INTRODUCTION

The central sterile services department (CSSD) is an integrated State-of-the-art facility that performs sterilization on medical devices, equipment and consumables; for subsequent use by health workers in the operating theatre of the hospital.

Infrastructure:  CSSD is typically divided into three major areas/zones.

1. Decontamination area (Dirty Zone)
2. Packing Area (Clean zone)
3. Sterile storage area (Sterile zone).

Standard operating procedure of CSSD:

• General:
  1. On entering the Central Sterile Service Department, all staff will change into departmental uniform provided in the changing area.
  2. Staff moving on to dirty zone will wear addition PPE (Macintosh, gloves and protective goggles) in addition to the departmental uniform
  3. No personal belonging is allowed inside CSSD
  4. Food and drinks are not allowed inside any zone

• Decontamination Area (Dirty zone):
  1. Soiled instruments from all OT’s are first inspected against a list which is provided with sterilized set.
  2. No sets are received without list or if it incomplete
  3. Instruments are first manually cleaned in a two-bay sink wash station; the process combines the enzymatic solution and detergent solution in one bay. The second bay contains clean, treated water.
  4. A brush or flushing with pressurized water may be used to loosen soils on all instruments including suction tube.
  5. Lubricant is applied after manual cleaning.
  6. Ultrasonic cleaners are typically used to clean instruments that are sensitive to damage, and are too delicate for a traditional washer/disinfector; also instruments used on HBS/HCV etc. must go through the ultrasonic cleaner to guarantee removal of all gross
  7. Automated washer disinfectors are used after manual wash.
• Packing Area
  1. All staff visitors and other personnel wishing to enter the preparation room will change into the uniform provided and will wear mask, head cap and shoe cap.
  2. After decontamination, all clean items are received into the packing area
  3. Items received in the packing area from washer disinfector are left to cool for 5 minutes.
  4. Any item that is rejected due to evidence of residual blood, body fluid, stains or water will be returned to wash area.
  5. Any item that is damaged or broken is sent for repair or will replaced if available in CSSD.
  6. Check if the instruments set tray is complete with indicator strip and check list, double-checked by supervisor or technician
  7. Lone instruments are packed in plastic pouches and is sealed using the heat sealing machine
  8. After performing the entire required test on the autoclave each set is given a special serial number and is loaded into the autoclave.
  9. Packages must not be in contact with walls or ceiling of chamber, package damage from heat or moisture may occur
  10. In the event of a cycle failure / cycle aborted, the entire load will need to go through the full reprocessing cycle
  11. Lenin should be packed outside of clean zone and will be sterilized in separate cycle.

• Sterile Pack Storage
  1. Only CSSD staff are allowed access to the storage area
  2. Before opening the door, thoroughly wash hands according to Hospital Policy
  3. Temperature and air cycles should be controlled
  4. Put on heat resistant gloves and remove carrier from Autoclave.
  5. Do not touch hot packs
  6. Allow to cool for 10 – 20 minutes before storage or dispensing.
  7. Inspect packages to ensure integrity and external chemical indicators have changed.
  8. Surgical and medical supplies should be stored at least 25cms from the floor, 45cms from the ceiling and 5cms from outside walls to allow for air circulation in the room and to prevent contamination during cleaning of the zone.
  9. Follow a system of use the First in First out (FIFO) system.
  10. Rotate stock so that oldest items are used first.
  11. Do not squeeze packs into tight spaces as this can tear the packaging
  12. Shelf time of item packed in crepe sheet is one month while items packed in plastic pouches has a shelf time of 6 months.
  13. Sets or instruments will be reprocessed after expiry of shelf time
  14. Events that can compromise the sterility of a sterile item include:
      1. Holes or torn wrappers
      2. Securing tapes or locks that have been tampered with or removed
      3. Broken or incomplete seals on laminated pouches
      4. Items that have been dropped on a dirty surface
• Equipment of CSSD:

Utilization of Equipment:

Dirty zone

1. Manual wash station:  We have 2 manual wash stations with a two bay sink setup in the dirty zone which is used for manual cleaning of 2 sets simultaneously.
2. Ultrasonic Cleaner:  It is used to clean instruments that are sensitive to damage, and are too delicate for a traditional washer/disinfector.
3. Washer disinfector: It is used to clean and disinfect instruments using high temperature up to 90c and enzymatic detergent. We have 2 units each with a capacity of 10 sets.
4. Washing trolley unit: Used to wash enclosed trollies which are used for transportation of instruments set outside of main OT.
5. Enclosed trolley: We have a total of 4 enclosed trollies of which one trolley is used to transport sterilize sets to Gynae OT and the rest are used to store CSSD items.

Clean zone

1. Heat sealing machine: Used to seal lone instruments.
2. Autoclave: We have two autoclaves each with a capacity of 8 sets.
3. Paper trolley: We have two paper trollies rack each with 4 stands. One is used for packing instrument sets and other is used for packing of lenin
4. Lenin Packing table:  Illuminated table used to inspect and pack lenin

Sterile Pack Storage

1. Wall rack: We have a total of 2 wall racks used to store sterile sets each with a capacity of up to 25 medium size instrument boxes.
2. Basket rack: We have a total of 2 basket racks used to store lenin packs and lone instrument pack.

Oil free air compressor:

Used to open and close doors of autoclaves and to manually clean and dry instruments in dirty zone.

RO unit:

Used to provide mineral, solid and ion free water to washer disinfector and autoclaves as tape water causes corrosion to surgical instruments and equipment chamber

Planned Maintenance Schedule of Equipment:

1. A schedule of planned maintenance of all machinery and equipment used in the department is documented
2. Service Engineers will carry out inspections under the planned preventative maintenance program according to the agreed schedule.
3. At the end of the visit the Service Engineer will complete a Planned Preventative Maintenance (PPM) form for the equipment checked.
4. The following information should be recorded in the maintenance logbook for each machine
5. R O filters should be replaced after every 2 months
6. Chemical level in washer disinfectors and R o should be regularly monitored

• Action for Breakdown of Equipment
  1. All equipment breakdowns will be reported to the Supervisor
  2. The Supervisor will remove the equipment from further use by switching off (if appropriate), implementing the defect reporting procedure and attaching a clear label showing:- “OUT OF ORDER - DO NOT USE”
  3. All breakdowns or repairs will be phoned into the relevant manufacturer if still under guarantee
  4. If equipment is still under guarantee NO-ONE must attempt to repair the equipment without the manufacturers permission
  5. Equipment on loan or used under service exchange must be returned to the relevant company for repair or replacement