Central sterile services department

General Planning Considerations

Sterilisation department in a hospital

The sterilisation department in a hospital is known by many acronyms, e.g.:

CSD Central Sterilisation Department

CPD Central Processing Area

SSD Sterile Service Department

TSSD Theatre Sterile Service Department

TSSU Theatre Sterile Service Unit

CSSD Central Sterile Service Department (the most widely used term in the South African context)

Location and functional relationship

Functional relationships to other departments

See Figure 1. The CSSD should be centrally located with ready access to all related service areas, such as the ICU, in-patient units and emergency unit. The department should also have direct access, either horizontally or vertically, to the operating theatres.

Deliveries and transportation routes

Trolleys are used as mode of transport for both receivables and deliveries. In order to cater for the high volume of trolleys to and from the CSSD receiving and dispatch areas, the entry/exit points should ideally be separated to create a uni-directional traffic flow and also to avoid cross-contamination through the division of the clean and dirty material.

Access for plant and equipment maintenance

Plant and equipment in service areas would need access from outside the CSSD, in order not to compromise the desired level of cleanliness in the unit. In some situations direct access between the plant area and the steriliser is required in order to allow access for maintenance staff to the equipment controls in the CSSD area side.

Figure 1: Departmental relationships (IUSS:GNS Adult Inpatient Services)

Primary function of a CSSD

The primary function of a CSSD is to provide an efficient, economic, continuous and quality supply of sterilised items, when needed, to all patient-care service points in the hospital, and to receive returned contaminated items for cleaning. This process is generally referred to as the “decontamination life cycle” (see Figure 2).

Figure 2: Decontamination life cycle

Activities in a CSSD can functionally be sorted under the following primary zones:

• Dirty Decontamination Zone

• Clean IAP (Inspection and Packing Zone)

• Sterile Clean Zone

In addition to the above primary zones, supporting activities are accommodated in the CSSD.

Support zone

In order to identify the functional relationship between the various spaces, the convention is used throughout this guide to indicate the respective zones in the following colours:

In order to create a work space for maintaining a clean environment suitable for handling sterile articles, access to the red, blue and green zones is restricted and subjected to “red-line” principle.

In addition to the above, the red area (decontamination zone) is divided with a hard barrier from the IAP area, in order to prevent contaminated particles from freely entering the relatively cleaner IAP area. This barrier could be a solid brick wall, or glass wall.

Activities comprising the decontamination cycle should allow a progressive work-flow pattern that commences with a “dirty” entry and receiving area, proceeds to a cleaning, decontamination and drying area, into a sorting and packing area, through to sterilisation and cooling area, to finish with sterile storage, distribution and exit areas.

Figure 3: Work flow through the primary zones

Activities in a CSSD

The main activities of the “decontamination life cycle” taking place in a CSSD can be listed as follows:

• receiving of soiled (and contaminated) returns

• cleaning of trolleys

• sorting returned trays

• sorting, disassembling, cleaning and drying of all returned medical devices

• checking functionality and cleanliness of cleaned medical devices

• assembling, packing and wrapping of trays

• sterilisation

• cooling of sterile packs

• storage of sterilised items

• dispatching of orders

• quality control

• maintenance

• record keeping

• receiving new supplies.

These activities can be classified under the following functional areas:

Decontamination

Decontamination involves the use of automated and manual cleaning to remove harmful blood-borne pathogens on the surfaces of equipment and instruments. Soiled items for re-use (medical devices, textiles and equipment) are received in the sterilising department after use in the various clinical departments. These could be operating theatres, emergency department and various wards. Medical devices, equipment and other contaminated articles will be sorted, disassembled, pre-rinsed and cleaned in the decontamination/dirty area. Used linen is put into linen bags and sent to the laundry. Waste items are sorted into suitable containers, according to policy, for appropriate disposal methods.

If items are heavily soiled a manual washing procedure will precede the automated cleaning process by washer-disinfectors. For manual cleaning, a double- (two-) sink arrangement is optimal, one for cleaning and one for rinsing. Automated washers or washer-disinfectors can be provided as single or double-door designs (the latter to allow for physical separation of the dirty and clean areas of the decontamination area).

Photograph 1: Manual cleaning

Photograph 2: Automated cleaning

Inspection

Decontaminated medical devices and equipment are visually inspected for functionality, damage and cleanliness according to required standards, the manufacturer’s instructions and written protocols.

Photograph 3:

Packing

Decontaminated instruments, equipment and other articles are sorted, assembled, counted and packed prior to sterilizing.

Photograph 4:

Sterilisation

Sterilisation is a defined process used to render a surface or product free from viable organisms, including bacterial spores. Depending on the product this procedure could vary from steam sterilisation, dry heat sterilisation, to low temperature sterilising processes.

Photograph 5:

Storage

Sterile items are stored in a clean controlled environment to prevent re-contamination before use.

Photograph 6:

Figure 4: The decontamination life cycle at a glance

Functional Requirements

Activity zones in a typical CSSD

Figure 5: Dispatch points in the decontamination cycle

Figure 5 above is a variation of the generic ‘decontamination life cycle’, indicating the various dispatch points in the cycle.

Based on this principle, the activity spaces in a CSSD could be organised as per figure 6

Figure 6: Configuration of activity spaces

Decontamination zone

• Receiving and sorting

• Waste disposal 

• Cleaner/sluice

• Trolley wash 

• Manual cleaning 

• Automated cleaning 

• Raw materials and chemicals storage

• PPE area (gowning).

Figure 7: Areas related to the decontamination zone