How Should Be Arranged The Central Sterile Services Department (cssd)

Introduction

The Central Sterile Services Department (CSSD) is a critical component in healthcare facilities, responsible for ensuring the proper sterilization and distribution of medical instruments and supplies. CSSD is made up of three zones: the soiled zone, the clean zone, and the sterile zone. It also includes two barriers, primarily constituted by washer disinfectors and secondarily by a row of sterilizers. This layout and material flow are designed to minimize contamination of sterile products. The two main elements to consider during CSSD operations are the movement of staff within CSSD and the flow of reusable medical devices and consumables.

Soiled Zone

The soiled zone includes the receiving area, cleansing area, and disinfection area. The cleansing area encompasses a decontaminating area, a manual washing area, and an ultrasonic cleaning area, while the disinfection area includes an automated washing area and an automated cart washer.

Clean Zone

The clean zone includes the inspection, assembly, and packing area, documentation and label printing area, clean stores, sterilizer loading area, and sterilizer room.

Sterile Zone

The sterile zone comprises sterilizers, a cooling area, a sterile store, and a sterile item issuing area.

Receiving Area

The receiving area should be located at the entrance to CSSD and secured to prevent unauthorized access. A red line should be drawn on the floor to designate the beginning of the area for soiled trolleys and materials. This area includes a computer with CDDS management software, an uninterruptible power supply for the computer, a barcode scanner, stainless steel tables, and movable stools. Engineering services required include switch socket outlets for the computer and scanner, data ports for network connections, door access control, intercom, and telephone connection.

Decontamination Area

The decontamination area is identified and labeled as “Biohazard Instruments.” It should have space for foot-operated clinical waste bins. Equipment and fixtures include a double bowl stainless steel deep sink, stainless steel tabletops, and movable stools. Engineering services required include a cold water supply to the hand wash basin.

Manual Cleaning Area

The manual cleaning area is adjacent to the decontamination area and includes all the equipment found there, plus special equipment such as a spray gun at the sink to facilitate cleaning lumens. Engineering services required include a cold water supply and medical air for cleaning.

Ultrasonic Cleaning

For effective ultrasonic cleaning, the ultrasonic cleaner should have an interlock lid and thermostatically controlled heaters or a hot water boiler. It also needs a rack with baskets to keep the equipment and fixtures. Engineering services required include deionized water, switch socket outlets, a water outlet, and a hot water boiler.

Water Disinfector

The water disinfector requires a dedicated floor-mounted conveyor line and sufficient ventilation to remove heat and odors from disinfecting agents. This area needs transfer trolleys and conveyor lines for transporting equipment. Engineering services required include domestic hot and cold water supply, de-ionized water, switch socket outlets, a water outlet, and an intercom.

Cart Washer

The cart washer requires a dedicated room adjoining the cart washer to accommodate the boiler and air compressor. This room can either be part of the cart washer package or a dedicated facility. Sufficient space should be provided around the equipment for inspection and repairs, and access doors should be sized to allow complete replacement of the equipment. A water jet facility for cleaning the washer disinfector is also required. Engineering services required include a dedicated steam boiler and compressed air, domestic hot and cold water supply, switch socket outlets, waste water outlet, and a water jet facility.

Transfer Hatch

Transfer hatches should be able to close to create an airlock to minimize air movement between the soiled zone and the clean zone. Additionally, dedicated floor-mounted conveyor lines should be placed at the transfer hatch, along with stainless steel conveyor lines. Engineering services required include an intercom for staff communication between the two zones.

Medical Drying Cabinet

The medical drying cabinet should have sufficient space at the back of the dryer for proper air circulation. There is no specific equipment required in this category area, but engineering services always need a switch socket outlet.

Documentation and Label Printing Area

The documentation and label printing area utilizes proprietary software for CSSD management. Equipment required includes a computer, a printer for checklists, a label printer, a scanner, an uninterruptible power supply (UPS), a stainless steel table, and a movable stool. Engineering services required include switch socket outlets for the computer, printer, scanner, data line for network, intercom, and telephone connection.

Inspection, Assembly, and Packing Area

The inspection, assembly, and packing area needs to be sufficiently sized and suitably arranged. Windows to the outside are not necessary but must be sealed when needed. The internal walls and doors should have vision panels. Moreover, the area should maintain a positive pressure differential with respect to adjacent areas. Equipment needed includes adjustable height stainless steel packing tables and stools, stainless steel storage and wrapper racks, stainless steel wire containers or plastic, table lamps with light and magnifier, mobile, high adjustable stools, and stainless steel trolleys. There are two types of rotary heat sealing machines: one for high temperature and high-pressure pouches and the second for low-temperature pouches. Engineering services required include a Class A clean room design for the assembly area. Natural lighting is not a must but should be in place at the assembly tables where items are inspected. Switch socket outlets are also required for task lighting.

References

• Association for the Advancement of Medical Instrumentation (AAMI). (2015). Comprehensive guide to steam sterilization and sterility assurance in health care facilities. Arlington, VA: AAMI.
• World Health Organization (WHO). (2016). Decontamination and reprocessing of medical devices for health-care facilities. Geneva: World Health Organization.