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CSSD Central Sterile Supply Department

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CSSD Central Sterile Supply Department Thermal Death Time (TDT) TDT is the time required to kill a known population of microorganisms in a specific suspension at a ... – PowerPoint PPT presentation

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Title: CSSD Central Sterile Supply Department


1
CSSDCentral Sterile Supply Department
2
  • No Stronger Condemnation of any hospital or
    ward could be pronounced than the simple fact
    that ZYMOTIC DISEASE has originated in it or that
    such disease attack other patients than those
    brought-in with
  • - FLORENCE NIGHTINGALE

3
  • BHATTA CHARJEE DEFINES CSSD
  • as that service, with in the hospital, catering
    for the sterile supplies to all departments ,
    both to specialized units as well as general
    wards and OPDs.

4
  • 1928 American College Of Surgeons CSSD.
  • 1942 World War II .Cairo, British SDS Unit .
  • 1955 Cambridge Military Hospital Regular CSSD
    in UK.
  • 1965 First CSSD in India Safadarajan Hosptial

5
  • AIMS
  • To provide sterilized material from a central
    department where sterilizing process is carried
    out under properly controlled conditions
  • To alleviate the burden of work of the nursing
    personnel, there by enabling them to devote more
    of their time to patient care .

6
ADVANTAGES
  • 1. Bacteriological safe sterilization.
  • 2. Less expensive.
  • 3. Elimination of unsound practices
    establishment of standard procedures.
  • 4. Assurance of adequate supply of sterile
    products immediately and constantly available
    for sometime as well as emergency use.

7
  • 5. Conservation of trained staff.
  • 6. Better quality control
  • 7. Better good of material flow
  • 8. Prolonged life by proper care of equipment

8
ITEMS COMMONLY HANDLED BY CSSD STORES
9
  • 1. Syringes
  • 2. Procedure Sets
  • Lumbar puncture sternal puncture
    venesection paracentesis aspiration
    catheterization tracheotomy suturing
    dressing biopsy incision drainage
    aortography cardiac resuscitation etc
  • 3. Needles
  • 4. Gloves

10
  • 5. I.V.Fluids.
  • 6. Treatment Trays.
  • 7. O.T Instruments.
  • 8. O.T. Linen
  • 9. Infusion Fluids for Renal Dialysis.
  • 10. At times LINEN. (other than O.T)
  • NB Diet , drugs , bedpans urinals are not
    included by convention .

11
PLANNING A DEPT (COPP)
  • 1. Physical Planning.
  • 2. Functional Planning.
  • 3. Personnel Planning.
  • 4. Equipment Planning.
  • 5. Financial Planning.
  • 6.Quality Control.
  • 7.Preventive Maintenance.

12
PHYSICAL PLNG
  • 1. Location Grouping .
  • 2. Lay Out Space Reqts.
  • 3. Fixturtes Furniture .

13
RULE OF THE THUMB ROUGHLY 10 SQFT / BED -
MCGIBONY
14
EQPT IN CSSD
  • 1.Jet water cleaning gadgets.
  • 2.Ultrasonic Washers
  • 3.Glove sharpener
  • 4.Needle sharpener.
  • 5.Gas, Chemical or steam autoclaves.
  • 6.Testing apparatus for efficiency of
    sterilization

15
OTHERS
  • 1.Maint Repair EQPT
  • 2.Adequate number of cabins Furniture
  • 3.Telephone or intercom.
  • 4.Adequate no of syringes procedure sets.

16
NUMBER OF SETS/SYRINGES

Total 4.5 to 5 times of the daily requirement
17
  • Methods Of Sterilization / Disinfection

Natural Chemical
Physical
Sun Light (UV) Air (Desiccation)
Solids Lime, Bleeching Powder, KMNO4 Liquids
Formalin, Phenol , Alcohol , Glutaraldehyde Gase
s Formaldehyde, Ethylene Oxide
Dry Heat Burning or Dry Air (160C for 60
Min) Moist Heat Boiling Steam Radiation Ionising
Radiation U V Rays
18
CHEMICAL
  • CIDEX A Glutaraldehyde derivative is most
    effective as it destroys spores too.
  • ETHYLENE OXIDE (ETO)
  • Quite effective against spores too.
  • Useful for delicate instruments and item which
    cant be immersed in liquids
  • - Low Boiling Point (10 degree C)
  • - Prolonged Aeration
  • - Highly Expensive / Explosive / Toxic

19
Types Of Sterilization Techniques
  • 1.Dry Heat
  • 2.Steam High Pressure Autoclaves operated by
    Gas, K.oil or Electricity ( Flash, Pulse)
  • 3. Ethylene Oxide Sterilization.
  • 4. Chemical Sterilization.
  • 5. Radiation Sterilization.
  • - Infra Red Radiation Syringes
  • - Ultra Violet Radiation Decontamination of
    Air
  • - Ionising Radiation / Gamma Radiation
  • ISOMED at BARC

20
  • STERILISATION .
  • It is a process of freeing an article from all
    living organisms including bacteria ,fungal
    spores and viruses.
  • A material is pronounced sterile if it
  • achieves 99.99 kill of bacterial spores.

21
STEAM STERILATION
  • - Water ? Saturated ? Wet vapor ? Dry saturated
    Vapor ? Super Heated Vapor / Steam
  • - Steam with lt0.95 Dryness Factor is not useful
    for Sterilization.
  • - Superheated Steam acts like Dry Hot Air only .
    ( Strength Of Steam is its Latent Heat)

22
  • MODE OF ACTION.
  • Dry Heat ? Oxidation
  • Steam ? Denaturation Coagulation of Proteins

23
  • TYPES OF AUTO CLAVING MACHINES
  • 1. Downward Displacement
  • 2. Vacuum Assisted.
  • 3. Pulsed Steam Dilution

24
TESTS FOR EFFICENCY OF STERILISATION
  • 1. Specially treated paper strip.
  • 2. Pressure sensitive tape to be fixed to the
    final fold
  • 3. Brown indicator tubes - (very expensive)
  • 4. Biological. Green strip containing bacteria
    (Color must change to black)

25
  • 5. Cellophane wrapped tablet containing
  • - Lactose - 75
  • - Starch - 24
  • - Magnesium Trisilicate 1 (Tablet turns
    brown during autoclaving)
  • 6. Microbiological examination of finished
    products.
  • 7. Thermo - couples .

26
ADVANTAGES OF STEAM STERILISATION
  • 1. Rapid heating penetration of loads.
  • 2. Destruction of all forms of microbial life
  • 3. No residual toxicity.

27
  • 4. No damage to supplies being sterilised.
  • 5. Easy Quality Control
  • 6. Economical Reliable
  • This method is unsuitable for heat sensitive and
    non- permeable material

28
  • RADIATION STERILISATION
  • ISO MED at BARC Trombay dose - 2.5 Mega
    Rhontgen Source Cobalt-60 /Caesium 137/
    Electron Beam (generated by linear accelerator)
  • Reliable, can penetrate all types of packing.
    Large diverse shaped articles can be
    sterilised. No residual radio activity at 2.5
    mega rhontgens.
  • Glass becomes dark, cotton looses tensile
    property, food gets undesirable flavor. Not
    practicable in hospitals

29
STAFFING CSSD
  • BHATTA CHARJEE RECOMMENDS
  • SUPERVISORS (sister/male ward masters) 4
  • STAFF NURSES
    5
  • TECHNICIANS (ORA)
    6
  • ATTENDANTS
    24
  • SWEEPER
    4
  • CLERK
    1
  • TOTAL
    44

CENTRALISED SUPPLY (RULE OF THUMD 2PER 100 BEDS)
30
  • DISTRIBUTION SYSTEMS
  • 1. Regular issue of one days requirement.
  • 2. Clean for dirty exchange.
  • 3. Milk round system (topping up predetermined
    stock level)
  • 4. As on required basis. (Grocery system)

31
FLOW PROCESS CSSD
WARDS/DEPTS
BULK STORES
DIRTY RECEIPT
CLEAN RECEIPT
COTTON GAUGE
DISASSEMBLY
INSTRUMENT GLOVES RUBBERWARE
WASHING AREAS
ASSEMBLY
INSPECTION
PRE STERILE STORAGE
STERILISATION
STERILESTORAGE
DISTRIBUTION
32
A SUGGESTED LAYOUTOF CSSD
AUTOCLAVE
ROOM
ASSEMBLY (PARKING)
STERILE STORAGE
CLEANING WASHING
GLASS PARTITION
Supervisors office
disassembly
Clean storage
Verandah
STERILE ISSUE
Dirty reception
0
clean reception
RAMP
INTRA MURAL COMMUNICATION LINE
33
Thank You
34
Thermal Death Time (TDT)
  • TDT is the time required to kill a known
    population of microorganisms in a specific
    suspension at a particular temperature
  • Increasing temperature decreases TDT
  • Lowering the temperature increases TDT

35
Thermal Death Time ( cont.)
  • Acidic or basic pHs decrease TDT
  • Fats and oils slow penetration and increase TDT
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