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BDS3 BAMS Patient Safety > Decontamination: Operator Level and Process Overview > Flashcards

Decontamination: Operator Level and Process Overview Flashcards

1
Q

processing

A
  • refers to how we manage the journey of our RMD’s after they have been used for a procedure and have been contaminated
  • must use a series of automated and manual processes to remove all of the contamination from the surface of the instruments and then sterilise them to ensure we have made them safe to be reused on other pts
    • there are established and agreed procedures for ‘processing’ instrumentation in a way that achieves the globally recognised set-points and stages
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2
Q

RMD’s

A

reusable medical devices

  • not all equipment used in a procedural environment is reusable
    • large proportion is single use and must be disposed of using the correct waste streams
  • instrumentation that is our responsibility to process correctly in line with guidance and standards nationally agreed
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3
Q

conditions to met on cleanliness, disinfection and sterilisation of RMDs

A

conditions required to meet cleanliness, disinfection and sterilisation are globally recognised

  • use guidance documents as resources to identify them
    • reference standards and legislation which is relative to the area in which you work
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4
Q

guidance

A
  • series of documents available – SHTM’s (Scottish Health Technical Memorandum)
  • documents vary depending on the region you work within the UK
    • other local procedures will have been agreed out-with the UK and Europe so familiarise yourself with local guidance
  • offer advice and direction on what standard must be achieved in relation to any piece of equipment we purchase, install and operate
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5
Q

standards

A

refers to the British and Europeans Standards (BS EN)

  • agreed through a collaboration between Scientific, Engineering and Healthcare Professionals
    • spanning decades
  • framework for how every piece of equipment should be operated, the parameters that it must work within and the standard in which it is produced to

BSEN documents are extensive and highly technical with a far reaching ranfe

  • Cover everything from the manufacturing of equipment, the installation of it, the services it requires to operate, the conditions it should be able to achieve, how we should test its operation and validate it for usage
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6
Q

legislation

A
  • Legal requirement to achieve all locally agreed standards and operate your facility, and every piece of equipment within it, in line with all recommendations and obligations
  • Practices receive a CPI (Combine Practice Inspection) on a periodic basis
    • Trained professionals verify you are operating a sufficient and effective process
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7
Q

services

A
  • Things that your equipment needs to operate correctly
    • such as hot or cold water, purified water, drainage connections, steam connections and electricity
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8
Q

validate/ equipment validation

A
  • before we start to use a medical device to carry out our day-to-day production work, it must be validated to ensure it is working properly
    • extensive engineering work that tests all components of the machine to verify their correct operation
      • all incoming supplies are available and suitably matched to the machine requirements
      • test the actual operation of the machine, check loading patterns for instruments and cycle programming along with temperature set-points and other critical data
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9
Q

LDU

A

local decontamination unit

GDH&S LDU

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10
Q

used instrumentation goes

A

on entering LDU must set instruments down in an established area

  • depending on size of unit you may have a separate set down area or might be the same as the established unload area
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11
Q

suitable transportation containers must (3)

A
  • rigid, durable, leak proof containers
  • tight fitting lid
  • easily cleaned and disinfected

containers must also be easily distinguishable from each other (generally colour coded) so that they cannot be mixed up

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12
Q

Personal protective equipment PPE

A
  • consumable items that we use to protect ourselves and everyone else from the infectious substances that we encounter within a decontamination environment

follow ‘donning’ and ‘doffing’ recommendations

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13
Q

donning PPE

A

hand hygiene

gown/apron

mask

visor/eye protection

gloves

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14
Q

doffing PPE

A

gloves

eye protection/visor

mask

apron/gown

hand hygiene

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15
Q

gloves

A

prevent infectious substances adhering to our hands

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16
Q

gown or apron

A

protect ourselces from splashes and contamination

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17
Q

face visor

A

prevent contamination being splashed into our eyes and face

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18
Q

heavy duty rubber gloves when manually washing instrumentation

A

protect against sharp injuries

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19
Q

hand hygiene

A
  • essential to carry out sufficient hand hygiene on entering and leaving the decontamination environment
    • if operating a single room facility, we should also carry out hand hygiene procedures during clean and dirty steps of the process
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20
Q

hang hygiene + PPE donned

A

working in a safe manner

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21
Q

processing cycle of RMDs

A
  • red tab is the beginning of the process where we either introduce newly acquired instrumentation into our cycle or start processing instrumentation we already have in use
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22
Q

what stages take place in AWD

A

cleaning and disinfection (1 and 2)

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23
Q

AWD

A

automated washer disinfector

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24
Q

cleaning

A
  • Remove any biological matter, bodily fluids, proteins (with specific relation to prion vCJD) or infectious substances and also reduce the amount of microbial presence
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25
Q

disinfection

A
  • First part in our decontamination cycle that we are actively targeting microbial presence and reducing the amount on the surface of our instrumentation
    • Carried out using heat
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26
Q

checks of machines in LDU

A

Before we can start to process our instrumentation through any of our machines, must carry out some simple checks to verify everything in the machine is in working order

  • Referred to as ‘daily’ and ‘weekly’ checks
    • are the responsibility of the operator and persons loading and using the equipment to carry it out
    • Simple mechanical checks that may help prevent failed loads or instrumentation not being cleaned to the required standard
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27
Q

responsibility of ‘daily’ and ‘weekly’ machine checks

A
  • are the responsibility of the operator and persons loading and using the equipment to carry it out

Simple mechanical checks that may help prevent failed loads or instrumentation not being cleaned to the required standard

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28
Q

importance of ‘daily’ and ‘weekly’ checks

A

Simple mechanical checks that may help prevent failed loads or instrumentation not being cleaned to the required standard

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29
Q

‘daily’ and ‘weekly’ checks in reference to AWD (5)

A
  • Verifying the spray arms rotate freely and without obstruction and that none of the jets are blocked
    • One on bottom and one at top
      • can be removed, cleared and hand tightened is jet blocked
  • Verify that the load carrier is not damaged and has no debris or parts of instrumentation from previous cycles
  • That the strainers/filters on the bottom of the chamber are clear and there are no blockages present
  • Check the door seal (which is white rubber seal on the machine in LDU) is intact and there is no contamination or debris present that might prevent it from sealing
  • Sufficient amount of chemical within the reservoir of the machine for the cycles we are running
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30
Q

readings needed from AWD

A

Also need to take some readings from the machine in relation to the cycles we are running

  • Cycle numbers, times and set-points (temperatures, chemicals dosed)
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31
Q

guidance for operating equipment

A

all must adhere to the guidance on operating equipment (SHTM 2030) so that they are achieving the right standard

large number of suppliers of medical devices for processing instrumentation – all have their own processes and functions

  • They can structure their processes how they wish as long as meet agreed criteria
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32
Q

‘load carrier’

A

door opened with the ‘load carrier’ sitting on it

  • this holds the instrumentation in place as it is processed through the cycle
  • also designed to connect with water outlets (bottom left at back) and position what is being processed in such a way that it will be cleaned to the highest capability of the machine
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33
Q

describe this AWD

A

underbench, single chamber, single door access AWD

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34
Q

what is on the right hand side of this AWD

A

Right hand side of picture is the operations panel and LED screen – where we can initiate cycles and gather information on the progress of the cycle as well as operating temperatures and times

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35
Q

loading AWD

A
  • PPE
  • No overlapping or shadowing
  • Hinged/jointed instruments should be opened at hinge
    • Position in such a way that they will not close during the cycle
  • Disassemble assemblies
  • Use the carrier furniture to not overload the machine

Shut door correctly

Operations panel

  • Buttons correspond to different cycles
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36
Q

what cycle is selected on AWD and how to start

A
  • short’ cycle
  • ‘maintenance’ – indicates machine is due a periodic maintenance visit

Middle cycle button to start – then display changes to current temperature in the machine and drain (refers to first stage of cycle)

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37
Q

AWD cycle begins with

A

drain stage incase there is any water left from pervious cycle

  • Cross contamination risk
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38
Q

one of the most effective features of AWD

A

uses fresh water for each individual stage – meaning any contamination is removed at each stage, is then flushed away and is no longer present

  • E.g. NOT the case when using ultrasonic bath
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39
Q

how to use the load carrier effectively in AWD

A

on the left have handpieces connected to the rail which allows water to flow through the inside of the handpiece, cleaning everything internally while the water distribution system cleans the outside

then rigid steel instrumentation (probes, mirrors etc) loaded into cassettes and organised utilising the available slots on the load carrier

on the right there is the assemblies disassembled (assembly is anything with more than one part, that can be disassembled) and forceps positioned in a way that they are opened at the hinge and should remain opened throughout the different stages of AWD cycle

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40
Q

criteria AWD must meet

A
  • Have a sufficient, validated washing and cleaning process, which will remove all biological matter and contamination from the surface of the instruments. This can consist of numerous stages to ensure it has been carried out correctly.
  • The machine must then carry out a thermal disinfection, saturating all of the items being processed, with water heated to between 90 - 95oC, for a set hold time.
  • The machine must then dry all of the instrumentation, generally using hot air, so that at the end of the cycle it is dry and the majority of excess moisture has been removed. Wet instrumentation can cause problems for us as we reach the sterilisation stage within out decontamination cycle.
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41
Q

3 stages in AWD

A

prewash/flush

main wash/wash

rinse

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42
Q

prewash/flush stage in AWD

A

This is the initial stage and uses water below 35 oC. This stage removes ‘Gross Contamination’ and helps to saturate remaining contamination, making it easier for the following stages to remove.

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43
Q

mainwash/wash stage in AWD

A

This stage of the cycle is supplemented with detergent. It must be heated to the temperature specified by the detergent manufacturer (generally in the range of 45 – 65oC). This is for the efficacy of the detergent. The cycle is validated with the specific detergent used so we must continue to use that detergent, or have a re-validation carried out

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44
Q

rinse stage in AWD

A

This stage helps to remove any remaining residue from previous stages, including any residue from the chemicals used.

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45
Q

all 5 stages in AWD

A

prewash/flush

main wash/wash

rinse

thermal disinfection/disinfection

drying

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46
Q

by the end of the Rinse stage in AWD

A

all contamination should have been removed by the end of the Rinse stage

The stages up until this point are considered collectively to be the cleaning stages.

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47
Q

thermal disinfection/disinfection stage in AWD role

A

carried out at high temperature and has the potential to bake any remaining contamination on to the surface of the instruments, making it harder to remove

  • instrumental in removing prion or vCJD.
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48
Q

thermal disinfection/disinfection in AWD

A

This stage actively targets microbial presence. Due to the high temperatures achieved, after this stage, we have removed more than 99% of all contamination/microbial growth on the surface of the instruments. The stage achieves temperatures between 90 - 95 oC for a minimum stage time of 1 minute.

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49
Q

drying stage in AWD

A

This stage uses hot air to remove any remaining moisture from the surface of the instruments so they are dry for following stages. There is no required temperature set point, only a ‘Load Dryness’ check at the end of the cycle.

50
Q

post AWD

A

so far dealing with the cleaning and disinfection stages.

  • Once load finished in the AWD it will have been disinfected and free from 99% of all contamination that it arrived in the LDU with.

before we unload the machine it is essential that we dispose of the PPE that we had been wearing and perform hand hygiene practices again.

  • Any of the potentially harmful substances that may have been present on the instrumentation, may very well be on your gloves and apron at this stage.
    • So remove the PPE, dispose of it in the correct waste stream, carry out hand hygiene and then put on fresh PPE.
  • minimising the risk of spreading infectious or harmful substances throughout the LDU.
51
Q

once instruments out of AWD

A

inspect instrumentation to verify that process has been carried out to required standard

  • instrumentation must be free from all contamination and biological matter and have no visible residue of any kind

use an illuminated magnifier to assist in thorough inspection

52
Q

how to remove any residual moisture that can be on the instruments post AWD

A

use a non/low linting cloth to remove any moisture that could be present post cycle – sterile at point of use

53
Q

where to check for remainig contamination with illuminated magnifier

A
  • hinges
  • inner surface of jaws
  • any textured surfaces of the instruments
54
Q

I can operate a medical device, for the reprocessing of RMD’s, without first having a validation carried out

true or false

A
  • False - every Medical Device must first be validated by a trained and qualified engineer.
55
Q

what is the temperature recommendation for the first stage of an AWD cycle

A
  • < 35 degrees
  • Higher temperatures than this may cause proteins to coagulate, potentially making then harder to remove
56
Q

I should manually wash my instruments before processing them in an AWD to help with the cleaning process?

A
  • False – if AWD can do it – why bother at this stage
57
Q

guidance documents refer to

A

BS EN standards

  • Guidance documents are our ladder to understanding the standards we should operate our equipment in line with.
58
Q

temperature range for removing gross contamination

A

<35oC

59
Q

sterilisation

A

the process which used instrumentation is subject to, generally using high temperature and clean-steam pressure to destroy any microbial presence on the surface of the instruments, offering assurance that we have minimised the risk of Healthcare Associated Infections (HAI’s),

  • by ensuring the instruments are sterile or have been sterilised, for any patients that the instruments will be used on in the future.

From SHTM 01 - 01 Part A - In a sterilization process, the nature of microbial inactivation is exponential and thus the survival of a microorganism on an individual item can be expressed in terms of probability.

  • While this probability can be reduced to a very low number, it can never be reduced to zero
60
Q

SHTM 01-01 Part A sterilisation

A

In a sterilization process, the nature of microbial inactivation is exponential and thus the survival of a microorganism on an individual item can be expressed in terms of probability.

  • While this probability can be reduced to a very low number, it can never be reduced to zero
61
Q

clean steam

A

this term is in reference to steam made form purified water opposed to steam being made directly from potable water (tap water).

  • essential in the sterilisation process as almost every bit of particulate has been removed from the water before it is used to produce steam
62
Q

potable water

A

Potable water still has the potential to carry harmful substances and mineral particulate that can form residue on items it contacts. (tap water)

63
Q

sterile

A

the definition for this is ‘free from all viable microorganisms’.

  • As with the above definition the only guarantee that we can offer is that we processed our instrumentation to the best of our abilities, following all recommended guidance and achieving all required standards.
64
Q

sterilised

A

this would suggest that something is not sterile at the point of use.

  • An instrument may have been subject to a sterilisation process but without proper handling and management may no longer be sterile at the point it will be used for a procedure.
  • This will become clear as we progress.
65
Q

pressure can be measured/displayed by

A

‘Bar gauge’ or ‘Bar absolute’

66
Q

bar gauge

A
  • this is in reference to pressure being measured with the starting pressure/atmospheric pressure listed as ‘0 bar’ (atmospheric pressure is approximately 1 bar)
67
Q

bar absolute

A
  • this is in reference to pressure being measured from absolute zero (complete vacuum) where atmospheric pressure is identified, correctly, as 1 bar
68
Q

3 categories for sterilisers

A
  • Type-N
  • Type-B
  • Type-S
69
Q

common factor in different sterilisers

A

all use steam to destroy microbial presence.

On-board the machine itself there is a steam generator.

70
Q

issue with generating steam for sterilisers

A

issue we have is that the temperature we require exceeds the boiling point of water.

  • We must increase the pressure and in order for us to do this we need to trap the steam with a vessel while producing more steam to feed into that vessel.
    • The pressure will then begin to increase and the temperature along with it.
  • The vessel in this situation is the chamber of the steriliser where we will be loading the instrumentation.

This allows us to increase the temperature of the steam to the required temperature banding that we are looking for (134 – 137o).

Unfortunately, the process is not as simple as injecting steam into a chamber though.

71
Q

‘pressure vessel’ checks

A

requires an annual validation and inspection by a ‘Competent Person’ from your insurance company.

  • Competent person
    • anyone with the requisite skill set that is occupationally competent to be carrying out the work, within their designation.
72
Q

type N steriliser

A

also referred to as a ‘Gravity Displacement Steriliser’.

offers the most basic of sterilisation processes and has limitations on the equipment that can be processed through the machine.

  • Only unwrapped, rigid steel instruments, without channels or lumens, can be processed through this equipment.

The cycle differs significantly from other, more effective, sterilisation processes.

73
Q

type B steriliser

A

also referred to as a ‘Porous Load or Vacuum Capable’ steriliser.

The process in this machine is far more robust and effective than the Type - N.

  • All our equipment (providing it is not temperature sensitive) can be processed through the machine.
  • Wrapped instrumentation and channelled and lumened instrumentation can also be processed.
74
Q

type S steriliser

A

also referred to as a ‘Statim’ or ‘Special’ steriliser.

The process in these varies significantly from the other two.

They potentially have more processes than simply sterilising such as washing and lubrication as well.

We can only process the specific instrumentation mentioned in the manufacturer’s recommendations for use.

  • Manufacturers recommendations should be followed at all stages for this equipment, including, type of instrumentation, loading requirements and continued testing and maintenance of the machine.
75
Q

channelled and lumened

A
  • this is in reference to instrumentation that has internal structures (water channel, air channel) and must be sterilised inside and out. Easiest example of this would be a hand piece
76
Q

main difference between Type N and Type B

A

N does not have vacuum capabilities.

  • It achieves the same temperature and holds it for the same amount of time;
    • (134 - 137oC for a minimum of 3 minutes)

but it does not have air removal due to the lack of vacuum capabilities which creates the limitations on the equipment that can be processed through this machine

77
Q

issue with air in type N steriliser

A

When we close the door on the chamber, it is filled with air.

On this machine the steam is created inside the chamber, almost like a pressure cooker.

As the steam pressure builds up it passively forces the air from the chamber.

  • This process isn’t entirely efficient and can lead to pockets of air remaining in the chamber.

Air does not behave the same way as steam, it does not heat well and will always be a lower temperature.

  • This is an issue for us as every part of the chamber and everything being processed must reach the required temperature, for the required amount of time.
78
Q

issue of air in steilisation

A

Air does not behave the same way as steam, it does not heat well and will always be a lower temperature.

  • This is an issue for us as every part of the chamber and everything being processed must reach the required temperature, for the required amount of time.
79
Q

cannot process

in type N

A
  • wrapped instruments,
    • as the steam cannot penetrate the wrapping to contact the instruments,
  • channelled/lumened instruments,
    • as the steam will not reach all internal and external surfaces.

This limits the testing of the process as well.

80
Q

type B steriliser

A

vacuum capability is entirely different and far more robust than that of type N

81
Q

process in Type B

A

close the door on the chamber, it is filled with air.

the first stage of the machine is to remove all of this air by using a vacuum pump.

  • Atmospheric pressure is approximately 1 bar or 1000 millibar (mb), as is the case within the chamber, when we have loaded our instrumentation.
  • Because the door and chamber are sealed together, when the vacuum process begins, it causes a drop in pressure inside the chamber,
    • from the 1 bar at atmospheric pressure, down towards absolute zero.
      • Atmospheric pressure - 1000mb.
      • Pressure during vacuum stage - 80mb.
    • That means we have a 920mb difference in pressure from atmospheric.
      • physically sucks all of the air from the chamber so that it cannot interfere with our process.
        • temperature differential can be in excess of 5oC if air is present within the chamber.

The steam is not produced in the chamber on this machine either.

  • There is a clean steam generator built into this equipment that feeds steam into the chamber.

As soon as the steam valve opens, because of the negative pressure inside the chamber the steam is sucked right inside, rushing in to come into contact with all surfaces.

There are several ‘pulses’ of steam,

  • where steam is introduced and then drawn back out of the chamber, via the vacuum pump.
    • This is to ensure that the first bit of steam we introduce to the chamber has not condensed back into water, while waiting on us reaching our sterilisation temperature (134 - 137 oC for minimum 3 minutes).

At the end of the cycle there is a another vacuum stage that allows any remaining moisture to vaporise so that it does not saturate the product.

  • By dropping the pressure it changes the boiling point of water which means any remaining moisture will turn into steam at much lower temperatures (approx. 80 oC or less).
82
Q

can process in type B

A

Because of the combination of air removal and high steam inlet pressure, we are able to penetrate wrappings surrounding the instruments and contact all surfaces of the instruments being processed. The same applies when processing channelled and lumened instruments.

  • If we are processing a hand piece, the vacuum stage means that the steam rushes in and floods the internal surface of the hand piece, and all channels within it as well.
83
Q

required pressure =

A

meeting required temperature

84
Q

importance of packaging remaining intact for Type B sterilisation

A

Because instruments are wrapped in semi-porous packaging before they are processed through a Type - B, as long as the packaging remains intact, the instruments will be sterile at the point of use.

  • The packaging has been fully sterilised on the inside, along with the instruments within it, and acts as a protective layer allowing processed equipment to be stored and remain sterile while doing so.
85
Q

type N daily checks

A
  • Verify condition of door seal – ensure no contamination debris or damage that may prevent it from sealing properly
    • Safety – high temperature and pressures
  • No instruments from previous cycles or debris on load carrier or inside the chamber (wrappings etc)

Heating element at bottom of chamber – water enters and is heated inside the chamber

  • Ensure sufficient amount of water in reservoir – on top of machine
86
Q

type B daily checks

A
  • Verify condition of door seal – ensure no contamination debris or damage that may prevent it from sealing properly
    • Safety – high temperature and pressures
  • No instruments from previous cycles or debris on load carrier or inside the chamber
  • Load carrier is in a sufficient condition

No heating element in chamber in B type

Sufficient water in feed tank

87
Q

tests for type B sterilisers

A

‘Bowie-Dick’ test or ‘Steam Penetration’ test on a daily basis.

chemical indicators

88
Q

Bowie-dick test

A

checks for steam penetration but also informs us that our temperature has been reached and there has been sufficient air removal within the chamber.

  • Once the correct temperature is achieved within the machine the colour change (yellow - navy blue) takes place.
  • Anything less than a 100% colour change is a fail.
89
Q

devices for testing sterilisers known as

A

PCD/ Process Challenge Device/ Process Control Device

chemical indicator

90
Q

examples of PCDs

A
  • the ‘Bowie-Dick’ test sheet on the bottom right,
  • ‘hollow load check’ or ‘helix’ on the top right
  • on the left hand side just a standard chemical indicator.

They are all chemical indicators that have intelligent ink that changes colour (yellow - navy blue) at a very specific temperature (at least 134oC). Due to the way the other two are setup during processing, they also inform us of steam penetration and air removal.

91
Q

loading instruments in N-type sterilisers

A

limitation to what we can process – recommended do not process anything with channels or lumens, hinge (preferably B), wrapped

  • so only rigid steel instrumentation with no channels, lumens or joints

no overlapping or shadowing

adequate space between instrumentation

use load carrier

  • ensure steam comes into contact with all surfaces of instrumentation

close door and manually lock

select cycle button (134oC)

92
Q

loading instruments in typeB steriliser

A

can process wrapped instrumentation

  • steam able to penetrate throught porous side of wrapping and come into contact with all sides of instruments

same principles – don’t overload, overlap and utilise load carrier

  • chemical indicator on wrapping
    • 2 coloured bars on top of packet
    • Colour change takes effect when designated temperature achieved
  • Essential to not damage wrapping as loading instrumentation into the machine
    • Damage – air and contamination can enter – instrumentation no longer sterile, has just been sterilised
93
Q

general loading requirements

follow at all times for all instruments

A
  • no over-lapping or shadowing of equipment
  • do not overload the machine or chamber
  • utilise the space on the available load carrier or basket
  • hinged or jointed instruments should be open at the hinge
  • any assemblies should be disassembled prior to processing
  • everything should be processed to the best of your capabilities so that it maintains its position throughout processing
94
Q

what can be processed in type N steriliser

A
  • only rigid steel instruments should be processed through this machine (probes, mirrors, tweezers)
  • no channelled or lumened instruments such as hand pieces. The machine process is not capable of sterilising all surfaces inside and out
  • wrapped instrumentation cannot be processed through this machine at all
95
Q

what can be processed in Type B steriliser

A
  • nearly all instrumentation can be processed through this type of equipment
  • wrapped instrumentation and porous loads (fabrics, cotton swabs) can be processed through this equipment
  • we can process channelled and lumened instruments through this equipment
  • it is essential we do not damage wrappings when loading the machine
96
Q

what can be processed in Type S steriliser

A
  • these machines are specialist and generally designed for a specific purpose eg sterilisation of hand pieces
  • manufacturers recommendations must be followed for the loading and operation of this equipment
97
Q

vacuum leak/air leaking test

A

this is to verify the vacuum capability of the machine and is carried out on a weekly basis

98
Q

helix/bowie-dick test

A

this test is for steam penetration and is carried out on a daily basis with the use of PCD’s

99
Q

ADFT test

A

air detection function test

this test is carried out on a weekly basis and is designed to check the safety device within the machine, for detecting air

100
Q

different cycles and temperatures of steriliser

A

some are for tests (vaccuum leak, bowie-dick, AFDT)
standard temperature steriliation

‘fast’ cycles/ other temperature cycles

  • generally reserve these for temperature sensitive equipment i.e. anything that could be damaged by the process at 134 – 137oC.
101
Q

134-137oC

sterilisation

A

for a minimum ‘stage’ hold time of 3 minutes (this is the most commonly used temperature set-point)

102
Q

121-124oC

sterilisation

A

for a minimum ‘stage’ hold time of 15 minutes (for temperature sensitive equipment)

103
Q

115-118oC

sterilisation

A

for a minimum ‘stage’ hold time of 60 minutes (generally lab sterilisers, rarely used in health care)

104
Q

3 sterilisation temperature ranges

A
  • 134 - 137 oC most commonly
  • 121 - 124 oC temp sensitive equip
  • 115 - 118 oC rare in healthcare
105
Q

issue with reduction in sterilisation temperature

A

Due to the significant increase in processing times, a reduction in sterilisation temperature can alter the production capabilities of a unit and reduce its efficiency to process the desired volume of instrumentation.

3 mins at 134-137

60 mins at 115-118

106
Q

‘sterilisation cycle’

A
  • A full cycle on a machine will take in excess of 30 minutes, generally.
107
Q

‘stage hold time’

A
  • The stage time is in reference to the minimum amount of time the sterilisation stage must last for, after the required temperature has been reached
    • i.e. once our chamber temperature is over 134 oC the ‘stage’ must hold that temperature for at least 3 minutes.
108
Q

fast cycles are

A

cut down version of the main cycle.

  • The sterilisation stage will remain a constant.

It may not produce the same level of vacuum efficiency or might have a shortened drying stage at the end of the cycle.

  • This cycle could be used if we were processing a reduced number of instruments or smaller loads through the machine.
109
Q

protein/prion can only be removed in

A

rigorous cleaning process. Prion (specifically vCJD) can survive temperatures in excess of 150 oC for hours at a time (AWD)

  • It is not feasible for us to operate a sterilisation service such as this and the set-points of this cycle would not cater for that
110
Q

what happens when sterilisation process complete

A

machine will inform us when the cycle has achieved its set-points and completed successfully (END on screen)

Particular attention should be given to making sure the machine identifies the cycle has completed successfully, as this will offer us assurance that sterilisation has taken place.

  • A print out, receipt or on more modern machines, a PDF document will be created to verify all cycle set-points have been achieved, and also for traceability purposes, to ensure you are operating your equipment to the required standard.
111
Q

can moisutre be present after steilisation cycle

A

yes

common for type N

112
Q

what to do if moisture on instruments post sterilisation cycle

A

recommended to leave in machine with door ajar so that they can cool down and any remaining moisture can lift itself from the surface

113
Q

what happens when open door after sterilisation cycle for Type N

A

recontamination

no wrappings

114
Q

health and safety concern for any operators in regards sterilisation machines

A

excessive high temperatures and pressures during the cycle

  • Hot
  • Use handle to remove instrumentation
115
Q

chemical indicator on wrappings

A

change colour when reach steriliastion temperature – easy ID if been processed or not

  • Cannot be used as challenge devices – only serve to identify if something has actually been processed through a sterilisation cycle or not
    • Used to ensure everything has been subject to the correct and required processes
116
Q

what to do with instruments after sterilisation

A

Leave to cool down in clean instrument cool down area before placing in clean instrument transport box (blue)

  • If placed in hot there is potential for condensation to build up and soak into packaging
117
Q

affect of using tap water in steriliser

A
  • It has the potential to leave residue on the surface of the instruments
    • As none of the particulate or minerals have been removed these can potentially create deposits on the surface of instrumentation
118
Q

wrapped instruments processed in

A

type B steriliser

119
Q

For our standard sterilisation temperature banding, the cycle time should be 3 minutes

A
  • False – don’t confuse cycle time and stage time
120
Q

vacuum sterilisers first stage is

A

air removal

121
Q

standard sterilisation cycle temperature

A

134-137

BDS3 BAMS Patient Safety (12 decks)

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