The Central Sterile Supply Department (CSSD) is responsible for delivering sterile supplies of surgical instruments, linen, dressing material and other reusable devices to clinical areas like operation theatres, specialty units such as bone marrow transplantation units (BMT), wards, day care units, and out-patient clinics so that procedures can be conducted with safe, contamination-free medical devices and consumables. The defining feature of the CSSD at Tata Medical Center is the presence of modern, world class equipment infrastructure and a team of professional & dedicated personnel. The department is committed to maintain a high level of standards with respect to QA/QC (quality assurance and quality control) activities which involve monitoring the processes through physical, chemical, and biological indicators, and other process challenge devices. The overall vision is to deliver quality in all deliverables of the CSSD, not just sterile supplies.

CSSD Services:

The services of CSSD includes collecting, sorting, cleaning, disinfecting, drying and assembling instruments; preparation of linen items; packaging, sterilizing, storing and issuing sterilised trays and boxes; quality monitoring, and record keeping.

Departmental Objective:

Central Sterile Supply Department (CSSD) at Tata Medical Centre – Kolkata is committed to the efficiency, economy & uniformity of sterile supply for the care of all patients with aseptic techniques. The main aim is to supply the sterile medical devices to the clinical areas at right time, right place and right condition.

Physical Location:

The CSSD is located on the 2nd floor of the Main Hospital building, at the distal end of the Operation Theatre Complex. The operations of CSSD are spread across an area of approximately 3000 square feet.

Name of the CSSD equipment, installation area and functions:

• Ultrasonic Cleaner
  This is kept in the decontamination area. It is used for cleaning of delicate surgical instruments.
• Automated Washer Disinfector
  This is kept in the decontamination area. It is used for cleaning and disinfection of soiled surgical instruments.
• Thermal Drying Cabinet
  This is kept in the preparation (packaging) area. It is for drying the wet surgical instruments and endoscopes.
• Rotary Sealer
  This is kept in the preparation (packaging) area. It is used for sealing the individual packed items.
• Steam Sterilizer (Autoclave)
  This is kept in the preparation (packaging) area. It is used to sterilize the heat resistant items.
• Ethylene Oxide Gas Sterilizer
  This is kept in the preparation (packaging) area. It is used to sterilize the heat sensitive items.
• Hydrogen Peroxide Gas (Plasma) Sterilizer
  This is kept in the preparation (packaging) area. It is also used to sterilize the heat sensitive items.

Other Supportive Equipment:

Water and air jet system for cleaning hollow/luminal instruments, disinfection tank, washing sink, eye wash facility, bar-code scanner with printer, batch monitoring label gun, hollow process challenge devices (for chemical and biological indicator monitoring), packing table fitted with magnifying lamp, light fitted linen packaging table, trolley wash system, room heater for humidity regulation, conductivity meter for total dissolved solid measurement, hygrometer for temperature and humidity measurement.

Consumables used for cleaning, disinfection and sterilization purposes:

• Packaging materials
• Sterilization indicators
• Cleaning solutions
• Brushes used for cleaning of luminal instruments
• Instrument lubricants
• Dressing materials (e.g. cotton, bandages)

Types of modern sterilization baskets and container:

• Stainless steel wire mesh baskets for autoclaving
• Thermo-lock rigid container for autoclaving
• Polypropylene based plastic container for ethylene oxide or hydrogen peroxide sterilization
• Container for fiber optic rigid scopes

Workload

Infection Prevention & Control:

CSSD is an essential part of Infection Prevention activities of any health care institution. In Tata Medical Center, Kolkata, the infection control activities are managed through the Hospital Infection Control Committee (HICC) and the Infection Control Team (ICT). CSSD Scientific Officer is a member of both the HICC and the ICT.

The infection prevention and control activities include training/awareness programs on infection control, department specific infection control policy development and policies for sterilization systems in CSSD. The CSSD has played a significant role in various accreditation programs like NABH Safe-I, NABH Nursing Excellence and cGreen-OT Certification.

CSSD quality management systems (quality indicators):

• Logical workflow (e.g. dirty instruments should never get entry into the clean   area).
• Access control system for all CSSD doors.
• Epoxy coated floor, tiled walls and steel based ceiling for easy cleaning.
• Computerized surgical instrument set check list.
• Bar coding and batch monitoring for sterility tracking and re-call procedure.
• Software based surgical set tracking system.
• Temperature & humidity monitoring in CSSD premises.
• Quality certificates for all consumables.
• Cleaning checklist and cleaning audits.
• Biomedical equipment maintenance record including record of CMC     (comprehensive maintenance contract).
• Daily equipment monitoring and validation (physical, chemical and biological).
• Environmental Microbiology: Water & Air microbiology and medical device   sterility testing.
• Water quality monitoring in CSSD (Total Dissolved Solid test, Chlorine test).
• Record of staff training and evaluation.
• Immunization of staffs as per NABH and WBPCB guidelines.
• Equipment for occupational safety such as eye wash system, ethylene oxide   detector, trolley wash facility etc.
• Computer based and paper based record keeping system as per international   standard.
• Third party assured validated sterilizers.

CSSD related academic activities (workshops, symposium) conducted at Tata Medical Center, Kolkata:

• Monitoring of Cleaning and Sterilization Processes in Healthcare Facilities, Year-2013
• Infection prevention and global best practices in operation theater and CSSD, Year-2014
• Live CSSD workshop, Year-2015.
• Care and maintenance of open surgery instruments and associated problems, Year-2016
• Awareness program on proper CSSD processes, Year-2017
• Sterilizer validation by data logger system at Tata Medical Center, Kolkata. Available at: https://youtu.be/xKG60o-C4hs

CSSD Related Publications:

• An overview of central sterile supply department of the Tata Medical Center, Kolkata. In: Scientific Operating Procedures for Sterilization Practices in India. New Delhi: Office of the Principal Scientific Adviser to the Government of India, 2012:165–183.
• Basu D, Bhattacharya S, Mahajan A, Ramanan VR, Chandy M. The importance of the central sterile supply department in infection prevention and control. Infect Control Hosp Epidemiol. 2014 Oct; 35(10):1312-4.
• Basu D, Bhattacharya S, Mahajan A, Ramanan VR, Chandy M. Sterilization indicators in central sterile supply department: quality assurance and cost implications. Infect Control Hosp Epidemiol. 2015 Apr; 36(4):484-6.
• Basu D. The importance of chemical solutions used for cleaning stainless steel surgical instruments in the central sterile supply department. Infect Control Hosp Epidemiol. 2015 Jul; 36(7):868-9.
• Basu D, Dutta SK, Bhattacharya S, Mahajan AY, Ramanan VR, Chandy M. The Economics of Autoclave-Based Sterilization: Experience from Central Sterile Supply Department of a Cancer Center in Eastern India. Infect Control Hosp Epidemiol. 2016 Jul; 37(7):878-80.
• Basu D. Reason behind wet pack after steam sterilization and its consequences: An overview from Central Sterile Supply Department of a cancer center in eastern India. J Infect Public Health. 2017 Mar – Apr; 10(2):235-239.
• Basu D, Bag SC, Das A, Razario JD. The importance of paper records and their preservation period in a Central Sterile Supply Department: An experience from a oncology center in eastern India. J Infect Public Health. 2017 Sep – Oct; 10(5):685-687.
• Basu D, Bag SC, Das A, Rozario JD, Goel G.  Comparing sterilization efficacy and cost implications of various gas based sterilization methods used in a   Central Sterile Supply Department. J Acad Clin Microbiol (Article in press)
• Basu D, Mondol P, Suman S, Mukherjee S, Goel G. A comparative study on nonwoven fabric and rigid container based packaging system used in Central Sterile Supply Department: Experience from a cancer center in eastern India.  J Acad Clin Microbiol (Article in press)