaned and disinfected instruments are brought to the packaging area Linen packs: The packs is wrapped using two layers of material Pack is sealed with autoclave tape( Indicator) and labeled with date, content, cycle and operator.
Pouch packs: used for single instrument Pouches are heat sealed and rolled and labeled.

B)Chamber loading C)Autoclave cycle At high temperature 134`c,30 psi pressure-7 min At low temperature 121`c, 30 psi pressure- 20 min

ETHYLENE OXIDE GAS STERILIZER

2 ETO sterilizers- 1 manual & 1 automatic

Here automatic machine uses 100 gms of ETO gas cartridge Manual machine uses 40gms of ETO gas cartridge

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Thermal paper roll for printer and gives printed details of each cycle 12 hours of cycle and 6 hours aeration period 1 year validity for sterilized instruments Label over sterilized items should contain sterilization date and expiry date with signature of head.

PLASMA STERILIZER
In this department, a hydrogen peroxide plasma gas sterilizer is available

Identified Advantages: Materials and device compatibility Rapid turnaround times In-house control of sterilization Lower inventory requirements

STEPS FOR PLASMA STERILIZATION 1. The Vaccum Phase:

The chamber is evacuated, reducing internal pressure in preparation for subsequent reaction

2. The Injection Phase" A measured amount of liquid hydrogen peroxide is injected into the chamber, evaporating the aqueous hydrogen peroxide solutions and dispersing it into the chamber where it kills bacteria on any surface it can reach.

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3.Diffusion Phase:

The hydrogen peroxide vapour penetrates the chamber, exposing all load surfaces to sterilant and rapidly sterilize devices and materials without leaving any toxic residue At the completion of this phase,the chamber pressure is reduced and the plasma discharge is initiated.

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4. Plasma:

An electromagnetic field is created in which hydrogen peroxide vapour breaks apart, producing low temperature plasma cloud that contains ultraviolet light and free radicals Following the reaction, the activated components lose their high energy and recombine to form oxygen and water.

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5. Vent Phase:

The chamber is vented to equalize the pressure enabling the chamber door to be open. There is no need for aeration or cooldown. Devices are ready to reuse immediately.

Long cycle takes 72 mins and short takes 52-55 mins

Tylveks packet roll is used for packaging

The sterilized instruments are valid for 3 years.

QUALITY INDICATORS
Quality indicators are used and maintained by CSSD senior manager in this hospital

Bowie Dick type test Steam indicator Chemical indicator for sterilizing steam Biological indicator for Steam, ETO and Plasma sterilizer ETO indicator for ETO sterilizer Plasma indicator for plasma sterilizer

RECORD MAINTENANCE

In the CSSD, they are maintaining 3 registers regarding duties allotment and technician and attendants attendance register. It is also recorded in a departmental computer. CSSD register is implemented with CSSD reference number and maintained well from each and every department before sterilization and after sterilization so recall procedure can be done easily in case of problem in sterilization. 1.Orthopedic OT Autoclave and ETO cycle register 2. Cathlab, trauma and cardiac OT register 3. Wards ETO and Autoclave 4. Plasma cycle record 5. ETO cycle register

 The departmental head indent materials from general store and they will provide it according to needs
In case of problem in any machine, the department head will contact Bio medical engineering department and a company man for repairing.

SUGGESTIONS

Ideally CSSD should be unidirectional There is less space available for this department It should be airconditioning.