From the desk of Dr. Sambi : -

The last few years have witnessed an increasing interest in organizing sterilization due to the increase in infections and resistant strains of micro-organisms that cause disease to humans. Every new hospital now being planned in the world includes provision for a central sterile supply department (C.S.S.D.) as we are convinced of the need, in the interests of hygiene, safety and efficiency, to centralize those less personal services such as sterilization, linen, etc.

The objective of establishing a C.S.S.D. is to make reliably sterilized articles available at the required time and place for any agreed purpose in the Hospital as economically as possible, having regard to the need to conserve the time of users (especially Doctors And Nurses). The C.S.S.D. also aims at assuming total responsibility for processing hospital items thereby assuring that all of them receive the same degree of cleaning and sterilization. It also contributes to the educational program within the hospital relating to infection control and develops a cost-effective program by cost analysis of personnel, supplies and equipment.

The C.S.S.D. within a hospital receives stores, sterilizes and distributes to all departments including the wards, outpatient department and other special units such as operating theatre. Major responsibilities of C.S.S.D. include processing and sterilization of syringes, rubber goods (catheters and tubing), surgical instruments, treatment trays and sets, dressings etc. It is also responsible for economic and effective utilization of equipment resources of the hospital under controlled supervision. All this is after a great deal of planning and work that is initiated by the hospital pathologist, who takes the initiative in the planning, organizing and running of these departments.

The main objectives of the central sterile supply department are:

1. To provide sterilized material from a central department where sterilizing practice is conducted under conditions, which are controlled, thereby contributing to a reduction in the incidence of hospital infection.
2. To take some of the work of the Nursing staff so that they can devote more time to their patients.
3. To avoid duplication of costly equipment’s, which may be infrequently used.
4. To maintain record of effectiveness of cleaning, disinfection and sterilization process.
5. To monitor and enforce controls necessary to prevent cross infection according to infection control policy.
6. To maintain an inventory of supplies and equipment.
7. To stay updated regarding developments in the field in the interest of efficiency, economy, accuracy and provision of better patient care.
8. To provide a safe environment for the patients and staff.

Infection records to date indicate a reduction in secondary infection of surgical wounds and by far the total sepsis rate has been estimated at 3%. The trend for small size Indian hospitals is to use an indigenous autoclave, which may be difficult to monitor or validate. The automated steriliser on the other hand is equipped with quality control checks, gives an automated and digital output in the form of print-outs and graphs. There is a constant effort to bring out safer sterilisers and make them more reliable. Experts say that sterilisation involves a lot of variables, hence the effort should be to minimise the chances of an instrument not getting sterile, which can be a hazard to the patient. Before considering how central sterile supply departments should be run it may be of value to enumerate the means of effecting sterilization. So far as hospitals are concerned there are five possible methods: by chemical means, by irradiation, by using gases, by steam, by hot air.

The purpose of a C.S.S.D. is to supply all departments of a hospital theatres, wards, out-patient and casualty departments with complete, sterile (and the accent is on "sterile ") equipment ready and available for immediate use in the treatment of patients. The only exception to this may be the theatre instruments, which are generally kept, cleaned, sterilized and used in the theatre suites.

The essentials of the department are correct design, modern plant, skilful operators, and a proper work-flow. Regular skilled maintenance to avoid breakdowns of plant, especially steam-pressure sterilizers, is also essential. The basic equipment consists of steam pressure sterilizers and hot-air ovens, which provide a uniform standard of sterility of supplies throughout the hospital-a much higher standard than prevails where decentralized boiling-water sterilizers, used for instruments, bowls, syringes, etc., are scattered in wards, theatres, out-patient and casualty departments and are manipulated by many persons engaged in multifarious duties. Other advantages include decreased maintenance and replacement costs of expensive equipment, more time for the nursing staff to devote to nursing care, better care and maintenance of instruments and utensils resulting in longer life, and fewer losses of items due to control from the centre at all stages. But perhaps the greatest value of a C.S.S.D. is the supply of sterile equipment designed to suit every procedure in ward or theatre, and the sterility of which can be guaranteed-a further step towards the prevention of hospital infection.

Dr. Ravinder Singh Sambi

Physician and Cardiologist

National Heart Institute

New Delhi-110065

From the Sambion Works : - 

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