Transcript here - Indmedica

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

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 –
Safadarajan Hosptial

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 ;
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
ITEMS COMMONLY HANDLED
BY
CSSD STORES
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)
1. Physical Planning.
2. Functional Planning.
3. Personnel Planning.
4. Equipment Planning.
5. Financial Planning.
6.Quality Control.
7.Preventive Maintenance.
PHYSICAL PLNG
1. Location & Grouping .
2. Lay Out & Space Reqts.
3. Fixturtes & Furniture .
RULE OF THE THUMB
ROUGHLY – 10 SQFT / BED
- MCGIBONY
ADM & STORAGE
21² M
(UNSTERILE) AREA
RECEPTION,CLEANING, 35² M
CHECKING,ASSEMBLY
& PACKING AREA
AUTOCLAVING AREA
28 ² M
STERILE STORAGE &
ISSUE AREA
TOTAL
28 ² M
SCALES OF
ACCN FOR
ARMED
FORCES
HOSPITALS
AH/CH/ SAY >
700 BEDS
1,320 ² ft
(COPP)
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
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
A - 1½ Daily requirement in use at wards / Departments
B - 1 Daily requirement in sterile state at CSSD, ready
for issue
C - 1 Daily requirement being processed at CSSD
D – 1to 1½ Daily requirement held in reserve – dome
in CSSD, some in medical stores
Total: 4.5 to 5 times of the daily requirement
Methods Of Sterilization / Disinfection
Natural
Chemical
Physical
Sun Light (UV)
Solids
Dry Heat
Air
(Desiccation)
Lime, Bleeching Powder,
KMNO4
Burning or Dry Air
Liquids
Formalin, Phenol , Alcohol ,
Glutaraldehyde
Gases
Formaldehyde, Ethylene
Oxide
(160°C for 60 Min)
Moist Heat
Boiling Steam
Radiation
Ionising Radiation
U V Rays
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
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
- 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
Sterilization Time
(Holding Time + Safety
Time)
2' + 1′ = 3'
8' + 2' = 10'
12' + 3' = 15'
Pressure Temperature
(PSI) ( C° )
30
20
15
134
126
121
TYPES OF AUTO CLAVING
MACHINES
1. Downward Displacement
2. Vacuum Assisted.
3. Pulsed Steam Dilution
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
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
BHATTA CHARJEE RECOMMENDS :
SUPERVISORS (sister/male ward masters) 4
STAFF NURSES
TECHNICIANS (ORA)
ATTENDANTS
SWEEPER
CLERK
TOTAL
CENTRALISED SUPPLY (RULE OF THUMD 2PER 100 BEDS)
5
6
24
4
1
44
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
DIRTY RECEIPT
BULK STORES
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)
CLEANING&
WASHING
Clean
storage
clean
recepti
on
disasse
mbly
Dirty
recep
tion
GLASS PARTITION
STERILE
STORAGE
Supervisors
office
Verandah
° ° °
° 0 °
° ° °
STERILE
ISSUE
RAMP
INTRA MURAL COMMUNICATION LINE
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.)

Acidic or basic pHs decrease TDT

Fats and oils slow penetration and increase
TDT