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Home - Hospital Infra - Article

Planning a CSSD

The Central Sterile Supply Department being the most essential department within a hospital set-up contributes in reduction of infection rate, says, Dr Sudhakar Manav, CEO, Ojjus Medicare


Dr Sudhakar Manav

CEO,
Ojjus Medicare Pvt Ltd,
New Delhi

Central Sterile Supply Department (CSSD) is the most essential feature of the hospital. It aims at centralising the activities of receipt, cleaning, assembly, sterilisation, storage and distribution of sterilised materials from a central department where bacteriologically safe sterilisation is done under controlled conditions with adequate managerial and technical supervision at an optimum cost. It contributes to reduction in hospital infection rate.

Definition

The CSSD is a service catering to the needs of a hospital or a group of hospitals for the supply of sterilised articles to all the departments including the wards, OPDs, other special units and the operation theatre if there is no Theatre Sterile Supply Unit.

Scope

Diet, drugs, linen, bedding, bedpan, urinals are not included in the scope of CSSD. The hospitals are suggested to buy from manufacturers only those sterile disposables which they can not process satisfactorily such as sutures etc.

Physical Facility and Equipment Availability
Sr. No.
Rooms in the CSSD Nature of the work Provision of the Space (%)
1.
Wash Rooms
Dirty
10
2.
Work Room (Packing Room)
Clean
26
3.
Syringe & Needle Processing
Clean
9
4.
Unsterile Pack Store
Clean
4
5.
Bulk Store
Clean
11
6.
Sterile Store
Sterile
16
7.
Miscellaneous (a)Gloves room
(b)Office room (c)Rest room
Clean
19
8.
Autoclaves
Clean
5

Aim

The CSSD is to provide an efficient, economic, continuous and quality supply of sterilised material to various areas of the hospital to deliver quality and infection free patient care.

Objectives

  • To provide all the departments with an adequate supply of reliably sterilised material for immediate and emergency use. The sterilisation process is conducted under controlled conditions at minimum cost to reduce the incidence of hospital associated infections.
  • To supervise and provide facilities for the bulk-sterilisation of the materials.
  • To pool in the equipment resource of the hospital for economical and effective utilisation under adequate managerial and technical supervision.
  • To Provide facilities for in-service teaching and training of nursing and ancillary personnel in the sterilisation practices.
  • To undertake operation research techniques for improving sterilisation practices and to participate in research pertaining to supply of equipment.
  • To provide the most suitable material for the patient care.
  • To play an effective role in hospital infection control activities.
  • To ensure quality control for infection free patient care.

Planning

The size and location usually depends on the number of the hospitals the CSSD will serve as well as the number of beds and the future expansion of the hospital. However seven to 10 square feet per bed is recommended as an area of requirement for the CSSD.

According to Thomson an area of 2000 square feet for a 500 bedded and 3500 square feet for 1000 bedded hospital will be adequate for Indian conditions.

  • There should be no back tracking of sterile goods.
  • The materials/ items from contaminated and sterile areas should not get mixed.
  • There should be physical barrier between clean and dirty areas.
  • The floor should be smooth, impervious, non skid and robust.
  • Light fittings should be recessed
  • Relative humidity should be maintained at 45±5 per cent
  • The clean area should be provided with air locks and maintained at positive pressures relative to the adjoining spaces. The minimum ventilation rate should be six to 10 air changes per hour.
  • The work area should be made of marble / granite / stainless steel
  • The sterilisation must be planned for autoclaving by steam as well as by gas since certain items such as rubber, plastic or delicate instruments can not be autoclaved.

Location

The CSSD should be close to the casuality, operation theatre and wards which are the largest consumer of the sterilised material. In multistoried buildings CSSD may be planned in the lower floor right under the operation theatre where vertical movement will be the quickest possible movement of the material.

Layout

The CSSD should have four zones for a smooth work flow. The following facilities should be provided in the lay out:

1. Entrance lobby
2. Reception and Cleaning room
3. Glove room
4. Work room (Preparation and assembling of packs)
5. Syringe room
6. Sterilisation room
7. Store room
8. Nurses room
9. Staff changing room
10. Cloak room

Functions and Activities

Receipt: This includes receiving the materials, supplies and equipment, dressings and other specialised surgical items for processing.

Cleaning: This function means cleaning of the used equipments/materials, rubber and plastic goods either manually or by machines eg., ultrasonic cleaner, jet glove washing machines, washer disinfectors, anesthetic tubing washers and dryers. This function may also include cleaning of the delivery trolleys.

Checking, Assembling and Packaging: It includes checking of glass items for breakages, needles and instruments for sharpness and breakages, assembling of the equipment after washing and drying, making sets and packaging for sterilization.

Sterilisation: It renders materials bacteriologically safe for quality patient care.

Labelling: Easy identification for prompt and proper use.

Storage: The function includes storage of sterilised packs, drums and disposables, dressing materials, spare parts of machines or sterilisers for routine maintenance and broken/ unserviceable items for condemnation. Paper is fast replacing linen wrappers. Space should also be provided for storing distribution trolleys. Sterile store maintains inventory of all types of sterile packs.

Issue and Distribution: The function entails issue of the sterilised packages, dressings, linen, instruments and disposables to various departments of the hospitals.

Methods of Distribution of Supplies

The aim is to avoid hoarding of supplies in order to minimise unproductive storage of expensive items, re-sterilisation of packs kept for long periods and also to avoid stock outs during emergency needs. To satisfy above stated conditions there are four systems in use. The one or mix that suits should be selected for particular CSSD.

  • One for One Exchange System: All the used articles are collected in the locked canvas bags and similar number of packs and trays in sterile state are returned to the respective areas. 2 such rounds of collection and distribution are done in a day.
  • The Milk Round System: Daily topping up of each department stock level to an agreed level. Maximum daily requirement for all the packs are kept in each department. Delivery and collection rounds are planned twice daily. If single round is made stock provided needs to be 50 per cent extra and when two rounds are made the stock provided should be 25 per cent extra of over and above the daily consumption.
  • The Grocery System: The departments send their requisition to CSSD from where deliveries are made in accordance with the demand. This system is sometimes not practical as some departments demand the entire amount of stock from the CSSD having nothing left for the others. The efficiency of the system depends on the wisdom and experience of the person making the indent.
  • The Clean for Dirty Exchange System: According to this system one clean article is issued for each dirty returned to the CSSD.

Despite all measures and advancements in technology hospital acquired infections remain a challenge in healthcare scenario today. The hospitals are required to adopt strict quality control processes with the latest cutting technology to mitigate hospital acquired infections.

 

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