In infection prevention and control practice, Central Sterile Services Departments (CSSDs) are classified according to various criteria, such as hospital size, level of specialization, technologies employed, or scope of service coverage. However, the most common and widely adopted classification today is based on organizational structure and operational model.
Selecting an appropriate Central Sterile Services Department (CSSD) model is a strategic decision for healthcare facilities, particularly given the diversity of healthcare settings, including general hospitals, specialty hospitals, clinic chains, field hospitals, and facilities located in remote or resource-limited areas.
In infection prevention and control practice, CSSDs may be classified according to various criteria such as hospital size, level of specialization, technologies employed, or scope of service. However, the most widely adopted classification today is based on organizational structure and operational model.
Based on organizational structure, CSSD models are typically categorized into three main types:
1. Decentralized Model
In the decentralized model, medical devices are cleaned, disinfected, and sterilized within individual clinical departments (e.g., Surgery, Obstetrics, Dentistry). Each department organizes its own reprocessing area and workflow to support its specific clinical activities.
Advantages:
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- Extremely rapid instrument turnaround time, as transportation is minimized.
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- Staff are highly familiar with their department-specific instruments.
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- Reduced concern regarding loss or damage during long-distance transport.
Disadvantages:
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- Instrument reprocessing is not centralized, leading to variability.
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- Lack of dedicated reprocessing personnel; nurses often perform dual roles (instrument reprocessing and patient care).
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- Increased staffing requirements across departments; standardized training in disinfection, sterilization, and infection prevention and control (IPC) is time-consuming and costly.
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- Limited capacity to implement advanced technologies and automated reprocessing equipment.
2. Centralized Model
The centralized model is considered the modern standard in infection prevention and control. All used medical devices from clinical departments are transported to a single central CSSD. Devices are processed according to a unidirectional workflow: receipt → cleaning → disinfection → inspection → packaging → sterilization → storage and distribution.
Advantages:
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- Personnel receive specialized training in infection prevention and focus exclusively on device reprocessing, reducing errors and improving quality.
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- Standardized and consistent quality control, aligned with recognized standards (e.g., ISO, JCI).
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- Optimized investment and operational costs through high-capacity equipment and efficient use of chemicals, utilities, and packaging materials.
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- Centralized maintenance enhances equipment lifespan.
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- Facilitates implementation of tracking software to ensure traceability (e.g., sterilization batch number, packaging staff, sterilizer load identification).
Disadvantages:
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- Requires sufficient instrument inventory to maintain rotation during processing cycles.
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- Potential risk of damage if packaging and transportation are not properly managed.
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- Significant initial investment in infrastructure and equipment.
3. Outsourced Model
Under this model, the hospital contracts with an independent external sterilization center. Used instruments are transported to a commercial sterilization facility and returned sterile, typically within 12–24 hours.
This model has become increasingly common in developed countries such as the United States, Germany, the United Kingdom, and in several major hospitals in Singapore.
Advantages:
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- Hospitals do not need to manage CSSD staffing, equipment maintenance, or dedicated sterilization space, reducing infrastructure and maintenance burdens.
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- Quality assurance is provided by specialized service providers, which often invest in high-capacity, advanced equipment beyond the financial reach of individual hospitals.
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- Frees hospital space for clinical use.
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- Converts capital expenditure into operational expenditure with structured oversight.
Disadvantages:
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- Requires a larger instrument inventory compared to in-house CSSD models.
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- Requires careful selection of an appropriately located outsourcing partner to ensure timely turnaround.
=> Due to the diversity in scale, hospital type, and operational conditions, the selection of a CSSD model should be flexible and strategically tailored to each healthcare facility. The above classification is based solely on organizational structure; in practice, many hospitals adopt hybrid approaches to achieve optimal efficiency and quality outcomes.