Test Review: Disinfection, Decontamination, Sterilization, & Asepsis Flashcards


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1

Association for the Advancement of Medical Instrumentation (AAMI) –

Provides recommended practices & technical information for the U.S. Medical professions

Develop standards with support of FDA

2

Association of Surgical Technologist (AST) –

Organization for ST’s that publishes guidelines for many practices in the area of perioperative setting

3

Centers for Disease Control & Prevention (CDC) –

Federal agency that provides research & protocols in all areas of public health

4

Centers for Disease Control & Prevention-Healthcare Infection Control Practices Advisory Committee (CDC-HICPAC) –

Federal agency that provides research & protocols in all areas of public health and infection control, including professional environment

5

ECRI Institute –

Research and consulting organization that applies scientific research to determine which medical procedures, devices, drugs, and processes are best for patient care

6

The Joint Commission (TJC) –

Accreditation agency for all health care organizations in the United States (oversees compliance with environmental and patient safety regulations and enforces compliance with standards)

7

Food and Drug Administration (FDA) –

Federal agency responsible for the regulation of medical devices, drugs, food, and cosmetics

8

Antiseptic –

Chemical that is used to remove microorganisms on the skin or other tissue

Surgical soaps and hand rubs contain antiseptic

Used to cleanse patient’s skin (animate-living surface) prior to surgery to reduce the number of microorganisms

9

Asepsis –

Process of using soap or hand rub to clean patient’s skin or our OR teams' hand and arms

10

Bacteriostatic –

Process or chemical that inhibits bacterial colonization, but does not destroy bacteria

11

Bioburden –

Number of live bacterial colonies on a surface at a given time before it is sterilized (refers to the degree of microbial contamination)

12

Biofilm –

Composed of dense colonies of microbes that are attached to surfaces

13

Contaminated –

Any surface or tissue that has come in contact with a potential or actual source of microorganisms

14

Cleaning (Mechanical Action) –

Physical removal (scrubbing or washing) of blood, body fluids, and/or gross debris from the surface an inanimate object (non-living)

15

Disinfection –

Process which most but not all microorganisms located on inanimate surfaces are destroyed

Chemical or physical agent used for disinfection is a disinfectant

This is only used on inanimate (nonliving) surfaces

16

Reprocessing –

All steps necessary to render soiled medical devices safe for use on patients

These are the steps of decontamination, washing, preparing items for sterilization, and sterilization

17

Sterilization –

Destruction (killing) of all microorganisms, including spores, on inanimate surfaces

Performed by steam, chemical agents, EtO gas, high-velocity electron bombardment, UV radiation, gamma irradiation

18

Terminal cleaning –

Process of removing organic soil from all exposed surfaces of the critical and semi-critical areas of the operating room

This is performed daily in the operating room

Signifies the end-of-day cleaning and entails a thorough cleaning of OR equipment, rooms and areas outside the OR

19

Terminal decontamination –

Process in which instruments and supplies are processed to ensure they are safe to handle

This is performed to ensure it is safe for the staff to handle during subsequent stages of reprocessing

20

Spaulding Classification System:

Allows for selection of the exact method of reprocessing according to where in the body the item will be used

Based on the level of risk for infection associated with that part of the body

21

Items Classified in the Spaulding Classification System that are CRITICAL are:

Items used for invasive procedures or vascular access (enter what is considered sterile tissue)

Carry high potential for causing SSI

These items must be sterilized

Examples: Instruments or devices that enter the vascular or urinary systems (vascular and urinary catheters), implantable items, needles

22

Items Classified in the Spaulding Classification System that are SEMI-CRITICAL are:

Items that come in contact with mucous membrane or nonintact skin

Carry a lesser risk of infection due to properties of resistance of the intact mucosal lining

High-level disinfectants should be used for items in this category, but sterilization may also be preferred following decontamination (EGD)

Examples: laryngoscopes, bronchoscopes, anesthesia and respiratory equip (ETT), some endoscopes

23

Items Classified in the Spaulding Classification System that are NON-CRITICAL are:

Items that come in contact with intact skin and clean environmental equipment

Does not come in contact with mucous membrane

Pose least risk of infection

Require either intermediate- or low-level disinfection

Examples: blood pressure cuffs, tourniquet cuffs, pulse oximeters, stretchers, or other furniture

24

High Level Disinfectant:

Effective against all microorganisms except spores

If the instrument is soaked for 10 hours, it is considered sterile

25

Intermediate Level Disinfectant:

NOT effective on spores

Used on instruments that come in contact with skin

26

Low Level Disinfectant:

Used on non-critical items, come in contact with skin and environmental surfaces

27

These factors affect disinfectant efficiency:

Concentration level, bioburden, contact time, physical factors of the solution (i.e. temperature of solution, water hardness, pH level, exposure time)

28

Glutaraldehyde (Cidex) 2% concentration:

HLD (20 minutes) that could become a sterilant (10 hours)

One of 3 methods that is used to sterilize scopes (Others are EtO and Steris/Peracetic Acid)

29

Sodium Hypochlorite (Bleach):

Used on surfaces, floors, and equipment

30

Quaternary Ammonium Compounds (Quats):

Bactericidal, fungicidal, and psudomonacidal

NOT sporicidal, virucidal, or tuberculocidal

31

Isopropyl and Ethyl Alcohol 60-70%:

Tuberculocidal, bactericidal, viricidal, and fungicidal

NOT sporicidal

Used for cleaning and disinfecting small, noncritical surfaces

NEVER used to clean an endoscope because it breaks down the glue that holds scope camera in place

32

Decontamination Area:

Never put in the same room as processing

Filtered air is exhausted outside the facility

Minimum air exchange 10 times per hour in decontamination area

Temp 64°F-70°F and humidity 35%-72%

NEGATIVE AIR PRESSURE (not pushing contaminated air out)

33

Cleaning solutions which may be used for soaking instruments:

Sterile (distilled) water

Enzymatic solution

Detergent solution

34

Advantages and Limitations of Sterile Water:

Advantages: Keeps organic debris moist

Disadvantages: Ineffective in softening or removing dried debris

35

Advantages and Limitations of Enzymatic Solution:

Advantages: Removes moistened and dried debris without the need for mechanical action

Disadvantages: Efficiency depends on concentration of solution, temperature, and contact time

36

Advantages and Limitations of Detergent Solution:

Advantages: Keeps organic debris moist, while loosening dried on debris

Disadvantages: Mechanical action is necessary to completely remove soil

37

Recommendations for Transporting Instruments to the Decontamination Area:

Place heavy instruments on the bottom of a trays

Instruments with ring handles should be unratcheted

Instruments with multiple parts should be disassembled

Place instrument trays into or on case cart and transport to decontamination room

Can use a table and wrap with table drape

CANNOT transport uncovered – potential for environmental contamination

38

Chelation:

The process of binding minerals, such as iron or magnesium, in the solution to prevent deposit on the surface of surgical instruments, which causes spotting

39

Enzymatic:

Catalysts that aid in breaking down organic soil such as blood and tissue into solution

Used as a soaking solution

40

Emulsification:

Action of dispersing two liquids that are not capable of being mixed

41

Solubilization:

Action by which the solubility of a substance is increased within a solution

42

Ultrasonic:

Cleaning solutions are manufactured specifically for use in ultrasonic cleaners

43

Manual Detergent:

Products usually used for hand cleaning of items and/or for presoaking

44

Washer Decontaminator:

Liquid solution that is available in three different pH levels

45

Neutral-pH product:

Least corrosive, less effective at removing organic soil

46

Moderate-pH product:

Low level of alkaline and may be combined with surfactant and chelating agents

47

High-pH product:

Most effective for removing heavy amounts of soil

48

Steps of the Instrument Cleaning Process:

Transport to decontamination

Sort instruments by type and weight

Disassemble (if necessary)

Soak with water plus enzymatic solution, followed by disinfection

Sterilization

Rinse

Lubricate

Dry

Inspect and Reassemble

Package and Prepare for Sterilization

49

Mechanical Decontamination:

The physical removal of blood and body fluid from inanimate objects

50

Recommendations for Preparing Instruments for Decontamination in a Machine:

Instruments must be placed into a perforated or wire mesh tray

Hinged instruments must be left in open position to allow water, cleaning agent, and steam to contact total surface area

Instruments with attachments must be disassembled

Instruments with concave surfaces should be placed up-side down to allow proper cleaning, rinsing, steam contact, and drainage

51

Washer-Decontaminator:

Does not incorporate a sterilizing phase

Items exposed to intermediately critical area

52

Surgically Clean:

Instruments and equipment that is mechanically cleaned and chemically disinfected, but not rendered sterile

53

Washer-Sterilizer:

Includes steam sterilization cycle, but not considered appropriate for use on patient (not sterile)

Put like metals together to avoid electrolytic conduction reaction (DO NOT let different types of metals touch)

54

Ultrasonic Cleaner:

Removes small organic particles (debris) from areas of instrumentation that manual or mechanical cleaning cannot reach

Uses cavitation to clean areas

Causes bubbles that implode

Used for delicate instruments

55

Items requiring special care:

Items with lumens

Powered instruments

Oil powered instruments according to manufacturer’s recommendations

Ridged endoscopes

Flexible endoscopes

56

Lubrication:

Last step before instruments are reassembled and prepared for sterilization

Surgical instruments must be lubricated to maintain optimal function

Process is commonly referred to as milking

57

Prior to the first procedure of the day:

Clean all surfaces in the OR

Damp dusting begins with the highest surface

Pads are removed when cleaning the OR table

OR table should be unlocked and moved to facilitate mopping

58

Intraoperative Decontamination Practices in the OR:

Basin with sterile water should be used for soaking and cleaning instruments

Instruments not cleaned easily should remain in sterile water to prevent drying of the blood if not used again during the procedure

Instruments with a lumen should periodically flushed with sterile water to prevent clogging

59

Areas that are Terminally Cleaned:

Substerile room

Stretchers

Scrub sinks

Hallway floors

60

Packaging Material Must Have the Following Performance Characteristics When Used for Sterilization:

Efficiency

Ease of opening

Sterilization suitability

Strength

Barrier efficiency and support impermeability

Seal integrity

Safety

Sterility maintenance

61

Woven textiles:

Cotton or cotton-blend

Reusable fabric

Double-ply required when wrapping trays to be sterilized

Economical, reusable, easily penetrated by sterilants

Absorbent material may absorb moisture during steam sterilization, which inhibits the necessary contact of the moisture with all surface areas of the items

Not recommended for use with EtO

Must use heat seal patch to fix holes

62

Woven textiles with barrier properties:

Do not absorb moisture

63

Muslin:

Made of cotton

Have a thread count 140 - unbleached

Available in single or double ply

Double ply required for sterilization

Have to rehydrate muslin to prevent superheating of fabric, even if it was not used

Must use heat seal patch to fix holes

64

Nonwoven Materials:

Disposable, thus commonly referred to as disposables

Includes items such as drapes and gowns

Excellent barrier properties

Lint free, impervious to moisture, tear resistant

Costly, as they are single use items and not as “memory-free” as woven materials

65

Paper Materials:

Nonwoven material that is easily penetrated by steam; single-use items

Does not have the flexibility of other nonwoven materials, becomes brittle in dry conditions, easily torn and ruptured

66

Peel Pack Pouches:

Paper-plastic and Tyvek-plastic

Must ensure all air is forced out prior to sealing

Never staple or rubber band together

67

Rigid Instrument Containers:

Provide containment

Provide assurance of sterility

Can be used for returning contaminated items

Disposable chemical indicator use

Available in a variety of sizes and designs

Should not exceed 25 lbs

68

General Principles of Packaging:

After laundering, woven fabrics should be stored for at least two hours at a t emperature of 64-72°F and h umidity of 35-70%

Recommended size: 12 inches high x 12 inches wide x 20 inches long

Linen packs should not exceed 12lbs

Instrument trays should not exceed 25lbs

69

Preparation for sterilization of instruments begins after decontamination and involves the following steps:

Inspection (Includes demagnetizing needle holders)

Reassembly

Preparation

70

Functional Testing Guidelines for Instrument Inspection:

Cutting edges of scissors

Instruments ratchets

Jaws or clamps

Needle holders

Forceps

Self-retaining retractors

Non-disposable trocars

Powered instruments

71

Preparation of Instrument Trays for Sterilization:

Items must be properly prepared for effective sterilization

Proper preparation will ensure that:

Sterilant contacts all surface area

The instruments are positioned in a protective manner until they are used

The instruments are evenly distributed

Power driven instruments should be disassembled before steam sterilization process

72

Basins sets should have a towel placed between the nested basins to:

Absorb the condensate

To aid in air removal

To create an adequate space for the penetration of steam

73

Specialty Procedure Trays:

Surgical instruments may be prepared for procedures on trays that are designated for a specific procedure

Examples: Cut-down trays, Suture trays, Tracheotomy/tracheostomy trays

74

Label information:

Package contents

Shelf-life indication

Date of sterilization

Identification of the sterilizer

Cycle or load number

Initials of person preparing package

Department to which the package is to be returned to

75

Sterilization:

The compete destruction of all living organisms in or about an object

Process that assures all microorganisms, including spores, are killed

76

Complete Destruction of All Living Organisms in or About an Object can be Accomplished with the Use Of:

Steam

Chemical agents

High-velocity electron bombardment

Ultraviolet radiation

These processes are monitored using mechanical, chemical, and biological indicators to ensure sterility

77

Steam Sterilization:

Utilizes moist heat in the form of saturated steam under pressure within an enclosed environment

Most common thermal sterilization method and most dependable method of sterilization

BIOLOGICAL INDICATOR IS GEOBACILLUS STEAROTHERMOPHILUS

MINIMAL TEMPERATURE FOR THERMAL DEATH (kill bacterial spores) is 121°C / 250°F

78

Five Factors Critical to the Outcome of the Sterilization Process:

Time - Length of time the sterilant must remain in contact with the items to render them sterile

Contact - Sterilant must have contact with all surfaces of the items in order to render them sterile

Temperature - Must be achieved in order to kill all microbes, including spores

Moisture (humidity) - Specific amount of moisture that must be present to aid in the destruction of microbes

Pressure - Increases the temperature of steam to the level where it can destroy all microbes

79

Gravity Displacement Sterilizer Cycle Includes:

Condition Phase

Exposure Phase

Exhaust Phase

Dry Phase (REQUIRED)

80

Gravity DIsplacement MINIMUM Exposure Standards:

Instrument set, wrapped – 250°F for 30 minutes

Instrument set, unwrapped and Set with no lumen instruments – 250°F for 15 minutes; 270°F for 3 minutes

Set with lumen instruments, and Instruments with tape – 250°F for 20 minutes ; 270°F for 10 minutes

81

Prevacuum Steam Sterilizer (Dynamic Air Removal) Cycle Includes:

Air Removal Phase

Conditioning Phase

Second Air Removal Phase

Exposure Phase

Exhaust Phase

Drying Phase (REQUIRED)

82

Prevacuum (Dynamic Air Removal) Minimum Steam Sterilization Exposure Cycle Standards:

Instrument set, wrapped - 270°F for 4 minutes

Instrument set, unwrapped and Set with no lumen instruments - 270°F for 3 min

Set with lumen instruments - 270°F for 4 min

83

Bowie-Dick Test:

Test used in the prevacuum sterilization cycle to check for air entrapment

NEVER performed on a gravity displaced sterilizer, ONLY on dynamic air removal sterilizer (prevac)

84

Immediate Use Steam Sterilization (IUSS):

Items to be immediate-use steam sterilized must be decontaminated and cleaned with detergent and water

Only used when no other method is available

Implants are NOT flash sterilized except in an emergency and must be monitored with a Biological Indicator control system

85

IUSS Exposure Cycle Standards:

Metal, nonporous, and no lumens - Gravity 3 minutes; Prevac 3 minutes

Metal, porous, with lumens - Gravity 10 minutes; Prevac 4 minutes

86

Gravity Sterilization Exposure Temperature, Pressure, and Time:

250°F – 275°F (121°C – 132°C)

15–17 psi

Minimum exposure time – 15 minutes

87

Prevacuum/Dynamic Air Removal Sterilization Exposure, Temperature, Pressure, and Time:

270°F – 276°F (132°C – 135°C)

27–30 psi

Minimum exposure time – 4 minutes for wrapped items

88

Class 1 Chemical Indicators:

External and Process indicators

Examples: Tape, paper indicator strips, labels, locking devices (arrow)

89

Class 2 Chemical Indicators:

Indicators used for specific tests

Examples: Bowie-Dick, DART

90

Class 3 Chemical Indicators:

Variable indicators

Example: Heat-sensitive pellet encased in a glass tube

91

Class 4 Chemical Indicators:

Multivariable indicators designed to react to two or more parameters of sterilization

Example: Paper strips

92

Class 5 Chemical Indicators:

Integrating indicators designed to react to all sterilization parameters

Most accurate (exacting) of the internal chemical indicators

Example: Biological Indicator

93

Class 6 Chemical Indicators:

Emulating indicators

Example: Internal pack control of each cycle run

94

Incubation Periods for Biological Indicators:

Steam Sterilizers – Recorded at 24 hours, rapid read at 3 hours

EtO Sterilizers – Recorded 48 hours, rapid read at 24 hours

95

Ethylene Oxide (EtO):

Used to sterilize items that cannot tolerate the heat, moisture, and pressure of the steam sterilizer

Must remain in an aerator for 8 hours at 140°F or for 12 hours at 120°F

Temperature Range: Cold 85°F – 100°F; Warm 130°F – 145°F

2-3 hours for sterilization cycle

BIOLOGICAL INDICATOR IS BACILLUS ATROPHAEUS and BACILLUS SUBTILIS

One of three methods recommended for sterilization of endoscopes (others: Cidex [Glutaraldehyde], Steris/Peracetic Acid)

96

Hydrogen Peroxide Gas Plasma (Sterrad):

Uses gas at low temperatures to sterilize heat or moisture sensitive materials

Cannot be used for narrow lumens or long cannulated instruments

Cycle time ranges from 28-38 minutes

Biological Indicator is Bacillus atrophaeus

97

The minimum amount of air exchanges per hour in the OR is:

20 per hour

(4 of the 20 are fresh air)

98

Peracetic Acid Sterilization (Steris):

Kills by oxidation to denature proteins

One of 3 methods to terminally decontaminate endoscopes

Items cannot be stored following sterilization; THEY DO NOT MAINTAIN STERILITY IF THEY ARE NOT USED IMMEDIATELY

99

Ionizing Radiation:

Uses Cobalt-60 radioactive isotopes

100

Primary Source of risk to the Patient of SSI are:

Endogenous flora encountered in contaminated procedures (Ex. Bowel case with spillage, appendix rupture during removal, cutting into the bladder during a C-section

101

Risk to the patient of developing and infection postoperatively may be influenced by:

Age

Obesity

General health

Carriers of S. aureus

Remote infections

Preoperative hospitalization

Preexisting illness and related treatment

102

Surgical Conscience is:

The basis for the practice of strict adherence to sterile technique by all surgical team members

103

Three Principles of Asepsis:

A Sterile Field is Created for Each Surgical Procedure

Sterile Team Members Must be Appropriately Attired Prior to Entering Sterile Field

Movement in and Around the Sterile Field Must Not Compromise the Sterile Field

104

Surgical gown is considered sterile where:

In front of gown, 2 inches below the neckline to table level (OR table, not back table), and sterile gloved hands and gown sleeves up to 2 inches above the elbows

105

A draped patient is considered the ______ of the sterile field during the surgical procedure

Center