Difference between revisions of "Central sterile services department"

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Activities in a CSSD can functionally be sorted under the following primary zones:  
 
Activities in a CSSD can functionally be sorted under the following primary zones:  
  
* Dirty      Decontamination Zone
+
*Dirty      Decontamination Zone
* Clean    IAP (Inspection and Packing Zone)
+
*Clean    IAP (Inspection and Packing Zone)
* Sterile  Clean Zone  
+
*Sterile  Clean Zone
  
 
In addition to the above primary zones, supporting activities are accommodated in the CSSD.   
 
In addition to the above primary zones, supporting activities are accommodated in the CSSD.   
Line 57: Line 57:
 
The main activities of the “decontamination life cycle” taking place in a CSSD can be listed as follows:  
 
The main activities of the “decontamination life cycle” taking place in a CSSD can be listed as follows:  
  
* receiving of soiled (and contaminated) returns  
+
*receiving of soiled (and contaminated) returns
* cleaning of trolleys  
+
*cleaning of trolleys
* sorting returned trays  
+
*sorting returned trays
  
* sorting, disassembling, cleaning and drying of all returned medical devices
+
*sorting, disassembling, cleaning and drying of all returned medical devices
* checking functionality and cleanliness of cleaned medical devices
+
*checking functionality and cleanliness of cleaned medical devices
* assembling, packing and wrapping of trays  
+
*assembling, packing and wrapping of trays
* sterilisation  
+
*sterilisation
* cooling of sterile packs
+
*cooling of sterile packs
* storage of sterilised items  
+
*storage of sterilised items
* dispatching of orders  
+
*dispatching of orders
* quality control  
+
*quality control
* maintenance
+
*maintenance
* record keeping  
+
*record keeping
* receiving new supplies.
+
*receiving new supplies.
  
 
These activities can be classified under the following functional areas:  
 
These activities can be classified under the following functional areas:  
Line 123: Line 123:
 
==Decontamination zone==
 
==Decontamination zone==
  
* Receiving and sorting  
+
*Receiving and sorting
* Waste disposal 
+
*Waste disposal 
* Cleaner/sluice  
+
*Cleaner/sluice
* Trolley wash   
+
*Trolley wash 
* Manual cleaning   
+
*Manual cleaning 
* Automated cleaning   
+
*Automated cleaning 
* Raw materials and chemicals storage  
+
*Raw materials and chemicals storage
* PPE area (gowning).  
+
*PPE area (gowning).
  
 
Figure 7: Areas related to the decontamination zone
 
Figure 7: Areas related to the decontamination zone
Line 136: Line 136:
 
==Inspection and packing zone (IAP Zone)==
 
==Inspection and packing zone (IAP Zone)==
  
* Inspection and packing (IAP)  
+
*Inspection and packing (IAP)
* Sterile pack  
+
*Sterile pack
* Textile folding  
+
*Textile folding
* Raw materials storage  
+
*Raw materials storage
* PPE area (gowning).  
+
*PPE area (gowning).
  
 
Figure 8: Areas related to the inspection and packing zone
 
Figure 8: Areas related to the inspection and packing zone
Line 146: Line 146:
 
==Sterile zone==
 
==Sterile zone==
  
* Sterilisation
+
*Sterilisation
* Cooling   
+
*Cooling 
* Sterile pack storage  
+
*Sterile pack storage
* Dispatch.
+
*Dispatch.
  
 
Figure 9: Areas related to the clean zone
 
Figure 9: Areas related to the clean zone
Line 155: Line 155:
 
==Support zone==
 
==Support zone==
  
* Office
+
*Office
* Staff rest room  
+
*Staff rest room
* Kitchenette
+
*Kitchenette
* Female change room  
+
*Female change room
* Male change room  
+
*Male change room
* Manager’s office  
+
*Manager’s office
* Steriliser plant room.  
+
*Steriliser plant room.
  
 
Figure 10: Areas related to the support zone
 
Figure 10: Areas related to the support zone
Line 194: Line 194:
 
Planning and design features to support infection control should include the following:
 
Planning and design features to support infection control should include the following:
  
* Restricted/controlled access  
+
*Restricted/controlled access
* Unidirectional work flow, progressing from dirty to clean to sterile areas  
+
*Unidirectional work flow, progressing from dirty to clean to sterile areas
* Controlled air flow with positive air pressure from clean to dirty areas  
+
*Controlled air flow with positive air pressure from clean to dirty areas
* Containment of steam and moisture, preventing potential contamination of stored sterile articles.  
+
*Containment of steam and moisture, preventing potential contamination of stored sterile articles.
* Building and layout details that would facilitate easy cleaning  
+
*Building and layout details that would facilitate easy cleaning
* Selection of suitable building materials and finishes  
+
*Selection of suitable building materials and finishes
* Selection of fixtures, fittings and equipment with suitable detail, materials and finishes for easy cleaning, and prevention of build-up of harmful organisms  
+
*Selection of fixtures, fittings and equipment with suitable detail, materials and finishes for easy cleaning, and prevention of build-up of harmful organisms
* Adequate facilities for cleaning and waste management  
+
*Adequate facilities for cleaning and waste management
* Access to the area should be limited and controlled. This should prevent any unauthorised person from entering the area without permission  
+
*Access to the area should be limited and controlled. This should prevent any unauthorised person from entering the area without permission
* Staff/visitors should have access to hand-washing facilities, separate from those used for cleaning devices, before entering or leaving the areas.
+
*Staff/visitors should have access to hand-washing facilities, separate from those used for cleaning devices, before entering or leaving the areas.
* The flow of both staff and equipment must allow no cross-over of soiled and clean materials  
+
*The flow of both staff and equipment must allow no cross-over of soiled and clean materials
* The operating procedure for infection control in a CSSD falls outside the scope of this guideline.  
+
*The operating procedure for infection control in a CSSD falls outside the scope of this guideline.
  
 
==Design for Occupational, Health and Safety==
 
==Design for Occupational, Health and Safety==
 
Planning and design features to support occupational health and safety include the following:  
 
Planning and design features to support occupational health and safety include the following:  
  
* Selection of floor finishes with a non-slip finish  
+
*Selection of floor finishes with a non-slip finish
* Selection of fixtures, fittings and equipment with suitable detail, materials and finishes to prevent personal injury through accidents or misuse  
+
*Selection of fixtures, fittings and equipment with suitable detail, materials and finishes to prevent personal injury through accidents or misuse
* Provision of suitable and adequate facilities to support and encourage a high level of personal hygiene, with special reference to hand hygiene
+
*Provision of suitable and adequate facilities to support and encourage a high level of personal hygiene, with special reference to hand hygiene
* Provision of adequate dispensing points for the appropriate personal protection items (PPE) for the specific area to enable strict enforcement of PPE requirements in the protection of healthcare workers, especially as preventive measures against HIV aids  
+
*Provision of adequate dispensing points for the appropriate personal protection items (PPE) for the specific area to enable strict enforcement of PPE requirements in the protection of healthcare workers, especially as preventive measures against HIV aids
* Top-loading, worktop equipment should be accessible to staff members of all heights  
+
*Top-loading, worktop equipment should be accessible to staff members of all heights
* Ill-considered dimensions and layouts of fixtures and fittings could have a significant negative effect on occupational health and safety of staff.
+
*Ill-considered dimensions and layouts of fixtures and fittings could have a significant negative effect on occupational health and safety of staff.
  
 
As the requirements of the Occupational Health and Safety Act will apply, this section needs to be read in conjunction with the OHS-related guidelines.
 
As the requirements of the Occupational Health and Safety Act will apply, this section needs to be read in conjunction with the OHS-related guidelines.
Line 222: Line 222:
 
Although it is difficult to predict future trends in CSSD technology, it is advisable to allow some flexibility and adaptability in space requirements, electrical consumption and layout, and also in air-handling capacity. Current trends that need to be considered are the following:
 
Although it is difficult to predict future trends in CSSD technology, it is advisable to allow some flexibility and adaptability in space requirements, electrical consumption and layout, and also in air-handling capacity. Current trends that need to be considered are the following:
  
* The increasing complexity of surgical procedures requires more intricate equipment and instruments that need specialised care and handling during the sterilisation procedure  
+
*The increasing complexity of surgical procedures requires more intricate equipment and instruments that need specialised care and handling during the sterilisation procedure
* Integrated computerised tracking facilities have become widely used and have become an essential tool in the validation of the sterilisation process  
+
*Integrated computerised tracking facilities have become widely used and have become an essential tool in the validation of the sterilisation process
* Changing staff-flow patterns due to changing work-flow patterns as a result of procedural and/or equipment innovations  
+
*Changing staff-flow patterns due to changing work-flow patterns as a result of procedural and/or equipment innovations
* Design towards sustainable architecture, i.e. water-saving equipment, and equipment with reduced toxic emissions. Constant improvements and innovations lead to products that run more economically and reach a higher level of environment compatibility   
+
*Design towards sustainable architecture, i.e. water-saving equipment, and equipment with reduced toxic emissions. Constant improvements and innovations lead to products that run more economically and reach a higher level of environment compatibility 
* The facility should be able to reasonably accommodate access and positioning of possible outsize equipment. Consideration for this possibility should be given from (and including) point of delivery to point of positioning  
+
*The facility should be able to reasonably accommodate access and positioning of possible outsize equipment. Consideration for this possibility should be given from (and including) point of delivery to point of positioning
* It is advisable to allow capacity for extra machinery in the event of increased production demand.
+
*It is advisable to allow capacity for extra machinery in the event of increased production demand.
  
 
==Ergonomic and user-comfort considerations==
 
==Ergonomic and user-comfort considerations==
Line 243: Line 243:
 
Noise must be controlled  
 
Noise must be controlled  
  
* A threshold of 60dBA (decibel) must not be exceeded   
+
*A threshold of 60dBA (decibel) must not be exceeded 
* The walls and ceilings should be made of absorbent materials so that they do not reflect sound   
+
*The walls and ceilings should be made of absorbent materials so that they do not reflect sound 
* Insulation of sterilisers and washer-disinfectors in technical walls will reduce the noise level
+
*Insulation of sterilisers and washer-disinfectors in technical walls will reduce the noise level
* Offices should allow confidential discussions to take place in privacy, away from noisy mechanical or high-volume human areas.  
+
*Offices should allow confidential discussions to take place in privacy, away from noisy mechanical or high-volume human areas.
  
 
==Natural light==
 
==Natural light==
Line 261: Line 261:
 
=CSSD Area Determination=
 
=CSSD Area Determination=
  
== Determination of size and layout ==
+
==Determination of size and layout==
 
The size of a CSSD in a hospital is unique to that hospital, as the size, layout and function of a CSSD are defined in the Operational Policy Statement that guides the operational management of the hospital. The operational policies specific to the CSSD precede sketch design stage. These policies are developed by the project team in consultation with health; service stakeholders, who should have the knowledge and experience to analyse the various processes in and related to the CSSD.  
 
The size of a CSSD in a hospital is unique to that hospital, as the size, layout and function of a CSSD are defined in the Operational Policy Statement that guides the operational management of the hospital. The operational policies specific to the CSSD precede sketch design stage. These policies are developed by the project team in consultation with health; service stakeholders, who should have the knowledge and experience to analyse the various processes in and related to the CSSD.  
  
 
These operational policies define the “What, How, When, Where, Who and With What” of any activity and/or process and are major space determinants which could significantly affect the planning and design of the CSSD, as they can have an impact on the size, configuration and the nature of accommodation.  Operational policies will vary from unit to unit depending on a wide range of factors, both external and internal to the CSSD.  
 
These operational policies define the “What, How, When, Where, Who and With What” of any activity and/or process and are major space determinants which could significantly affect the planning and design of the CSSD, as they can have an impact on the size, configuration and the nature of accommodation.  Operational policies will vary from unit to unit depending on a wide range of factors, both external and internal to the CSSD.  
  
=== Determining factors external to the CSSD ===
+
===Determining factors external to the CSSD===
 
Examples of these space determinants could include the following:  
 
Examples of these space determinants could include the following:  
  
* number of theatres/case mix  
+
*number of theatres/case mix
* surgical procedures  
+
*surgical procedures
* extent of storage in the theatres and wards  
+
*extent of storage in the theatres and wards
* distribution system that will be used (vertical, horizontal, trolleys, lifts)  
+
*distribution system that will be used (vertical, horizontal, trolleys, lifts)
* amount of space needed for waste management
+
*amount of space needed for waste management
* processing needs for re-usable textiles (receiving, transporting, collecting, storing)  
+
*processing needs for re-usable textiles (receiving, transporting, collecting, storing)
* staff facilities to be shared with adjacent departments. See annexure A for a generic set of Standard Operating Policies (SOP) for a typical sterile service department.  
+
*staff facilities to be shared with adjacent departments. See annexure A for a generic set of Standard Operating Policies (SOP) for a typical sterile service department.
  
=== Determining factors internal to the CSSD ===
+
===Determining factors internal to the CSSD===
 
Examples of these space determinants could include the following:  
 
Examples of these space determinants could include the following:  
  
* types of processing equipment to be used (washer, washer-disinfectors, single- or multi-chamber washers, ultrasonic cleaners, endoscope processors)
+
*types of processing equipment to be used (washer, washer-disinfectors, single- or multi-chamber washers, ultrasonic cleaners, endoscope processors)
* types of packaging to be used (disposable wraps and pouches, re-usable wraps, rigid containers  
+
*types of packaging to be used (disposable wraps and pouches, re-usable wraps, rigid containers
* echnology to be used for sterilisation (high temperature or low temperature sterilisation, other chemical sterilants, steam)  
+
*echnology to be used for sterilisation (high temperature or low temperature sterilisation, other chemical sterilants, steam)
* anticipated inventory storage  
+
*anticipated inventory storage
* anticipated volume of consumable supplies  
+
*anticipated volume of consumable supplies
* type of documentation and record-keeping system to be used (manual vs computerised)  
+
*type of documentation and record-keeping system to be used (manual vs computerised)
* instrument inventory  
+
*instrument inventory
* equipment inventory  
+
*equipment inventory
* projected workload  
+
*projected workload
* staffing structure – number of offices  
+
*staffing structure – number of offices
* staffing policy - number of staff to be accommodated  
+
*staffing policy - number of staff to be accommodated
* types of cleaning equipment selected such as multi chamber or single chamber  
+
*types of cleaning equipment selected such as multi chamber or single chamber
* number of sterilisers and whether front or double sided loading  
+
*number of sterilisers and whether front or double sided loading
* emergency sterilisation requirements.
+
*emergency sterilisation requirements.
  
=== CSSD area determination ===
+
===CSSD area determination===
 
Hoët (1989 cited in AFS Working Group, 2008b, p.281) has estimated the following ratios as a broadbased calculation of CSSD space:  
 
Hoët (1989 cited in AFS Working Group, 2008b, p.281) has estimated the following ratios as a broadbased calculation of CSSD space:  
  
* 0.7 m²/bed from 0 to 300 beds
+
*0.7 m²/bed from 0 to 300 beds
* 0.6 m²/bed from 300 to 600 beds
+
*0.6 m²/bed from 300 to 600 beds
* 0.5 m²/bed for more than 600 beds.  
+
*0.5 m²/bed for more than 600 beds.
  
 
Based on these ratios, the following table can be compiled:  
 
Based on these ratios, the following table can be compiled:  
Line 367: Line 367:
 
Studies done by Putsep and Cowan (1983, p.8) produced the following ratios depending on the ‘active’ nature of the bed.  
 
Studies done by Putsep and Cowan (1983, p.8) produced the following ratios depending on the ‘active’ nature of the bed.  
  
TABLE 4: COMPARATIVE RECOMMENDATIONS FOR ESTIMATING THE SIZE OF A CSSD (PUTSEP AND COWAN, 1983, P. 8)  
+
Table 4: Comparative recommendations for estimating the size of a CSSD (Putsep and Cowan,1983, p.8)
 
{| class="wikitable"
 
{| class="wikitable"
 
|'''NR OF  '''  
 
|'''NR OF  '''  
  
 
'''BEDS'''  
 
'''BEDS'''  
|'''SCANDINAVIA'''  
+
|'''SCANDINAVIA'''        
|'''BELGIUM'''  
+
|   '''BELGIUM'''  
 
|'''NETHERLANDS'''  
 
|'''NETHERLANDS'''  
|'''RSA<sup>1</sup>'''  
+
|       '''RSA<sup>1</sup>'''  
 
|-
 
|-
|  
+
|
+
| colspan="3" |                               '''m² PER BED'''  
| colspan="2" |'''m² PER BED'''  
 
 
|
 
|
 
|-
 
|-
Line 418: Line 417:
 
|'''RSA<sup>3</sup>'''  
 
|'''RSA<sup>3</sup>'''  
 
|-
 
|-
|  
+
|
+
| colspan="4" |                           '''TOTAL AREA'''  
| colspan="2" |'''TOTAL AREA'''  
 
|
 
 
|-
 
|-
 
|200 BEDS  
 
|200 BEDS  
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It is however; clear that the size of a CSSD cannot be generically determined on the basis of statistics or averages. Every CSSD has its own set of area determinants that need to be logically evaluated in order to arrive at an area that is the optimal combination of functionality and cost effectiveness.  
 
It is however; clear that the size of a CSSD cannot be generically determined on the basis of statistics or averages. Every CSSD has its own set of area determinants that need to be logically evaluated in order to arrive at an area that is the optimal combination of functionality and cost effectiveness.  
  
'''Proportional allocation of space in a CSSD facility'''
+
== Proportional allocation of space in a CSSD facility ==
 
+
Table 5: Space allocation in a CSSD (Putsep and Cowan,1983, p.9)
TABLE 5: SPACE ALLOCATION IN A CSSD (PUTSEP AND COWAN, 1983, P.9) ''''' '''''
 
 
{| class="wikitable"
 
{| class="wikitable"
 
|'''AREA'''  
 
|'''AREA'''  
Line 527: Line 523:
 
|15  
 
|15  
 
|}
 
|}
 +
 +
AFS Working Group (2008b, p.291) states that the areas within the CSSD can be sub-divided as follows:  
 +
 +
Receiving: 10% of the surface area  
 +
 +
Decontamination: 25% of the surface area  
 +
{| class="wikitable"
 +
| colspan="2" |'''DIRTY                  35%'''
 +
 +
 +
IAP                       35% of the surface area 
 +
|-
 +
| colspan="2" |'''CLEAN'''                '''35%'''
 +
 +
 +
Sterile Storage    20% of  the surface area
 +
|-
 +
| colspan="2" |'''STERILE'''              '''20%'''
 +
 +
 +
Annexes:              10% of the surface area
 +
|}
 +
'''SUPPORT 10%'''  
 +
 +
If the generic plan used as basis for this study (LAYOUT 2.1) is subjected to an area analysis, the following table can be compiled (TABLE 4.5) for an autonomous (support services not shared) CSSD of 600m². If staff facilities and corridors are shared with another department (e.g. theatre department), the CSSD’s size reduces to 450m² as per TABLE 4.6, illustrating the difficulty in achieving universally applicable areas, and the effect of hospital-specific policies.  
 +
 +
It is significant that the percentage of total areas of TABLE 4.6 compares favourably with the AFS Working Group’s recommendations.  
 +
 +
Table 6: Proportional space allocation - Generic layout (600M<sup>2</sup> gross area)
 +
{| class="wikitable"
 +
| colspan="5" |                                                  '''DIRTYCLEANSTERILE SUPPORT'''
 +
|-
 +
|
 +
|Area (m²)
 +
|Area (m²)
 +
|Area (m²)
 +
|Area (m²)
 +
|-
 +
|
 +
|
 +
|
 +
|
 +
|
 +
|-
 +
|WASTE DISPOSAL
 +
|12
 +
|
 +
|
 +
|
 +
|-
 +
|SLUICE
 +
|12
 +
|
 +
|
 +
|
 +
|-
 +
|RECEIVING & SORTING
 +
|25
 +
|
 +
|
 +
|
 +
|-
 +
|TROLLEY WASH
 +
|5
 +
|
 +
|
 +
|
 +
|-
 +
|TROLLEY HOLDING
 +
|5
 +
|
 +
|
 +
|
 +
|-
 +
|STORE
 +
|12
 +
|
 +
|
 +
|
 +
|-
 +
|PPE TO DECON AREA
 +
|8
 +
|
 +
|
 +
|
 +
|-
 +
|DECONTAMINATION AREA
 +
|100
 +
|
 +
|
 +
|
 +
|-
 +
|PPE TO IAP AREA
 +
|
 +
|8
 +
|
 +
|
 +
|-
 +
|STORE
 +
|
 +
|12
 +
|
 +
|
 +
|-
 +
|TEXTILE AREA
 +
|
 +
|16
 +
|
 +
|
 +
|-
 +
|INSPECTION & PACKING
 +
|
 +
|100
 +
|
 +
|
 +
|-
 +
|STERILIZATION
 +
|
 +
|30
 +
|
 +
|
 +
|-
 +
|DISPATCH
 +
|
 +
|
 +
|15
 +
|
 +
|-
 +
|STERILE STORE
 +
|
 +
|
 +
|40
 +
|
 +
|-
 +
|COOLING
 +
|
 +
|
 +
|30
 +
|
 +
|-
 +
|STERILIZER PLANT ROOM
 +
|
 +
|
 +
|
 +
|18
 +
|-
 +
|OFFICE
 +
|
 +
|
 +
|
 +
|12
 +
|-
 +
|KITCHENETTE
 +
|
 +
|
 +
|
 +
|12
 +
|-
 +
|STAFF REST ROOM
 +
|
 +
|
 +
|
 +
|35
 +
|-
 +
|FEMALE CHANGE
 +
|
 +
|
 +
|
 +
|30
 +
|-
 +
|MALE CHANGE
 +
|
 +
|
 +
|
 +
|15
 +
|-
 +
|CSSD CORRIDOR
 +
|
 +
|
 +
|
 +
|48
 +
|-
 +
|
 +
|
 +
|
 +
|
 +
|
 +
|-
 +
|'''TOTAL AREA (SQ M)  '''  
 +
|'''179'''
 +
|'''166'''
 +
|'''85'''
 +
|'''170'''
 +
|-
 +
|'''% OF TOTAL AREA  '''  
 +
|'''30%'''
 +
|'''28%'''
 +
|'''14%'''
 +
|'''28%'''
 +
|}
 +
Table 7: Proportional space allocation - Generic layout  without staff facilities (450M<sup>2</sup> gross area)
 +
{| class="wikitable"
 +
| colspan="5" |                                                '''DIRTY      CLEAN      STERILE  SUPPORT'''
 +
|-
 +
|
 +
|Area (m²)
 +
|Area (m²)
 +
|Area (m²)
 +
|Area (m²)
 +
|-
 +
|
 +
|
 +
|
 +
|
 +
|
 +
|-
 +
|WASTE DISPOSAL
 +
|12
 +
|
 +
|
 +
|
 +
|-
 +
|SLUICE
 +
|12
 +
|
 +
|
 +
|
 +
|-
 +
|RECEIVING & SORTING
 +
|25
 +
|
 +
|
 +
|
 +
|-
 +
|TROLLEY WASH
 +
|5
 +
|
 +
|
 +
|
 +
|-
 +
|TROLLEY HOLDING
 +
|5
 +
|
 +
|
 +
|
 +
|-
 +
|STORE
 +
|12
 +
|
 +
|
 +
|
 +
|-
 +
|PPE TO DECON AREA
 +
|8
 +
|
 +
|
 +
|
 +
|-
 +
|DECONTAMINATION AREA
 +
|100
 +
|
 +
|
 +
|
 +
|-
 +
|PPE TO IAP AREA
 +
|
 +
|8
 +
|
 +
|
 +
|-
 +
|STORE
 +
|
 +
|12
 +
|
 +
|
 +
|-
 +
|TEXTILE AREA
 +
|
 +
|16
 +
|
 +
|
 +
|-
 +
|INSPECTION & PACKING
 +
|
 +
|100
 +
|
 +
|
 +
|-
 +
|STERILIZATION
 +
|
 +
|30
 +
|
 +
|
 +
|-
 +
|DISPATCH
 +
|
 +
|
 +
|15
 +
|
 +
|-
 +
|STERILE STORE
 +
|
 +
|
 +
|40
 +
|
 +
|-
 +
|COOLING
 +
|
 +
|
 +
|30
 +
|
 +
|-
 +
|STERILIZER PLANT ROOM
 +
|
 +
|
 +
|
 +
|18
 +
|-
 +
|OFFICE
 +
|
 +
|
 +
|
 +
|12
 +
|-
 +
|
 +
|
 +
|
 +
|
 +
|
 +
|-
 +
|'''TOTAL AREA (SQ M)  '''  
 +
|'''179'''
 +
|'''166'''
 +
|'''85'''
 +
|'''30'''
 +
|-
 +
|'''% OF TOTAL AREA  '''  
 +
|'''39%'''
 +
|'''36%'''
 +
|'''18%'''
 +
|'''7%'''
 +
|}
 +
 +
== Typical Floor Layouts ==
 +
The following generic plans are included to illustrate the combined effect of gross floor area allocation, proportional space allocation, and work-flow requirements.  
 +
 +
Drawing 1: Typical floor layout (Small - 250M² gross area) not to scale '''Proportional Net space allocation'''
 +
{| class="wikitable"
 +
|DIRTY  
 +
|37%  
 +
|-
 +
|CLEAN  
 +
|36%  
 +
|-
 +
|STERILE  
 +
|21%  
 +
|-
 +
|SUPPORT  
 +
|6%  
 +
|}
 +
Drawing 2: Typical floor layout (Medium - 400M² gross area) not to scale '''Proportional Net space allocation'''
 +
{| class="wikitable"
 +
|DIRTY  
 +
|38%  
 +
|-
 +
|CLEAN  
 +
|33%  
 +
|-
 +
|STERILE  
 +
|22%  
 +
|-
 +
|SUPPORT  
 +
|7%  
 +
|}
 +
Drawing 3: Typical floor layout (Large - 600M² gross area) not to scale '''Proportional Net space allocation'''
 +
{| class="wikitable"
 +
|DIRTY  
 +
|30%  
 +
|-
 +
|CLEAN  
 +
|28%  
 +
|-
 +
|STERILE  
 +
|14%  
 +
|-
 +
|SUPPORT  
 +
|28%  
 +
|}
 +
 +
= Individual Space Requirements =
 +
 +
== CSSD Layout  Unpacked ==
 +
Due to the uni-directional sequential nature of the work flow in the CSSD, activities are interrelated and inter-dependent. It is, therefore, critical to the functional efficiency and safety of the CSSD that those areas are sequentially linked for uni-directional flow-through of instrumentation, with no room for back tracking.  
 +
 +
The above work flow and interrelationship between the adjacent areas dictates the characteristics of each space. In order to discuss each area individually, it is necessary to have a base plan as a reference point. The typical floor layout based on a 600m<sup>2</sup> unit will be used for this purpose.
 +
 +
Drawing 4: A generic layout to illustrate  room layouts
 +
 +
== Receiving and Sorting ==
 +
 +
=== Function  ===
 +
This is the area where all soiled articles for reprocessing are received on trolleys from the main corridor from user departments throughout the hospital.  
 +
 +
=== Location and Relationship  ===
 +
 +
* Close to main entry doors to the CSSD unit  
 +
 +
* Visual access to main entry.  
 +
 +
Drawing 5: Receiving and sorting
 +
 +
=== Activities  ===
 +
 +
* Access for deliveries of supplies, return of contaminated goods and the collection of waste and contaminated linen  
 +
* Contaminated articles are received at a counter with a trolley hatch, where the articles are logged, sorted and forwarded to the decontamination area  
 +
 +
* Contaminated linen is put into linen bags and stored in the waste-disposal store for transport to the laundry  
 +
* Supplies are received in the supplies store where they are opened and packaging is discarded in the waste-disposal store  
 +
* Trolleys are sent to the trolley wash bay.  
 +
 +
=== Requirements  ===
 +
 +
* Visual access to entrance doors  
 +
 +
* All entrances should be secure and controlled by means of communication to prevent access by unauthorised people  
 +
* A glass partition with lockable sliding hatch between this area and the corridor • A lockable hatch for trolleys  
 +
* The red-line principle is applicable at the receiving area; only material and trolleys are to enter the CSSD via this entrance • Worktop for unpacking and sorting  
 +
* Hand-washing facilities.  
 +
 +
=== Fixtures, fittings and equipment  ===
 +
 +
* Receiving counter with pass-through hatch and trolley hatch, acting as red line  
 +
* Sorting work tables – standing height  
 +
* Clinical hand-wash basin, complete with liquid soap dispenser and paper-towel dispenser • Space should be allowed for record-keeping and record-keeping supplies.  
 +
 +
Photograph 7: Trolley pass-through hatch (Tygerberg hospital)
 +
 +
=== Services  ===
 +
 +
* 2 x telephones  
 +
* 2 x data points  
 +
* CSSD technician call system  
 +
* Power outlets for computer points, computer, fax and printer  
 +
 +
* Access control to outside door.
 +
 +
== Waste Disposal ==
 +
'''Function'''  
 +
 +
Contaminated waste articles are stored for collection and transport to the respective disposal areas.  
 +
 +
=== Location and relationship ===
 +
Attached to the receiving area.  
 +
 +
Drawing 6: Waste disposal
 +
 +
=== Activities  ===
 +
 +
* The sluice area and waste-disposal area could be combined in smaller units  
 +
* Contaminated waste articles are temporarily stored for collection and transport to the respective disposal areas  
 +
 +
* Contaminated linen is temporarily stored in canvas bags for collection and transport to the laundry  
 +
* Third-party collection area (depot).  
 +
 +
Categories of waste stored in the waste-disposal area could include:  
 +
 +
* Health-care waste, infectious waste, sharps  
 +
* General office waste  
 +
 +
* Packaging and cartons from bulk supplies stored in the unit • Linen bags used to collect reusable items  
 +
* Sharps from theatres.  
 +
 +
=== Requirements  ===
 +
 +
* An independent secure area for temporary storage of clinical waste awaiting collection in accordance with local waste management policy  
 +
* The door to the receiving/sorting area side should be lockable from the CSSD side to prevent unauthorised entry  
 +
 +
* Room layout should allow for easy recycling/re-use/disposal policy  
 +
* Space for linen bags and waste containers  
 +
* An impermeable, hard-wearing floor with good drainage; it should be easy to clean and to disinfect, with an accessible water supply for cleaning purposes  
 +
* The area should be protected from outside elements, inaccessible to animals, insects or birds and not situated in close proximity to fresh food stores, food preparation areas or patient waiting areas  
 +
* It should be sized according to the volume of waste generated by the facility as well as the frequency of collection.  
 +
 +
* A bumper rail to protect the wall behind the trolleys • Containers according to waste policy.
 +
 +
Photograph 8: Soiled-Linen trolleys
 +
 +
Photograph 9: Infectious-waste and sharps-disposal containers
 +
 +
=== '''Fixtures, fittings and equipment '' ''''' ===
 +
• Clinical hand-wash basin, complete with liquid-soap dispenser and paper-towel dispenser.  
 +
 +
== Sluice ==
 +
 +
=== '''Function'''  ===
 +
Heavily soiled items are rinsed and waste items are discarded in suitable containers.  
 +
 +
4.2. Location and relationship  
 +
 +
 +
 +
 +
 +
 +
 +
 +
 +
 +
 +
 +
  
  
  
  
{{Expand}}
+
<br />{{Expand}}
 
<references /><br />
 
<references /><br />
 
[[Category:Support Services]]
 
[[Category:Support Services]]

Revision as of 09:59, 12 October 2020

Contents

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

Inspection and packing zone (IAP Zone)

  • Inspection and packing (IAP)
  • Sterile pack
  • Textile folding
  • Raw materials storage
  • PPE area (gowning).

Figure 8: Areas related to the inspection and packing zone

Sterile zone

  • Sterilisation
  • Cooling 
  • Sterile pack storage
  • Dispatch.

Figure 9: Areas related to the clean zone

Support zone

  • Office
  • Staff rest room
  • Kitchenette
  • Female change room
  • Male change room
  • Manager’s office
  • Steriliser plant room.

Figure 10: Areas related to the support zone

Functional relationship between activity spaces

Figure 11: Functional relationship between activity spaces

Workflow

Design solutions should follow work-flow principles, separating dirty and clean areas. The workspaces in the decontamination and clean areas should be designed as open-plan work areas subdivided by benches and/or equipment into functional work areas. These work areas should be arranged to allow for a progressive work flow that commences with a ‘dirty’ entry and receiving area, proceeding to a cleaning, decontamination and drying area, into a sorting and packing area, through to a sterilisation- and cooling area, with sterile storage, distribution and exit areas completing the process. 

It is critical to the functional efficiency and safety of the CSSD that these spaces are sequentially linked for one-way flow-through of instrumentation. The separation between the dirty area, where soiled goods are collected, and the clean area where washed and disinfected instruments are inspected, sorted and packed, is realised by a high throughput pass-through washer disinfector barrier.

Treated instruments are unloaded and managed directly in the clean packing area by different staff.

Figure 12: Work flow through the zones

Material flow

Figure 13: Material flow through the zones

Personnel flow

Figure 14: Personnel flow through the zones

Air flow

Figure 15: Air flow through the zones

General design considerations

Design for infection control

The design of a CSSD plays an essential role in addressing infection control issues to minimise the risk of infection transmission. 

Planning and design features to support infection control should include the following:

  • Restricted/controlled access
  • Unidirectional work flow, progressing from dirty to clean to sterile areas
  • Controlled air flow with positive air pressure from clean to dirty areas
  • Containment of steam and moisture, preventing potential contamination of stored sterile articles.
  • Building and layout details that would facilitate easy cleaning
  • Selection of suitable building materials and finishes
  • Selection of fixtures, fittings and equipment with suitable detail, materials and finishes for easy cleaning, and prevention of build-up of harmful organisms
  • Adequate facilities for cleaning and waste management
  • Access to the area should be limited and controlled. This should prevent any unauthorised person from entering the area without permission
  • Staff/visitors should have access to hand-washing facilities, separate from those used for cleaning devices, before entering or leaving the areas.
  • The flow of both staff and equipment must allow no cross-over of soiled and clean materials
  • The operating procedure for infection control in a CSSD falls outside the scope of this guideline.

Design for Occupational, Health and Safety

Planning and design features to support occupational health and safety include the following:

  • Selection of floor finishes with a non-slip finish
  • Selection of fixtures, fittings and equipment with suitable detail, materials and finishes to prevent personal injury through accidents or misuse
  • Provision of suitable and adequate facilities to support and encourage a high level of personal hygiene, with special reference to hand hygiene
  • Provision of adequate dispensing points for the appropriate personal protection items (PPE) for the specific area to enable strict enforcement of PPE requirements in the protection of healthcare workers, especially as preventive measures against HIV aids
  • Top-loading, worktop equipment should be accessible to staff members of all heights
  • Ill-considered dimensions and layouts of fixtures and fittings could have a significant negative effect on occupational health and safety of staff.

As the requirements of the Occupational Health and Safety Act will apply, this section needs to be read in conjunction with the OHS-related guidelines.

Design for change and technology

Although it is difficult to predict future trends in CSSD technology, it is advisable to allow some flexibility and adaptability in space requirements, electrical consumption and layout, and also in air-handling capacity. Current trends that need to be considered are the following:

  • The increasing complexity of surgical procedures requires more intricate equipment and instruments that need specialised care and handling during the sterilisation procedure
  • Integrated computerised tracking facilities have become widely used and have become an essential tool in the validation of the sterilisation process
  • Changing staff-flow patterns due to changing work-flow patterns as a result of procedural and/or equipment innovations
  • Design towards sustainable architecture, i.e. water-saving equipment, and equipment with reduced toxic emissions. Constant improvements and innovations lead to products that run more economically and reach a higher level of environment compatibility 
  • The facility should be able to reasonably accommodate access and positioning of possible outsize equipment. Consideration for this possibility should be given from (and including) point of delivery to point of positioning
  • It is advisable to allow capacity for extra machinery in the event of increased production demand.

Ergonomic and user-comfort considerations

Sterile services departments should be designed to protect staff from avoidable risks of injury. Badly designed elements such as height, depth and design of workstations and counters, shelving and the layout have an impact on the occupational health and safety of staff. Workspaces should therefore be sufficiently flexible and adaptable to accommodate adequate working space for individual comfort, and to reduce any unnecessary physical stress or risk of injury to the body from any repetitive and/or periodic actions such as lifting, pulling, pushing, etc. 

Ergonomics considers the understanding of human-equipment interaction and design to minimise safety risks and achieve the optimum use of equipment. When particular high risks are identified, these should be minimised when designing the facility – while providing good lighting (preferably natural light), adequate ventilation, plenty of space, and comfortable humidity/temperature conditions. Workbenches and chairs must be height-adjustable, allowing staff to adopt the correct posture when sitting or standing. 

Enough space must be available to allow for organisation of the workspace. All materials, for example those in the packing area, should be located within easy reach of the workbench (packaging materials, indicators, etc.). A similar concept should apply to device-sorting or manual-cleaning areas. There should be adequate space to manoeuvre, queue, and unload trolleys or other means of transportation.  This will allow not only for good ergonomics but also for efficient work practices. 

The provision of a pleasant interior environment can contribute to staff morale. Temperature and humidity control (air-conditioning), in particular in areas where heat-associated equipment (such as steam sterilisers and thermal washer-disinfectors) is used, is preferred. Provision must be made for adequate heat extraction systems from heat generating equipment such as autoclaves and instrument washers. This should be done as close to the source as possible i.e. above autoclave doors and instrument washers. This heat source can be utilized to pre-heat water going to the boilers. Consideration should also be given to ensure there is adequate lighting (preferably natural) and noise control. 

For larger facilities, provision may need to be made for managers’ offices, general staff areas (for eating and drinking) and storage areas that are separated from the decontamination area. Good interior design also contributes to staff morale. The aim should therefore be to create an attractive and cheerful environment throughout the department.

Sound

Noise must be controlled

  • A threshold of 60dBA (decibel) must not be exceeded 
  • The walls and ceilings should be made of absorbent materials so that they do not reflect sound 
  • Insulation of sterilisers and washer-disinfectors in technical walls will reduce the noise level
  • Offices should allow confidential discussions to take place in privacy, away from noisy mechanical or high-volume human areas.

Natural light

Natural lighting is highly desirable, especially in the work areas, and should be used wherever possible, especially in areas such as the cleaning and packing areas. However, direct sunlight on work spaces should be avoided.

Natural ventilation

Natural ventilation through opening-section windows should be limited to offices and staff rooms. However, this is not recommended as it could promote contamination of the internal space by outside sources. Mechanical ventilation should be provided through the remainder of the CSSD, with good primary and secondary filters which must be monitored with differential manometers linked to an alarm system.

Communication

Provision must be made for communication systems to minimise the passage of staff to and from the clean zone. Glass partitions, communication panels, IT and video links for data transfer, intercom and telephones can serve as appropriate means of communication. 

Glass partitions should be used to permit observance of the activities within the clean zone (from the outside) without having to enter it. The glass panels must be of a non-opening design and must be waterproof and flush-mounted.

CSSD Area Determination

Determination of size and layout

The size of a CSSD in a hospital is unique to that hospital, as the size, layout and function of a CSSD are defined in the Operational Policy Statement that guides the operational management of the hospital. The operational policies specific to the CSSD precede sketch design stage. These policies are developed by the project team in consultation with health; service stakeholders, who should have the knowledge and experience to analyse the various processes in and related to the CSSD.

These operational policies define the “What, How, When, Where, Who and With What” of any activity and/or process and are major space determinants which could significantly affect the planning and design of the CSSD, as they can have an impact on the size, configuration and the nature of accommodation.  Operational policies will vary from unit to unit depending on a wide range of factors, both external and internal to the CSSD.  

Determining factors external to the CSSD

Examples of these space determinants could include the following:

  • number of theatres/case mix
  • surgical procedures
  • extent of storage in the theatres and wards
  • distribution system that will be used (vertical, horizontal, trolleys, lifts)
  • amount of space needed for waste management
  • processing needs for re-usable textiles (receiving, transporting, collecting, storing)
  • staff facilities to be shared with adjacent departments. See annexure A for a generic set of Standard Operating Policies (SOP) for a typical sterile service department.

Determining factors internal to the CSSD

Examples of these space determinants could include the following:

  • types of processing equipment to be used (washer, washer-disinfectors, single- or multi-chamber washers, ultrasonic cleaners, endoscope processors)
  • types of packaging to be used (disposable wraps and pouches, re-usable wraps, rigid containers
  • echnology to be used for sterilisation (high temperature or low temperature sterilisation, other chemical sterilants, steam)
  • anticipated inventory storage
  • anticipated volume of consumable supplies
  • type of documentation and record-keeping system to be used (manual vs computerised)
  • instrument inventory
  • equipment inventory
  • projected workload
  • staffing structure – number of offices
  • staffing policy - number of staff to be accommodated
  • types of cleaning equipment selected such as multi chamber or single chamber
  • number of sterilisers and whether front or double sided loading
  • emergency sterilisation requirements.

CSSD area determination

Hoët (1989 cited in AFS Working Group, 2008b, p.281) has estimated the following ratios as a broadbased calculation of CSSD space:

  • 0.7 m²/bed from 0 to 300 beds
  • 0.6 m²/bed from 300 to 600 beds
  • 0.5 m²/bed for more than 600 beds.

Based on these ratios, the following table can be compiled:

Table 2:mratio of hospital bed to CSSD area

BED SIZE   CALCULATION   SURFACE AREA  
200 BEDS   0.7 m² /bed   210 m²  
400 BEDS   0.6 m² /bed   240 m²  
600 BEDS   0.5 m² /bed   300 m²  
800 BEDS   0.5 m² /bed   400 m²  
1000 BEDS   0.5 m² /bed   500 m²  
1200 BEDS   0.5 m² /bed   600 m²  

AFS Working Group (2008b, p.291) states that the CSSD has few internal corridors, the commonly used net to department functional factor adopted is 1.30. The 1.30 factor anticipates that the internal circulation must be added to connect functional areas and individual rooms. This minimal surface area required can be estimated as being 200m² useful and 260m² net floor areas.  

Based on the above assumption, AFS Working Group (2008b, p.291) calculates the useful surface area using the MSO ratio based on the number of beds used for Medical – Surgery – Obstetrics (MSO), using the following calculation basis:  

Table 3: Ratio of MSO to CSSD area

MSO – NR OF BEDS   USEFUL SURFACE AREA/BED   USEFUL SURFACE AREA   NET SURFACE AREA  
< 200 BEDS   200   200 m²   260 m²  
200 – 300 BEDS   1,5 m² /bed   300 – 400 m²   400 - 520 m²  
300 – 400 BEDS   1,2 m² /bed   350 – 420 m²   450 – 550 m²  
450 + BEDS   1,0 m² /bed   450 m²   600 m²  

Studies done by Putsep and Cowan (1983, p.8) produced the following ratios depending on the ‘active’ nature of the bed.  

Table 4: Comparative recommendations for estimating the size of a CSSD (Putsep and Cowan,1983, p.8)

NR OF  

BEDS  

SCANDINAVIA   BELGIUM   NETHERLANDS   RSA1  
  m² PER BED  
200 BEDS   1,1 m² /bed   0,6 - 1 m² /bed   0,7 m² /bed   1,0 m² /bed23  
350 BEDS   1,1 m² /bed   0,6 - 1 m² /bed   0,6 m² /bed   1,0 m² /bed  
500 BEDS   1,1 m² /bed   0,6 - 1 m² /bed   0,5 m² /bed   1,0 m² /bed  
750 BEDS   1,1 m² /bed   0,6 - 1 m² /bed   0,4 m² /bed   1,0 m² /bed  

 

Based on the above data, the areas are as follows:  

NR OF  

BEDS  

SCANDINAVIA   BELGIUM   NETHERLANDS   RSA3  
  TOTAL AREA  
200 BEDS   220 m²   160 m²*4   140 m²   200 m²  
350 BEDS   385 m²   280 m² *   210 m²   350 m²  
500 BEDS   550 m²   400 m² *   250 m²   500 m²  
750 BEDS   825 m²   600 m² *   300 m²   750 m²  

As the schedules of accommodation on which the above analyses are based have not been included in the study, the equitability of the comparisons is in doubt.  

It is however; clear that the size of a CSSD cannot be generically determined on the basis of statistics or averages. Every CSSD has its own set of area determinants that need to be logically evaluated in order to arrive at an area that is the optimal combination of functionality and cost effectiveness.  

Proportional allocation of space in a CSSD facility

Table 5: Space allocation in a CSSD (Putsep and Cowan,1983, p.9)

AREA   NUFFIELD  

PROVINCIAL  

HOSPITALS TRUST  

(1963)  

ESTIMATED  

AVERAGE –  

SWEDISH  

PRACTICE  

NORWEGIAN  

RECOMMENDATIONS  

(1978)  

HOET  

(1981)  

RECEIVING  

WASHING  

DECONTAMINATION  

10   19   10   30  
CLEAN AREA   35   20   25   30  
STERILISATION AREA   5   8   5   25  
STERILE SUPPLY  
STORE DISPATCH   16   29   25  
BULK STORE   11   14   20   15  
STAFF AREA  

OFFICE  

HOUSEKEEPING  

23   10   15  

AFS Working Group (2008b, p.291) states that the areas within the CSSD can be sub-divided as follows:  

Receiving: 10% of the surface area  

Decontamination: 25% of the surface area  

DIRTY 35%


IAP  35% of the surface area

CLEAN   35%


Sterile Storage 20% of the surface area

STERILE   20%


Annexes: 10% of the surface area

SUPPORT 10%  

If the generic plan used as basis for this study (LAYOUT 2.1) is subjected to an area analysis, the following table can be compiled (TABLE 4.5) for an autonomous (support services not shared) CSSD of 600m². If staff facilities and corridors are shared with another department (e.g. theatre department), the CSSD’s size reduces to 450m² as per TABLE 4.6, illustrating the difficulty in achieving universally applicable areas, and the effect of hospital-specific policies.  

It is significant that the percentage of total areas of TABLE 4.6 compares favourably with the AFS Working Group’s recommendations.  

Table 6: Proportional space allocation - Generic layout (600M2 gross area)

DIRTYCLEANSTERILE SUPPORT
Area (m²) Area (m²) Area (m²) Area (m²)
WASTE DISPOSAL 12
SLUICE 12
RECEIVING & SORTING 25
TROLLEY WASH 5
TROLLEY HOLDING 5
STORE 12
PPE TO DECON AREA 8
DECONTAMINATION AREA 100
PPE TO IAP AREA 8
STORE 12
TEXTILE AREA 16
INSPECTION & PACKING 100
STERILIZATION 30
DISPATCH 15
STERILE STORE 40
COOLING 30
STERILIZER PLANT ROOM 18
OFFICE 12
KITCHENETTE 12
STAFF REST ROOM 35
FEMALE CHANGE 30
MALE CHANGE 15
CSSD CORRIDOR 48
TOTAL AREA (SQ M)     179 166 85 170
% OF TOTAL AREA     30% 28% 14% 28%

Table 7: Proportional space allocation - Generic layout without staff facilities (450M2 gross area)

DIRTY CLEAN STERILE SUPPORT
Area (m²) Area (m²) Area (m²) Area (m²)
WASTE DISPOSAL 12
SLUICE 12
RECEIVING & SORTING 25
TROLLEY WASH 5
TROLLEY HOLDING 5
STORE 12
PPE TO DECON AREA 8
DECONTAMINATION AREA 100
PPE TO IAP AREA 8
STORE 12
TEXTILE AREA 16
INSPECTION & PACKING 100
STERILIZATION 30
DISPATCH 15
STERILE STORE 40
COOLING 30
STERILIZER PLANT ROOM 18
OFFICE 12
TOTAL AREA (SQ M)     179 166 85 30
% OF TOTAL AREA     39% 36% 18% 7%

Typical Floor Layouts

The following generic plans are included to illustrate the combined effect of gross floor area allocation, proportional space allocation, and work-flow requirements.  

Drawing 1: Typical floor layout (Small - 250M² gross area) not to scale Proportional Net space allocation

DIRTY   37%  
CLEAN   36%  
STERILE   21%  
SUPPORT   6%  

Drawing 2: Typical floor layout (Medium - 400M² gross area) not to scale Proportional Net space allocation

DIRTY   38%  
CLEAN   33%  
STERILE   22%  
SUPPORT   7%  

Drawing 3: Typical floor layout (Large - 600M² gross area) not to scale Proportional Net space allocation

DIRTY   30%  
CLEAN   28%  
STERILE   14%  
SUPPORT   28%  

Individual Space Requirements

CSSD Layout Unpacked

Due to the uni-directional sequential nature of the work flow in the CSSD, activities are interrelated and inter-dependent. It is, therefore, critical to the functional efficiency and safety of the CSSD that those areas are sequentially linked for uni-directional flow-through of instrumentation, with no room for back tracking.  

The above work flow and interrelationship between the adjacent areas dictates the characteristics of each space. In order to discuss each area individually, it is necessary to have a base plan as a reference point. The typical floor layout based on a 600m2 unit will be used for this purpose.

Drawing 4: A generic layout to illustrate room layouts

Receiving and Sorting

Function  

This is the area where all soiled articles for reprocessing are received on trolleys from the main corridor from user departments throughout the hospital.  

Location and Relationship  

  • Close to main entry doors to the CSSD unit  
  • Visual access to main entry.  

Drawing 5: Receiving and sorting

Activities  

  • Access for deliveries of supplies, return of contaminated goods and the collection of waste and contaminated linen  
  • Contaminated articles are received at a counter with a trolley hatch, where the articles are logged, sorted and forwarded to the decontamination area  
  • Contaminated linen is put into linen bags and stored in the waste-disposal store for transport to the laundry  
  • Supplies are received in the supplies store where they are opened and packaging is discarded in the waste-disposal store  
  • Trolleys are sent to the trolley wash bay.  

Requirements  

  • Visual access to entrance doors  
  • All entrances should be secure and controlled by means of communication to prevent access by unauthorised people  
  • A glass partition with lockable sliding hatch between this area and the corridor • A lockable hatch for trolleys  
  • The red-line principle is applicable at the receiving area; only material and trolleys are to enter the CSSD via this entrance • Worktop for unpacking and sorting  
  • Hand-washing facilities.  

Fixtures, fittings and equipment  

  • Receiving counter with pass-through hatch and trolley hatch, acting as red line  
  • Sorting work tables – standing height  
  • Clinical hand-wash basin, complete with liquid soap dispenser and paper-towel dispenser • Space should be allowed for record-keeping and record-keeping supplies.  

Photograph 7: Trolley pass-through hatch (Tygerberg hospital)

Services  

  • 2 x telephones  
  • 2 x data points  
  • CSSD technician call system  
  • Power outlets for computer points, computer, fax and printer  
  • Access control to outside door.

Waste Disposal

Function  

Contaminated waste articles are stored for collection and transport to the respective disposal areas.  

Location and relationship

Attached to the receiving area.  

Drawing 6: Waste disposal

Activities  

  • The sluice area and waste-disposal area could be combined in smaller units  
  • Contaminated waste articles are temporarily stored for collection and transport to the respective disposal areas  
  • Contaminated linen is temporarily stored in canvas bags for collection and transport to the laundry  
  • Third-party collection area (depot).  

Categories of waste stored in the waste-disposal area could include:  

  • Health-care waste, infectious waste, sharps  
  • General office waste  
  • Packaging and cartons from bulk supplies stored in the unit • Linen bags used to collect reusable items  
  • Sharps from theatres.  

Requirements  

  • An independent secure area for temporary storage of clinical waste awaiting collection in accordance with local waste management policy  
  • The door to the receiving/sorting area side should be lockable from the CSSD side to prevent unauthorised entry  
  • Room layout should allow for easy recycling/re-use/disposal policy  
  • Space for linen bags and waste containers  
  • An impermeable, hard-wearing floor with good drainage; it should be easy to clean and to disinfect, with an accessible water supply for cleaning purposes  
  • The area should be protected from outside elements, inaccessible to animals, insects or birds and not situated in close proximity to fresh food stores, food preparation areas or patient waiting areas  
  • It should be sized according to the volume of waste generated by the facility as well as the frequency of collection.  
  • A bumper rail to protect the wall behind the trolleys • Containers according to waste policy.

Photograph 8: Soiled-Linen trolleys

Photograph 9: Infectious-waste and sharps-disposal containers

Fixtures, fittings and equipment  

• Clinical hand-wash basin, complete with liquid-soap dispenser and paper-towel dispenser.  

Sluice

Function  

Heavily soiled items are rinsed and waste items are discarded in suitable containers.  

4.2. Location and relationship