CSS.pptcssd and hospital related documents

This is case ppt

1. CENTRAL
STERILE
SUPPLY
DEPARTMENT

2. 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.

3. 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 .

4. 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. 5. Conservation of trained staff.
6. Better quality control
7. Better good of material flow
8. Prolonged life by proper care of
equipment

6. ITEMS COMMONLY HANDLED
BY
CSSD STORES

7. 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

ITEMS COMMONLY HANDLED BY
CSSD STORES

8. 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 .

9. PLANNING
1. Physical Planning.
2. Functional Planning.
3. Personnel Planning.
4. Equipment Planning.
5. Financial Planning.
6.Quality Control.
7.Preventive Maintenance.

10. PHYSICAL
PLANNING
1. Location
2. Lay Out & Space Reqts.
3. Fixturtes & Furniture .

11. ADM & STORAGE
(UNSTERILE) AREA
21² M
SCALES OF
ACCN FOR
ARMED FORCES
HOSPITALS
AH/CH/ SAY >
700 BEDS
RECEPTION,CLEANING,CHE
CKING,ASSEMBLY &
PACKING AREA
35² M
AUTOCLAVING AREA 28 ² M
STERILE STORAGE & ISSUE
AREA
28 ² M
TOTAL
1,320 ² ft
(COPP)
RULE OF THE THUMB
ROUGHLY – 10 SQFT / BED

12. EQUIPMENT
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

13. OTHERS
1.Maint & Repair
equipment
2.Adequate number of
cabins & Furniture
3.Telephone or intercom.
4.Adequate no of syringes &
procedure sets.

14. 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

15. Methods Of Sterilization / Disinfection

Natural Chemical Physical
Sun Light (UV)
Air
(Desiccation)
Solids
Lime, Bleeching Powder,
KMNO4
Liquids
Formalin, Phenol , Alcohol ,
Glutaraldehyde
Gases
Formaldehyde, Ethylene
Oxide
Dry Heat
Burning or Dry Air
(160°C for 60 Min)
Moist Heat
Boiling Steam
Radiation
Ionising Radiation
U V Rays

16. 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

17. 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

18. 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.

19. 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)

20. MODE OF ACTION
Dry Heat  Oxidation
Steam  Denaturation = Coagulation of
Proteins
Sterilization Time
(Holding Time + Safety
Time)
Pressure
(PSI)
Temperature
( C° )
2' + 1′ = 3'
8' + 2' = 10'
12' + 3' = 15'
30
20
15
134
126
121

21. TYPES OF AUTO CLAVING
MACHINES
1. Downward Displacement
2. Vacuum Assisted.
3. Pulsed Steam Dilution

22. 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)

23. 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 .

24. ADVANTAGES OF STEAM
STERILISATION
1. Rapid heating &
penetration of loads.
2. Destruction of all forms of
microbial life
3. No residual toxicity.

25. 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

26. 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

27. STAFFING :CSSD
SUPERVISORS (sister/male ward masters)
4
STAFF NURSES 5
TECHNICIANS (ORA) 6
ATTENDANTS 24
SWEEPER 4
CLERK
1
TOTAL 44
CENTRALISED SUPPLY (RULE OF THUMD 2PER 100 BEDS)

28. 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)

29. FLOW PROCESS : CSSD
WARDS/DEPTS BULK STORES
DIRTY RECEIPT
CLEAN RECEIPT COTTON & GAUGE
DISASSEMBLY
INSTRUMENT GLOVES RUBBERWARE
WASHING AREAS
ASSEMBLY
PRE – STERILE STORAGE
INSPECTION
STERILISATION STERILESTORAGE
DISTRIBUTION

30. A SUGGESTED LAYOUTOF
CSSD
INTRA MURAL COMMUNICATION LINE
RAMP
ASSEMBLY
(PARKING)
CLEANING&
WASHING
AUTOCLAVE

ROOM
GLASS PARTITION
STERILE
STORAGE
STERILE
ISSUE
clean
recepti
on
Clean
storage
Supervisors
office
Verandah
disasse
mbly
Dirty
recep
tion
° ° °
° 0 °
° °
°

31. Thank
You

32. 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

33. THERMAL DEATH TIME ( CONT.)

Acidic or basic pHs decrease TDT

Fats and oils slow penetration and increase
TDT