CNOR Infection Prevention and Control of Environment, Instrumentation, and Supplies pt 2 Flashcards
(146 cards)
1
Q
Packaging materials should be compatible with what?
A
different types of sterilization methdos
2
Q
What 3 things disqualify a package from being used?
A
- broken seals
- evidence of loss of package integrity (the condition of a sterilized package)
- evidence of moisture penetration
3
Q
What 2 things should be inspected on an instrument prior to being packaged?
A
- cleanliness
- function
4
Q
instruments should be what prior to packaging?
A
dry
5
Q
Instruments with multiple parts should be what?
A
disassembled if possible
6
Q
instruments with locks should be what?
A
processed in the open position
7
Q
What should not be placed in sterilization containers unless required by the manufacturer’s IFU?
A
towels
8
Q
What is used to prevent microbial migration?
A
sequential wrapping with 3 single wraps or a single wrap with 2 layers
9
Q
What should be followed when placing one pouch inside another?
A
IFU
10
Q
If recommended by the manufacturer, pouches should be placed how?
A
paper side to paper side
11
Q
To allow sterilant contact and drying during sterilization, pouches should be what?
A
properly spaced and positioned on edge
12
Q
package labels should be what? so that what?
A
should be secured so that they do not become dislodged during processing, storage, and movement to the point of use
13
Q
peel pouches should not be placed where?
A
in instrument sets
14
Q
What is the weight limit for instrument pans and their contents?
A
a 25 lb weight limit
15
Q
Why is their a weight limit for instrument pans?
A
allows for adequate drying of contents and decreases the risk of injury to the staff handling the sets
16
Q
Before placing the contents of a rigid container, OR personnel should check what 3 things?
A
- check the filters for defects and determine whether the valve is functional
- ensure that no moisture is present
- determine whether the indicator has turned
17
Q
What should OR personnel check wrapped containers for?
A
check for perforations and moisture and whether the indicator has turned
18
Q
Where should personnel label a peel pack?
A
on the plastic side
19
Q
What can writing on the paper side of a peel pack do?
A
may cause the ink to leach through and compromise the integrity of the package
20
Q
discovery of a wet pack involves what?
A
a multidisciplinary approach to determine and correct the problem
21
Q
Who will be involved if a wet pack is discovered?
A
- infection preventionist
- perioperative and sterile processing staff and managers
- facility manager
22
Q
What are the subsequent events if a wet pack is discovered?
A
- load in question should be quarantined according to lot number
- surgeons should be notified
- the sterilizer should be repaired if needed
23
Q
Documentation on the package label should include what 5 things?
A
- the sterilizer identifier
- the cycle or load number
- the date of sterilization
- a description of the contents
- assembler identification information
24
Q
New, repaired, refurbished, or loaned instruments need to be what before use?
A
cleaned, decontaminated, inspected, and sterilized
25
What does single use mean?
that personnel must use that item only one time
26
single-use istruments that are reprocessed must meet what?
FDA guidelines for reprocessing, which includes policies, procedures, competencies, and education
27
Items that are not clean cannot be what?
sterilized
28
What can be used to sterilize heat- and moisture-stable items?
saturated steam under pressure
29
what is the critical step in steam sterilization?
the removal of air from the chamber
30
How can the removal of air from the chamber be achieved?
via gravity displacement or through a dynamic air removal process (prevacuum)
31
What are the 4 parameters of steam sterilization?
1. pressure
2. temperature
3. time
4. moisture
32
what are the first 3 parameter that are captured as part of the sterilizer monitoring log or record?
pressure, temperature, time
33
What are examples of items that can be sterilized with saturated steam?
stainless steel instruments, glass, and towels
34
What may you also use saturated steam with but may require longer exposure or drying times?
some powered instruments, specialty orthopedic instruments and devices, and neurosurgery
35
Both terminal sterilization and immediate-use steam sterilization follow what?
the manufacturer's written guidelines for required cycles for different devices and load configurations
36
immediate-use steam sterilization follows the same what?
process as that for saturated steam under pressure without the dry cycle
37
Why should IUSS not be used frequently?
increased risk of infection secondary to inconsistent cleaning practices in the OR and the transfer of the item from the sterilizer to the point of use
38
IUSS should only be used when?
in specific situations when there is not enough time for a full cycle
39
What should definitely not be sterilized through IUSS?
implants; except in the case of a defined emergency in which no other option is available
40
If an implant is processed via IUSS, what needs to be run with the load?
a biological indicator and a type V integrating chemical indicator
41
Records for IUSS should include what?
1. the item sterilized
2. the patient's name
3. the sterilizer number
4. the cycle paramaters - temperature, duration of cycle
5. monitoring results
6. the date and time the cycle was run
7. the name of the cycle operator
8. the reason for IUSS
42
what provides a monitoring system for quality assurance with IUSS?
routine follow up audits
43
what is ethylene oxide sterilization?
a low temperature sterilization method used for moisture- and heat-sensitive devices (fiberoptic cords, lensed instruments, flexible endoscopes)
44
EO is very effective but what 4 features make it less than ideal choice?
1. EO is a known carcinogen
2. the extensive time required for aeration (up to 8 hours) makes EO an impractical choice for many operating rooms
3. EO is explosive and flammable
4. Sterilizer installation must meet National Institute for Occupational Safety and Health (NIOSH) and EPA standards for exhaust of flumes
45
items must be what before placement in the chamber for EO?
must be dry
46
what is imperative in EO and why?
correct loading of the baskets or cart is imperative to allow for EO circulation and penetration.
47
EO-sterilized items must be what to prevent burns to staff or patients?
must be aerated at the endy of the cycle
48
Peronnel must wear what with EO?
must wear EO monitoring badges during exposure
49
low-temperature hydrogen peroxide methods (vapor, gas plasma combination, ozone combination) can be used when?
to sterilize items that cannot tolerate high temperatures and humidity (i.e. some plastics, electical devices, and corrosion-susceptible metal alloys
50
Why is low-temperature hydrogen peroxide desirable?
packages do not require aeration
51
What are the risks that accompany low-temperature hydrogen peroxide methods?
it may cause burns, upper airway irritation, and, in cases of severe exposure, permanent lung damage
52
what cannot be used in low-temperature hydrogen peroxide methods?
liquid and cellulose-based paper
53
instruments should be evaluated for what with low-temperature hydrogen peroxide methods?
for acceptable lumen diameter and length
54
what needs to be specially designed and designated for low-temperature hydrogen peroxide sterilization?
trays, mats, and containers AND cleared by the FDA
55
What can ozone sterilization be used for?
to sterilize moisture- and heat-sensitive items according to the manufactuerers' IFU
56
What has the FDA approved the use of ozone sterilization for?
for use with metal and plastic surgical instruments
57
what does ozone sterilized use?
uses only oxygen and water in the sterilizer chamber
58
personnel should first determine what before using ozone sterilization?
lumen diameter and length
59
What cannot be used with ozone sterilization?
cellulose-based paper
60
What can be used with ozone sterilization?
FDA approved rigid containers and nonwoven packages
61
When is dry heat sterilization used?
for materials that are impenetrable to moist heat and can withstand high temperatures
62
What are examples of items that can tolerate high, dry heat?
dental instruments, oils, and heat-stable powders
63
What usually cannot withstand the high temperatures associated with dry heat sterilization?
most types of type
64
what kind of containers should be used for dry heat? and why?
small containers to allow for the lowest possible package density
65
What should personnel use to prevent burns with dry heat?
proper PPE - insulated gloves, handles
66
At the end of the cycle, personnel should what with dry heat sterilization?
should not touch the sterilizer chamber or items in the chamber. allow things to cool before handling
67
What is paracetic acid liquid sterilization?
a low-temperature sterilant that should not be used for devices that are heat sensitve, can be immersed, are approved for this process, and cannot be sterilized using steam sterilization methods
68
In FDA-cleared formulated prodcuts, paracetic acid liquid is effective even when what is present?
organic matter
69
What is really important for paracetic acid liquid with use?
since the processed item is wet and the container is not sealed, the item should be transported to the point of use to be used immediately, not stored for later use
70
Paracetic has what kind of implications for staff?
health implications, include skin and eye irritation, burns, and toxic effects to internal organs
71
glutaraldehyde and ortho-phthalaldehyde are used as what?
high-level disinfectants or chemical sterilants
72
To use chemical sterilants, the device must be able to be what?
be immersed in the disinfectant bath
73
What is the advantage of glutaraldehyde?
it has a noncorrosive action on endoscopic equipment, thermometers, rubber, anesthesia equipment, respiratory equipment, and plastic
74
What are health concerns associated with glutaraldehyde?
include respiraotry irritation from the vapor and contact dermatitis
75
where should the glutaraldehyde bath be located?
in a well-ventilated area that has 7 to 15 air exchanges per hour to prevent toxic fume buildup
76
what should be checked prior to each glutaraldehyde load?
concentration and temperature of the solution
77
If a glutaraldehyde solution is not within acceptable parameters what should eb done?
the solution must be discarded
78
what should the container being processed with glutaraldehyde and ortho-phthalaldehyde have?
a tight fitting lid
79
In order to avoid diluting the glutaraldehyde and ortho-phthalaldehyde solutions, items must be what?
dry
80
thorough cleaning of the instrument prior to placement in the bath is important why?
HLDs may fix blood and organic material to the surface of the instrument
81
At the end of a cycle with glutaraldehyde and ortho-phthalaldehyde, instruments must be what?
thoroughly rinsed and lumens flushed at the end of the cycle
82
what does working with glutaraldehyde, hydrogen peroxide, and ortho-phthalaldehyde require?
that perioperative nurses wear protective attire, which may include chemical-resistant gloves, protective eyewear, and an impervious gown or apron
83
the process of sterilization requires what?
properly functioning devices
84
what does monitoring of both packages and sterilizers provide?
provides verification that the recommended parameters for sterilization have been met
85
What 3 things should be used to monitor the sterilization process?
physical, chemical, and biological indicators
86
What are physical monitors that are reviewed by staff at the end of each cycle to ensure that paramaters for meeting sterility have been met?
- temperature, time, pressure, humidity, sterilant concentration
87
Where are physical monitors results recorded?
in logs, digital readings, printouts, graphs, or gauges
88
What should documentation of sterilization process incorprated into?
the facility's quality assurance plan
89
If physical parameters are not met, or if the sterilizer has been moved, cleaned, or repaired, what must happen?
a biological indicator must be negative for 3 consecutive cycles (empty chamber) before the sterilizer is returned to service
90
what are chemical indicators used for?
to immediately verify that the package has been exposed to the sterilization process
91
chemical indicators do not establish what?
sterility of the content
92
biological indicators are used to monitor what?
sterilizer efficacy
93
when should biological testing for steam sterilizers be performed?
at least weekly, although most facilities choose to test their sterilizers daily to allow for earlier discovery of equipment malfunction or errors
94
all loads containing implants should contain what?
a BI and be quarantined until the BI results are known
95
Storing sterilized items in a controlled environment helps to ensure what?
the integrity of the product and decreases the risk for contamination through dust, moisture, heat, or excessive handling of the packaging
96
Shelf life is related to what rather than what?
related to event (amount of handling, exposure to humidity) rather than to the length of the time the package sits on the shelf or the date it was sterilized
97
What 3 environmental conditions help assure sterility of stored packages?
1. the temperature does not exceed 75 degrees fahrenheit
2. there are 4 total air exhanges per hour
3. the relative humidity is between 20% and 60% and no higher than 70%
98
personnel should place chemical indicators where in the package?
in the package area that offers the most challenge for air removal and sterilant contact
99
Storage areas for sterilized instruments and supplies and shelves, racks, bins, and containers must be what? and kept?
in compliance with fire codes and kept clean and dry
100
sterile supplies must be how many inches above the floor?
8-10 inches above the floor
101
sterile supplies must be how many inches from the outside walls?
2 inches
102
sterile supples must be how many inches from the ceiling or sprinkler heads to support adequate air circulation and cleaning?
18 inches
103
sterile supplies must never be stored where?
under sinks or other areas where moisture or vermin can compromise the integrity of the packaging
104
sterile items stored outside a designed sterile storage room should be kept where?
in closed cabinets or carts
105
sterile storage rooms may contain either?
closed or open shelves or racks
106
the bottom of an open shelving unit must be what?
solid
107
Flexible endoscopes should be stored how?
vertically in a drying cabinet or closed cabinet with high-efficiency particulate air (HEPA) filtered air that provides positive pressure to promote drying and discourage bacterial growth
108
Is there a standard for maximum storage time of flexible endoscopes?
no
109
A multidisciplinary team should establish what for endoscopes?
a policy for the length of time an endoscope may be stored before reprocessing is required
110
What is the description of a chemical indicator CLASS I?
process. place externally (i.e. tape)
111
What is the purpose of a chemical indicator CLASS I?
immediately verifies exposure to the sterilization process
112
What is the description of a chemical indicator CLASS II?
speciality (i.e. bowie-dick air removal test sheet/pack)
113
What is the purpose of a chemical indicator CLASS II?
tests for the precence of air in the sterilizer chamber of a prevacuum steam sterilizer
114
What is the description of a chemical indicator CLASS III?
single parameter (i.e. time or pressure)
115
What is the purpose of a chemical indicator CLASS III?
reacts to 1 critical process parameter
116
What is the description of a chemical indicator CLASS IV?
multi-paramter (time, temperature, and pressure)
117
What is the purpose of a chemical indicator CLASS IV?
reacts to 2 or more critical process parameters
118
What is the description of a chemical indicator CLASS 5?
integrating. place internally. multilayered trays may require an indicator on each layer
119
What is the purpose of a chemical indicator CLASS 5?
reacts to all critical process parameters. used for all implantable devices
120
What is the description of a chemical indicator CLASS 6?
emulating. place internally.
121
What is the purpose of a chemical indicator CLASS 6?
reacts to all the critical parameters of a specialized sterilization cycle
122
A health care facility plan for receiving and using loaned instrumentation includes what?
tracking and maintaining quality controls
123
A health care facility plan for receiving and using loaned instrumentation must describe what?
appropriate decontamination and sterilization processes for the loaned items
124
A health care facility plan for receiving and using loaned instrumentation should most importantly include what 3 thingS?
1. details about how to acquire instruments and implants
2. written manufacturer's instructions for cleaning, assembly, and sterilization
3. requirements to limit instrument set weight to no more than 25 pounds
125
requests for loaned instrument use should include what?
quantities and the time of use, return, and restocking to prevent the need for IUSS
126
Sterile processing manager should maintain what for loaned instruments?
should maintain the documentation of loaned transactions in a central location and give a copy to the industry representative
127
What must be removed before loaned items are transported to the sterile processing area?
external shipping containers
128
sterile processing personnel should inspect what upon receipt? and then do what?
should inspect rigid instrument containers upon receipt and then clean and decontaminate the containers
129
sterile processing personnel should inventory what?
inventory the instruments and implants and then clean, decontaminate, and sterilize the loaned instruments before sending them to the point of use
130
true or false; presterilized loaned instruments do not need to be reprocessed
false; they do to ensure sterility and prevent cross-contamination from another facility or during transport to the receiving facility
131
At the completion of the procedure, sterile processing personnel should what what before returning loaned instruments to an industry representative?
clean, decontaminate, inventory, and inspect the instruments
132
What helps ensure that instruments have been returned in good repair and are safe to handle?
documentation
133
steam sterilizer (include IUSS) has what biological indicator?
geobacillus stearothermophilus
134
What is the timing of testing for steam sterilizers and biological indicators?
at least weekly, preferably daily
135
steam sterilizer, dynamic air displacement has what biological indicator?
bowie dick
136
What is the timing of testing for steam sterilizer, dynamic air displacement and biological indicators?
empty the chamber at the beginning of each day the sterilizer is used
137
EO has what biological indicator?
bacillus atrophaeus
138
What is the timing of testing for EO and biological indicators?
every load
139
low-temp hydrogen plasma has what biological indicator?
geobacillus stearothermophilus
140
What is the timing of testing for low-temp hydrogen plasma and biological indicators?
at least daily
141
ozone has what biological indicator?
geobacillus stearothermophilus
142
What is the timing of testing for ozone and biological indicators?
at least daily
143
dry heat has what biological indicator?
bacillus atrophaeus
144
What is the timing of testing for dry heat and biological indicators?
at least daily
145
paracetic acid has what biological indicator?
no fda-cleared biologic indicator is available currently
146
