Central Service Technical Manual Boxed Course: Sterile Processing Chapter 15 & 16 Flashcards


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1

Designer of steam sterilizers

Charles Chamberlain
1880

2

Important factors for sterilization

Type of microorganisms present
Number of microorganisms (bioburden)
Amount of protection a medical devices provides

3

What is bioburden?

The number of microorganisms on a contaminated object, also called bio load, or microbial load

4

Transmission of heat from one part to another part of a material. Methods of high temperature sterilization (steam)

Conduction (solids)
Dry heat

5

Transfer of heat from one point (or molecule) to another as liquid or gas circulates. Methods of high temperature sterilization (steam)

Convection (liquids or gases)
Steam

6

Transfer of heat from one object to another without warming the space between the objects. Methods of high temperature sterilization (steam)

Radiation
Not used in hospitals

7

Steam sterilization benefits

Low cost
Fast cycles
Simple technology
Leaves no chemical residue

8

Size of steam sterilizers

Small table top (clinics and dentists)
Mid size units
Large size units

9

Component of steam sterilizer - Surrounds top, middle and bottom of the vessel

Jacket

10

Component of steam sterilizer - weakest part of a steam sterilizer, can be tightened but not loosened while the chamber is under pressure

Door & Gasket

11

Component of steam sterilizer - Located at the front or center of the floor in most sterilizers

Chamber drain

12

Component of steam sterilizer - Located in the drain line and is the coolest place in the sterilizer. Controls the flow of air and condensate

Thermostatic trap

13

Component of steam sterilizer - Provides a written record of sterilization

Gauges and control monitoring

14

Type of gravity air displacement, typically used in clinics and dentists

Table top sterilizers

15

What sterilizer operates at 250 degrees F

Table top sterilizers

16

Small to medium sized sterilizer - hot air is introduced while rising to the top forcing cooler air to the bottom of the chamber

Gravity Air Displacement Sterilizer

17

What additional items can a Gravity Air Displacement Sterilizer be used for

Sterilize liquids

18

Similar in construction to gravity sterilizer except that a vacuum pump or water ejector removes the air during preconditioning phase

Dynamic Air Removal Sterilizer

19

Temperature that Dynamic Air Removal Sterilizer operates at

270 DF

20

What indicator is used to ensure a Dynamic Air Removal Sterilizer have all air removed

Bowie Dick

21

Special purpose pressure sterilizer intended for emergency use

Flash sterilization

22

A sterilizer that uses higher temperatures for shorter exposure times to handle emergency sterilization of dropped instruments

Flash sterilizer

23

Combination units that wash and sterilize instruments to insure the safety of processing personnel

Instrument washer (IWS) Sterilizer

24

Steam Sterilizer Cycle phase 1

Conditioning

25

Steam Sterilizer Cycle phase 2

Exposure

26

Steam Sterilizer Cycle phase 3

Exhaust

27

Steam Sterilizer Cycle phase 4

Drying

28

Process of sterilizing an item that IS NOT packaged

Flash (sterilization)

29

The process of sterilizing an item that IS packaged

Terminal sterilization

30

Passive or active air removal - Gravity

Passive air removal

31

Passive or active air removal - Pre vacuum steam sterilizer

Active air removal

32

Passive or active air removal - Pulse (Steam flush SFPP)

Active air removal - SFPP

33

(STEAM)Once door is closed steam enters at the back portion and strikes a baffle plate to prevent steam from hitting the load

Conditioning

34

(STEAM) Pressure begins to rise, with temperature, system begins timing the ..... stage

Exposure

35

(STEAM) At the end of the exposure phase, chamber drains, steam is removed through ..... line

Exhaust

36

(STEAM) Conclusion of exhaust phase, uses the heat of the chamber walls to activate ..... cycle

Drying

37

Conditions necessary for effective steam sterilization

Contact
Time
Temperature
Moisture

38

In order to be effective steam sterilizers much reach ........

250-270 DF depending on load

39

Inadequate exposure ........ can lead to failure of the process

Time

40

When boiling water begins the volume increases gently. As it continues water changes to steam and temperature rises

Time and temperature relationship

41

Steam that contains the maximum amount of water vapor

Saturated steam

42

Absolute pressure (-)atmospheric pressure (14.7 psi at sea level) also called over pressure

Gauge pressure (steam)

43

Gauge pressure (psi) + atmospheric pressure (14.7 psi at sea level)

Absolute pressure (steam)

44

Dry steam: the condition of steam when its temperature is too high relative to pressure in steam table

Superheated steam

45

Higher elevation =

Higher psi eg Denver is 3 psi higher than sea level

46

Several environmental factors can reduce its life eg heat, light, acids

Catheters, tubing, rubber

47

The weight of wrapped basin sets should not exceed ....

7 pounds

48

What should be moistened with distilled water or demineralized water so air can be more easily displaced

Lumens

49

Least used and least understood sterilizing agent

Dry heat

50

Dry heat is a relatively ....... sterilizing agent, and requires ..... temperature

slow acting / higher

51

Dry heat has the ability to penetrate a variety of materials, including

oils, petroleum jelly, and closed containers not permeable to steam

52

Dry heat sterilization is achieved by ....... heat

Conduction

53

Dry heat advantages:

Can sterilize powers/oils
Will not erode the surface of glass
Does not have a corrosive effect on metals
Will reach all surfaces

54

Dry heat disadvantages:

Difficult to control
Penetrates materials slowly and unevenly
Requires long exposure times
Requires high temperatures
Not suitable to sterilize fabric or fubber goods

55

A heat transfer method in which heat is absorbed by an items exterior surface, and passed inwards to the next layer

Conduction

56

The process of heat transfer by the circulation of current from one area to another

Convection

57

As air within the chamber is heated, it rises and displaces cooler air that descends into the lower part of the chamber.

Gravity Convection
Prone to air layering which casues inconsistent temps

58

Utilizes a blower system to insure even heating throughout the cycle

Mechanical Convection

59

Devices intended for use with individual units - packs or containers

Process indicators

60

Systems that reveal a change in one or more predefined process parameters or physical change

Chemical indicators

61

Tape, load cards, Labels etc

External indicators

62

Processing indicators used within individual packs to demonstrate that they have been exposed in the sterilization process

Class 1 indicators

63

Indicators, such as the Bowie Dick

Class 2 indicators

64

Single parameter indicators to react to one of the critical parameters of sterilization

Class 3 indicators

65

Multi parameter indicators that react to two or more critical parameter's

Class 4 indicators

66

Integrating indicators designed to react to all critical parameters over a specified range of sterilization cycles

Class 5 indicators

67

Label information on sterilization packages etc

Load control number

68

Number of days that have elapsed since January 1st

Julian date

69

Include time, temp, pressure records, digital printouts and gauges

Physical Mechanical Monitoring

70

Geobacillus stearothermaophilus

Steam sterilizer bacteria

71

Bacillus atrophacus

Dry heat bacteria

72

Procedures used by equipment manufacturers to obtain, record, and interpret test results in a sterile product

Validation

73

Procedures used by healthcare facilities to confirm that the validation undertaken by the equipment manufacturer is applicable to the specific setting

Verification

74

The amount of time to kill 90% of the microorganisms present

D-Value

75

Death occurs in a definite relationship to time, and this rate is governed by factors including temp, age of test culture

D-Value Sterilization Effectiveness

76

Caused by abnormal proteins called prions

Creutzfeldt-Jacob Disease (CJD aka mad cows disease)

77

Virus like infectious agents that cause neurodegenerative disease

Prions

78

Solutions that are administered to patients intravenously

Parental solutions

79

Solutions that are usexd for irrigating, topical application, and surgical use that are given orally or by inhalation

External solutions

80

The continual movement of water from the atmosphere to the earth and back to the atmosphere

Hydrologic cycle

81

A water treatment process which dissolves impurities are separated from the water

Reverse osmosis

82

Can be used to produced distilled water and isotonic solutions

Flashing technique
250-254 DF

83

The probability of a viable microorganism being present on a product unit after sterilization

Sterility assurance level (SAL)

84

Limits developed by OASHA to indicate the maximum airborne exposure an employee may be exposed to

Permissible exposure limits (PELs)

85

The employees average airborne exposure in any 8 hour workday

Time weighted average (TWA)

86

The process by which Ethylene Oxide destroys microorganisms, inability of the cell to metabolize

Alkylation

87

The act or process of oxidizing - chemical breakdown of nutrients for energy

Oxidation

88

Process monitoring consist of:

"4Rs" Run, read, recor, and retain

89

Terminal low sterilization methods

ETO
Hydrogen peroxide
Ozone

90

Low temperature - To be effective it must meet a sterility assurance level of:

10-6

91

Toxicity standards low level
ETO

1.0ppm
800 ppm

92

Toxicity standards low level
Hydrogen peroxide

1.0ppm
75ppm

93

Toxicity standards low level
Ozone

0.1ppm
10ppm

94

ETO Benefits

Small molecule that can penetrate through plastics
Kills microorganisms by reacting with molecules
targets specific molecules

95

A process in which a device is subjected to moving air

Aeration

96

The amount of ETO that remains after they are sterilized

Residual chemicals

97

Effective alkylating agent that kills wide range of microorganisms, destroys ability to reproduce

ETO method

98

Popular low sterilization method because of short cycle times that allow faster turn around

Hydrogen Peroxide (Gas plasma) sterilization method

99

Not compatible with powders and stronger absorbers such as paper, or linen. It cannot be used to process liquids

Hydrogen Peroxide (Gas plasma)

100

Destroys microorganisms by oxidation, and H2O2

Hydrogen Peroxide aka Gas plasma

101

Relatively new low temp sterilization method, requires no sterilant.

Ozone (O3)

102

Overview ETO

Alylation
1-4 hours exposure plus 8-12 aeration
Time, temp, ETO, Relative humidity
Flush load with warm filtered air
Long total cycle
1.0 ppm
All standard packaging

103

Hydrogen perioxide/Plasma Overview

Oxidation
28-50 min depends on load
Time, temp, concentration, vacuum level, plasma
1.0ppm
Non woven or tyveck

104

Ozone overview

Oxidation
4 hour exposure
Time, temp, concentration, relative humidity
0.1ppm
Compatible most products