Functioning:
Central Sterile Processing is a service whereby medical/surgical supplies and equipment-both sterile and non-sterile are cleaned, prepared, processed, stored and issued for patient care. Its primary function is the sterilization of instruments for surgery, labour and delivery and other departments. It is also responsible for the distribution of sterile and clean disposable items.
Objective:
The objective of the CSSD is to provide a centralized and standardized sterilization facility with a view to reducing the incidence of infection in a healthcare setting.
Location:
Since around 40% of the load on CSPD is from the surgical department the ideal location of the CSPD would be next to the surgery or either above or below surgery. Vertical transport is important if the location is either above or below the surgical department. This is usually through dumbwaiters that provide direct access for both clean as well as soiled materials.
Interdepartmental relationships:
The CSSD is located such that it is easily accessible from the surgical department, the wards and the ICUs.
Key factors to be kept in mind while planning CSSD:
While designing the CSSD care should be taken that the flow of traffic is continuous from receiving where the soiled items commence their journey to issuing where sterilized items are issued, without retracting steps.
The CSSD is located on a lower floor then 2 dedicated dumbwaiters should be provided-one sterile and the other soiled-which connect the CSSD floor with the surgical suite. Dumbwaiters are small elevators that are used to deliver supplies. The sterile dumbwaiter opens into the sterile area of the surgical suite and transports all sterile items without being contaminated in transit. The second dumbwaiter which opens from the disposal zone of the surgical suite, brings down the soiled items to the soiled area of the CSSD for reprocessing.
Work Flow:
IN
Soiled returns from
theatres Soiled returns from
wards and departments
SORT/WASH/DISINFECT/DRY
SET Trays Make up packs
Sterilize
Sterilize
Hold in processed goods
The department is divided into three zones to accomplish the functions of decontamination, assembly and sterile processing and sterile storage and distribution. These zones are a follows
1. Decontamination zone.
2. Sterilization zone
3. Storage and distribution zone.
A distinct separation must be maintained between the soiled and sterile areas.
The staff works on either side and cannot cross from one side to the other.
1. Decontamination zone:
The reusable equipment and soiled instruments and supplies are received from departments for initial or gross cleaning. These items are cleaned and decontaminated by means of manual or mechanical processes and chemical disinfection.
Equipments used are:
Washer Decontaminator: Used to clean heat intolerant items.
Ultrasonic washer: Used to remove fine soil from surgical instruments after manual cleaning and before sterilization
2. Sterilization zone:
After the instruments have been cleaned and inspected, they are assembled into sets and trays. Each set or tray is wrapped or packaged for terminal or final sterilization. Then the sets are prepared for issue, storage or further processing.
Equipment most commonly used are:
• High/Low pressure sterile processing systems.
• Ethylene oxide gas sterilizers.
• Chemical sterilization systems.
• Microwave sterilization systems.
3.Storage and distribution zone:
Following sterilization instruments are stored in sterile storage or sent to the appropriate department.
Space requirements:
The space requirements for CSSD are around 10 –15 sq. ft per bed.
Primary areas:
1. Entrance area.
2. Soiled returns hold.
3. Washing area.
4. Gowning area.
5. Packing room.
6. Linen preparation room.
7. Sterilizer loading area.
8. Sterilizer plant room.
9. Cooling area.
10. Processed goods store.
11. Dispatch area.
Offices and staff facilities:
12. Staff changing room.
13.Staff toilets.
14. Office of the manager/in charge of dept/CSSD supervisor room.
Functions of each area:
1. Entrance area: There may be one or more entrance areas to the CSPD. One may be for the staff and visitors and the return of soiled goods whereas the other may be for the delivery of sterile supplies.
2. Soiled returns hold: The primary function is receiving collection trolleys containing soiled returns from users in the hospital. Adequate parking space is required for the no. of trolleys expected to be held at any time.
3.Washing area: Its function is to offload soiled returns from trolleys, to sort, clean and dry all reprocessable items returned. Most items including trays and containers will be cleaned and dried using an automated process. Items not suitable for the automatic process will be cleaned at a hand-washing and drying systems facility.
4.Gowning area: Before entering the packing room all staff and visitors must conform to the changing procedure policy.
5.Packing room: Here all items are inspected and assembled in preset trays and procedure packs and then transferred as packaged goods to the sterilizer loading area.
6.Linen preparation room: The function is to receive clean linen from the materials store and to transfer prepared linen into the packing room.
7.Sterilizer loading area: This is located next to the packing room. Trays and packs will be received from the packing room and loaded onto carriers and pallets. The carrier or pallet will be loaded onto the appropriate sterilizer chamber using a sterilizer loading trolley.
8.Sterilizer plant room: Its primary function is accommodating steam and hot air sterilization machines if required.
9.Cooling area: The function is cooling trays and packs. To achieve a good and safe practice, loads should remain on the carrier or pallet until cooled.
10.Processed goods store: Here goods that have been processed by the department are stored.
11.Despatch area: Its function is to receive trays and packs from the processed goods store and to load distribution trolleys with goods for dispatch.
12.Staff changing room: Full changing facilities for male and female staff are required if suitable central staff change is not available nearby. An individual locker may be allocated to each full-time and part-time, member of staff.
13.Staff toilets: Toilets should be provided for the staff with WCs and washbasins.
14.Office of the manager/incharge of the dept : The requisites for this room are computer facilities, a desk with telephone and a document storage cabinet. There should be enough space for the manager and visitors.
Equipment and accessories:
1. SS work table with wastage bin.
2. Worktable with undershelf.
3. Vertical sliding door
4. Two door instrument washer-disinfector.
5. Single free standing basket rack.
6. Storage shelf.
7. Storage shelf
8. Work table with single sink 9. Work table with 2 sinks 10. Ultrasonic cleaner.
11. Glove washer 12. Glove dryer 13. Glove powderer.
14. Glove storing bin.
15. E.T.O. sterilizer.
16. Preparation & packing table.
17. Rectangular sterilizer.
18. Trolley with carriage.
19. Storage tank 20. Water still
21. Double free standing basket rack.
Finishes:
In the processing areas finishes should be suitable for frequent washing down and tolerant to disinfectants. Joints should be avoided as they can hold moisture, encouraging the growth of organisms. Worktops, sinks, etc should be built up to walls and any gaps sealed. Where gaps are unavoidable they should be wide enough for easy cleaning. Movable worktops adjacent to machines permit easy cleaning and maintenance.
Ledges trap dust particles and should be avoided. This is particularly important in the packing room and linen preparation room which as clean rooms require finishes which are easily cleaned and low in maintenance.
Finishes must be suitable to cope with heavily loaded trolleys which are used in many spaces. Buffering on trolleys and mobile equipment is one of the most effective ways of reducing damage.
Flooring in the CSPD:
Throughout the processing areas, stores and circulation spaces a uniform floor level must be maintained. The finish must be suitable for heavy trolley traffic. The flooring should be turned up at walls in an integral covered skirting which should be continuous with the floor and be finished flush with the wall so that the junction between the skirting and the wall does not provide a ledge for the collection of dust.
The finish must be hardwearing and easy to clean. Appropriate finishes would be PVC sheet with welded joints or resin based flooring. A non slip surface should be considered for wet areas.
Walls in the CSPD:
In the storage and processing areas hollow wall construction should not be used because of possible infestation risk and liability to trolley damage.
Walls should be of solid construction, rendered to a hard smooth finish to withstand heavy treatment. Epoxy coating would be appropriate in
processing areas. Emulsion paint is appropriate in stores, circulation areas and staff areas.
Ceilings:
The minimum height from floor level to ceiling is 2.8 metres.
Doors:
Doors should be adequately sized to allow clear passage of trolleys and wheeled medical equipment.