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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.
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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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