Central Sterile Service Department (CSSD)

The Word central already indicates or say that this department must be centrally located or
positioned within the hospital.

Must be easily accessible to areas or departments i.e. Emergency Centre (EC), Labour
Ward (LW)

The purpose of the CSSD is enough and quality sterilized equipment throughout the
hospital when and where needed 24 hours a day.

When packs are delivered to the wards and or departments including the operating
theatres, enclosed four wheel trolleys are used.

The department must also have two specified points i.e. one for taking out cleaned sterile
packs and the other for receiving dirty/used packs/instruments. This is important so the dirty
and clean does not mix and in doing so cause contamination.

Specialised machines are used to do the washing/cleaning of used/dirty equipment and

these machines must be serviced monthly or 6 monthly to ensure it functions effectively.

When the service of the machines is done a report must be submitted for staff to be
informed regarding the outcome, any problems or repairs to be done.

Special manual tests sort of old fashioned are still being performed or used to be done i.e.
to test the packs for sterility when autoclaving the packs. The test is known as the Dickson
Bowie.

There are three areas in the department i.e. dirty, clean & sterile

The process followed in the CSSD from receiving dirty instruments – washing – cleaning, -
folding of green towels, packing - sterilizing – autoclaving – cooling packing onto shelves
and into trolleys must flow to ensure the sterile and or clean packs is not contaminated
again.

Staff allocated to perform one or two of the tasks in the demarcated /designated areas must
wear personal protective clothing for the various tasks they perform as per policy.

These areas are clearly separated to ensure the dirty is not mixed with the clean linen and
instruments.

ACTIVITIES IN CSSD:

 Receiving of dirty/contaminated equipment from the wards, departments, Out Patient

Departments (OPD) etc.
 Collection of trolleys from the various areas
 Sorting the equipment/instruments received from the wards etc.
 Cleaning of soiled/dirty equipment
 Checking the equipment i.t.o procedure used for, all equipment pieces returned, all in
good working condition, no broken or missing instruments/ pieces
 All packs should/to have a checklist for staff to check when packing or preparing the
packs and for the scrub sister to check and sign after every operation. In short stock
control sheet.
 In the event of any instrument missing, faulty, broken/damaged it should be reported
with immediate effect by the scrub sister or the staff member in the CSSD
respectively depending where the problem is detected.
 All instruments are counted when packed onto the tray
 Packing and wrapping the trays then into autoclave for sterilisation process
 Pack then to cool off, then packed into the trolleys before delivered to the various
wards/departments.
 Delivering the orders to various wards
 Remaining sterile packs are stored/pack on shelves in one of the sterile storage area
dry and clean.
Surgical instruments can vary widely by the field of surgery that they are used in. In general instruments
can be divided into five classes by function:

1. Cutting and dissecting instruments:

o Scalpels, scissors, and saws are the most traditional
o Although the term dissection is broad energy devices such as diathermy/cautery are often
used as more modern alternatives.
2. Grasping or holding instruments:
o Classically this included forceps and clamps predominantly
o Roughly forceps can be divided in traumatic (tissue crushing) and atraumatic (tissue
preserving, such as Debakey's)
o Numerous examples are available for different purposes by field
3. Hemostatic instruments:
o This includes instruments utilized for the cessation of bleeding
o Artery forceps are a classic example in which bleeding is halted by direct clamping of a
vessel
o Sutures are often used, aided by a needle holder
o Cautery and related instruments are used with increasing frequency in high resource
countries
4. Retractors:
o Surgery is often considered to be largely about exposure
o A multitude of retractors exist to aid in exposing the bodies cavities accessed during surgery
o These can broadly be hand held (often by a junior assistant) or self retaining
5. Tissue unifying instruments and materials:
o This would include instruments that aid in tissue unification (such as needle holders or staple
applicators)
o And the materials themselves (sutures, staples, glue etc)
Instruments used in surgery are:[1][2][3][4][5][6][7][8][9][10][11]
This list is incomplete; you can help by expanding it.

Instrument class Image Uses Specific instruments

Articulator Galotti articulator

 Cutting
Bone chisel
instrument

To cut the pins

after they are
Pin cutter used to place
bone in correct
place

Clamps and
Bone distractor
distractors

Accessories
llizarov apparatus
and implants

Intramedullary kinetic Clamps and

bone distractor distractors

To drill inside
Bone drill
the bone

Accessories
Elevator
and implants

Bone mallet Accessories

Cutting
Bone rasp
instruments

Cutting
Bone saw
instruments
Bone skid

Bone splint

Bone button

Caliper To measure Castroviejo caliper

Accessories
Cannula Spackmann Cannula
and implants

To cauterize
and seal
Cautery vessels and
bone, using
electricity

for scraping or
debriding
biological tissue
or debris in a
biopsy,
Curette
excision, or
cleaning
procedure
Cutting
instrument

Depressor

Accessories
Dilator
and implants

cutting
Dissecting knife
instrument
 Grasping/
surgical Pinzette
holding

To take off a
top layer of skin
Dermatome
to implant over
another area.

Grasping/
holding. Usually
Forceps, Dissecting used in skin Adson
closure or small
wounds

Grasping/
Forceps, Tissue Allis
holding tissue

Used to secure
towels or Backhaus penetating
Penatrating towel clamp
reduce bone towel clamp
fragments

Acanthulus or Acanthabo
Thorn removal
los
 Grasping/
Bone forceps
holding

haemostatic
Carmalt forceps kalabasa
forceps

grasping/ Non-toothed dissecting

Cushing forceps
holding forceps

haemostatic
Dandy forceps
forceps

Non-toothed dissecting
grasping/ forceps designed for use
DeBakey forceps
holding on blood vessels, organs,
or deilcate tissue

Non-crushing clamp
clamps and
Doyen intestinal clamp designed for use on the
distractors
intestines

Epilation forceps

haemostatic
Tiberio forceps
forceps

hemostatic
Kelly forceps
forceps

hemostatic
Kocher forceps
forceps
 hemostatic
Mosquito forceps
forceps

Hook retractor

Nerve hook retractor

Obstetrical hook retractor

Skin hook retractor

Lancet (scalpel) cutting

Lythotome

Lythotript

Mallet

Partsch mallet

Mammotome
 grasping/ Castroviejo Crilewood Ma
Needle holder
holding yo-Hegar Olsen-Hegar

Occluder

Osteotome cutting

Epker osteotome cutting

Periosteal elevator cutting

Joseph elevator cutting

Molt periosteal elevator cutting

Obweg periosteal
cutting
elevator

Septum elevator cutting

Tessier periosteal
cutting
elevator

Probe
Retractor retractor

Deep wound
Deaver retractor
retraction

self-retaining
retractor. Used
Gelpi retractor for superficial
wound
exposure

self-retaining
retractor. Used
Weitlaner retractor for superficial
wound
exposure

USA-Army/Navy
retractor
retractor

O'Connor-O'Sullivan retractor

Mathieu Retractor retractor

Jackson Tracheal Hook retractor

Crile Retractor retractor

Meyerding Finger
retractor
Retractor

Little Retractor retractor

Love Nerve Retractor retractor

Green Retractor retractor

Goelet Retractor retractor

Cushing Vein Retractor retractor

Langenbeck Retractor retractor

Richardson Retractor retractor

Richardson-Eastmann
retractor
Retractor

Kelly Retractor retractor

Parker Retractor retractor

Parker-Mott Retractor retractor

Roux Retractor retractor

Mayo-Collins Retractor retractor

Ribbon Retractor retractor

Alm Retractor retractor

West, Travers and

Self Retaining Retractors
Norfolk & Norwich

Weitlaner Retractor
Beckman-Weitlaner
Retractor

Beckman-Eaton
Retractor

Beckman Retractor

Adson Retractor

Rib spreader

cutting
Rongeur
instrument

Ultrasonic scalpel cutting

Laser scalpel cutting

Scissors cutting

Iris scissors cutting

Kiene scissors cutting

 To dissect
Metzenbaum scissors cutting
delicate tissue

To cut suture,
Mayo scissors bandages, or cutting
dressings

Tenotomy scissors cutting

Spatula

To retract the
Speculum walls of the Graves vaginal speculum
vagina

Mouth speculum retractor

Rectal speculum retractor

To retract the
Sim's vaginal speculum walls of the
vagina

Cusco's vaginal
retractor
speculum

accessories
Sponge bowl
and implants
 accessories
Sterilization tray
and implants

Sternal saw cutting

Suction tube and accessories

Yankeur suction tip and implants

Surgical elevator

Surgical hook retractor

Used to cut
vessels or
Surgical blade #15
make small
incisions

accessories
Surgical mesh
and implants

accessories
Surgical needle
and implants

Surgical snare

Surgical sponge
Curettes

Used to make a
GIA stapler gastrointestinal Linear stapler
anastamosis

Surgical tray

Suture

Tongue depressor

Tonsillotome

Towel clamp clamp

Towel forceps clamp

Backhaus towel forceps

Non-
Lorna towel clamp penatrating
towel clamp

Tracheotome

accessories
Tissue expander
and implant

Subcutaneous inflatable accessories

balloon expander and implants

cutting
Trephine
instrument

Trocar Access
instrument.
Used to create
an opening into
a space without
opening the
abdominal
cavity. A
camera then
inserted
through one to
Disposable trocar family
view the inside
of the space
while
instruments are
inserted
through the
 others to
manipulate the
organs.

Surgical device
using electrical
energy that's
converted to
mechanical
ultrasound
Ultrasonic energy device
energy typically
used to dissect
tissue but also
seals small
vessels and
tissue bundles.

Vessel sealing
device used to
weld vessels
together prior to
cutting. These
devices used
Vessel Sealing Device Advanced Bipolar Energy
bipolar radio
frequency
energy to
create heat that
welds the
Vessel sealing device tissue.