It has always been a debate that CSSD is required for only large hospitals and hospitals which are going till exit level NABH accreditation, whereas small hospitals having one or two operation theatres and just going with entry level NABH need not have a full fledge CSSD. We are still witnessing hospitals purchasing only a vertical or cooker sterilizers for their OT complex. We would first like to emphasize that the vertical / cooker type of machines are not to be called as sterilizers. Most of the standards say at least a horizontal shape machine is required to call it as a sterilizer / autoclave. It is not the question of size of the hospital; it is actually the infection control and safety of patient that matters. CSSD controls post operative infection and enhances patient safety which a single autoclave cannot do. Even through three zone separation is the ideal requirement for a full fledge CSSD, at least two zone separation with flow for materials, staff and patient to be clearly marked.