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Management of Sterile Instrumentation in CSSD

Updated: May 17, 2021

The management of sterile supplies in the Central Sterile Supply Department (CSSD) starts when the sterilizer cycle ends. How you manage the sterile items determines the sterility outcome of each package. Event-related sterility is always in play, even when you are using a date-related storage process.

End of the Sterilization Cycle

Managing the cooling down process of sterile items after the sterilization process is one of the most critical steps in sterility maintenance. Simple but important steps include proper placement of the sterilization load cart & temperature management of the instrumentation. Sterilizer carts should be placed in an area of limited traffic and away from direct exposure to downdraft air conditioning. Excessive traffic can increase bioload buildup on the surfaces of the items, increasing the possibility of contamination during the handling process. Cold downdrafts from air conditioning may rapidly cool the sterile items and create sweating of the package, forming moisture issues. Sterile items also should not be handled before they reach room temperature to eliminate cross-contamination from your hands.

Inspection Post Sterilization/Handling

All sterile packaging removed from the sterilization cart needs to be inspected before placement into storage. Packages need to be review for event-related issues such as damage to the packaging and moisture. Another area of concern is the inspection of the process indicators and the internal integrators. Any damage found or failed indicator/integrator requires the package to be resterilized. It would also be true of any package mishandled during the unloading of the sterilizer cart or transportation cart. Sterile items that are dropped can become contaminated by compression and require reprocessing.


There are several key aspects to the storage of sterile items. Sterile supplies should be stored at least 8 inches from the floor and have solid bottom shelves to allow for cleaning of the floors without contaminating the supplies. Sterile supplies should also be stored at least 2 inches from outside walls to facilitate airflow and 18 inches below sprinkler heads unless stored on a perimeter wall. The Joint Commission stipulates:

The 18-inch applies only to areas that have sprinklers installed.

Picture a horizontal plane parallel to the ceiling that is 18 inches below the sprinkler heads. Nothing should be in that area between the bottom of the sprinkler heads and the imaginary horizontal plane parallel to the ceiling that is 18 inches below. This is done to allow an even and unobstructed spray pattern from the sprinklers when triggered to extinguish the fire.

Perimeter wall shelving and storage are allowed to extend from floor to ceiling level.

The ANSI/ASHRAE/ASHE Standard 170-2017 recommends a temperature range in the sterile storage area of no more than 75F degrees and no more than 60% relative humidity.


Distributing sterilized instrumentation should be on a first-in/ first-out basis to eliminate extended storage, again, whether you are using event-related sterility or dated related storage process. Extend storage increases the opportunity for event-related issues like increased handling, which can result in contamination. Sterile supplies should be transported in covered or closed carts to minimize cross-contamination on route to the place of usage. The sterile packs should also be reviewed for proper tracking information in the form of a load sticker in case of a recall. If you are using a date-related storage process, the sterile packaging should be reviewed to ensure it is not outdated.

In Conclusion

In every step in the lifespan of a sterile package, there are opportunities for contamination to occur; we call these events. Proper management of sterile instrumentation requires constant diligence to avoid these occurrences.

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