Abstract: OBJECTIVE From a hierarchical perspective, to systematically investigate the current construction status and disparities of the central sterile supply department (CSSD) in hospitals of different grades across various regions nationwide, and to explore differentiated development paths suitable for CSSDs in hospitals at all levels, thereby providing reference for the new construction, renovation and expansion of CSSDs. METHODS Relevant literature at home and abroad was searched, and a questionnaire on the current construction status of hospital CSSDs was developed based on the WS 310 series industry standards. A questionnaire survey was conducted among 103 hospitals in seven provinces across China from Jul. 2025 to Sep. 2025. RESULTS Statistically significant differences were observed among hospitals of different grades in terms of CSSD centralized supply rates (tertiary hospitals 92.45%, secondary hospitals 84.21%, primary hospitals 58.33%), architectural layout standardization, medical staffing, core equipment allocation and information traceability system coverage (P＜0.05). Limited space, insufficient human resources and equipment shortages were identified as the main factors restricting centralized supply in CSSDs of primary hospitals. The intelligent and automated configurations in hospitals at all levels were generally lagging, and the allocation rate of auxiliary quality monitoring equipment was low. CONCLUSIONS The construction of CSSDs in hospitals at different levels in China exhibits characteristics of imbalanced development. Tertiary hospitals should aim to become regional hubs and benchmarks for intelligence, secondary hospitals need to strengthen standardized construction and county-level collaborative capabilities, and primary hospitals should adopt a lightweight outsourcing model.