Central Sterilization Supply Department (CSSD)
The Central Sterilization Supply Department (CSSD) is an integrated service in hospitals that performs sterilization and other actions on medical devices, equipment, and Supplies. This unit ensures the safe management of decontamination services in healthcare through safe, efficient, effective, and reliable systems. This Department provides complex services, including preparing sterile medical supplies for the operating room and all other units and departments in the Children’s Cancer Hospital Egypt 57357.
The scope of the tasks and responsibilities of CSSD places it as a department that deals with the prevention of nosocomial infections and represents one of the core aspects of comprehensive health care. This department provides specialized hygienic operations (complex pre-sterilization preparation, steam sterilization, plasma sterilization), the output of which is sterile medical supplies. To routinely supply the hospital with all necessary sterile material, the department’s management closely cooperates with the leading employees of the operating rooms and inpatient and outpatient clinics. The main aim of the Department of Central Sterile Supply is to guarantee a high quality and level of sterilization for all medical supplies. The protection of all patients is critical to our work.
The Central Sterilization Supply Department comprises five major areas: decontamination and processing, assembly, sterilizing, sterile storage, and distribution.
The objectives of central service include the following:
- Disinfection, mechanical treatment, and manual treatment of all medical supplies in automatic washers with adjustable and controlled parameters. The machine-controlled washing is carried out in a closed system and uses thermal-chemical or thermal disinfection. The quality of pre-sterilization preparation is checked and performed by different indicators.
- Organizing and completing surgical instruments into sets by qualified technicians, as well as medical supplies are packed into special single-use or reusable sterile packs in a qualified manner.
- Visual control of completeness, preparation, and packing of surgery room cloths by preparing and packing the cloths in single-item packs or set packs according to requirements of individual operating rooms or other departments and units all over the hospital.
- Moreover, Plasma sterilization is used for thermo-labile reusable medical supplies (made of plastic). The sterilization medium is a low-temperature plasma created in a high-frequency electromagnetic field that interacts with 58 percent hydrogen peroxide vapors in a high vacuum. Plasma sterilization is a dry sterilization process. All sterilization processes are carried out in modern machines with controlled parameters and written records providing details. Both chemical and biological indicators rigidly monitor all sterilization processes.
- Moist heat or autoclave sterilization is used for metal, porous, hollow, or otherwise thermos-stable medical products. The sterilizing medium is saturated water vapor, which transmits thermal energy by condensing medical supplies. Furthermore, the department employees carry out final inspections using different indicator tests to ensure the quality of sterilization. The department takes care of the delivery of sterile medical supplies.
Types of Sterilization in CSSD
There are three main types of Sterilization in CSSD (Central Sterile Supply Department) : steam sterilization, Ethylene Oxide Sterilization, Hydrogen Peroxide sterilization, and also other ways, and we are going to demonstrate each one.
Overview of different types of sterilization methods
The items that undergo the sterilization process depend on the manufacturers’ guidelines.
That can vary from:
- Steam Sterilization or a Pre-vacuum cycle that is suitable for instruments that can withstand high temperatures and humidity.
- Or Low-Temperature Sterilization methods like ethylene oxide (ETO), vaporized hydrogen peroxide, liquid chemicals, and ozone.
Steam
- Steam sterilization (Autoclave) is the most effective method of sterilization using steam under pressure using a temperature of 120 degrees Celsius with 15 pounds of pressure for 20 to 30 minutes to complete the process of sterilization.
- There is a special model of the autoclave that can reach 132 degrees Celsius called flash sterilization and as a result of its high temperature the cycle of sterilization is about 3 to 5 minutes only.
- Steam sterilization (aka autoclaving) is a fast, safe, not toxic for humans, and affordable, economical, and environment-friendly option for sterilization.
- Steam sterilization has the ability to penetrate packaging and sterilize liquids, it can also eliminate fire risks, unlike dry heat.
- But Some disadvantages of steam sterilization are that it can’t sterilize heat/moisture sensitive material, has the potential to cause burns, and requires multiple utilities like water and electricity.
- Steam sterilization is considered the predominant form of sterilization in CSSD.
- Its cycle types include gravity, pre-vacuum, and SFPP (Steam Flush Pressure Pulse), depending on cycle type, load weight, density, and variables like exposure and drying time the time of the cycle varies.
Ethylene Oxide
In the U.S. about 50% of sterilization depends on ethylene oxide.
- Ethylene oxide is one of the most highly effective methods in sterilization that doesn’t cause damage to the device during the sterilization process.
- It is remarkable for medical devices that are made of plastic or resin, it is suitable also for glass or devices that have multiple layers or that have hard-to-reach places, like catheters as a result it is used for general health care practices like wound dressings to more specialized devices that used in treating areas of the body like stents.
- It is specialized for heat and moisture-sensitive items.
- The cycle of ETO sterilization takes far longer than steam sterilization, which can reach from 8 to 12 hours.
- The Ethylene Oxide Sterilization is composed of five stages:
- Preconditioning and humidification, gas introduction, exposure, evacuation, and air washes take about 1 to 4.5 hours to get rid of the effect of toxicity of ethylene gas.
- As ethylene oxide is a toxic gas, there is a special team of well-trained healthcare professionals to deal with this type of sterilization.
Hydrogen Peroxide Plasma Sterilization
- Hydrogen peroxide gas plasma is one of the most common methods for sterilizing at low temperatures.
- Through a process, the Hydrogen peroxide is activated to create a reactive plasma or vapor.
- It is called Vaporized Hydrogen Peroxide Sterilization or hydrogen peroxide gas sterilization, which is used in the sterilizing of heat-sensitive devices.
- In the sterilization process, H2O2 vapor fills the sterilization chamber to contact and sterilize exposed device surfaces.
- After the sterilization cycle ends, the vapor is removed from the chamber and converted to water and oxygen.
- One of the advantages of using hydrogen peroxide is that it has near zero risk to the workers and the time of cycle compared to ETO takes a fraction of the time.
Others
Dry heat sterilization uses thermal processing to remove moisture content from coatings and other materials, it is used only for materials that might be damaged by moist heat or that are impenetrable to moist heat, like powders, petroleum products, and sharp instruments.
Liquid Chemical Sterilization considers safe and effective reprocessing for heat-sensitive, critical, and semi-critical devices such as duodenoscopes and other complex endoscopes.
One of the newest sterilization methods is Ozone Sterilization, by which one more oxygen atom attached to the molecule can destroy microbes to sterilize devices, it also has no toxic emissions.
Sterilization by Radiation can be divided into two groups:
- Electromagnetic waves like infrared radiation, ultraviolet light, X-rays, and gamma rays.
- Streams of particulate matter like alpha and beta radiations.
Infrared radiation, ultraviolet light, gamma radiation, and high-velocity electrons are considered the most frequently used in sterilization.
Sterilization Cycle Verification
As the importance of the sterilization process, this process needs to be verified before it is used in the healthcare units.
Types of Sterilization in CSSD are tested with biological and chemical indicators.
Firstly The sterilization process needs to be verified before usage, especially
- after the installation process.
- After the sterilizer is relocated or redesigned.
- When the sterilizer has been repaired.
- Or there is a failure has occurred for sterilization.
All of these to ensure that they are done in their function properly before usage.
Each cycle of steam sterilization is tested separately through three consecutive empty steam cycles with a biological and chemical indicator using a test package, and there are also three empty cycles using the Bowie-Dick test for the pre-vacuum cycle.
When the biological indicators are negative and chemical indicators have the correct end-point response, then the sterilizer can be used.
For monitoring Sterility assurance, the test packers are used and the choice of it depends on the type of sterilization process used or parameters being measured.
Some types of sterility assurance products include:
The Biological Indicators
used within process challenge devices or challenge packs for routine monitoring, load monitoring, and qualification of the sterilization systems once BI has a negative result that indicates the load can safely move on to sterile storage.
The Chemical Indicators
can be put externally or internally in the package container, external chemical indicators show that the set has been fully exposed to the sterilization process, but internal chemical indicators are placed in the most challenging area of the set to confirm that sterile penetrated the load.
The Bowie Dick Test
It is used to check the efficiency of the air removal and steam penetration in the chamber, and this test must be run daily before any pre-vacuum cycles are run.
Factors influencing the choice of sterilization type in the Central Sterile Supply Department (CSSD)
There are many factors in choosing types of Sterilization in CSSD.
Type of Instruments
Depending on the type of instrument the sterilized method can be detected and there are different types of instruments that require different sterilization methods, depending on their size, shape, and materials.
Material Compatibility
Some materials may not be compatible with certain sterilization methods, which can cause damage to the instruments or reduce the effectiveness of the sterilization process.
Sterilization Efficacy
The chosen sterilization method should be effective in eliminating all microorganisms, including bacteria, viruses, and fungi, from the instruments.
Volume of Instruments
Some sterilization methods are more suitable for high volumes of instruments, while others are better suited for smaller quantities.
The Cost
Different sterilization methods have different costs associated with them, and the choice of the method should take into account the budget and resources available to the CSSD.
Environmental Impact
Some methods may produce waste that requires special disposal methods, while others may be more environmentally friendly.
Safety
The chosen sterilization method should not pose a risk to the staff or the patients, and appropriate safety measures should be in place during the sterilization process.
There are different types of Sterilization in CSSD and there are many factors to determine the suitable method, but each one has its advantages and disadvantages. Finally Innova Arabia can present the services of managing and sterilization of CSSD to increase the qualification of your unit.
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what is central sterile supply department
FAQS
What is Steam Sterilization?
Steam sterilization, also known as autoclaving, is a widely used method in Central Sterile Supply Departments (CSSD) to effectively sterilize medical equipment and instruments. This process involves subjecting the items to high-pressure saturated steam at a specific temperature for a designated period. The combination of heat and moisture ensures the destruction of microorganisms, including bacteria, viruses, and spores.
Key information:
- Steam sterilization is a widely used method in CSSD.
- It involves subjecting items to high-pressure saturated steam at a specific temperature.
- The process effectively destroys bacteria, viruses, and spores.