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Sterile Processing Chapter 15 & 16

front 1

Designer of steam sterilizers

back 1

Charles Chamberlain
1880

front 2

Important factors for sterilization

back 2

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

front 3

What is bioburden?

back 3

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

front 4

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

back 4

Conduction (solids)
Dry heat

front 5

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

back 5

Convection (liquids or gases)
Steam

front 6

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

back 6

Radiation
Not used in hospitals

front 7

Steam sterilization benefits

back 7

Low cost
Fast cycles
Simple technology
Leaves no chemical residue

front 8

Size of steam sterilizers

back 8

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

front 9

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

back 9

Jacket

front 10

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

back 10

Door & Gasket

front 11

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

back 11

Chamber drain

front 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

back 12

Thermostatic trap

front 13

Component of steam sterilizer - Provides a written record of sterilization

back 13

Gauges and control monitoring

front 14

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

back 14

Table top sterilizers

front 15

What sterilizer operates at 250 degrees F

back 15

Table top sterilizers

front 16

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

back 16

Gravity Air Displacement Sterilizer

front 17

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

back 17

Sterilize liquids

front 18

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

back 18

Dynamic Air Removal Sterilizer

front 19

Temperature that Dynamic Air Removal Sterilizer operates at

back 19

270 DF

front 20

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

back 20

Bowie Dick

front 21

Special purpose pressure sterilizer intended for emergency use

back 21

Flash sterilization

front 22

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

back 22

Flash sterilizer

front 23

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

back 23

Instrument washer (IWS) Sterilizer

front 24

Steam Sterilizer Cycle phase 1

back 24

Conditioning

front 25

Steam Sterilizer Cycle phase 2

back 25

Exposure

front 26

Steam Sterilizer Cycle phase 3

back 26

Exhaust

front 27

Steam Sterilizer Cycle phase 4

back 27

Drying

front 28

Process of sterilizing an item that IS NOT packaged

back 28

Flash (sterilization)

front 29

The process of sterilizing an item that IS packaged

back 29

Terminal sterilization

front 30

Passive or active air removal - Gravity

back 30

Passive air removal

front 31

Passive or active air removal - Pre vacuum steam sterilizer

back 31

Active air removal

front 32

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

back 32

Active air removal - SFPP

front 33

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

back 33

Conditioning

front 34

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

back 34

Exposure

front 35

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

back 35

Exhaust

front 36

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

back 36

Drying

front 37

Conditions necessary for effective steam sterilization

back 37

Contact
Time
Temperature
Moisture

front 38

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

back 38

250-270 DF depending on load

front 39

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

back 39

Time

front 40

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

back 40

Time and temperature relationship

front 41

Steam that contains the maximum amount of water vapor

back 41

Saturated steam

front 42

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

back 42

Gauge pressure (steam)

front 43

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

back 43

Absolute pressure (steam)

front 44

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

back 44

Superheated steam

front 45

Higher elevation =

back 45

Higher psi eg Denver is 3 psi higher than sea level

front 46

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

back 46

Catheters, tubing, rubber

front 47

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

back 47

7 pounds

front 48

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

back 48

Lumens

front 49

Least used and least understood sterilizing agent

back 49

Dry heat

front 50

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

back 50

slow acting / higher

front 51

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

back 51

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

front 52

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

back 52

Conduction

front 53

Dry heat advantages:

back 53

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

front 54

Dry heat disadvantages:

back 54

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

front 55

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

back 55

Conduction

front 56

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

back 56

Convection

front 57

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

back 57

Gravity Convection
Prone to air layering which casues inconsistent temps

front 58

Utilizes a blower system to insure even heating throughout the cycle

back 58

Mechanical Convection

front 59

Devices intended for use with individual units - packs or containers

back 59

Process indicators

front 60

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

back 60

Chemical indicators

front 61

Tape, load cards, Labels etc

back 61

External indicators

front 62

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

back 62

Class 1 indicators

front 63

Indicators, such as the Bowie Dick

back 63

Class 2 indicators

front 64

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

back 64

Class 3 indicators

front 65

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

back 65

Class 4 indicators

front 66

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

back 66

Class 5 indicators

front 67

Label information on sterilization packages etc

back 67

Load control number

front 68

Number of days that have elapsed since January 1st

back 68

Julian date

front 69

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

back 69

Physical Mechanical Monitoring

front 70

Geobacillus stearothermaophilus

back 70

Steam sterilizer bacteria

front 71

Bacillus atrophacus

back 71

Dry heat bacteria

front 72

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

back 72

Validation

front 73

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

back 73

Verification

front 74

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

back 74

D-Value

front 75

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

back 75

D-Value Sterilization Effectiveness

front 76

Caused by abnormal proteins called prions

back 76

Creutzfeldt-Jacob Disease (CJD aka mad cows disease)

front 77

Virus like infectious agents that cause neurodegenerative disease

back 77

Prions

front 78

Solutions that are administered to patients intravenously

back 78

Parental solutions

front 79

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

back 79

External solutions

front 80

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

back 80

Hydrologic cycle

front 81

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

back 81

Reverse osmosis

front 82

Can be used to produced distilled water and isotonic solutions

back 82

Flashing technique
250-254 DF

front 83

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

back 83

Sterility assurance level (SAL)

front 84

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

back 84

Permissible exposure limits (PELs)

front 85

The employees average airborne exposure in any 8 hour workday

back 85

Time weighted average (TWA)

front 86

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

back 86

Alkylation

front 87

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

back 87

Oxidation

front 88

Process monitoring consist of:

back 88

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

front 89

Terminal low sterilization methods

back 89

ETO
Hydrogen peroxide
Ozone

front 90

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

back 90

10-6

front 91

Toxicity standards low level
ETO

back 91

1.0ppm
800 ppm

front 92

Toxicity standards low level
Hydrogen peroxide

back 92

1.0ppm
75ppm

front 93

Toxicity standards low level
Ozone

back 93

0.1ppm
10ppm

front 94

ETO Benefits

back 94

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

front 95

A process in which a device is subjected to moving air

back 95

Aeration

front 96

The amount of ETO that remains after they are sterilized

back 96

Residual chemicals

front 97

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

back 97

ETO method

front 98

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

back 98

Hydrogen Peroxide (Gas plasma) sterilization method

front 99

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

back 99

Hydrogen Peroxide (Gas plasma)

front 100

Destroys microorganisms by oxidation, and H2O2

back 100

Hydrogen Peroxide aka Gas plasma

front 101

Relatively new low temp sterilization method, requires no sterilant.

back 101

Ozone (O3)

front 102

Overview ETO

back 102

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

front 103

Hydrogen perioxide/Plasma Overview

back 103

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

front 104

Ozone overview

back 104

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