front 1 Asepsis | back 1 The absence of of pathogenic microorganisms |
front 2 bacteriocidal | back 2 substance that destroys/kills bacteria |
front 3 bacteriostatic | back 3 substance that inhibits the growth and reproduction of bacteria |
front 4 bioburden | back 4 the number of microbes or amount of organic debris on an object at any given time |
front 5 contamination | back 5 the presence of pathogenic materials |
front 6 cross-contamination | back 6 the contamination of a person or object by another |
front 7 decontamination | back 7 to reduce to an irreducible minimum the presence of pathogenic material |
front 8 disinfectant | back 8 chemical agent that kills most microbes, but usually not spores; used on inanimate objects because compounds are too strong on living tissues *is a category of disinfection |
front 9 event-related sterility | back 9 determined by how a package is handled; package is considered sterile until opened or integrity of package material is damaged *mostly used now, except implants still have expiration dates *dust covers gave an extra 6 months on expiration |
front 10 fomite | back 10 inanimate object that harbors microorganisms |
front 11 fungicide | back 11 agent that destroys fungus |
front 12 infection | back 12 invasion of the human body or tissue by pathogenic microorganisms that reproduce and multiply, causing disease |
front 13 nosocomial | back 13 infection acquired within a health care facility - HAI |
front 14 pathogen | back 14 any microbe capable of causing disease |
front 15 resident flora | back 15 microbes that normally reside BELOW the skin surface or WITHIN the body |
front 16 transient flora | back 16 microbes that reside ON the skin surface and are EASILY REMOVED *we try to lower their numbers for surgery to obtain surgically clean |
front 17 sepsis | back 17 infection, usually accompanied by fever, that results from the presence of pathogenic microorganisms |
front 18 spore | back 18 a resistant form of certain types of bacteria that are able to survive in adverse conditions |
front 19 sporicide | back 19 liquid substance that kills/destroys bacteria in the spore stage |
front 20 sterile | back 20 having been rendered free of all living microorganisms, including spores |
front 21 sterile field | back 21 specified area, usually the area immediately around the patient, that is considered free of microorganisms |
front 22 sterile technique | back 22 techniques of creating a sterile field and performing within the sterile field to keep microbes at an irreducible minimum |
front 23 strike-through contamination | back 23 contamination of a sterile field that occurs through the passage of fluid through, or a puncture in, a microbial barrier |
front 24 surgically clean | back 24 mechanically cleaned and chemically disinfected but not sterile |
front 25 terminal disinfection | back 25 to render item safe to handle by high-level disinfection *not used invasively |
front 26 terminal sterilization | back 26 to render items safe to handle by sterilization *used invasively |
front 27 vector | back 27 living carrier that transmits disease ex: mosquitos (west nile virus) |
front 28 virucide | back 28 agent that destroys viruses |
front 29 CDC and FDA classification system for patient care items and surgical devices | back 29 Critical Semi-Critical Non-Critical |
front 30 surgical instruments, devices that enter the vascular urinary systems, and any monitors or prove that enter deep tissue layers or cavities. needles, catheters, implantable items (wires, screws, joint replacements, sutures) | back 30 Critical patient care items |
front 31 Antisepsis | back 31 process in which most but not all microorganisms located on animate surfaces, such as the skin, are destroyed |
front 32 Semi-Critical patient care items | back 32 items that come into contact with mucous membranes or non-intact skin carry a lesser risk of infection laryngoscopes, anesthesia and respiratory equipment, and some endoscopes. High-level disinfection should be used |
front 33 Non-Critical patient care items | back 33 items that come into contact with a patient's intact skin. Least risk of infection blood pressure cuffs, pulse oximeters, OR transport stretchers, and other furniture. Intermediate-level to low-level disinfection |
front 34 AST recommended standards of practice applicable to decontamination and sterilization | back 34 RSOP: for the Decontam. of Instruments for Packaging Material and Preparing Items for Sterilization for Monitoring Sterility |
front 35 Disinfecting Agents | back 35
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front 36 Disinfecting agent: CLEANING | back 36 physical removal of blood, body fluids, gross debris (fat, tissue) (Bioburden) |
front 37 Disinfection agent: DISINFECTION | back 37 destruction of pathogenic microorganisms by direct exposure to chemical or physical agents. *Three levels of disinfection |
front 38 Disinfection agent: HIGH-LEVEL DISINFECTION | back 38 kills all microorganisms except spores and prions (CJD) *scope washers |
front 39 Disinfection agent: INTERMEDIATE-LEVEL DISINFECTION | back 39 kills most microorganisms, including bacteria, most viruses and fungi. M. Tuberculosis and HBV: ineffective against spores |
front 40 Disinfection agent: LOW-LEVEL DISINFECTION | back 40 kills some fungi and viruses, and most bacteria, but is not effective against spores and M. tuberculosis |
front 41 Disinfection agent: STERILIZATION | back 41 destruction of all microorganisms in or about an object with steam (flowing or pressurized) chemical agents (alcohol, phenol, heavy metals, or ethylene oxide gas) high-velocity electron bombardment, UV |
front 42 disinfectant compounds also serve as sterilants when used in sterilization systems | back 42 Peracetic acid - used in Steris system *liquids - items immersed to the liquid for certain amount of time |
front 43 factors that influence efficiency of disinfectants | back 43
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front 44 Disinfectant concentration is too high | back 44 *increases the level of disinfection *too corrosive for use on rubber |
front 45 effectiveness of disinfection is decreased on contaminated items | back 45 *blood, body fluids, or tissue present on an item can make disinfectant difficult to be effective. - unable to contact surface *must contact all surfaces *thoroughly cleaned prior to decontamination process *instruments disassembled, ratchets and locks opened |
front 46 20-30 minutes | back 46 contact time that is generally recommended for high-level disinfection |
front 47 10-15 minutes | back 47 contact time that is recommended for intermediate and low-level disinfection |
front 48 safety with handling disinfectant solutions | back 48
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front 49 High-level disinfectant **can also be used as a sterilant Glutaraldehyde | back 49 also known as Cidex one of the best overall disinfectant/liquid sterilants on the market used on devices that can withstand immersion in the liquid used with decontamination or sterilization of rigid and flexible endoscopes |
front 50 shelf life | back 50 Glutaraldehyde's is 14 days; with a surfactant it increases to 28 days and must be tested prior to each day during the 14-28 day period the period of time between activation of the disinfection solution or number of uses after which the efficiency is diminished - must be at 2% strength - tested with test strips |
front 51 requirements for items prior to being immersed in glutaraldehyde | back 51
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front 52 immersed 20 minutes at room temperature for high-level disinfection or immersed 10 hours for sterilization | back 52 Glutaraldehyde's exposure times |
front 53 glutaraldehyde - alkylation of cell protein ADVANTAGES | back 53 dual purpose (disinfectant and sterilant) noncorrosive to metals, lensed and cemented items, rubber and plastic bactericidal against gram + and gram- microbes, tuberculocidal, virucidal |
front 54 glutaraldehyde - alkylation of cell protein DISADVANTAGES | back 54 noxious odor irritating vapors unstable shelf life items must be cleaned and dried prior to immersion |
front 55 Sodium Hypochlorite - household bleach - disrupts cellular metabolism high-level disinfectant | back 55 effective fast-acting disinfectant solution for surfaces, floors, and equipment. recommended by the CDC to clean blood and body fluid spills |
front 56 Sodium Hypochlorite - high-level disinfectant ADVANTAGES | back 56 bactericidal, virucidal, tuberculocidal, effective against HIV, HBV, and other viruses |
front 57 Sodium Hypochlorite - high-level disinfectant DISADVANTAGES | back 57 Noxious odor corrosive harmful to the skin loses effectiveness in the presence of organic soil |
front 58 Intermediate-level disinfectant compounds | back 58 capable of killing spores or certain hydrophilic viruses; however, they do kill all bacteria, fungi, and non-hydrophilic viruses. used to disinfect countertops, OR furniture, floors, and other surfaces, and instruments that only come into contact with the skin of the patient |
front 59 Phenol (Carbolic Acid) - denatures enzymes and causes cell lyses intermediate-level disinfectant | back 59 used as a concentrate with detergent additives and is diluted with tap water. Used to disinfect large areas (floors and countertops) on a general basis. |
front 60 Phenol (carbolic acid) ADVANTAGES | back 60 economical choice for the OR because it is a highly concentrated solution that is easily diluted effective in eliminating fecal contamination |
front 61 Phenol (carbolic acid) DISADVANTAGES | back 61 Highly irritating to the skin - isopropyl alcohol should be used to neutralize noxious odor respiratory tract irritant limited to disinfection of noncritical items |
front 62 Quaternary Ammonium Compounds - cause leakage of the protoplasm in microbes Intermediate-level disinfectant | back 62 they are commonly called quats, are bactericidal, fungicidal, and pseudomonacidal - unable to kill TB, spores, or viruses |
front 63 Quaternary Ammonium Compounds ADVANTAGES | back 63 low cost easy to mix odorless noncorrosive |
front 64 Quaternary Ammonium Compounds DISADVANTAGES | back 64 kill limited number of classes of microbes effectiveness easily reversed when solution contacts organic debris tap water, or detergents gauze or fabrics absorb the disinfectant rendering it ineffective |
front 65 Alcohol - causes protein denaturation, lysis, and metabolic interruption of cells intermediate-level disinfectant | back 65 Isopropyl and ethyl alcohol in a dilution of 60-70% alcohol concentration are tuberculocidal, bactericidal, virucidal, and fungicidal; they are not sporicidal |
front 66 Alcohol ADVANTAGES | back 66 nontoxic to the skin effectively reduces number of bacteria on the skin - skin prep good range of effectiveness against several types of microbes including HIV |
front 67 Alcohol DISADVANTAGES | back 67 slight odor do not use to clean surgical instruments - highly corrosive do not use to clean endoscopes - breaks down cement highly flammable! |
front 68 OSHA exposure control plan | back 68 explains the protective measures needed to create a safe working environment A routine schedule should be established for the cleaning and decontamination of OR surfaces, scrub sinks, cabinets, floors, walls, and ceilings - Joint Commission will inspect |
front 69 Decontamination practices in the OR : prior to the first procedure of the day | back 69
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front 70 Decontamination practices in the OR : intraoperative | back 70
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front 71 Decontamination practices in the OR: between procedures turnover - which marks the preparation for the next procedure | back 71
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front 72 Terminal cleaning | back 72 end-of-day cleaning routine. A thorough cleaning of the rooms and areas outside of the OR after the last case of the day has been completed. Zambonium - a machine to clean the OR floor.. floors are usually flooded, beds are broken down to power wash them |
front 73 Other area of the surgical department that should be cleaned | back 73 substerile and storage rooms stretchers for transporting scrub sinks - due to their heavy use hallway floors - cleaned similar to the OR floors **scrub solution dispensers - gram negative bacilli have been known to contaminate disinfectant solutions and soap dispensers in the OR |
front 74 Weekly cleaning in the OR | back 74
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front 75 Dirty Cases - last procedure of the day in an OR so a thorough terminal cleaning process will occur | back 75 floor should be cleaned with phenolic detergent equipment and furniture - wiped with 70% alcohol |
front 76 First step in the prevention of the transmission of microbes Critical patient item or instrument that will be used on open tissue or be placed in the sterile field must be sterilized to remove all microbes, including spores | back 76 decontamination process |
front 77 Decontamination room | back 77 a separate area, usually in proximity to the clean sterile processing area. The design of the decontamination area environment should follow these principles:
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front 78 The first step in the decontamination process begins | back 78 at the point of use ST responsible for pre-soaking contaminated instruments to prevent drying of organic matter...
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front 79 advantages of presoaking solutions | back 79 sterile water - keeps organic debris moist enzyme - removes moistened and dried debris w/o the need for mechanical action detergent - keeps organic debris moist while loosening dried-on debris |
front 80 limitations of presoaking solutions | back 80 sterile water - ineffective in softening or removing dried debris enzyme - efficiency depends on concentration of solution, temperature, and contact time detergent - mechanical action is necessary to completely remove soil |
front 81 when cleaning instruments, remove organic and inorganic soil through one of the following methods, depending on the type of cleaning solution used | back 81 chelation enzymatic emulsification solubilization |
front 82 chelation | back 82 process of binding minerals in the solution. this prevents their deposit on the surface of surgical instruments, which causes spotting |
front 83 enzymatic | back 83 catalysts that aid in breaking down organic soil such as blood and tissue into solution |
front 84 emulsification | back 84 action o dispersing two liquids not capable of being mixed |
front 85 solubilization | back 85 action by which the solubility of a substance is increased within a solution |
front 86 common chemical cleaners: Enzymatic | back 86 organic substance that aids in the chemical reaction of breaking down organic debris. specific to type of debris to be removed more effective in warm water |
front 87 common chemical cleaners: Ultrasonic | back 87 specifically for use in ultrasonic cleaners. may contain a surfactant (to enhance wetting ability) and chelating agents |
front 88 common chemical cleaners Manual detergent | back 88 products usually used for hand cleaning of items and/or presoaking. Some of the manual cleaners are high foaming and therefore should not be used in mechanical cleaning equipment. mechanical action is required to assist in removing the soil. Surgical instruments must be thoroughly rinsed after being placed in the detergent |
front 89 common chemical cleaners Washer-decontaminator | back 89 liquid solution that is available in three different pH levels. Neutral-ph= least corrosive/less effective Moderate-ph= low-level alkaline, may be combined w/surfactants and chelating agents. Safe on SS instruments but harmful to the chromium oxide layer that protects instruments from corrosion High-pH= most effective/corrosive, must be neutralized |
front 90 cleaning - the first step in decontamination ideally this trio arrangement is utilized | back 90 First sink: wash sink with water and detergent Second sink: intermediate rinse with distilled water Third sink: final rinse with distilled water |
front 91 Manual cleaning of instruments is a three-step process | back 91 ---instruments are immersed in a solution of lukewarm water, detergent, and/or enzymatic cleaner with a neutral pH. Avoid hot water to avoid blood and tissue from being set on surface ---The last step is to rinse the instruments in distilled water ---To avoid spotting the instruments, the items should be immediately dried after rinsing |
front 92 Mechanical cleaning... recommendations for preparing instruments for the washer-sterilizer, washer-decontaminator, or ultrasonic washer | back 92 ---instruments must be placed into a perforated or wire mesh tray ---heavier instruments should be placed on bottom, delicate on top ---hinged instrument must be left in an open position to allow water, cleaning agent, and steam to contact the total surface area ---instruments with attachments must be dissembled ---instruments with concave surfaces should be placed upside down to allow proper cleaning, rinsing, steam contact, and drainage |
front 93 Washer-Decontaminator | back 93 *does not incorporate a sterilizing phase *4 cycles - prerinse, cleaning, final rinse 180-195 degrees, and drying phase |
front 94 Washer-Sterilizer | back 94 *gross soil is removed then processed in here *SS instruments not placed next to other metals-reaction could damage instruments *low-sudsing only - high-sudsing will leave a residue *8 cycles - presinse, automatic detergent injection fill phase, wash phase, postrinse, sterilization phase, lubrication (milking), drying phase |
front 95 Ultrasonic Cleaner | back 95 Used to remove small organic particles and soil from areas of instrumentation that manual or mechanical cleaning cannot reach. ex: box locks, serrations, and ratchets Utilizes cavitation for cleaning insruments |
front 96 cavitation | back 96
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front 97 Instrument preparation | back 97 here in the "clean room" (CSPD) is where instruments are checked for function and integrity and prepared for sterilization |
front 98 Advantages to non-woven materials | back 98 Impervious to moisture = waterproof |
front 99 types of pouch packaging used by health institutions | back 99 Paper-plastic combinations that are used for steam and EtO sterilization Tyvek-plastic combination used for EtO (only) and Sterrad |
front 100 Reusable rigid instrument containers with locking lids have become popular with health care facilities. The containers are multipurpose and have the following characteristics: | back 100
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front 101 ANSI/AAMI | back 101 recommends that instrument sets should not exceed 25# |
front 102 Preparation of instruments include:
| back 102 *One of the steps is proper inspection of powered instruments *An instrument may need to be lubricated and operated for a designated amount of time to ensure lubricant distribution. The power hose should be checked for cracks and cuts. The power hose should be coiled loosely to prevent kinking and damage. |
front 103 Preparation of instruments for effective sterilization..If done properly will ensure: | back 103
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front 104 How should instruments be placed: | back 104 A mesh-bottom or wire mesh basket with an absorbent towel lining the bottom |
front 105 instruments that need special preparation prior to sterilization | back 105 instruments with lumens, such as a Frazier suction tip, may have air trapped in the lumen and may prevent steam from contacting the inner surface. To prevent this entrapment of air, a residual amount of distilled water should be left inside the lumen. |
front 106 more special preparations of instruments prior to sterilization | back 106 basin sets are conducive to the formation and retention of condensate due to their density. Basins that will be nested within each other or that may contain other metal items must have adequate air space between each item. An absorbent towel should be used to separate the basins and items. It should be fully opened to absorb the condensate, to aid in air removal, and to create an adequate space for the penetration of steam. A towel should also be used to separate items from each other in the basin. |
front 107 Julian date | back 107 indicates the date of sterilization. It is the number of the calendar day 1-365/366 |
front 108 Steam Sterilization | back 108 the destruction of all microorganisms in or about an object can be accomplished with the use of steam under pressure. dependable and inexpensive method |
front 109 Methods of sterilization | back 109 Chemical agents (alcohol, phenol, heavy metals, and ethylene oxide gas,) high-velocity electron bombardment, or UV radiation. |
front 110 How are microbes killed | back 110
*heat alone is sufficient, but the process is accelerated with the addition of moisture and pressure. Pressure that is greater than that of the atmosphere is necessary to increases the temperature of the steam in order to cause the destruction of microbes. |
front 111 Factors that are critical to the outcome of the sterilization process | back 111
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front 112 sterilization failures | back 112 Containers are posiitoned incorrectly on the cart. Instrument trays, basins, and peel packs must be positioned to allow air to escape wrapped packs are placed too close together on cart. Packs should be loosely arranged on the autoclave cart to allow complete removal of trapped air and free circulation of steam |
front 113 components of an autoclave | back 113 some generate their own steam, but others rely on an outside source. When this happens 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. |
front 114 Gravity displacement sterilizer | back 114 rely on gravity to passively remove air from the sterilization chamber. Steam enters at the top of the chamber and displaces the air. Air is heavier than steam, so as the steam occupies more space, the air is pushed out the drain at the bottom front of the chamber. The pressure in the chamber increases the temp. of the steam reaches a preset temperature. these are slower than prevacuum/dynamic-air removal sterilizers because gravity is relied on to remove the air. |
front 115 Bowie-Dick test | back 115 named after two English microbiologists J.H.... ad J.... This test is used in the prevacuum sterilizer to check for air removal and entrapment and is conducted daily on the first run of the day before any loads are sterilized or after it has undergone repair |
front 116 Immediate use or "flash" sterilization | back 116 unwrapped items, such as instruments that have been dropped during a procedure. *can be performed in a gravity or prevacuum sterilizer |
front 117 advantages of steam sterilization | back 117 saturated steam is many times more effective in transferring thermal energy than hot air most economical and inexpensive safest |
front 118 dynamic-air removal (prevacuum) steam sterilization cycle times | back 118 instrument set wrapped 270 degrees for 4 minutes |
front 119 gravity displacement steam sterilization | back 119 instrument set wrapped 270 degrees for 15 min. |
front 120 methods of monitoring the sterilization process | back 120
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front 121 chemical indicators | back 121 consists of paper that has been impregnated with a dye that changes color in the presence of temperature and sterilant |
front 122 Internal steam chemical indicators | back 122 placed inside packages, peel pack, and instrument trays to indicate the contents have ben exposed to the conditions of sterilization. available as commercial strips of paper impregnated with ink should be placed in the area of the package or tray where the greatest challenge exists for penetration of steam an air removal. It is read when the package or tray is opened at time of use |
front 123 Biological indicator (BI) | back 123 *a device that contains a specific type of microorganism that is killed when exposed to the sterilization conditions *contains the spore "Geobacillus stearothermophilus" *incubated for 24hours before the reading is recorded |
front 124 where is the (BI) test pack placed | back 124 area of the sterilizer that is most difficult for the sterilant to reach. The "coldest" area where air entrapment is most likely to occur. This is the bottom front of the sterilizer cart over the chamber drain. |
front 125 EtO Ethylene Oxide | back 125 gas sterilant used to process materials that cannot be processed using steam sterilization, such as heat or moisture sensitive materials. |
front 126 EtO factors for proper sterilization | back 126 humidity: moisture hydrates spores and bacteria that would otherwise be resistant to the gas alone. Humidity is kept between 30-80% |
front 127 Moving EtO loads | back 127 loads from this sterilizer must be pulled instead of pushed to avoid the possibility of "downwind" of the fumes *EPA concerned personnel safety with its use. It's CFCs damaging to the ozone layer *OSHA developed strict PEL with its use |
front 128 Advantages of EtO | back 128 used for heat sensitive materials less corrosive to metals less damaging to plastic and rubber |
front 129 Disadvantages of EtO | back 129 aeration times an be lengthy - up to 21 days with pacemakers personnel hazards |
front 130 (BI) for EtO | back 130 Bacillus atrophaeus |
front 131 (BI) for Hydrogen Peroxide gas plasma | back 131 Bacillus atrophaeus |
front 132 (BI) for Peracetic acid | back 132 Geobacillus steraothermophilus |
front 133 Hydrogen Peroxide gas plasma limitations | back 133 difficulty with narrow-lumen or channeled instruments of sterilant reaching the innermost surfaces |
front 134 HPGP (hydrogen peroxide gas plasma) packaging | back 134 must be made of nonwoven polypropylene or other synthetic, non-cellulose, nonwoven material. Peel packages made of Tyvek are appropriate for use. |
front 135 Peracetic acid | back 135 skin tumors in mice used with Steris maching 122degrees used for rigid and flexible endoscopes used for single sterilization cycle ***FOR IMMEDIATE USE ONLY" cannot be stored! impregnated strip "wash-off" chemical strips detect that the active ingredient is present in greater than 1500 parts per million are available for routine monitoring of concentration levels |
front 136 ionizing radiation | back 136 used by industrial manufactures to sterilize prepackaged products for use in the OR and hospital environment. Uses a process of irradiation to produce thermal and chemical energy, killing microbes/spores. Gamma Rays or Beta particles to sterilize Manufacture does not use chemical indicators...pkg. integrity is the method for determining sterility |
front 137 Event-Related sterility | back 137 replaced older time-related system. It is determined by how it is handled and that contamination is not by expiration. economical for healthcare facility. It eliminates pulling expired items from shelves. |
front 138 Principles are synonymous with | back 138 action/practices |
front 139 Principles and practices/actions of sterile technique | back 139 designed to protest the sterile field from contamination and keep microbial counts to an irreducible minimum |
front 140 Surgical conscience | back 140 basis for the practice of strict adherence to sterile technique by all surgical team members. It involves a level of honesty and moral integrity that every surgical technologist must uphold in order to deliver quality patient care "There can be no compromise of sterile technique" safety of patient depends on strict adherence to this practice. And other members of the surgical team. Adherence to asepsis aids in preventing SSIs understanding of microbiology, disease transmission, cross-contamination, disinfection and sterilization |
front 141 Primary method through which microbes are kept to a minimum in the OR | back 141 Sterile field A separate sterile area that consists of the surgical site itself, draped portions of the patient, OR table, sterile portions of the gown and gloves, draped ring stands, Mayo stand, and back table. Sterile instruments, sutures, an equipment to be used during the procedure |
front 142 Inside of the paper wrappers containing linens or other sterile items is considered sterile except... | back 142 1 inch perimeter around the outside edge of the wrapper |
front 143 The integrity of sterile packaging must be checked before opening | back 143 No evidence of strike-through, tears, or punctures, all seals must be intact; and CIs must have turned color to indicate exposure to sterilizing conditions |
front 144 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 | back 144 upper chest area on the front of the gown is considered nonsterile because it cannot be directly viewed by the wearer and because of the possibility of the chin coming into contact with this part of the gown |
front 145 Sterile surgical team members should either pass while facing one another or pass back to back by rotating 360 degrees | back 145 The ST should turn her or his back to a nonsterile individual or area when walking past |
front 146 A nonsterile individual must maintain a minimum distance of 12in. from any sterile item, area, or field to prevent contamination | back 146 additionally, equipment and furniture that is not covered by a sterile drape must not be included in the sterile field and must be kept a minimum of 12 in. away from a sterile surface pr item. The ST must be conscious of these nonsterile items and personnel and maintain the 12 in. distance |
front 147 When draping a nonsterile table to create 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 | back 147 drape should be opened away from the body toward the far side of the table and then toward the body to avoid contamination |