The CSSD, or Central Sterile Supply Department, is a crucial hospital department

responsible for the cleaning, disinfection, sterilization, and distribution of medical instruments,
equipment, and supplies

What is a defined CSSD?

The Central Sterile Supply Department (CSSD) is a specialised area responsible for the
collection, decontamination, assembling, packing, sterilisation, storing and distribution of
sterile goods and equipment to patient care areas

 functioning
 Receiving and Sorting:
Collecting used medical equipment and instruments from different hospital
units.
 Decontamination and Cleaning:
Thoroughly cleaning and disinfecting all items to remove any biological
material or contaminants.
 Inspection and Assembly:
Inspecting equipment for damage or defects and preparing them for
sterilization.
 Sterilization:
Utilizing autoclaves, ethylene oxide, or other methods to eliminate
microorganisms and sterilize items.
 Packaging:
Wrapping, bagging, or packaging sterilized items to maintain their sterility
during storage and distribution.
 Storage and Distribution:
Maintaining a secure storage area for sterilized items and ensuring timely
delivery to various hospital departments.
 Record Keeping:
Maintaining records of sterilization processes, instrument usage, and
inventory management.
 Quality Control:
Implementing rigorous quality control checks to verify the effectiveness of
sterilization and adherence to established protocols.
 Training and Education:
Providing training and education to other healthcare staff regarding proper
use and handling of sterile items, and infection control protocols.
In essence, the CSSD is crucial for maintaining a safe and hygienic
environment in hospitals by ensuring a constant supply of sterile medical
equipment and instruments, thus contributing to effective patient care and
preventing the spread of infection.
6 Steps of Instrument Reprocessing

1. Transport 2. Cleaning & Inspection 3. Packaging 4. Sterilization 5. Storage & Delivery 6. Quality
Assurance

1.TRANSPORT Contaminated instruments should be handled carefully to prevent exposure using

appropriate PPE (personal protection equipment). At point of use, they should be placed in a sealed,
leak proof container (displaying a biohazard symbol) to prevent any injuries or cross contamination
during transport to the processing area

TRANSPORT from Treatment Area • Organization • Efficiency • Safety • Puncture resistant, leak-
proof container with lid

CLEANING

Manually or mechanically clean soiled instruments as soon as possible in a designated area, wearing
appropriate PPE. Quick cleaning removes blood much easier, and can minimize instrument staining,
corrosion and/or pitting

Be sure to use approved cleaning solutions and cleaning brushes as commercial products not
intended for use with surgical instruments can cause damage and/or limit cleaning effectiveness

Mechanical cleaning is a safer practice for staff and a more effective process over manual cleaning.
Therefore, whenever possible, mechanically clean instruments, using warm water and a neutral pH

Ultrasonic Cleaner
• Remove gross soil before using • Use an enzymatic cleaning solution • Use treated water when
needed • Change solution AT LEAST daily • Must use lid • Don’t overload • Periodically perform ‘foil
test detergent.

Instrument Washer •

Increase productivity • Improve cleaning effectiveness • Decrease personnel sharps risk •

Accommodate more instruments than ultrasonic units • Use automated washing cycles • Eliminate
need for manual presoaking, hand scrubbing rinsing, and drying • Some have high temp cycle =
thermal disinfection
RINSING

After cleaning, thoroughly rinse instruments with tap water and ensure all debris and detergent
residue is removed. If the tap water is of poor quality, consider using treated water as a final rinse to
avoid instrument staining.

INSPECTION

Each instrument should be critically inspected after each cleaning for residual debris or damage.
Replace instruments as needed and never sterilize a “dirty” instrument.

In addition, check each instrument for proper function and lubricate as required by the instrument
manufacturer. Hinged instruments with stiff joints may be a sign of inadequate cleaning

PACKAGING

Instrument packaging should be done in a clean and low contamination area, using FDA approved
products: • Sterilization pouch • Sterilization wrap • Sterilization container

Sterilization pouches are for packaging loose instruments and small, light weight items. Paper/plastic
pouches allow you to see the contents and come with a build in adhesive strip for seal sealing. It is
important to remove all excess air, prior to sealing the sterilization pouch.

For quality assurance, be sure to include a chemical indicator inside each pouch. Per CDC guidelines,
this will verify sterilization parameters were met inside, as well as outside the pouch (time,
temperature and sterilant contact

Special Note: Some new technology pouches come printed with an external and internal chemical
indicator. If the internal indicator is a multi-parameter chemical indicator, there is no need to add a
separate indicator strip inside. To assist sterilization and aid drying, place pouches facing each other
and on edge using a divider

Sterilization wrap is ideal for packaging surgical kits. For sterility maintenance, be sure to use two
layers of wrap per industry standards and the wrap MFR’s FDA clearance For quality assurance,
include a chemical indicator inside to verify the sterilant reached the inside of the package. Wrap in
a way that allows sterile presentation and aseptic and delivery of the surgical pack or kit

Sterilization indicator tape should be used to secure the wrapper.

Special Note: Most steam indicator tapes contain latex in the adhesive and lead in the color change
ink. Latex and leadfree indicator tape is commercially available.

STERILIZATION

Heavier wraps should be placed on the lower shelf of the sterilizer and pouches (being lighter) on
the top, on edge. This enables moisture to drain out without wetting other items in the load
Sterilizers are Class 2 medical devices requiring FDA clearance. They are available in a variety of sizes
with the following processes most common to medical:

• Steam • Chemical vapor • Dry heat / Rapid heat transfer

Saturated steam under pressure is one of the oldest methods used to sterilize surgical instruments.
The CDC recommends steam sterilization as the process of choice, because it is efficient, fast, and
inexpensive. By heating distilled water under pressure, moist heat is created and rapidly kills
microorganisms. Some common steam sterilizer cycle parameters are

: • 250°F/121°C for 30 min (Gravity) • 270°F/132°C for 10 min (Gravity) • 270°F/132°C for 4 min
(DAR)

There are three (3) different types of steam sterilizers

: 1. Gravity Displacement 2. Prevacuum 3. Steam Flush Pressure Pulse (SFPP) Gravity displacement
sterilizers heat the water which converts it to steam and pushes the air out the drain gradually. This
is called “passive air removal”

Prevacuum (also called Class B) sterilizers heat water and convert it to steam; however, they use a
vacuum pump to quickly remove the air which allows for faster cycles. This is called “dynamic air
removal”. Because prevacuum steam sterilizers rely on a pump to remove air, an air removal test
called Bowie-Dick test should be performed daily.

AIR REMOVAL TEST Test Procedure: Place a Bowie-Dick test pack on the lowest shelf, over the drain
in an empty chamber at 273°F for 3.5 or 4 minutes exposure time. After processing, the color change
indicator inside the test pack should show a uniform color to pass. Retain the indicator as part of
your Infection Control records

Steam-flush-pressure-pulse (SFPP) sterilizers are also considered dynamic air removal, but use steam
flushes and pressure pulses to remove the trapped air from the chamber and load. As with
prevacuum sterilizers, air removal is more efficient than gravity displacement sterilizers and permits
shorter cycle times. Because SFPP air removal occurs through atmospheric pressure pulses rather
than the vacuum pulses used in prevacuum sterilizers, a daily air removal test is not necessary.

Storage & Delivery

Sterile items should be stored in a manner that reduces the potential for contamination. The shelf-
life of sterile items is event related and depends on the quality of the packaging material, storage
conditions and amount of handling. Sterile packages should always be handled with care. Avoid
dragging, crushing, bending, compressing or puncturing, as this can compromise sterility. Be sure to
inspect sterile packages before distributing. Do not use any package that is damaged, wet or opened

Quality Assurance Sterility assurance of processed instruments should be routinely verified using
three (3) types of indicators: 1) Physical 2) Chemical 3) Biological
 1) Physical indicators are the time, temperature and pressure gauges built into sterilizers. These
readings should be recorded for every cycle and verified prior to unloading the sterilizer.
Hospital sterilizers are required to have a chart or printout, whereas this is optional for
sterilizers located in private offices or clinics.
2) 2) Chemical indicators should be on the outside and inside of all packages to verify they have
been processed. The outside can be a single parameter indicator, i.e. change with heat alone;
however, the internal should be multi-parameter requiring more than just heat to make it pass
We mentioned that some newer pouches now offer external and internal indicators printed with
every pouch. Be sure the supplier has validated the internal indicator as a multiparameter
indicator, per CDC guidelines
3) 3) Biological indicators provide users the highest level of sterility assurance and contain bacterial
spores available in plastic vial or paper strip format. The CDC says sterilizers should be tested at
least weekly, and every load that contains an implant. An unprocessed Control test, from the
same lot must be included In-office biological monitors are processed along with a normal load.
After processing, the plastic vial is activated by crushing the side and then incubated. Sterilizer
failure is noted if the test vial changes color from purple to yellow. An unprocessed vial should
be incubated each time to verify test results. A BI inside a Test Pack should be used to monitor
large sterilizers when processing packaged instruments. Steam - place on the bottom shelf,
directly above the drain with a load. The SPSmedical Steam BI test pack includes a BI, along with
a Class 5 integrator for immediate release of load, and is FDA cleared for use with standard or
extended sterilization cycles Paper strip biological indicators can be sent to an outside lab for 3
rd party verification. After processing a spore strip along with a normal load, the strip(s) are sent
to a lab for incubation. Test results are returned via mail or fax, with some services offering
internet record keeping via password
4) What’s New? The FDA has approved the SPS STEAM Plus integrator as equal in performance to
the spore test. This does not mean it replaces the weekly spore test; however, we do
recommend it be used with each steam cycle to protect against the release of non-sterile items
While sterilizers can and do mechanically fail, operator error is the leading cause of sterilizer
failure, e.g. • Cold start • Wrong cycle • Overloading • Improper packaging

Autoclave
An autoclave is a machine that provides a physical method
of sterilization by killing bacteria, viruses, and even spores
present in the material put inside of the vessel using steam
under pressure.
Autoclave sterilizes the materials by heating them up to a particular
temperature for a specific period of time. The autoclave is also
called a steam sterilizer that is commonly used in healthcare
facilities and industries for various purposes. The autoclave is
 considered a more effective method of sterilization as it is based on
moist heat sterilization

Autoclave Parts/ Components

a. Pressure Chamber
 The pressure chamber is the main component of a steam
autoclave consisting of an inner chamber and an outer jacket.
 The inner chamber is made up of stainless steel or gunmetal,
which is present inside the out chamber made up of an iron case.
 The autoclaves used in healthcare laboratories have an outer
jacket that is filled with steam to reduce the time taken to reach
the sterilization temperature.
 The inner chamber is the case where the materials to be sterilized
are put.
 The size of the pressure chamber ranges from 100 L to 3000 L.
 b. Lid/ Door
 The next important component of an autoclave is the lid or door of
the autoclave.
 The purpose of the lid is to seal off the outside atmosphere and
create a sterilized condition on ht inside of the autoclave.
 The lid is made airtight via the screw clamps and asbestos washer.
 The lid consists of various other components like:
Pressure gauge
 A pressure gauge is present on the lid of the autoclave to indicate
the pressure created in the autoclave during sterilization.
 The pressure gauge is essential as it assures the safety of the
autoclave and the working condition of the operation.
Pressure releasing unit/ Whistle
 A whistle is present on the lid of the autoclave is the same as that
of the pressure cooker.
 The whistle controls the pressure inside the chamber by releasing
a certain amount of vapor by lifting itself.
Safety valve
 A safety valve is present on the lid of the autoclave, which is
crucial in cases where the autoclave fails to perform its action or
the pressure inside increases uncontrollably.
 The valve has a thin layer of rubber that bursts itself to release the
pressure and to avoid the danger of explosion.
c. Steam generator/ Electrical heater
 An electrical steam generator or boiler is present underneath the
chamber that uses an electric heating system to heat the water
and generate steam in the inner and the outer chamber.
 The level of water present in the inner chamber is vital as if the
water is not sufficient; there are chances of the burning of the
heating system.
 Similarly, if the water is more than necessary, it might interfere
with the trays and other components present inside the chamber.
d. Vacuum generator (if applicable)
 In some types of autoclaves, a separate vacuum generator is
present which pulls out the air from the inside of the chamber to
create a vacuum inside the chamber.
 The presence of some air pockets inside the chamber might
support the growth of different microorganisms. This is why the
vacuum chamber is an important component of an autoclave.
 e. Wastewater cooler
 Many autoclaves are provided with a system to cool the effluent
before it enters the draining pipes.
 This system prevents any damage to the drainage pipe due to the
boiling water being sent out of the autoclave.
Autoclave Principle/ Working

 The autoclave works on the principle of moist heat sterilization

where steam under pressure is used to sterilize the material
present inside the chamber.
 The high pressure increases the boiling point of water and thus
helps achieve a higher temperature for sterilization.
 Water usually boils at 100°C under normal atmospheric pressure
(760 mm of Hg); however, the boiling point of water increases if
the pressure is to be increased.
 Similarly, the high pressure also facilitates the rapid penetration of
heat into deeper parts of the material, and moisture present in the
steam causes the coagulation of proteins causing an irreversible
loss of function and activity of microbes.
 This principle is employed in an autoclave where the water boils at
121°C at the pressure of 15 psi or 775 mm of Hg.
 When this steam comes in contact with the surface, it kills the
microbes by giving off latent heat.
 The condensed liquid ensures the moist killing of the microbes.
 Once the sterilization phase is completed (which depends on the
level of contamination of material inside), the pressure is released
from the inside of the chamber through the whistle.
 The pressure inside the chamber is then restored back to the
ambient pressure while the components inside remain hot for
some time.
Procedure for running an autoclave
In general, an autoclave is run at a temperature of 121° C for at
least 30 minutes by using saturated steam under at least 15 psi of
 pressure. The following are the steps to be followed while running
an autoclave:
1. Before beginning to use the autoclave, it should be checked for
any items left from the previous cycle.
2. A sufficient amount of water is then put inside the chamber.
3. Now, the materials to be sterilized are placed inside the chamber.
4. The lid is then closed, and the screws are tightened to ensure an
airtight condition, and the electric heater is switched on.
5. The safety valves are adjusted to maintain the required pressure in
the chamber.
6. Once the water inside the chamber boils, the air-water mixture is
allowed to escape through the discharge tube to let all the air
inside to be displaced. The complete displacement can be ensured
once the water bubbles cease to come out from the pipe.
7. The drainage pipe is then closed, and the steam inside is allowed
to reach the desired levels (15 lbs in most cases).
8. Once the pressure is reached, the whistle blows to remove excess
pressure from the chamber.
9. After the whistle, the autoclave is run for a holding period, which is
15 minutes in most cases.
10. Now, the electric heater is switched off, and the autoclave is
allowed to cool until the pressure gauge indicates the pressure
inside has lowered down to that of the atmospheric pressure.
11. The discharge pipe is then opened to allow the entry of air
from the outside into the autoclave.
12. Finally, the lid is opened, and the sterilized materials are taken
out of the chamber
Types of Autoclave
There are different types of autoclaves present in the market, some
of which are:
Pressure cooker type/ Laboratory bench
autoclaves (N-type)
 These, as domestic pressure cookers, are still in use in many parts
of the world.
 The more modern type has a metal chamber with a secure metal
lid that can be fastened and sealed with a rubber gasket.
 It has an air and steam discharge tap, pressure gauge, and safety
valve. There is an electric immersion heater at the bottom of the
chamber.
 Gravity displacement type autoclave
 This is the common type of autoclave used in laboratories.
 In this type of autoclave, the steam is created inside the chamber
via the heating unit, which then moves around the chamber for
sterilization.
 This type of autoclave is comparatively cheaper than other types.
Positive pressure displacement type (B-type)
 In this type of autoclave, the steam is generated in a separate
steam generator which is then passed into the autoclave.
 This autoclave is faster as the steam can be generated within
seconds.
 This type of autoclave is an improvement over the gravity
displacement type.
Negative pressure displacement type (S-
type)
 This is another type of autoclave that contains both the steam
generator as well as a vacuum generator.
 Here, the vacuum generator pulls out all the air from inside the
autoclave while the steam generator creates steam.
 The steam is then passed into the autoclave.
 This is the most recommended type of autoclave as it is very
accurate and achieves a high sterility assurance level.
 This is also the most expensive type of autoclave

Uses of Autoclave
Autoclaves are important devices to ensure the sterilization of
materials containing water as they cannot be sterilized by dry heat
sterilization. Besides, autoclaves are used for various other
purposes.
1. They are used to decontaminate specific biological waste and
sterilize media, instruments, and labware.
2. Regulated medical waste that might contain bacteria, viruses, and
other biological materials is recommended to be inactivated by
autoclaving before disposal.
3. In medical labs, autoclaves are used to sterilize medical
equipment, glassware, surgical equipment, and medical wastes.
4. Similarly, autoclaves are used for the sterilization of culture media,
autoclavable containers, plastic tubes, and pipette tips.

Precautions
Although autoclaves are pretty simple to use, there are certain rules
of precautions to be followed while operating an autoclave. Some of
the important precautions to be followed while running an autoclave
are:
1. Autoclaves should not be used to sterilize water-proof or water-
resistant substances like oil or powders.
2. The autoclave should not be overcrowded, and the materials
should be loaded in a way that ensures sufficient penetration of
articles by the steam.
3. TheThe items to be autoclaved should always be placed in a
secondary container.
4. Only autoclavable bags are to be used to autoclave packaged
waste.
5. To ensure sufficient penetration, articles should be wrapped in
something that allows penetration by steam, and materials like
aluminum foils should not be used.
6. The items placed inside the chamber should not touch the sides or
top of the chamber.
7. The wastes and clean items should be autoclaved separately.
8. Attempts to open the lid when the autoclave is working should
never be made.
9. Liquid components should never be autoclaved in sealed
containers.
10. The liquid inside the containers should only be filled 2/3 rd of the
total volume to prevent the spilling of the liquid.
11. Plastic or polyethylene trays or containers should not be used
as they might melt and damage the autoclave.
12. Besides, never autoclave flammable, reactive, corrosive, toxic,
or radioactive materials, household bleach, or paraffin-embedded
tissue.
13. The paper should not be placed directly inside an autoclave as
it is a combustible substance. It should be autoclaved in a waste
bag on a bio bag setting to prevent fire.