Preventing Perioperative Disease Transmission Chapter 7 (Nicola)
Absence of microorganisms
Device to accomplish steam or gas sterilization
Amount of gross organic debris or the number of microorganisms on an object at any given time
A method for testing the sterilization capability of a sterilizer; contains microorganisms that are killed when exposed to a sterilization process; only method of guaranteeing the sterility of an item(s)
Specifically designed for use with a prevacuum steam sterilizer to test for air entrapment
Mechanical process used by ultrasonic cleaners during which air pockets implode to dislodge debris and soil from the crevices and serrations of surgical instruments and equipment
A method of cleaning instruments in which the chosen cleaning solution uses the process of binding ions, such as iron and magnesium, in the solution to prevent their deposit on the surface of surgical instruments
Internal or external monitor that changes color when exposed to the sterilization process; only indicates that the sterilization process has occurred; it does not guarantee the sterility of the item
The growth and collection of microbes into a group that lives in a particular area, such as the colonization of S. aureus in the nares of humans
Soiled with gross debris or by the presence of microbes
A general term used to describe the various types of flexible or rigid scopes used to view the body’s internal structures
Sterility determined by how a sterile package is handled rather than time elapsed; the package is considered sterile until opened, or until the integrity of the packaging material is compromised
A process of quickly sterilizing unwrapped items (such as a surgical instrument that has been dropped on the floor and is needed right away) using prevacuum or gravity steam sterilizers
immediate-use steam sterilization
Placing an item in a container so it is completely covered by a liquid, such as immersing a surgical instrument in glutaraldehyde
Complete, with no breaks or tears
Level of disinfection in which most microorganisms are killed except spores
Calendar days that are sequentially numbered through the year; often used when maintaining sterilization records (i.e., February 1 would be the 32nd day of the Julian calendar)
The opening in a tube or vessel
Microorganism that is capable of causing disease
Area of sterility maintained by the surgical team during a procedure
The condition of being permeable; capable of allowing the passage of fluids or substances
(1) Procedure to render an individual incapable of reproduction; (2) process by which all microorganisms, including spores, are destroyed
A machine used to remove minute organic particles and soil from the areas of instrumentation hardest to reach by manual or other mechanical methods of cleaning; the washer utilizes the process of cavitation for cleaning instruments
Both organisms benefit from and depend on one another to a certain extent
What colonizes within the human intestine, obtains nutrients from the food that humans eat.
produces vitamin K, which is essential to the blood-clotting process in humans
Two organisms work together to achieve a result neither could obtain alone
Fusobacteria and spirochetes work together to cause a disease known as trench mouth
One organism benefits but second organism neither benefits nor is harmed
To a certain extent they benefit humans by occupying space and preventing other potentially harmful microbes from colonizing
Indigenous microflora on the skin of humans obtain nutrients, but do not affect the skin or human body
Two organisms occupy the same area with no effect on each other.
One microorganism inhibits or interferes with the growth of another.
Example: A microbe produces waste products that are toxic to the neighboring microbes
One organism benefits and the host is harmed. Commensal microbes that become opportunistic by entering through a surgical skin incision.
Endoparasites, such as intestinal worms, cause an infection and deplete the body of nutrition
Examples of Parasitism
What are opportunistic by entering through a surgical skin incision.
Infections acquired in a hospital - UTI
What kind of virus causes the common cold
According to CDC study on nosocomial infections
32% of all HAIs are urinary tract infections
22% are surgical site infections (SSIs)(SSIs)See surgical site infection (SSIs) See surgical site infection
CDC study Heath Care Infections counted for
15% are pneumonia (lung infections)
14% are bloodstream infections
All living cells are classified into two groups
prokaryotes and eukaryotes
Which bacteria is less complex organisms whose organelles are not membrane bound like those of the eukaryotes
Which bacteria cellular structure is complex, and this classification includes protozoa; fungi; green, brown and red algae; and all plant and animal cells.
What is size, shape, and arrangements of bacteria
What is round-shaped bacteria
coccus, singular form; cocci, plural form)
What is paired bacteria
What is Streptococci
chain of bacteria
What is Staphylococci
Cluster of bacteria
What is Bacillus
(bacillus, singular form; bacilli, plural)
What is Spirilla
Ability of a microbe to move by itself
What are long thin structure attached to the outside of the cell; uses whipping motion to provide motility to the cell
What are fine, short, hair like extensions located on the surface of the cell; their coordinated, rhythmic movement allows the cell to move
What are the oxygen requirements of Obligate aerobes
require level of oxygen found in a typical room
What are the oxygen requirements of Obligate anaerobes
will not grow if there is any amount of oxygen present in the environment
Which bacteria retain the crystal violet and therefore are a purple color
Which bacteria do not retain the crystal violet and are red from the safranin stain
What bacteria, such as Mycobacterium tuberculosis, do not consistently stain red or purple.
What is the bacterial species capable of forming spores
Spore forming (sporulation)
Example of Spore forming bacteria
the genetic material of the cell is enclosed in a protein capsule TB for example
Spore forming bacteria cause a number of diseases, including
botulism, anthrax, tetanus and acute food poisoning
Most common bacterial pathogen in the o.r
(type of bacteria commonly found on the skin and hair as well as in the noses and throats)
Types of Staphylococcus - S. aureus
Toxic shock syndrome
Osteomyelitis (bone infection)
Postoperative SSI (surgical site infection
Endocarditis (inflammation of the inner layer of the heart)
What is a sore, red throat
Streptococcus - S pneumoniae
Streptococcus - S. pyogenes
Rheumatic fever: If you have had this you will be put on an antibiotic before surgery
Necrotizing fasciitis: Flesh eating disease
What Aerobic Gram-Negative Cocci causes inflammatory disease leading to salpingitis
What Aerobic Gram-Negative Cocci causes Otitis media in children
Inflammation of the middle ear
Which Aerobic, Microaerophile Gram-Negative Bacilli, Spirochetes causes Legionnaires' disease
Severe form of pneumonia
Which Aerobic, Microaerophile Gram-Negative Bacilli, Spirochetes causes Chronic gastritis, Stomach ulcers, and Peptic ulcers
What family of penicillin has been used so much people have become resistant to it
Which Facultative Anaerobic Gram-Negative Bacilli can cause Respiratory tract infections, Bacterial pneumonia (elderly), Otitis media, Eye infections,
Septic arthritis and Cellulitis
commonly known as "the flu"
Which Facultative Anaerobic Gram-Negative Bacilli is associated with Health care–associated UTIs,
Wound and burn infections, Ankylosing spondylitis (sequelae of a Klebsiella infection)
What Anaerobic Gram-Positive Bacteria can cause Gas gangrene infection
What Mycobacteria causes Tuberculosis
What is the Mycobacteria responsible for sexually transmitted disease that men and women
Surgical procedures performed on known ...... carriers require implementing isolation precautions, in addition to isolation PPE, an National Institute of Occupational Safety and Health (NIOSH)–approved respirator must be worn
What are nonliving particles that are completely reliant on the host cell for survival
What contains either DNA or RNA and a protein coat that encases the nucleic acid.
Transmission: Percutaneous or permucous in blood, serum, and other body fluids
Description: Causes inflammation of the liver, jaundice, cirrhosis, and, in some cases, liver cancer
Hepatitis B (HBV)
Transmission: Blood-borne RNA; transmitted through blood and blood products
Description: Asymptomatic when acute; may be carried for 25 years; causes chronic hepatitis, cirrhosis, liver cancer
Transmission: Blood or other body fluids
Description: Compromises immune system
Human immunodeficiency virus (HIV)
Transmission: Contact with fluid from lesions
Description: Causes localized blister like eruptions; can also cause keratocon junctivitis, acute retinal necrosis, meningoencephalitis
Herpes simplex virus (HSV)
Transmission: Direct contact with another person
Transmission: Direct contact with body fluids
Description: Infects salivary glands or viscera; opportunistic infection in patients with HIV or hepatitis
Transmission: Exact mode of transmission unknown; thought to be by percutaneous inoculation with brain tissue or cerebral spinal fluid from infected persons; transmission has been associated with use of contaminated instruments; longer sterilization times required.
Description: Rapidly progressive fatal central nervous disease characterized by dementia, myoclonus
Creutzfeldt-Jakob Disease (CJD)
What is built of proteins and do not contain DNA or RNA. They attack the brain, which is why the diseases they cause are called subacute spongiform encephalopathies
is short for “proteinaceous infectious particle.”
What are two common forms of prions
Scrapie (a disease that infects sheep and goats) and bovine spongiform encephalopathy (commonly called mad cow disease).
What have two categories : unicellular protozoans and multicellular protozoans.
What are popularly known as worms. Those that are most common in the human population are tapeworms, flukes, and roundworms.
What are pork tapeworms that can migrate out of the intestinal tract and travel to muscle and brain tissue, and the eyes. They can cause palpable lumps in soft tissues, blurred vision and retinal detachment, and when located in the brain tissue cause seizures, ataxia, headaches, and possibly death.
Cysticeri - (Taenia solium)
What are eukaryotic organisms that are either unicellular yeasts or multicellular molds and mushrooms
What reproduce either sexually or asexually by producing spores; a true spore is formed by either asexual cleavage or sexual meiosis. diseases are called mycoses (the plural of mycosis).
What is a vaginal yeast infection and Trench mouth (thrush)
Common Fungal Infections
What common fungal infection preys on immunocompromised patients prone to serious infections of the brain, meninges, and heart valves Patients intubated or who have indwelling venous catheter or other type long-term indwelling catheter should be monitored for infection
What is Pneumocystis pneumonia (PCP),
Pneumocystis jiroveci is the most common opportunistic infection in persons with HIV
What fungus, caused by the common bread mold, if it enters the bloodstream can destroys the cranial bones, the brain tissue will be invaded.
Since a high percentage of individuals are carriers of ........ the threat is considerable enough to warrant the use of hair covers and masks
What are inanimate objects that may contain infectious microorganisms including walls, floors, cabinets, furniture and equipment.
The two primary sources of SSI risk to the patient are the ..........encountered in contaminated procedures and the ........ of the skin.
What factor increases risk of SSI for geriatric and pediatric patients have lower immunological defenses.
What factor increases risk of SSI for diminished blood flow, larger wound sizes, and the difficulty of handling adipose tissue make these patients more susceptible to infection.
What factor increases risk of SSI for patients in poor health or who have an inadequate nutritional intake generally have a predisposition to infection.
What factor increases risk of SSI for patients at greater risk of infection from their own endogenous flora
Carriers of S. aureus or MRSA
What factor increases risk of SSI for infections at other body sites increase the chance of SSI. Bacteria in the bloodstream enter and infect the surgical site.
What factor increases risk of SSI for infection rates increase parallel to the duration of preoperative stay. Patients are exposed to higher numbers of antibiotic-resistant strains of bacteria within the hospital.
What factor increases risk of SSI for infection rates are higher in patients with compromised immune systems; patients who have been treated with certain medications, including steroids or chemotherapy agents; and patients who have recently undergone radiation therapy.
Preexisting illness and related treatment
Procedure-related risk factors that increase the danger of SSI due to the use of razor blades that may leave nicks and scrapes on the skin
Preoperative hair removal
Procedure-related risk factors that increase the danger of SSI - what is Clean-contaminated (Class II), contaminated (Class III), and dirty (Class IV) cases carry a higher risk of infection as do cases that compromise blood flow to a particular area, such as coronary artery bypass procedures, where one or both internal mammary arteries are used.
Type of procedure
Procedure-related risk factors that increase the danger of SSI due a longer anesthetic and operative times have an accompanying increase in time for bacterial contamination to occur, increased tissue damage, and greater immunosuppression. Surgical team members become more fatigued, which may lead to breaks in sterile technique.
Duration of procedure
What is the growth and collection of microbes into a group that lives in a particular area
What is Absence of Microorganisms
What is the substance that destroys/kills bacteria
What is substance that inhibits the growth and reproduction of bacteria
What is the number of microbes or amount of organic debris on an object at any given time
What is the presence of pathogenic materials
What is the contamination of a person or object by another
What is it called to reduce to an irreducible minimum the presence of pathogenic material
What sterility is determined by how a package is handled rather than time elapsed; a package is considered sterile until opened or the integrity of packaging material is damaged
What is an inanimate object that harbors microorganisms
What is an agent that destroys fungus
What is microbes that normally reside below the skin surface or within the body
What is an infection, usually accompanied by fever, that results from the presence of pathogenic microorganisms
What is a microbes that reside on the skin surface and are easily removed
What is a process in which most but not all microorganisms located on animate surfaces, such as the skin, are destroyed.
What classification does the CDC and FDA give surgical instruments, devices that enter the vascular or urinary systems (needles, catheters), implantable items (wires, screws, joint replacements, mesh, sutures), and any monitors or probes that enter deep tissue layers or cavities. These items should be sterilized.
What classification does the CDC and FDA give surgical instruments, devices that come into contact with mucous membranes or non-intact skin carry a lesser risk of infection due to the properties of resistance of intact mucosal linings to many commonly encountered bacterial spores. Examples include: laryngoscopes, anesthesia and respiratory equipment, and some endoscopes. High-level disinfection should be used for items in this category
What classification does the CDC and FDA give surgical instruments, items that come into contact with a patient’s intact skin and clean environmental equipment items pose the least risk of infection. Examples include blood pressure cuffs, pulse oximeters, OR transport stretchers, and other furniture. These items require either intermediate-level or low-level disinfection.
The physical removal of blood, body fluids, and/or gross debris (bioburden) from an inanimate object.
Destruction (3 levels) of pathogenic microorganisms or their toxins or vectors by direct exposure to chemical or physical agents.
What kills all microorganisms except spores and prions (CJD).
What kills (ineffective against spores) most microorganisms, including bacteria, most viruses and fungi. M. tuberculosis and HBV
What kills some fungi and viruses, and most bacteria, but is NOT effective against spores and M tuberculosis.
What provides destruction of all microorganisms in or about an object with steam (flowing or pressurized), chemical agents (alcohol, phenol, heavy metals, or ethyl-ene oxide gas), high-velocity electron bombardment, or ultraviolet radiation.
What is a high-level disinfectant. Its common commercial name is Cidex.
20 mins disinfecting
10 hrs = sterile
What color should the test strip turn when testing Cidex to ensure its 2%strength
What is an effective disinfectant for surfaces, floors, and equipment. It is such an effective and fast-acting solution, and the CDC recommends its use in cleaning blood and body fluid spills.
What is usually used as a concentrate with detergent additives and is diluted with tap water. It is used to disinfect large areas such as floors and countertops and is used on a general basis as a health care facility cleaning agent.
Phenol (Carbolic Acid)
Who is involved in the “turnover” of the room, which marks the preparation for the next procedure
The surgical technologist, along with environmental services personnel
What should be available in the sterile field for soaking and cleaning if instruments.
What should never be used to soak instruments as the salt in the solution could cause pitting and corrode the metal
After which type of case should the floor be cleaned with a phenolic detergent and all equipment and furniture should be wiped down with 70% alcohol solution.
Design of the decontamination area
Filtered air is exhausted to the outside of the health care facility.
The minimum air exchange rate is 10 times per hour.
Temperature should be maintained between 64° and 70°F with a humidity of 35% to 72%.
Negative air pressure is maintained
What facilitates the removal of protein materials such as blood.
Proteolytic enzymatic cleaner
What facilitates the removal of fatty material such as adipose tissue and bone marrow
Lipolytic enzymatic cleaner
What is an organic substance that aids in the chemical reaction of breaking down organic debris, used as a chemical soaking solution, need warm water and dilution.
enzymatic chemical cleaner
Cleaning solutions are manufactured specifically for use in ....... cleaners. The solution may contain a surfactant (to enhance wetting ability) and chelating agents.
Products usually used for hand cleaning of items and/or for presoaking. Mechanical action is required to assist in removing the soil. Surgical instruments must be thoroughly rinsed after being placed in the detergent
Liquid solution that is available in three different pH levels. Neutral-pH product: Least corrosive to surgical instruments but less effective at removing substantial amount of organic soil.
The process of binding minerals, such as iron and magnesium in the solution to prevent their deposits on the surface, causing spotting
What are catalyst that aid in the breakdown of organic soil and blood
What is the action of dispersing two liquids not capable of being mixed
What is the action by which the solubility of a substance is increased within a solution
What does Impervious to moisture mean
What types of peel pack is used for steam and EtO sterilization
What types of peel pack is used for EtO and Sterrad
Heavy instrument sets should be
no more than 25lbs
If what is trapped in the lumen it may prevent steam from contacting the inner surface. To prevent this entrapment of a residual amount of distilled water should be left inside the lumen. The water will boil during sterilization, turning to steam and displacing the air within the lumen.
What indicates the date of sterilization. This date is the number of the calendar day (1-365/366); for example, the .... date for February 27, 2013 is 58 and March 5, 2013 is 64.
What requires a Cycle Time
Contents 270°F Drying Times
Instrument set, 4 minutes 20–30 minutes Wrapped
Instrument set, 3 minutes NA unwrapped, no lumen instrument
What sterilizer uses moister and heat to kill microbes, this process is accelerated when pressure is added
What generate their own steam When steam is supplied from an outside source, the walls of the chamber are preheated before the steam is allowed into the chamber. This is accomplished with a metal jacket that is built around the chamber. The space between the jacket and chamber is filled with steam to preheat the chamber walls when the machine is turned on.
Which sterilizer is slower than prevacuum/dynamic-air-removal sterilizers because gravity is relied on to remove the air.
Gravity displacement Sterilizer
What is referred to as an immediate use sterilization for unwrapped items
What are the three methods of monitoring the sterilization process
Which indicators are used externally and internally to verify that items have been exposed to sterilizing conditions
What is the spore used for ETO indicators
The inside of wrappers containing linens or other sterile items is considered sterile except for
1 inch perimeter around the outside edge of the wrapper
The integrity of the wrapper
must be checked before opening
The surgical gown is considered sterile in front
2 inches below the neckline to table level; bilaterally; and sterile gloved hands to 2 inches above elbows
Sterile surgical team members should either pass whilst
facing one another or back to back by rotating 30 degrees
A non sterile team member must maintain a distance of
12 inches from any sterile item, area, or field to prevent contamination
When draping a Nonsterile table to create a sterile field the Nonsterile individual should
cuff the hands in the underside folds of the drape or table cover to avoid contaminating the top surface