The sterile supply

Departments
quick guide manual

infection control directorate

 A word

Central sterile supply department(CSSD )is the most

essential feature in the hospital .It aims at centralizing
the activities of receipt ,cleaning ,assembly
,sterilization ,storage and distribution of sterilized
materials from a central department where
microbiologically safe .
Sterilization is done under controlled conditions with
adequate managerial and technical supervision at the
optimum cost. it contributes to improve patient’
safety programs through the reduction in hospital
infection rate.

Dr Haifa Al Mousa
Infection control directorate

infection control directorate

 content
1-Introduction -----------------------1
2- History -----------------------------2-3
3-CSSD responsibilities ----------------4
4-hand hygiene -----------------------5-6
5- CSSD layout -------------------------------7-8-9
6-Classification of instruments----------10
7-Sterile supply cycle ----------------- 11
8 - Collection------------------------12
9 - Segregation-----------------------13
10 - Cleaning & disinfection------------------14
11-W/D programs------------------------15-16-17
12-STF-------------------------------------18
13- C. dosing system-------------------19
14-Trolley washer----------------------20
15-Ultrasonic----------------------------21-22
16- foil test ----------------------------23
17-Manual wash ------------------------24-25-26
18- water treatment----------------------27-28
19-chemicals------------------------ 29
20- Endoscope ---------------------30-31
21-drying cabinet--------------------------32
22-Inspection & Assembly-------------------33
23-Functional test ------------------------34
24-Packaging-------------------------35
25-wrapping –parcel-------------------36
26-Wrapping – envelope-------------------37
27-see though pouch--------------------38
28-Labeling------------------------------39
29-seal check-----------------------------41

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 Content
30-Rigid containers-------------------42
31-Sterilization------------------43
32-Steam sterilizer------------------44
33-Steam sterilizer cycle---------------45
34-Programs---------------------------46
35-Onloading-----------------47
36-On removal------------------48
37-B&D test ------------------49
38- biological test-----------------50
39-Ethylene oxide sterilizer------------------51
40-E.T.O cycle-----------------------52
41-Plasma sterilization----------------53
42-Plasma sterilizer packaging-------54
43-Dry heat-------------------------55
44-Sterile store-------------------56
45-Unsterile store ---------------57
46-Raw materials-------------------58
47-G.laundry-----------------------59
48-Quality Assurance-----------------60
49-T.doc ----------------------61
50-ocuupational health------------------62
51- waste management ----------------63
52-Defifnitions

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1-Introduction :
Each day, millions of medical procedures are
performed in healthcare facilities worldwide, with
caregivers and patients relying on the availability
and use of a wide range of supplies, instruments and
equipment.
These devices must be properly cleaned, disinfected
and/or sterilized, under controlled environment &
inspected for quality to ensure good working
condition, and available at the point of care. In the
absence of proper handling, processing and storage,
these devices may become contaminated and
compromise quality patient care.
In most healthcare facilities, the central sterile
supply department (CSSD) plays a key role in
providing the items required to deliver quality
patient care. To support infection control within the
healthcare facility, the CSSD staff members must be
well-trained and skilled, and committed to “doing
what’s right” every step of the way.

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 2-History

--In the era of the late Sheikh Abdullah Al-Salem Al –Sabah

the development of health care facilities was emphasized
to ensure providing better health care services to the
population.
-- the building of Al Sabah hospital took place in the 1966
therefore the need for central sterile supply was
necessary .
Therefore a small CSSD was built on a small dimension to
receive, clean ,disinfect ,pack, sterilize, and distribute
the sterile medical supplies.

--The Number of CSSD equipments & staff at that time was

very small due to the limitation of health care services .

Until 1990 the CSSD workers were mainly from nursing

department and hotel services(cleaners ).
--Nurses had 6 months training on 1975 and 1980 to obtain
the basic of sterilization , However, with the development
of health care facilities and the growing awareness of
infection control the need for sterilization technicians was
mandatory to assure proper handling of sterile goods and
building a larger CSSD was also established to cover all Al
Sabah area hospitals located behind maternity hospital .

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In 1991 Ministry of health in association with
Public Authority for Applied Education and
Training started 2 years training course (4
semesters ) the training course including
theoretical & mostly practical training which
take part in the main CSSD .
--On February 2011 a Super CSSD was built of a
total Dimension 7 000 m₂ costing 3.5 million
KD located in Al-Sabah area. The New
building was opened by Minister of health Dr
Hilal Al-Sayer .
The super CSSD covers all hospitals located in Al-
Sabah area & supplies all hospitals &
polyclinics around Kuwait .
The super CSSD is equipped with up to date
machinery of 12 double door washer
disinfectors,13 double door steam sterilizers
,2 large Ultrasonic machines,25 heat sealing
machine and 25 working stations with the
addition of new CSSD technologies such as
Automatic loading system (AGS)for both
washer disinfectors & autoclaves and
automatic chemical refilling (Central dosing
system ) for washer disinfector.

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 3- CSSD responsibilities
1-Providing Sterile supplies to all hospitals, clinics and
polyclinics under the jurisdiction of ministry of Health.

2-Revision and approval for the design of any SSD in the

Ministries or private hospitals.
3-Providing policies / procedures and supervising the
implementation of the same in MOH.
4-Technical Supervision on CSSDs / TSSUs in Ministries
Hospitals.
5-Communicate with the end users to improve the quality of
the service.
6-Participating in committees to outline specifications of
purchased equipment and raw materials.
7-Specifying criterion for quality control of all items produced
by CSSDs.
8-Providing two years training programme in the field of
sterilization for the Public Authority for Applied Education
and Training for candidates who completed 12 years of
general education. Upon completion they will be certified
as qualified technicians. This training programme is unique
not only in Kuwait but also in the Middle East.
9-Training technical staff is a perquisite prior to employment in
private hospitals.
10-Providing consultancy and technical advice to enquiries
related to sterilization whether from Ministry of Health or
private hospitals.
Providing on job training programmes, refreshment courses
and continuous updating of technical staff

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 4-Hand Hygiene
Staff hands are the most common vehicle
for
infection transmission in health care.

Staff hands must be washed and dried:

• On commencement and completion of
duty
• Before and after using the toilet
• After working in a ‘dirty’ area
• Before working in a ‘clean’ area
• Before and following meal breaks
• Following any action that may
contaminate
hands

Finger nails should be kept short and clean

Hand and wrist jewelry must not be worn

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 5-layout

Properly designed central sterile supply

department (CSSD )s facilitate one-way flow of
items between soiled and clean work areas and
sterile storage. Walls and other barriers
separate the functional areas of a CSSD:
decontamination, preparation and packaging,
sterilization and sterile storage

Must separate decontamination area from all

other areas

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When you design CSSD remember

1-The department should be designed so that it is

physically separated from all other work areas.
2-The department should be designed to facilitate a
unidirectional flow from the
‘dirty’ area to the ‘clean’ area
3-There should be a changing area for workers
includes,
toilet facilities and lockers in proximity to the
decontamination area.
4-Access to the wash room and to the clean room
should be through dedicated
gowning rooms provided with hand hygiene facilities
5-The wash room, clean room and sterilizer unloading
area should be free from
‘opening’ windows, and unclean areas
6-All rooms in the department should be mechanically
ventilated and controlled
to provide a comfortable working environment,
(typically temperatures should
Be controlled between 18-22ºCelsius and relative
humidity should be controlled
within the range 35-60%).

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7- Staff movement between dirty and clean areas
should not be possible without passing through
a clothing change and wash-up area

8-Storage facilities for bulk items should be

provided external to the clean room and the
wash room

9-Number of Washers , ultrasonic ,sterilizers & other

equipments according to floor dimension ,Staff
total number & work load .

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 CSSD areas
1-Decontamination area :
Reception area
Trolley washer
Washer disinfector
Ultrasonic irrigator
Janitor + WC+ chemical store+ P.P.E +hand wash area
Sinks for Manual wash+ spray guns
Segregation table

2-Packaging area
Working stations with inspection lamps
Sealing machine
Reel dispenser with cutter
Wrapping papers trolley
Dryers

3- Sterile area
Steam sterilizers(Autoclaves )
Heat sensitive sterilizers ( ETO / Plasma/formalin )
Dry heat sterilizer

4- Storage area
Unsterile store located in the packaging area
Sterile store located in the sterile area
Raw material store located in the packaging area
5- Linen folding room + tailor

Located in the packaging area

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6-Classification of instruments
HIGH RISK:
Items in close contact with a break in the skin or
mucous membranes or introduced into a
normally sterile body cavity/organ e.g. surgical
instruments, catheters, needles etc.
Sterilisation is required.

MEDIUM RISK:
Items in close contact with mucous membranes,
contaminated with transmissible organisms or
to be used on immuno-compromised patients
e.g. respiratory equipment or endoscopes.
Disinfection is required, by heat where
possible.

LOW RISK:
Items in contact with normal and intact skin e.g.
stethoscopes, wash bowls, Cleaning and
drying is adequate.

SINGLE USE ITEMS:

To re-use a single use device without considering
the requirements and consequences could
expose the patient and re-processors to risks.
Single-use devices may not be designed to
allow decontamination -

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 7-Sterile supply cycle

-Each step in the sterile supply cycle is crucial to a good

and safe use of a sterile instrument or other item
during a medical intervention

-A mistake or failure in any of the steps may cause

recontamination and makes the whole procedure
useless.
-It may result in huge costs and can cause serious
suffering and even endanger the life of patients and
staff.

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8-Collection
All used, potentially contamination medical devices should arrive
the washroom in sealed containers into the reception area
(the vehicle should be approved by infection control
department ).

These containers should bear identification as to where

they have been dispatched from and preferably, their contents.

It is common in many Decontamination Service departments to

have a system installed for determining priorities for
reprocessing within the reception area to ensure minimum delays
with critical equipment take place .

Infectious items ( eg Hepatitis patient’ item )

should be placed in the lower shelf of washer
disinfector
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9- Segregation
• All devices are properly disassembled where necessary for cleaning
• baskets are never overloaded.

• Sharps and fine instruments are properly using fine mesh

process

-Sharp edges of the instruments should be facing

inwards

- jointed instruments must be opened ensuring

no areas are left unwashed

Always follow manufactures instructions for

dismantling complex items

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10-cleaning &disinfection
soil should be removed as soon as possible to:
• Reduce the number of micro-organisms on the item
• Remove the nutrient material that can support microbial growth
• Reduce the potential for environmental contamination by aerosol
or spillage
• Minimize potential damage to devices by blood and other
substances.

Cleaning
procedure

Washer Manual wash

disinfector ultrasonic

Infectious cases items should be placed in the

lower shelf of the washer disinfector

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 11-W/D Programs
Instruments types Disinfection Special rack
Temp .+ time
Program

-Metal instruments 90 c Program will

-Hard plastic or any material that 5 mints run
withstand high water automatically
temperature according to
According to manufacture rack label ( P1
instructions barcode
Program 1

Instruments made of plastic or 85 C Program will

glass or any material that can not 28 mints run
withstand the high water automatically
temperature according to
rack label ( P2
barcode
Program 2

Ensure correct program selection to prevent

instruments damage
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Use appropriate carts for instruments

Ensure proper connection to laminated

instruments for proper cleaning & disinfection

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All washer disinfectors used to clean and disinfect
medical devices (including) should be:

• Maintained regularly by qualified engineering

staff .
and results recorded
• Cleaned and checked daily by designated SSD
staff in accordance with written
departmental protocol
• Used only with detergents and other additives
which were used in the machine’s
• Operated according to manufacturer’s
instructions and agreed departmental work.

Loading Unloading
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12-STF stainless steel slide + paper sheets
1-Steel part is made of stainless steel
corrosion resistance similar to the
material used to manufacture surgical
instruments

2-the paper sheet contain

organic material similar to
coagulated human blood

3-The test should be placed in

different positions by clipping it to
the trays as shown in the picture

4-Preferably should be placed at

locations where it is difficult to clean
(the corners
5-At the end of the cycle the
paper sheet is removed and
checked

6-If complete removal of colour =

pass
Clolour remains = fail

7-If red colour remain after

repeating then stop the washer
and call specialist for repair
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 13- Washer disinfector
Central Dosing system

From accurate dosing and documentation to effective

spill containment and
space utilization, highly scalable Detergent Management
Systems
can dramatically facilitate regulatory compliance while
reducing
operational costs.

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14-Trolley washer for trolley & containers used
for collection

Used to clean and

disinfect the
collecting trolleys,
boxes and basins
with temperature
reaching 90 C and
disinfection
exposure time 1 -2
mints

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15-Ultrasonic -Irrigator

The effect of ultrasound is

based on the cavitation
which occurs at the water-
solid interfaces.
In the solution, small bubbles
are formed which
contain gas with low pressure.
When cavities
collapse, this results in very
high local differences in
pressure which affect the
removal of dirt particles.
In soft objects, e.g. rubber and
silicone, this effect is
not very pronounced.
Ultrasound is particularly
suitable for dissolving
dried dirt at sites which are
difficult to access

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When using Ultrasonic irrigator remember

--Don’t condense
--Don’t put the instruments directly
on the bottom ,use basket
--Dismantle complex items
--Use accessories for laminated
Instruments
-- Select appropriate program

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 16-Foil test
Prepare heavy duty foil width 1.5 Cm. the number of
foils depend upon ultrasonic capacity .
Use tape to fix the foil strips as shown in the picture
ensuring the foil does not touch the bottom .
Run the ultrasonic without instruments
After cycle finish check the changes on the foil
If uniform change on the foil appear then the test is
passed
If no changes appear call maintenance for repair

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 17-Manual wash

Immersion
Manual
wash Non -
immersion
Immersion
Equipment required::
• A double sink which will hold sufficient volume of
water
and enzymatic detergent such that the item of
equipment to be cleaned can be fully immersed
• -detergent solution of correct dilution and at a
temperature
• A clean, disposable, non-linting cloth or
mechanical drying facility )
-Brushes

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Manual wash without immersion

Used for instruments with electrical

connections 1

enzymatic detergent & lint free 2

towels are used

Follow manufacture instructions

3
regard dilution of enzymatic
detergent
Damp towel in solution then wipe the
instruments 4
Follow this step by wiping with only water
Keep wiping frequently until visual
cleanliness is achieved
Dry using lint free towel

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Manual wash with immersion

1
Rinse with water making sure to use spray
gun for cannulated instruments

Prepare enzymatic detergent 2

according to manufacture instructions

Immerse the instruments in the solutions

3
making sure to shake a little to get rid of
bubbles

Make sure cleaning is performed with the

instruments fully immersed avoiding
splatter

Use appropriate brush for cleaning and 4

change is necessary

Use lint free towel to dry instruments or 5

use dryer

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18-Water Conditioning
There are several methods which may be used for water
treatment; these include processes
such as:
• Water filtration – filters out impurities
• Water softening – converts ‘hard’ salts to ‘soft’ salts
• De-mineralization – removes specific minerals from
water
• De-alkalization – removes specific alkalis from water
Water purification processes include:
• Distillation
• Reverse osmosis.

Minerals in untreated water can cause spots & corrosion

to instruments
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Poor water quality cause spotting

The minerals causing

hardness, e.g. calcium
and
magnesium salts which
are found in all types of
tap water, produce
scale when heated. If
tap water
dries up, the minerals
causing hardness and,
in
addition, all other
dissolved water
components
remain in the form of
dry residue on the
surface
and form water
spotting

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19-chemicals used CSSD
1 Disinfectant tablets used
for disinfection floor &
surface s

2 Alkaline based detergent

used for CSSD washers

3 Acid based zero spot

( rinse aid ) used for
neutralization and
removal of detergents
residues
4 Neutral to mild alkaline
detergent with high effect
to break organic soils by
means of enzymes

Follow manufacture’s instructions for

dilution

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20-Endoscope reprocessing

Automated endoscope washer disinfector s ( AER)

must meet the requirements of HTM 2030
washer disinfector and BS EN ISO 15883 part 4

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 Flexible Endoscope reprocessing

1-post treatment 2- Wipe with 3- transfer in

the nurse should damped lint free closed containers
immediately towel using to the CSSD
dismantle enzymatic
detergent then
irrigate

4- sterilization 5-Manual cleaning 6- Use endoscope

technician should with enzymatic washer then store
perform leak test detergent using in drying cabinet
before cleaning appropriate
brushes

Only if you transfer the endoscope to outside the building

then plasma sterilization is required .
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 21- Drying cabinet

Used to dry surgical instruments & Anesthetic

devices
Temperature varies

Stainless steel instruments =90 C

Heat sensitive device = 70 C

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 22-Inspection & assembly

A missing or failing instrument while performing a surgical

procedure is the annoyance of any surgeon!
It can be the cause of great problems, for the patient as
well as the staff performing an operation.
It is therefore essential that instrument trays for all
procedures are complete and that each instrument
works That is why each individual instrument is
subjected to a vigorous inspection, and that each tray
should be double-checked for completeness correctly.

Soiled and stained items should return to

decontamination area
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23-Instruments functional check

• Critical areas such as handles, joints and jaws

require careful inspection
• Instruments with hairline cracks in the joint areas
as well as those that are
damaged, distorted or otherwise worn, must be
replaced because their function can
no longer be guaranteed
• Scissors should be tested for alignment and
smooth movement.

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 24-packaging
• Capability to safely contain contents (weight,
size)
• Ability of material to permit penetration and
removal of the sterilant agent (e.g. steam, gas,
gas plasma, irradiation) during sterilization
• Robustness of material to maintain sterility and
integrity of pack contents following
sterilization, during transportation and storage
until the time of use
• Allowing aseptic removal of pack contents at
point of use
• Ability for sealing and labeling
• Compliance with BS EN ISO 11607 – Sterilization
Medical Devices: Packaging of
Terminally Sterilized Medical Devices

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25-Wrapping – parcel technique

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 26-Wrapping
envelope
technique

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 27-See through technique

polymer (plastic) front; this material comes in either

reels or pouches;
advantage of sterilization pouches is that the
transparent front allows visual inspection of the
contents and should:
• Conform to the requirements of BS EN ISO 11607 –
Packaging of Terminally
Sterilized Medical Devices: Part 5
• Provide a bacteriological barrier.
• Be available in a choice of closures, heat seal or
hand/self-seal.
• Be available in a wide variety of sizes,

Follow diagram for direction of opening

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28-Labeling
. Labeling must be clear and accurate and include:
• Title of pack/description of pack contents
• Product identification number
• Name of manufacturer (your department) and packer
identification
• Date of manufacture
• Expiry date if pack contains biodegradable materials or local
policy demands
• Date and method of sterilization
• Lot/batch number where appropriate
• Cycle number of sterilizer
• Instructions for use where appropriate
• Notification of any known hazards relating to product use
where appropriate
• Pack destination and storage location where possible

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Chemical Sterilization
indicator tape

protector

Paper
Sterilization
bags

Wrapping
papers

transparent
flat reels

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29-seal check

Validation test for sealing

machines performed daily
before work to ensure the
closing quality of the sealing
machine that will not be
affected by the sterilization
conditions during the cycle

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30-Rigid containers
Rigid containers fitted with lids,
seals and filters, generally
manufactured from
stainless steel or anodised
aluminium that are designed to
operate as a packaging
system in their own right and must
comply with BS EN ISO 11607 –
Packaging for
Terminally Sterilized Medical
Devices: Part 8

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31-Sterilization Methods

The effectiveness of all sterilization

methods can be affected by several factors:
• The type and number of micro-organisms
which may present on the medical device;
some micro-organisms are more resistant
to the sterilization process than others

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32-Moist Heat (Steam) Sterilization

Steam sterilization is the most commonly used

sterilization process within healthcare
facilities.:.
The main attributes of steam are:
• it is low in cost and easy to produce
• It requires relatively simple technology and
therefore easy to use
• it leaves no chemical residues or by-products
behind
• It is non-toxic
• Sterilization cycles are shorter than other
methods
• The process can be easily monitored,
controlled and validated.

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33-Steam sterilization cycle

stage description
pretreatment Removal of air and introduction of
steam in pulses
sterilization Exposure time in which killing of
bacillus occur
Post-treatment Removal of steam - drying of
packages

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 34-Programs

Temp/timing Load type

134-137◦C 3- St.st porous load
7min
121◦C Heat sensitive load
15-20 mints
134 ◦C prion
18 mints
134◦ C B&D test
3.5 mints

N.B in Kuwait we use 7 mints exposure time only as

precaution however 4 mints are sufficient for sterilizing
time

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35- On
loading
autoclave
Under loading should •
be available to reduce
the amount of air in the
chamber & reduce the
load on the vacuum
pumps

When loading laminated

pouch load it at oblique
position with plastic
parts facing downwards

Use appropriate basket

size relevant to package
size

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 36-On Removal of Load

• Check recording chart/printout and sign-off

that required sterilizing parameters have been
met
• Notify supervisor if any problems are detected
• Keep cooling load away from high activity
areas
• Do not place cooling items on a solid surface,
as condensation may result

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 37-Bowei & Dick test

When performing the test, the test pack must be

removed from the sterilizer as soon as the
test cycle is complete. Failure to do so may give a false
test result as chemical reactions may
continue. It is important that the indicator sheet
contains the following information as a
minimum requirement:
• Sterilizer identity/Site
• Date
• Cycle number
• Operator
• User
• Pass/Fail

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38 -Biological test

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39-Sterilization using ethylene oxide(
E.T.O)
Ethylen oxide gas is
toxic,carcinogonic and
explosive and can cause
strictly controlled environment
. It is used to sterilize the heat
sensitive items
The process is long in
comparison to other
processes, typically taking four
to six hours, but is less
aggressive in terms of
products compatibility.
Aeration time must be
carefully validated
To ensure residual EO products
fall below internationally
agreed level.

Temp Gas Exposure Total cycle

Only
Tem. 55 C Time 1 hour 3 hrs 45
mints
Tem. 37 C Time 3 hours 5 Hrs 30 mints
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 40-E.T.O cycle
1- Pre-condition phase:
1- Preheat
: the chamber walls are heated to the selected temp.
2- Air removal
:Deep vacuum is created within the chamber to remove the air & to
improve the penetration & humidification of the load .
3-humidification:
Injection of low temp . steam to humidify the load . Improving the ETO
penetration.
2-Gas Exposure phase :

1- Cartridge puncture :
the difference in pressure between the vacuum in the chamber
and the pressure outside the chamber provides the force used
to puncture the cartridge
2-Gas exposure:
through out the gas exposure the sterilizer maintain negative
pressure to ensure gas will not escape the chamber .
3- Gas removal
:Deep vacuum is created to remove most of the ETO gas
followed by fresh air purge .but the material of the load will
continue
release the gas therefore the need for aeration
3-Aeration
24 Hrs

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 41-Plasma sterilization
Vaporized hydrogen peroxide is relatively new to
healthcare
There are several processes available in which
vaporised hydrogen peroxide in combination
with a

plasma phase.

Suitable for heat

sensitive items

Sterilization
temperature 50-
55 C

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42-Special packaging materials for
plasma

Use special packaging materials

( Tyvek ) cellulite free

Plasma sterilization biological test

should be performed with every
load incubation temp > ( 58 ◦C)

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 43-Dry heat

Mechanism of killing by dry heat is by

killing the organisms by destructive
oxidation of essential cell constituents
Killing the most resistant spores by dry
heat requires a temperature of about
160 C for 60 mints
Dry heat is employed for
glassware,syringes,metal instruments
and paper wrapped goods ,which are
not spoiled by high temperature
It is also used for anhydrous fats, oils and
powders that are impermeable to moisture.

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 44-Sterile store

-Room should be well

ventilated with
controlled
temperature ,clean
,with sealed
windows and
lighting fixtures.
-Access should be
limited to those
working within the
area

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 45-Unsterile store

Unsterile stock should be placed in

separate unsterile store
Statistics should be done to ensure
correct compensation
Communication is necessary
between packaging area and sterile
store.

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 46-Raw Materials

Ordering of raw materials and other items should be

strictly controlled within the
healthcare provider industry. Each institution is likely
to have its own set of rules which
must be observed; these will include spending levels
for individual managers and budget
control mechanisms to ensure cost containment and
inventory control.
Upon receipt, all materials/items must be checked
for:
• Condition of product on arrival and prior to
acceptance from delivery driver
• Product type and quantity matching order placed
• Specific storage requirements

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47-Green laundry
Made of various
materials Designed
to protect
healthcare
professionals and
patients from the
transfer of
microorganisms
designed to isolate
surgical site from
contamination
Reusable

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 48-Quality Assurance

Records must be maintained

There must also be records of
individual machine cycles linked
to the
devices processed in them which
identify the processed product to
facilitate
traceability •

Sterilizing Cycle Records

• Date of cycle
• Sterilizer code or number
• Cycle or load number
• Exposure time, temperature and pressure
• Name/ID of loading operator
• Name/ID of person authorizing release
• Specific content of load and
• Read out results of indicators used− Physical
chemical − Biological-

Stock levels must be managed to ensure maintenance

of service provided by health care facility
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 49-Tracing system ( T.doc)
Complete traceability in T –Doc
,all process ,machines,
patients ,operations, doctors,
etc that an instruments
encountered are registered
From purchase to scrap, and thus
the history of each
instruments is documented
this enables recall of
suspicious goods from
relevant departments quickly
and accurately . Traceability is
assured by the use of barcode
and / or other tracking
technologies.

infection control directorate

 50-Occupational health & safety
1-Burn hazards due to hot surfaces and exposure
to steam at the sterilizer
2-risk of injury due to pointed or sharp instruments
3-infections transfer by contaminated instruments
4-Hazards posed by physical influences alcohol
vapours ,heat,steam,compressed air ,gases, etc
5-Lifting and carrying loads (containers)

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 51-Waste management

Waste type Colour coding Description

infectious yellow Infectious waste that is
required to be
incinerated
Infectious Orange Infectious waste which
may be treated to
render safe prior to
disposal or alternatively
it can be incinerated

Anatomical Red Anatomical waste

which requires disposal
by incineration

Medical Blue Waste medicines for

incineration

Domestic Black This waste should not

contain any infectious
materials ,sharps or
medicinal products

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 discharge Used infectious
sharps in yellow sharp box

Keep an
eye on the
data
printed for
errors

Regular performing of
biological test is
important

Wash hands thoroughly

before and after work
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Use loading
trolley for
sterilizer
Use
appropriate
detergent for
manual wash

Personal
protective
attire is
mandatory

Random check
for sterile pack
Use special integrity is
material for necessary
packaging ( no
pins/ordinary
tape)

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Report injury
immediately

Keep record
of daily
production
and
distribution

Keep floor clean

Use help
when
lifting
Harsh brushing heavy
affect protective items to
layers of prevent
instruments injury
leading to
corrosion

infection control directorate

 Report default
& call
Bad packages conditions maintenance
should not be distributed

Quality assurance is
necessary

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Terminology

1-Sterilization

A validated process used to render a product free from

viable micro-organisms.
It achieves the complete killing or removal of all types of
micro-organisms, including bacterial spores

2-Decontamination

A general term to cover methods of cleaning,

disinfection and sterilization for removal of
microbial contamination from medical
equipment to render it safe.

3-disinfection
Process that kills pathogenic and other
microorganisms by physical or chemical means but
bacterial spores are remained .

4-Biological Indicator
A calibrated population of bacterial spores put up in a
package which maintains the integrity,
serves to demonstrate whether sterilization conditions
were met

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5-Bowie-Dick Test
A diagnostic test of a sterilizer’s ability to remove
air from the chamber.
6-Chemical Indicator
chemical device employed to monitor one or
more process parameters of the sterilization
cycle in order
to detect failures in packaging, loading, or
sterilizer function. The chemical indicator
usually consists of a sensitive chemical or
ink dye that may vary in sensitivity from product
to product.
7-Biofilm
a layer of material on the surface of an
instrument or device which contains
biological materials and in which
microorganisms are imbedded

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8- Bioburden

the number and types of microorganisms

present on an object or surface

9- Enzymatic detertgent
Instrument cleaning chemistry that is very effective in
removing soils from reusable medical devices.
These detergents contain
enzymes that produce a specific chemical reaction.
The enzymes assist in the cleaning process by
breaking down organic soils
(e.g., protein, blood, tissue, fat, starch)
10-Personal Protective Equipment (PPE)
Specialized equipment or clothing used by persons
decontaminating medical devices to protect
themselves
from direct exposure to blood or other potentially
infectious materials, including: fluid-resistant
gloves, gowns, aprons with arm
protection, head and foot coverings, high filtration
surgical masks and eye protection (goggles/face
shield)..
11-Shelf-life
When the term is used with respect to a sterilized
medical device, the period of time during which
the item is considered safe to use

infection control directorate

 References
1-Teaching & training manual for sterile services personnel-Institute of sterile
service management .
2-www.efhss.com
3-Steriliztaion of medical supplies by steam –volume 2
4-Proper maintenance of instruments
5-AAMI- comprehensive guide to steam sterilization
6-DGSV
German Society for Sterile Supply e.V.
7-A Practical Guide to Decontamination in Healthcare-
8-Ausculap academy – part 1 CSSD course

infection control directorate