1. GENERAL HOSPITAL
CLEANING DISINFECTION AND STERLILIZATION
PREOCEDURES
INSTRUMENTS AND HOSPITAL MEDICAL SUPPLIES
CENTRALSTERILE SUPPLY
DEPARTMENT
STANDARD OPERATING PROCEDURE

2. GENERAL HOSPITAL
GENERAL HOSPITAL
CSSD DOCUMENTS 2015
COLLECTING INSTRUMENTS FROM OPREATION THEATRE
OBJECTIVE:
To collect soiled instruments for transport to CSSD cleaning, decontamination area,while ensuring staff
safety and minimizing the risk of spreading germs in the environment.
INDICATION:
Any unwrapped material (RIMD) in an operation theatre, whether used or unused, must be collect after
each procedure, as quickly as possible, by the scrub nurse, circulating nurse or OT Technician in
operation theatre.
EQUIPMENTS:
 Plastic tub or container with lid cover and handle for transport, sized appropriately for the amount
of material to be collected.
 A perforated plastic basket, smaller than the tub, to be placed into the tub to make it easier to
remove the materials.
 Color coated bags.
 Disposable non-sterile gloves.
TECHNIQUE:
 Put on non-sterile gloves.
 Remove the lid from the tub.
 Collect the instruments.
 Wipe the instruments with compresses to remove the organic matter, this procedure should have
been done throughout the surgical aseptically technique.
 Place all instruments used or unused, open and dismantled, as well as any immersible item like
bowls, suction tubes, diathermy leads, electric drills, dermatomes, pneumatic drills, used during
the procedure, in the tub,s perforated basket or failing that, in the plastic tub.
 Close the tub with its lid to transport it to the CSSD,s decontamination area.
 Take of gloves and wash hands with disinfection solution and water.
IMPORTANTREMARKS:
 Place small parts from dismantled instruments in a bowl or kidney tray - or better yet, in a small
net bag – to prevent them from getting lost when the tub is emptied.
 Place heavy instruments in the bottom of the basket.
 Mark defective instruments with a leftover bit of suture, for example , for replacement when the
set is reassembled.
 Be sure not to put compresses,paper, leftover disinfection solution, needles, scalpel.
 Be sure to dispose of any non- reusable sharps inappropriate receptacles.
 Take care not to contaminate the outside of tub with soiled gloves.

3. GENERAL HOSPITAL
GENERAL HOSPITAL
CSSD DOCUMENTS 2015
PREDISINFECTING OF OT INSTRUMENTS
OBJECTIVE:
Pre-disinfection is the first step in the sterilization process. This step alone reduces the number of
microorganism on the surface of the material to be sterilized by a factor of 1000.
It make the cleaning process easier,reduces the risk of accidental exposure to blood for staff handling the
material, and protect the environment from spreading of microorganism.
INDICATION:
Any instrument or medical equipment (RIMD) has been unwrapped and used, or not used, during surgical
procedure or dressing change should be pre-disinfected as quickly as possible after use to prevent blood,
secretions, organic matter,debris, and small soft tissue from drying on the material, by the CSSD
Technician in decontaminated, dirty room, area.
EQUIPMET:
 Water source,sink with fast running clean water.
 Graduated plastic tub, marked every 05 liters with indelible marker, and perforated basket.
 Detergent,disinfection solution.
 Rubber gloves with long cuffs, plastic apron, mask, protective goggles, timer.
 Water spray gun, stylet, long stem thin brush, hand brush, 50 ml syringe with catheter tip.
TECHNIQUE:
 Protect yourself with long-cuffed rubber gloves, mask, goggles, and apron, in addition to CSSD
specific dress.
 Take delivery of plastic tub containing all medical supplies to be disinfected.
IMMERSIBLE ITEMS:
 Prepare the soaking bath in the graduated plastic tub, adjust volume of the bath solution to the
amount of material to be disinfected.
 Put the perforated basket containing the material in the pre-prepared detergent-disinfectant
solution. Take care to completely immerse the instruments in the solution.
 Be sure to irrigate all hollow, double lumen items with the solution, with a syringe, water spray
gun, and long stem brush.
 Take the perforated basket containing the instruments out of the bath the place it in the sink.
 Empty the pre-disinfection solution bath into the sink.
 Rinse the instruments in fast clean running water.
NON-IMMERSIBLE ITEMS:
 Wipe the item with a cloth soaked in detergent-disinfectant solution.
 Rinse with a cloth dampened in water.
 Wrap in a clean, solution-soaked cloth and leave it in contact for 30 minutes.

 Wipe with a clean, lint free cloth.
IMPORTANTREMARKS:
 Discard the pre-disinfection bath solution after each use.

4. GENERAL HOSPITAL
GENERAL HOSPITAL
CSSD DOCUMENTS 2015
PREDISINFECTING/COLLECTING INSTRUMENTS FROM CONSUMER DEPARTMENT
OBJECTIVE:
Pre-disinfect soiled instruments used in the consumer departments and collect them for transport to the
decontamination room, area in a way that ensures staff safety and minimizes the risk of spreading
microorganisms in the environment.
INDICATION:
Pre-disinfection applies to all instruments and medical equipment used in the consumer departments and
units during procedures. Instruments are collect two or three times a day, depending on consumer
departments, units activity.
EQUIPMENT:
 Transport trolley for soiled instruments.
 Water source,water spray gun, sink with running fast clean water, stylet, long stem thin brushes.
 Graduated plastic tub, marked every 05 liters with indelible marker, lid cover and handle for
transport, sizes appropriately for the amount to be collected.
 A perforated plastic basket, smaller than tub, to make it easier to remove the material from the
tub.
 Detergent- disinfectant solution.
 Rubber gloves with long cuffs, plastic apron, surgical goggles mask, protective gloves, timer.
TECHNIQUE:
 Prepare solution of detergent-disinfectant product in the soaking bin, adjusting the volume of the
bath to the amount of material to be disinfected.
 Protect yourself with long-cuffed rubber gloves, apron, mask, and goggles, in addition to work
clothing, CSSD specific dress.
 After each procedure,place all instruments and other reusable invasive medical devices, used or
unwrapped, open and dismantled, in the perforated basket in the tub containing the prepared
detergent-disinfectant solution.
 Be sure to irrigate all hollow and double lumen instruments and items with the solution, use
syringes, water spray guns, long stem thin brushes.
 Remove the perforated basket containing the instruments and place it in the sink.
 Rinse the instruments in running water.
 Wipe them with a clean, lint free cloth.
 Place then into the transport tub, close the tub with its lid.
 The tub should be transport to the decontamination area by transport trolley.
IMPORTANTREMARKS:
 Mark defective instruments for replacement when the set is reassembled.
 Be sure not put compresses,paper, leftover solution detergent-disinfectant used in procedures
remaining on the instrument trolley.
 Discard the pre-disinfectant bath solution after each use.

5. GENERAL HOSPITAL
GENERAL HOSPITAL
CSSD DOCUMENTS 2015
CLEANING-DISINFECTION-DRYING
OBJECTIVE:
Cleaning consists of eliminating blood, secretions, organic matter, and debris via the chemical action of a
detergent-disinfectant combined with the mechanical action of brushing and rinsing. All items must be
carefully cleaned before going into sterilizer.
“ Only that which is clean can be properly sterilized”
INDICATION:
All pre-disinfected items to be sterilized must be cleaned, immediately after pre-disinfection, in the
decontamination area of the CSSD, by CSSD Technician.
All new items delivered unsterilized and intended to be used after sterilization must undergo this step
before being sterilized and put into service.
EQUIPMENT:
 Water source,sink with running water.
 Water spray gun with extra nozzles for rinsing.
 Graduated plastic tub, marked every 05 liters with indelible marker.
 Detergent-disinfectant solution.
 Rubber gloves with long cuffs, plastic apron, mask, protective goggles.
 Soft brushes, test tube brushes, long stem thin brushes, different size syringes.
 Air pressure gun for drying.
 Lint free cloth.
 Timer.
TECHNIQUE:
 Protect yourself with rubber gloves, mask, apron, goggles, and in addition to CSSD specific
dress.
IMMERSIBLE ITEMS:
 Prepare the soaking bath, adjust the volume of the bath to the amount of material to be
cleaned/disinfected.
 Completely immerse the instruments in the prepared detergent-disinfectant solution.
 Meticulously brush the instruments with a soft brush in the solution to avoid spraying potentially
contaminated solution into environment. Pay particular attention to teeth and hard to reach areas,
shafts, joints, hinges, and marking. Do not use abrasive brushes, risk of corrosion and scratching.
 Clean the inside of hollow instruments using a test tube brush, water pressure gun, or syringe to
inject the solution under pressure into the lumen.
 Rinse instruments well under fast running clean water severaltimes.
 Inspect with a magnifying glass to make sure instruments are clean, if necessary repeat the
process.
NON-IMMERSIBLE ITEMS:
 Wrap in a detergent-disinfectant solution-soaked cloth and leave in contact 30 minutes, using a
timer.
 Brush anything that can be brush.
 Rinse with a clean cloth dampened in water.
 Wipe with a clean, lint-free cloth.
DRYING:

6. GENERAL HOSPITAL
GENERAL HOSPITAL
CSSD DOCUMENTS 2015
 Drain instruments well.
 Drain the tubes and hang them from a hook provided for this purpose.
 Arrange instruments on a disinfected work surface,protected with a clean, dry cloth.
 Be sure not to mix instrument sets.
 Wipe instruments very carefully with a clean, lint free cloth.
 Dry the inside of hollow instruments with an air filled syringe, an air pressure gun and hair
dryer for hard to dry orthopedic equipment.
 Cover the instruments and equipment with a clean cloth or place it is a closed bin to protect it
from potential airborne contamination.
 Shift them to the packaging area.
IMPORTANTREMARKS:
 Take care not to mix instrument sets.
 Discard the solution bath after use.
 All new instruments must be meticulously clean several times, at least twice, before use, in order
to remove all manufacturing residue.
EQUIPMENTMAINTENANCE:
 Transport bins should be cleaned with detergent-disinfectant solution, rinsed and dried before
sent to the consumer departments, units.
 Equipment: at the end of day or more often, if necessary – all equipment” soaking tubes, gloves,
brushes, apron,” should be cleaned and disinfected and dried. Hang the apron on a hook.
 Premises: work surfaces,door handles, taps, floors, walls are cleaned and disinfected with a
surface detergent-disinfectant solution, using a change technique for infectious risk area,the two
bucket method.
 LINEN: change the linen each day and when it is wet.
REASSEMBLING INSTRUMENT SETS

7. GENERAL HOSPITAL
GENERAL HOSPITAL
CSSD DOCUMENTS 2015
OBJECTIVE:
To reassemble the instrument sets in a standard way, received from OT and other consume departments
and units, make sure that the instruments and ancillary equipment are in good condition.
INDICATION:
This step applies to any instrument going back into a set. Instrument sets should be reassembled as soon
as possible after drying the instruments, to avoid recontamination by the air, in the CSSD packaging area,
by CSSD Technician.
EQUIPMENT:
 Large work surface.
 Working tables.
 Good lighting.
 Magnifying glass.
 Silicon tubing.
 Lubricant spray, silicon free.
 Sets reassembling sheets,kept up to-date.
 Spare, extra instruments, implants.
 Wire baskets.
 Instruments box, containers, and any sterilization gear with specific items, ancillary equipment,
external fixators, or other orthopedic equipment.
TECHNIQUE:
 Wash hands.
 Make sure that the instruments are dry.
 Check the instruments one by one, using magnifying glass if necessary and make sure they are all
in good condition and in working order.
 If they are not functioning properly, lubricate them with silicon free lubricant oil or spray; replace
them if that does not correct the problem.
 Replace any instruments marked earlier with a string “damaged instruments”.
 Reassembled the sets, strictly following the pre-established lists; refer to the binder holding the
sheets with reference name and,in some cases,images of instruments, equipment.
 Arrange the instruments in a wire basket in surgical order, aligned in the same direction, or in
their proper place in special trays,boxes. Put the heaviest instruments in the bottom of the basket.
 Cover the ends of sharp instruments with a small piece of silicon tubing to prevent them from
piercing the sterilization paper during handling of wrapped packs,and also protect them from
damaging.
 Close locking forceps at the first notch.
 Place bowls, kidney trays, upside down to prevent from collecting condensed water in the
sterilizer.
 The instrument sets are now ready for packaging.
IMPORTANTREMARKS:
 Check all instrument sets by 02 CSSD Technicians, set prepared by and set checked by.
PACKAGING INSTRUMENT SETS
OBJECTIVE:

8. GENERAL HOSPITAL
GENERAL HOSPITAL
CSSD DOCUMENTS 2015
To wrap the items to be sterilized – medical supplies, instruments, equipment, or linen packs – in a way
that allows to be sterilized by saturated steam and remain sterile until they used, packaging must allow
easy and aseptic opening of the pack.
Packaging must be permeable to steam, water repellent, resistant to tears and impermeable to
microorganisms.
INDICATION:
All cleaned and disinfected material to be sterilized must be packaged, as quickly as possible after
instrument sets are reassembled – or as soon as possible after drying, for items not belonging to sets – in
order to minimize the risk of recontamination by the environment. Packaging is done in the packaging
area of the CSSD, by CSSD technician.
EQUIPMET:
 Sterilization crepe paper or non-woven sheet for heavy boxes.
 Laminated pouches.
 Wire baskets.
 Sterilization container.
 Sealing machine.
 Steam indicator tape with dispenser.
 TST strips, integrators, biological vial indicators.
 Steam-resistant indelible marker.
TECHNIQUE:
 The packaging technique should allow the pack to be opened aseptically at the time of use.
 Wash hands.
 Place TST strip in instrument sets, ancillary equipment sets, and implants.
 A TST strip is not needed foe pack of accessory items,like single item pack in laminated
pouches.
 Wrap the instrument set or material with a first wrapping sheet cloth sized appropriately for the
pack to be sterilized in a parcel/square packaging method, using sterilization crepe paper with the
envelope fold technique, wrap the instrument set or material with a first crepe paper, and wrap
with a second crepe paper in the same way.
 Write the pack contents, sterilization cycle number, load number, sterilizer number, and Julian
date, sterilization date,and expiry date on the steam indicator tape.
 Close the pack with steam indicator tape,making sure to fold the end of the tape over on itself to
make it easier to grasp when the pack is opened.
IMPORTANTREMARKS:
 Never use a pen to write on crepe paper or non-woven sheets; due to risk of perforation, if
necessary use a special sterilization marker felt-tip marker.
 Be sure to use the right size sheet,crepe paper, laminated pouch; neither too large nor too small.
 Be sure not to crease the sheet,paper; this can cause channels or hollows that trap condensation.
 Sterilization crepe paper, laminated pouch are single use only.
CHECKING AND FOLDING SURGICAL LINEN
OBJECTIVE:

9. GENERAL HOSPITAL
GENERAL HOSPITAL
CSSD DOCUMENTS 2015
To make sure that linen is in good condition, mend it if necessary,iron it, and fold it.
It is important that surgical linen such as surgeon gowns, drapes,wrapping sheets,are in perfect
condition, are functional, and do not have hoe.
INDICATION:
Surgical linen is checked after drying, in the ironing and folding” LINEN PACKAGINGAREA” of the
CSSD, by CSSD Technician.
EQUIPMENT:
 Clean dry linen.
 Folding procedures.
 Multi shelves racks for storing linen.
 Transport trolley for transportation linen packs.
TECHNIQUE:
 Wash hands with antiseptic solution to avoid recontamination the clean linen during handling.
 Check the condition of the linen. Linen that is too badly damaged should no longer be used, but
saved to make rags or discarded. Replace the ties used for closing surgical gowns and scrubs.
 Iron the linen.
 Fold surgical linen according to the folding procedure to prevent asepsis error by the surgical
team while gowning or unfolding surgical drapes.
 Sort the linen and arrange by item, gowns, scrubs,drapes, sheets,and by unit or department.
 Spare linen should be put away in a closed racks, cupboards, closed plastic bins on a shelf in the
linen packaging area.
 Transport linen in clean bins or baskets reserved for this purpose to the treatment, consumer
department- or linen requiring sterilization- to the sterilization area.
IMPORTANTREMARKS:
 Linen should not be fold in the sterilization area or in the instrument sets packaging area,as this
release a lot of particles into the air.
PACKAGING LINEN BEFORE STERILIZATION
OBJECTIVE:

10. GENERAL HOSPITAL
GENERAL HOSPITAL
CSSD DOCUMENTS 2015
To reassemble sets of linen in standard fashion.
To wrap linen packs in packaging that can be penetrated by the sterilant, in this case saturated water
vapor, and that ensures its continued sterility after removal from the autoclave by virtue of its
impermeability to microorganisms.
Packaging must be permeable to steam, water repellent, and resistant to tears. The packaging technique
should allow the pack to be opened aseptically at the time of use.
INDICATION:
After linen is checked,ironed and folded in the linen packaging area,and received by CSSD Technician
in the packaging area of the CSSD.
EQUIPMENT:
 Large work surface.
 Surgical linen.
 Up-to-date reassembly list for linen sets.
 Sterilization crepe paper.
 Steam indicator tape.
 TST indicator strips.
TECHNIQUE:
 Wash hands.
 Reassemble the linen sets according to the pre-established lists.
 Wrap the linen set in a first sheet of wrapping cloth sized appropriately for the set to be sterilized,
according to the chosen technique, parcel/square folding technique.
 Wrap with a first crepe paper in envelop fold method and wrap a second crepe paper in the same
way.
 Close the pack with the steam indicator tape, making sure to fold the end of the tape over itself to
make it easier to grasp when the pack is opened.
 Write the contents of the pack, sterilization cycle number, load number, sterilization date,expiry
date, Julian date on the tape.
IMPORTANTREMARKS:
 Do not reassemble instrument sets at the same time as the linen sets (the latter generates
particles).
 Do not write on the crepe paper,risk of tear.
 Do not re-use crepe paper,for single use only.
 Make up packs according to needs.
 Arrange the linen in the pack by starting with the items that will be used last.

11. GENERAL HOSPITAL
GENERAL HOSPITAL
CSSD DOCUMENTS 2015
STERILIZATION OF MATERIAL & RIMD
OBJECTIVE:
To destroy all viable microorganisms on the surface of instruments and medical supplies intended for
sterile use.
INDICATION:
All equipment requiring steam sterilization should be placed in an autoclave/sterilizer after packaging, in
the CSSD, by CSSD Technician.
EQUIPMENT:
 Steam sterilizer, with internal and external steam supply.
 Water softener,RO plant.
 Biological indicator, TST strips.
 Heat resistant gloves.
 Sterilization cycle traceability record.
LOADING STERILIZER:
 Make sure that the load is homogeneous, linen or instruments, because these items do not respond
the same way to steam. It,s harder for steam to penetrate linen; condensation is different, as is
drying.
 Do not overload sterilizer; fill the chamber no more than 2/3 full to minimize condensation.
 Do not crowd the packs, so that steam can circulate.
 Make sure that the packs do not touch the walls of the sterilizer chamber.
 Place packs in the sterilizer chamber accordingly, small packs can be placed vertically, but
instrument sets packaged in wire basket or inner rack should be placed flat.
 Load the second basket or inner rack in the same way.
 For each basket or inner rack, place biological indicator, TST strip packaged in a double crepe
paper or in laminated roll in the middle of the load, or separately wrap TST strip, biological
indicator and integrator and distribute them in the load, one toward the back of the chamber, the
other at the front.
 Close the sterilizer doors.
 Select the cycle, 121C/250F or 134C/275F accordingly.
 Follow the operating manual of the sterilizer strictly for each cycle.
 In case of technical error call the service technical person.
UNLOADING STERILIZER:
 Wait until the end of the sterilization cycle.
 Wait 15 minutes for the load to cool.
 Put on heat resistant gloves.
 Open the sterilizer door.
 Empty the sterilizer; place the packs on a clean dry surface.
 Check to make sure the wrapping is intact well-dried.
 Unwrap the TST strip, biological indicator, and integrator that had been wrapped separately on
their placed in the load, and check that they have changed color.
 Put the biological indicator into incubator for 24 hours.
IMPORTANTREMARKS:

12. GENERAL HOSPITAL
GENERAL HOSPITAL
CSSD DOCUMENTS 2015
 If the indicator strip has not changed color, the load is considered non-sterile; it must be
repackaged and sterilized in sterilizer.
 Any pack that is dump or wet should be considered non-sterile. If needed urgently, it can used
immediately in semi critical procedures, otherwise it should be repackaged and sterilized in the
sterilizer.
 Any pack whose wrapper is torn should be repackaged and sterilized in the sterilizer.
BOWIE- DICK TESTING:
Bowie- dick testing: The bowie-Dick test is used to check for proper steam penetration into packs, and
thus the absence of residual air in the sterilizer. Every morning, before beginning sterilization cycle,
perform a Bowie-Dick test; empty sterilizer, 3.5 minutes, 134C plateau program cycle. Verify that the test
sheet has changed color as it should; write the date and cycle number on the test sheet and archive it by
stapling it to that day,s traceability record.
The bowie-dick cycle is recorded on the sterilization cycle log sheet any other cycle; date, number, and in
the load composition column, indicate “Bowie-Dick”. If the sterilizer has printer, attach the printed graph
indicating sterilization parameters to the box corresponding to that cycle on traceability sheet.
TRACEABILITY

13. GENERAL HOSPITAL
GENERAL HOSPITAL
CSSD DOCUMENTS 2015
OBJECTIVE:
To be able to link a pack sterilized in an autoclave and used for a patient during surgery or consumer
department to a given sterilized cycle.
Sterilization and patient traceability module and record intended to identify and log every cycle of a
surgery sterilizer and any equipment which has passed through this process and has been used on a
patient. To provided added security for you and your patients, you must able to identify any sterilized
item or equipment that has been used on a patient, proving that it has successfully been through a
decontamination and sterilization process.
For every sterilization cycle, it should be possible to prove that the autoclave was working properly on the
sterilization date, and that the sterilization cycle was as it should be.
Traceability consists of tracing all medical devices sterilized in the same load from their reception to their
distribution. This way, in case of failure during sterilization process, the entire load is identified and can
recycle or re-sterilized.
 For autoclave with a vacuum pump and internal or external steam generator (AUTOMATIC); the
correct functioning of the autoclave on the day of sterilization is evaluated using bowie-dick test
and the pressure graph, or T-DOC cycle system. Sterilization cycle compliance is evaluated with
the time-pressure-temperature recording.
 For vertical autoclave without vacuum pump and steam generator; sterilization cycle compliance
is evaluated by the changing of TST strip or integrator and the pressure read from the manometer
during the sterilization plateau.

In case of postoperative nosocomial infection of unexplained origin, it might be important to verify the
sterilization of the equipment in order to either rule it out as a cause or correct a malfunction.
INDICATION:
Traceability applies to all packs in an autoclave. It should be done for each sterilization cycle, in the
CSSD, by the CSSD Technician.
EQUIMENT:
 A binder/register for each autoclave.
 PC,computer system for monitoring and traceability.
 Biological indicator.
 Steam integrator, TST strip.
 Bowie-Dick test sheet.
 Printer attached with autoclave.
 Bar coding system if available.

14. GENERAL HOSPITAL
GENERAL HOSPITAL
CSSD DOCUMENTS 2015
TECHNIQUE:
 Fill out a pre-printed traceability and monitoring document, sheet, every day and for each new
cycle run.
 On traceability sheet write down:
 The date.
 The cycle number.
 The type of selected process cycle run, time, pressure,temperature.
 The composition of the load.
 Stick one of the cycle TST strip, integrator.
 Batch record
 Item record.
 Staff data record.
 Sterilizer record.
 CSSD audit record.
 Foe autoclave with a vacuum pump and temperature- pressure recorder,also attach the printed
graph from the corresponding cycle.
 Inter the complete data into software.
 Archive the binder/register in a dry place, protected from humidity.
IMPORTANTREMARKS:
 Use cycle numbering: do not restart numbering at the beginning of each month or year-
continuous the numbering from before. This prevents errors and make it easier to know how
many cycles, been run, or when the last maintenance was performed, if maintenance is done
every 100 cycle, maintenance should be done at number 200, then 300 etc, without looking in the
archive.

15. GENERAL HOSPITAL
GENERAL HOSPITAL
CSSD DOCUMENTS 2015
HIGH-LEVEL DISINFECTION
OBJECTIVE:
To temporarily destroy microorganisms on the surface of the heat-sensitive equipment by immersion in a
disinfectant solution.
INDICATION:
Any heat-sensitive equipment, unable to tolerate autoclaving, should undergo high-level disinfection as
quickly as possible after use to prevent blood, secretions, organic matters, and debris from drying on the
equipment. It is done in the decontamination area of the CSSD, by CSSD Technician.
EQUIPMENT:
 Graduated plastic tubs.
 High-level Detergent-disinfectant solution.
 Soft brush, syringe, bottle-brush.
 Clean RO water.
 Rubber gloves with long cuffs, goggles, mask, CSSD dress.
 Sterile gloves.
 Sterile cloth; a small surgical drape.
 Plastic container with perforated basket and lid cover.
 Timer.
TECHNIQUE:
Put on protective gloves, clothing and long cuffed gloves.
PRE-TREATMENT:wipe the equipment meticulously with a cloth or compresses.
CLEANING:
First cleaning:
 Prepare the soaking bath: adjust the volume of the bath to the amount of material to be
cleaned/disinfected.
 Completely immerse the equipment in the pre-prepared detergent/disinfectant solution.
 Start the timer.
 Very carefully brush the equipment with a soft brush, or a bottle brush for hollow items, using a
syringe to inject the cleaning solution under pressure into lumen of hollow items.
 Rinse equipment well under running clean distilled water,using the syringe for hollow
equipment.
Second cleaning:
 Repeat the same exercise,immerse the material in a new detergent/disinfectant solution; bath,
brush, clean with bottle-brush.
 Rinse the equipment well under running clean distilled water.

16. GENERAL HOSPITAL
GENERAL HOSPITAL
CSSD DOCUMENTS 2015
DISINFECTION:
 Prepare high-level disinfection solution; write down the preparation date.
 Immerse the equipment in the high-level bath solution.
 Start timer.
 Remove the equipment from the soaking bath solution.
 Put on sterile gloves and rinse the equipment with clean filtered (RO) water.
DRYING:
 Wipe equipment meticulously with a clean, lint-free cloth.
STORAGE:
 Wrap the equipment in a dry sterile cloth, crepe paper, wrapper sheet.
 Write down disinfection date.
 Put disinfected equipment away in a clean container labeled ”High-level disinfected” and close
with lid.
 If the equipment are not used within 24 hours of “high-level disinfection” repeat the whole
procedure of high-level disinfection before using again.
Maintaining equipment and saving high-level disinfectant solutions
 The two detergent/disinfectant bath solutions should be replaced each time they are used.
 The high-level detergent/disinfectant cab be kept for 7 days, but must be changed, straight away
if visible soiled.
 The tubs, test tube brushes, syringes, should be cleaned, rinsed and dried after each use.
IMPORTANTREMARKS:
 High-level disinfection is not sterilization. In no case can an item be considered sterile after high-
level disinfection.
 Never use “High-level disinfection” if an item can tolerate autoclave sterilization.
 Take the necessary precaution when handling high-level detergent/disinfectant solution, wear
protective gloves, clothing, goggles, mask, and avoid inhaling the fumes.

17. GENERAL HOSPITAL
GENERAL HOSPITAL
CSSD DOCUMENTS 2015
STERILE STORGAE
OBJECTIVE:
To preserve the integrity of packaging in order to keep equipment sterile until the time of use
. Storage should allow good inventory management and monitoring of expiration dates.
After sterilization it is necessary to store the sterile packages. The activities of personal in the storage area
and the environment itself have a great impact on pack sterility. There must be tight inventory control on
storage contents to assure supplies will be available when needed, that stock is properly rotated, that
packs with expired time sensitive items are cycled out and that the hospital is not wasting space on
seldom used items.
INDICATION:
Storage concerns all autoclave-sterilized materials awaiting use. Immediately after autoclaving, materials
are stored in a suitable room in surgical suite, or sterilized storage area in OT/CSSD.
The storage area should be clean, closed, and well-ventilated. It should not be a heavy trafficked area.
Sterilized packs should be stored away from dust, humidity, and sunlight by the CSSD Technician.
The room should be under positive pressure to reduce airborne contamination from air outside the storage
area.
The temperature and humidity should be controlled to between 65F to 75F and 35% to 75% humidity.
The moisture also provides an excellent opportunity for fungal growth through the packages. For these
reasons,it is also important to keep packs at least 2 inches away from walls.
EQUIPMENT:
 Container with lid cover.
 Multi shelves racks airlock.
 Closed cupboards.
 Inventories sheet.
 Sterilization and expiration sheet.
TECHNIQUE:
 Handle sterilized sets and packs with care.
 Put them away in closed cupboard or airlock racks.
 Arrange the sterilized packs in large container with lid cover, and put them away on shelves.
 There should be easy, quick access to storage.
 Arrange them logically, by surgical specialty, like orthopedics, gynecology, generalsurgery,
weight and size (heavy containers at ergonomic height), and frequency of use (the items used
most often should be the easiest to take).
 Arrange them according to their sterilization date to ensure good turnover and avoid expiration of
certain items; always use item closest to their expiration date first. (FIFO).
IMPORTANTREMARKS:
 Never store directly on the ground.
 Avoiding stacking packs to protect wrappers.
 Never put elastic band around wrappers,as this might cut the wrappers.
 Material intended for consumer departments should be transported in clean, closed bins; these
bins should be cleaned after each use.

18. GENERAL HOSPITAL
GENERAL HOSPITAL
CSSD DOCUMENTS 2015
EXPIRATION:
The length of time material sterile will depend on the quality of the entire sterilization process,the quality
of the packaging, packaging material and the quality of storage.
CHECKING:
Check the expired sets and equipment are on daily basis.
Record the check in the notebook, inventory register or in software; each check should be signed by the
person who performed it.
Any item that are beyond their expiration date or whose wrapper is damaged should be repackaged again
and re-sterilized.
An excessive amount of expired material could mean excess inventory or poor turnover. Review needs
and inventory management.
INVENTORYMANAGEMENT:
 Adjust the inventory to the activity level of the operation theatres and consumer departments.
 Log control numbers should be affixed on the packs.
 At the beginning of the cycle, the date,time, sterilizer operator, sterilization record cycle
identification, should be marked on the inventory register.
 At the end of the cycle, the response of TST should be recorded.
 Results of biological indicator should be recorded when obtained.
 The sterilization record should be examined and attested.
 Load record log should be maintained.