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Periop > Midterm Week 4 (Instrument Processing) > Flashcards

Midterm Week 4 (Instrument Processing) Flashcards

1
Q

Autoclave =

A

A steam sterilizer (uses moist heat in the form of saturated steam under pressure)

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2
Q

Bioburden =

A

A population of viable microorganism on a product

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3
Q

Tests to see if the Autoclave work (2)

A

1) Biological Indicators

2) Bowie-Dick Test

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4
Q

Biological Indicators =

A

= A sterilization monitor consisting of a known population of resistant spores that is used to test the sterilizer’s ability to kill microorganisms

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5
Q

Bowie-Dick Test =

A

= An air removal test designed to test the ability of the autoclave to remove air and gases from the chamber and of steam to penetrate into a specific pack

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6
Q

Chemical Indicator =

A

= Device used to monitor one or more process parameters in the sterilization cycle. The device response with a chemical or physical change (usually a color change). They are usually supplied as a paper strip, tape, label that changes color when parameters are met

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7
Q

Disinfectant =

A

= An antimicrobial agent used to destroy microorganisms on inanimate surfaces

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8
Q

Disinfection =

A

= Process that destroys pathogenic microorganisms through the use of liquid chemical germicide. Does not kill high number of spores

Note: Does not provide same margin of safety asctd with sterilization.

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9
Q

Flash Sterilization =

A

= (immediate use sterilization) - steam sterilization process for sterilizing items that are needed immediately ex) emergency: when inst. Falls and central sterile doesn’t have any

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10
Q

Spore =

A

= An inactive or dormant, but viable state of microorganism that is diff to kill. Sterilization methods are monitored by their ability to kill a known pop of highly resistant spores

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11
Q

Sterile =

A

= Free of all viable organisms, including spores

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12
Q

Sterilization =

A

= A process that kills all living microorganisms, including spores

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13
Q

Biofilm =

A

= A collection of microscopic organisms that exist in a polysacchride matrix that adheres to a surface and prevents antimicrobial agents from reaching the cells

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14
Q

Contaminated =

A

= Refers to items that are not sterile → soiled or potentially soiled, that were open for surgery, whether or not actually used

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15
Q

Decontamination =

A

= Process that renders a contaminated item safe for handling, accomplished manually or with an automated system

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16
Q

Washer-Decontaminator =

A

= Automated processing units used to decontaminate instruments; includes washing and rinsing and maybe ultrasonic cleaning

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17
Q

Washer Sterilizer =

A

= An automated processing unit used to decontaminate AND sterilize instruments; includes washing, rinsing, and sterilization. Instruments processed in this manner are not ready for patient use and must go through final sterilization process

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18
Q

Nursing Diagnosis rt surgical instrumentation

A

High risk for infection secondary to contact with contaminated instruments and injury from instrumentation failure

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19
Q

Nursing Responsibilities for surgical instrumentation

A
  • knowledge of principles of cleaning, inspecting, packaging and storage of sterile supplies
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20
Q

Desired pt outcome rt surgical instrumentation

A
  • Freedom of Infection rt postop wound infection/SSI
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21
Q

Central Sterile processing is considered what type of area? what should be worn?

A

Semi restricted = hair cover, proper OR attire

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22
Q

Spaulding Classifications of Items (3)

A

1) Critical
2) Semicritical
3) Non-Critical

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23
Q

1) Critical =

Critical items (4)

A

= Must be sterile, items that come in contact with sterile tissue or the vascular system

  • Surgical instruments, Orthopedic implants, Sutures, Cardiac Caths
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24
Q

2) Semicritical =

Semicritical items (3)

A

= High-level disinfection* but may be sterile: Items that contact unbroken mucous membranes but do not penetrate them

  • Thermometers, Cytoscopes, Dental Dams
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25
Q

3) Non-Critical =

Non-Critical items (3)

A

= Low-level disinfection: contact skin

  • Crutches, BP cuffs, Stethoscopes
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26
Q

What is Spaulding Classification used for?

A

To determine whether an item must be sterilized or whether disinfection is sufficient

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27
Q

Methods of Sterilization are chosen based on what?

A

Choice of method depends on compatibility of item to be sterilized with sterilization process, configuration of item, required equipment, cost, availability, safety factors, packaging of item and length of time of sterilization process. Each method has advantages & disadvantages

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28
Q

Types of Sterilization (2)

A

1) Thermal Sterilization
(Autoclave - Gravity Displacement/Prevacuum Sterilizer)
2) Chemical Sterilzation
(EO/Low Temp Hydrogen Peroxide Gas Plasma)

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29
Q

Autoclave

  • Is e____, s____, and e____
  • Used for the ____ of _____
  • For sterilization to be achieved, what must happen?
A
  • economical, safe, effective
  • majority of instruments
  • steam must penetrate every fiber of packaging and contact every surface of the item, and intended parameters be met
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30
Q

What are the parameters of the autoclave? (4)

A

1) Moisture/Humidity
2) Temperature
3) Time
4) Pressure

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31
Q

What is autoclave made up of?

A

Rectangular metal chamber and a shell

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32
Q

What is the term for the space in between the chamber and the shell?

A

Jacket

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33
Q

What happens when the autoclave is activated?

A

Steam and heat fill the jacket and maintained at constant pressure, keeping autoclave in heated ready state

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34
Q

Autoclave Advantages

Steam is:

  • A____, F___, E____, and E____ safe
  • ______ with most in house _____ materials
  • leaves no ____ residue
  • Suitable for a ____ range of instruments
A
  • Available, Fast, Economical, Environmentally
  • Compatible, packaging
  • Toxic
  • Wide
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35
Q

Autoclave Disadvantages

  • Variety of instruments cannot withstand?
  • Prone to?
  • _____ of sterilization cycle must be _____
A
  • moist heat above 250 F (like endoscope, but most stainless steel can)
  • operating error
  • Timing, adjusted
36
Q

Two Types of Steam Sterilizers (Autoclaves)

A

1) Gravity Displacement

2) Prevacuum Sterilizer

37
Q

Gravity Displacement =

A

= Air in chamber is displaced by gravity. As steam enters from a port located near the top and rear of the chamber, it is deflected upward. Air is heavier than steam and by force of gravity, the air is forced to the bottom while steam rides on top of air

38
Q

Prevacuum Sterilizer (Dynamic Air Removal) =

A

= Vacuum pump evacuates air from chamber before injection of steam

39
Q

Gravity Displacement Disadvantages (2)

A

Length of time

Dependence on gravity to remove air

40
Q

Prevacuum Sterilizer Advantages

  • ______ _____ of objects inside chamber will have ____ impact upon air removal
  • Entire load will heat r_____ and more u____
  • Autoclave may be used to _____ capacity
A
  • Incorrect placement, less
  • rapidly, uniformly
  • maximum
41
Q

Prevacuum Sterilizer Disadvantage (1)

A
  • In event of a leak, air pocket can form and inhibit sterilization
42
Q

IUSS (Immediate Use Steam Sterilization) =

  • when no ____ available
  • IUSS should not be used for?
A

= “sterilization of items intended for immediate use and cannot be stored for later use” (quick way to sterilize an unwrapped item)

  • replacement
  • routine sterilization or whole sets of instruments
43
Q

Chemical Sterilization (2)

A

1) Ethylene Oxide Gas (EO)

2) Low Temperature Hydrogen Peroxide Gas Plasma

44
Q

Ethylene Oxide Gas (EO) =

A

= a toxic gas used to sterilize items that cannot tolerate temperature and moister of steam sterilization. Achieves sterilization by interfering with protein metabolism and reproduction of cell

45
Q

What is EO Gas used for? (4)

A
  • flexible and rigid endoscopes
  • plastic goods
  • instruments with electrical components
  • delicate instruments that will dull after repeated steam sterilization
46
Q

What are the parameters for EO Gas sterilization? (4)

A
  • Temperature
  • Humidity
  • Exposure Time
  • Gas Concentration
47
Q

EO Gas Advantages (4)

A
  • Effective against all types of microorganisms
  • Does not require high heat
  • Noncorrosive
  • Effectively penetrates large bundles and permeates all porous items
48
Q

EO Gas Disadvantages (5)

A
  • Toxic (Carcinogen)
  • Lengthy time
  • Highly flammable
  • Strict local, state, and federal regulations
  • More expensive
49
Q

Low Temperature Hydrogen Peroxide Gas Plasma =

A

= radio frequency or electrical energy & hydrogen peroxide vapor within vacuum effectively kills microorganisms

50
Q

Low Temperature Hydrogen Peroxide Gas Plasma Advantages (5)

A
  • Safe alternative to EO (not toxic)
  • Short time
  • Hydrogen peroxide is compatibile with most metal and plastics
  • Simple to operate
  • No plumbing or drains
51
Q

Low Temperature Hydrogen Peroxide Gas Plasma Disadvantages (1)

A
  • Not compatible with powders, liquids, linen, gauze and paper
52
Q

Before it can be assumed that a sterilizer is working properly and that an article can be considered sterile, certain parameters must be met (4)

A

Time
Humidity
Pressure
Temperature

53
Q

Indicators are used to monitor these parameters, indicators provide opportunity for a variety of personnel to check the process (3)

A

Mechanical (Physical) Indicators
Chemical Indicators
Biological Indicators

54
Q

Physical Monitors =

A

= Graphs, Temperature, Pressure Recorders, Digital printouts and gauges that record activity during sterilization

55
Q

Biological Indicators =

  • __-__ indicators placed _____
  • ______ after sterilization for ___ hours
    • growth reading =
A

= Strips, Ampoules, Capsules that contain highly resistant spores

  • 1-2, inside
  • Incubation, 24
    = sterilization conditions not met → requires sterilizer to be taken out of service
56
Q

Which indicator is the most accurate method of ensuring efficacy of the sterilizer?

A

Biological Monitors

57
Q

How often should steam sterilizers be tested with the Biological Monitor?

A

Daily

58
Q

Chemical Indicators =

A

= Tapes, Strips, Labels impregnated with dye or chemical that develops visual or physical change when certain conditions are achieved

59
Q

The Bowie-Dick Test is what type of indicator?

A

Chemical indicator - to test efficacy of air removal and steam penetration in pre-vacuum sterilizers

60
Q

Where should chemical indicators be placed?

A

Inside and outside of all packages (possible to have an outside indicator pass and inside indicator fail)

61
Q

Do chemical indicators establish sterility?

A

NO, they are tools to determine whether conditions of sterilization have been met

62
Q

What does tape with black marks mean?

A

Tape with Black marks = has been processed/sterilized, may bring into OR, inside will be another tape indicator

63
Q

Examples of Disinfectants (5)

A
  • Alcohol, Chlorine, Formaldehyde, Glutaraldehyde, Hydrogen peroxide

Glutaraldehyde = high lvl disinfectant that is also capable of sterilization but bc of lengthy immersion period required to sterilize, rarely used

64
Q

Levels of Disinfection (3)

A

1) Low Level Disinfection
2) Intermediate Level Disinfection
3) High Level Disinfection

65
Q

Low Level Disinfection (3)

A

Vegetative bacteria, lipid viruses, some fungi

66
Q

Intermediate Level Disinfection (4)

A

Vegetative bacteria, Viruses, Fungi, + Myobacteria

BUT NOT SPORES

67
Q

High Level Disinfection (5)

A

Vegetative Bacteria, Virus, Fungi, Myobacteria

+ SOME SPORES

68
Q

Intraoperative Cleaning =

A

= First and most important step in instrument decontamination is cleaning

  • Contaminated instruments should be washes asap to prevent blood & debris from drying in crevices or on instrument surfaces
69
Q

Should instruments be washed during procedure? using what?

A

Should be periodically wiped and or rinsed with wet lap sponge or immersed in sterile water NOT saline, lumens should be flushed

70
Q

Postoperative Cleaning =

A

= start cleaning process ASAP → transported to dedicated decontamination area in leak-proof container

71
Q

What should be done before instruments are cleaned? (4)

A
  • Disassembled, Blade & drill bits removed from handles
  • Sharps should be segregated from general instruments
  • Box locks and other joints opened
  • Heavy instruments placed on bottom
72
Q

1) What if theres no automated washer?
2) Describe manual cleaning?
3) What should personnel wear during mechanical cleaning?
4) After mechanically cleaned, where do the instruments go?

A

1) May be manually cleaned
2) Mechanical cleaning in an automated system is preferable bc the process has been validated and is consistent
3) PPE
4) Placed in trays with wire open mesh bottom → then placed in washer sterilizer or washer-decontaminator where mechanical cleaning occurs

73
Q

Ultrasonic Cleaning =

A

= dislodges and removes tenacious debris → using high intensity sound waves that generate tiny bubbles that expand until they collapse or implode and dislodge the debris

74
Q

Ultrasonic Cleaning

  • Some instruments such as flexible _______ & ______ instruments need special attention and include a complex multistep process
  • Instruments with movable parts should be ->
  • Instruments are inspected for ->
A
  • endoscopes, robotic
  • lubricated with an antimicrobial, water soluble lubricant
  • cleanliness, integrity, alignment, sharpness of edges, and function
75
Q

Packaging Materials are intended to do what? and should be compatible with?

A

To maintain sterility of items, should be compatible with sterilization process and device manufacture directions

76
Q

Types of Packaging Systems (4)

A

Woven Fabrics
Non-Woven Fabrics
Plastic/Paper, Plastic/Tyvek pouches
Rigid Container Systems

77
Q

Woven Fabrics =

Reusable?

A

Cotton and polyester-blend fabrics are used to wrap material after cleaning and before sterilization

  • Reusable
78
Q

What types of sterilization are woven fabrics compatible with and not with? (2), (1)

A

Steam and EO, not Hydrogen Peroxide

79
Q

Nonwoven Fabrics

A

= Single use, disposable wrapper

80
Q

What types of sterilization are non-woven fabrics compatible with and not with?

A

Steam and EO, not Hydrogen Peroxide

81
Q

Plastic/Paper, Plastic/Tvek Pouches

Advantages (3)
Disadvantages (1)

A

= Used to wrap items in preparation for sterilization

  • Inexpensive, permit visualization of contents, lint free
  • Little resistance to puncture
82
Q

Rigid Container Systems =

Advantages (1)
Disadvantages (2)

A

= Rectangular receptacles made from aluminum, stainless steel, heat resistant plastic, or combination. Lid and base held together by a latch or lock and key

  • Durable and protects instruments from damage
  • Weight (heavy) and potential for residual condensation
    Must be washed, inspected and maintained prior to filling
83
Q

What type of packaging is best?

A

Rigid Container

84
Q

Shelf Life

1) Where should sterilized items be stored?
2) Where should sterile items vs clean items be stored?

A

1) Sterilized items should be stored in a well ventilated, limited access area with controlled temperature and humidity
2) Separately and not under sinks or other areas where may get wet

85
Q

How long is an instruments shelf life?

A
  • NO EXPIRATION DATE ON STERILITY, shelf life is event related, not time related
  • A package is sterile until an event happens to render that package unsterile

Periop (9 decks)

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