Patient Safety Flashcards
(83 cards)
1
Q
patient safety
A
- critical device
- semi-critical device
- non-critical device
2
Q
splauding classification
critical device definition/level of reprocessing/examples
A
- device that penetrates soft tissues, makes contact with bone and enters or contacts the bloodstream or normally sterile tissue
- device must be cleaned and then sterilised
- examples ; surgical biopsy instruments, forceps
3
Q
splauding classification
semi-critical device definition/level of reprocessing/examples
A
- device that comes into contact with non-intact skin or mucous membrane but does not penetrate soft tissue or make contact with bloodstream, bone or normally sterile tissue
- must be cleaned and subject to high level disinfection - steam sterilisation preferred
- examples : dental mirrors, anaesthetic syringes
4
Q
splauding classification
non-critical device definition/level of reprocessing/examples
A
- a device that only comes into contact with the skin and intact mucous membrane
- cleaning followed by low-level disinfection
- example : chair light handle
5
Q
life cycle diagram for processing instruments
A
- use
- transport
- cleaning
- disinfection
- inspection
- packaging
- sterilisation
- transport
- storage
- use and so on
6
Q
cleaning instruments summary
A
- first step of process
- removes all biological matter from surface of instruments
- recommended method is in a washer-disinfector
- backup method ultrasonic bath
- manual cleaning only carried out if it is the only option
7
Q
reasons instruments must be cleaned as the first stage
A
- functionality of instrumentation
- to minimise spread of contamination
- to prevent failed procedures (biopsy etc)
- to achieve steam contact
- it is a legal requirement
8
Q
instrument sterilisation summary
A
- after all visible contamination has been removed
- then processed through a steam steriliser
- use vacuum and non vacuum machines
- vacuum is best process (type B)
- non vacuum (type N
9
Q
cleaning and sterilisation
define operator
A
- person designated by management with authority to operate a washer-disinfector
- duties may include noting of WD instrument readings, replenishment of consumable items (detergent etc) and simple housekeeping duties
10
Q
manual cleaning
set points that must be achieved - sink
A
- must be a dedicated sink for the purpose of manually washing
- sink cannot be used for handwashing etc
- another separate sink is required for rinsing instruments following cleaning
11
Q
manual cleaning
set points that must be achieved - water
A
- standard potable water or tap water can be used for manually cleaning
- water must be between 30-35degrees celcius
- temperatures >35 can cause proteins to coagulate making them more difficult to remove
12
Q
manual cleaning
set points that must be achieved - chemicals
A
- chemical detergents used
- detergents should be formulated specifically for manual cleaning
- generally an enzymatic or pH neutral detergent
- manufacturers instructions should always be followed for dosing levels
13
Q
manual cleaning
correct PPE
A
- an apron must be worn
- facie shield to protect from splashing the face and eyes
- rubber gloves and heavy duty gloves on our hands
14
Q
manual cleaning
methods and instruments
A
- immersion or non-immersion
- instruments are scrubbed below the surface of the water with a long handled, soft bristled brush
- metallic brush should never be used as this could damage the instruments
15
Q
manual cleaning recommendations
A
- chemicals must be dosed based on manufacturers instructions - generally in ml/L
- essential temperature no greater than 35 degrees as may damage efficacy of chemical/coagulate proteins making them harder to remove
16
Q
manual cleaning
reasons to scrub below water surface
A
- intruments must be in contact with water and detergent solution
- minimise splashing as this will contaminate the surroundings
- scrubbing above the surface has the potential to produce aerosols
17
Q
manual cleaning only carried out when
A
- it is specifically recommended by the manufacturers instructions for processing
- if there is no other alternative ie all automated equiptment is out of service
- if ultrasonic or WD has failed to remove contamination
18
Q
ultrasonic bath summary
A
- considered to be secondary or back up method for cleaning after washer-disinfector
- uses soundwaves at high frequencies to produce bubbles that have a scouring effect on instrument surface
- has potential to damage instrumentation so always verify MI
19
Q
ultrasonic cleaning how it works
A
- as soundwaves pass through the water they cause microbubbles to form
- the fluctuation in pressure caused by the soundwaves causes the bubbles to rapidly expand and then collapse
- the process is referred to as cavitation
20
Q
ultrasonic cleaning
set points/requirements
A
- operating temperature is set between 20-30 degrees celcius
- machine can be filled with tap water to required volume marked on chamber
- chemical added to water based upon MI
- cycle must be ran for a specific period of time which is established at validation
21
Q
ultrasonic cleaning
degas cycle
A
- before production cycle chamber must be filled with water and detergent for degas cycle
- standard production cycle ran with the chamber empty appart from load carrier
- any bubbles created will collapse into the air bubbles
- this will effect efficacy of the equiptment and prevent proper cleaning of instrumentation
22
Q
following manual cleaning/ultrasonic cleaning
A
- instruments must be rinsed in separate sink
- then processed through WD - must be thermally disinfected again
- FIRST STAGE is use of washer-disinfector
23
Q
use of ultrasonic bath is secondary method
A
- if WD is out of service and you require instrumentation for a procedure
- if the WD process could not remove certain spots of biological matter
24
Q
manual washing/ultrasonic cleaning
reasons for
A
- manually scrubbing with a brush exherts a greater force than WD
- some equiptment must be manually washed in line with manufacturers recommendations
- ultrasonic baths have a feracious process that is very good at removing contamination
25
manual washing/ultrasonic cleaning
reasons against
* member of staff required to be present for entire process
* risk of aerosol production
* risk of contaminating surrounding environment
* potential for inconsistency in process due to human error
* high risk of sharps injuries for staff carrying out
* ultrasonics have ferocious process which can damage some equiptment
* no automatic water changes in ultrasonic bath
26
ultrasonic vs WD
* ultrasonic has a powerful process and can remove hard-to-reach contamination
* ultrasonic also automated but does not disinfect or dry
* ultrasonic contamination remains present in the chamber
* ultrasonic has potential to damage certain instruments and still requires manual stages such as rinsing
27
washer disinfector type of process
* automated process
* after operator has pressed the start button the machine will automatically cycle through stages
* produces instruments free from contamination, thermally disinfected and dry
28
washer disinfector stages
1. flush/prewash - saturates contamination and removes gross contamination
2. main wash - detergent used for more effective decontamination
3. rinse - removes residue (biological or chemical) before disinfection
4. thermal disinfection - actively kills microorganisms with heated water
5. drying - hot air to remove any moisture from surface of instruments
29
washer disinfector at each stage
* fresh water used for each individual stage
* fills the sump and is then circulated throughout the chamber
30
washer disinfector temp/timings of each stage
* flush/prewash - less than 35degrees
* main wash - temp dependant on chemical used
* rinse - less than 65 degrees
* thermal disinfection - 90-95 degrees for a MIN of 1minute
* drying - generally 100 degrees
* proteins or prions must be removed during the wash stages - they cannot be deactivqated through disinfection or sterilisation
31
why washer-disinfector is first step
1. no point manual cleaning if WD can remove all contamination automatically
2. fresh water used at each stage so removes contamination from instruments and the machine entirely
3. thermal disinfection makes instruments safe for staff to handle so thorough inspection can take place before steam sterilisation
4. machine is consistent - process is virtually same every time
5. traceability - automated process produce a printable record of each cycle
32
daily checks for washer disinfector
* check spray arms spin freely without obstruction
* check spray jets are not blocked
* make sure no debris on strainer/filter and no other potential blockages
* check condition of door seal and wipe and clean if necessary
* verify suitable amount of chemical in reservoir
* record disinfection tempertature of the first cycle every day (ACT)
33
washer disinfector
load requirements
* load carrier/basket must be used
* clip trays must be used and positioned correctly
* no overlapping or shadowing of equiptment
* hinged instruments must be opened at hinge
* all essemblies should be disassembled beforehand
34
after washer disinfector inspection/further processing
* use an illuminated magnifier
* inspect for damage or if contamination still present
* if instruments still contaminated can be processed through ultrasonic bath or manually cleaned
* following ultrasonic process of manual cleaning it must be processed through WD again
35
why steam for sterilisation
* steam carries massive amount of energy
* it is a non-toxic component
* it can be recondensed and used again
* main ingredient is water which is readily available
* no waste product except water
36
what is used for production of steam
* purified water - has had organics, minerals and micro-organisms removed
* or filtered from it beforehand
* RO
* de-ionised
* distilled
* sterile
37
volume of steam vs water and use in sterilisation
* volume of steam thousand times greater than water used to generate it
* creates a huge amount of pressure within small confined spaces
* can flood sterilisation chamber with steam from small amount of water
* high pressure also helps with permeability of steam
38
types of steriliser available
* type N - autoclave, most basic steriliser
* type B - vacuum capable
* type S - specialised equiptment for specific purpose
39
type N steriliser summary
* machine heats water in chamber and as it turns to steam passively forces air from the chamber out
* isnt fully efficient so can leave pockets of air in chamber
* cannot process wrapped instruments or channelled/lumened instruments
* recommended to only process rigid stell/solid instruments with no pocket channels or lumens
40
type N steriliser temp/pressure/time
* must achieve a temp between 134-137 degrees celcius
* pressure for temo of 2.05-2.35 bar gauge
* maintain this for a minimum stage hold time of 3 minutes
*
41
type N steriliser
instruments after sterilisation
* after process instruments have only been sterilised - they are not sterile at the point of use
* instruments should be wrapped immediately after being removed from chamber
* danger of re-contamination because of this
42
type N steriliser - air
* pockets of air can be left within the chamber
* cannot be heated or maintain temp the same way steam can
* it is always a lower temp than the steam surrounding it
* this means that anything in contact with air might not achieve its sterilisation temp for the minimum required time
43
type B steriliser summary
* first step is to remove all air from the chamber - vacuum created and negative pressure
* after that it fills the chamber with steam
* vacuum allows steam to rush into chamber meaning it can effectively contact all surfaces
* has capability to penetrate wrappings and sterilise instruments inside
* CAN process wrapped, channelled and lumened instruments and also porous items such as cotton wool swabs
44
type B steriliser temp/pressure/time
* must achieve temp 134-137 degrees celcius
* pressure 2.05-2.35 bar gauge
* hold for a minimum time of 3 minutes
* then has drying stage at end to remove any remaining moisture
45
type B instruments after sterilisation
* providing wrappings stay intact the instruments will be sterile at the point of use
* wrapped instruments can be stored for long periods of time in a suitable environment
* storage areas must be clean and free from aerosol contamination, dry, temp controlled, away from direct sunlight
* best practice system should be in place to manage stock (FIFO)
46
type S steriliser summary
* can wash and lubricate handpieces as well as sterilising them
* has a vacuum cycle but does not process wrapped instruments
* still achieves same temp and pressure and has same stage hold time of 3 mins
* can only be used for equiptment its designed to process - follow manufacturers reccomendations
47
sterilisers common daily tests
* check door seals intact and free from debris
* verify chamber is free from damage, debris, contamination or instruments from prev cycles
* verify condition of the load carrier
* fill and drain the feedwater reservoir each day
* drain the used water reservoir each day
48
type B steriliser tets
* daily basis - steam penetration test carries out using bowie dick test or a helix
* weekly basis - air leakage test, air detector fan test
* both these tests are machine cyles
49
decontamination equiptment
* transport container
* washer-disinfector
* lit magnifier
* ultrasonic
* steam steriliser
50
instrument transport container must be
* rigid sided
* with a tight fitting lid
* leak proof
* colour coded or clearly marked
51
time between use to transport
* best course of action is having ther shortest time between use and processing
* blood or biological matter can start to dry and stubbornly adhere to surface of instrument
52
sinner circle
* shows 4 key elements that are required for a successful cleaning process
* energy
* chemicals
* time
* temperature
53
water conductivity
* measures things water picks up along the route of travel such as minerals, silicates, metals, organics
* unit of measurement in micro-siemens (us)
* for disinfection stage water <30us is recommended
* purified water for sterilisation around 4.4us
54
pure water must be
* distilled - boiling and recondensing standard tap water
* de-ionised - passing water through ion exchange
* reverse osmosis - semi permeable membrane filter used
* sterile - already filtered and then sterilised
55
range of detergents used to different purposes
* high and low alkaline detergent - for enclosed processes (not designed to be in contact with skin)
* enzymatic detergents break down proteins into smaller particles - used in ultrasonic and manual washing
* pH neutral detergent less harmful to operators skin - used for manual washing and can be used in WD
56
detergent chemistry
* have hydrophilic and hydrophobic ends - one end repels water and the other is attracted to it
* contamination drawn to hydrophobic end and flushed away
57
sinner circle
energy
* energy or force that is used for cleaning and contact
* when manually cleaning we use a scrubbing brush
* ultrasonic bath force comes from high frequency sound waves causing cavitation
* WD uses high pressure water jet or spray
* energy is largest part of sinner circle
58
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60
61
cleaning and sterilisation
guidance/legislation/standards
* guidance - documents called SHTM provide info on testing requirements for decontam equiptment and other useful info about roles and designations
* legislation - outlined in government publications - legal obligation to follow official guidance and also governs production and manufacture of equiptment
* standards - documents that govern the way equiptment should be operated
62
cleaning and sterilisation
guidance
* SDCEP has several publications
* "cleaning of dental instruments"
* info on daily/weekly tests for WD
* quarterly tests for WD
* steriliser testing
63
cleaning and sterilisation
weekly tests for WD
* weekly safety checks
* carry out daily tests
* water hardness (all process stages)
* water conductivity (final rinse stage)
* cleaning efficacy test by residual soil detection
64
cleaning and sterilisation
quarterly tests for WD
* verification of calibration
* thermometric tests for disinfection
* cleaning efficacy test using test soil
* chemical dosage check
65
cleaning and sterilisation
SHTM guidance
* scottish health technical memorandum
* role designations and descriptions of each role
* process definitions and descriptions
* it links to other standards and guidance
66
cleaning and sterilisation
legislation
* health and safety at work act 1974 - outlines duties of employers to their employees
* medical device regulation (MDR 2017)
67
medical emergency
steps
* assessment
* diagnosis
* treatment
* disposal
68
medical emergency assessment
* airway
* breathing
* circulation
* disability
* exposure
69
medical emergency principles
* start at A and work through E
* treat as you meet
* continually reassess
70
emergency conditions
* anaphylaxis
* angina/MI
* asthma
* cardiac arrest
* choking
* hypoglycaemia
* seizure/fits
* syncope
71
medical emergency
oxygen
* 15 litres via non rebreathing mask
* GDC advice: give to anyone who is sick
72
anaphylaxis ABCDE
* A: swelling, stridor
* B: increased rate, wheeze
* C: increased rate, hypotension
* D: LOC
* E: rash, swelling
73
anaphylaxis tx
* call for help
* lie pt flat - with or without legs elevated
* give IM adrenaline 1:1000, 0.5mg at anterolateral middle third of thigh
* establish airway, give high flow O2
* if no response repeat IM adrenaline after 5mins
74
angina ABCDE
* A: talking
* B: increased
* C: increased
* D: alert
* E: plae, clammy, central chest pain
75
angina/MI tx
* GTN spray 400 micrograms per dose sublingual
* given sublingually - only symptomatic relief (vasodilation) doesnt decrease blockage of artery
* aspiring 300mg crushed or chewed if MI - dont give drink of water as doesnt absorb as quickly
76
asthma ABCDE
* A: difficult to complete sentences
* B: increased rate which wheeze
* C: increased rate
* D: alert
* E: tripods position
* when life threatening breathing rate drops to 8bpm, HR 50bpm, pt unresponsive and goes blue
77
asthma tx
* salbutamol 100micrograms per actuation
* 2 puffs
* use as required until ambulance arrives
* spacer device when appropriate
78
hypoglycaemia ABCDE
* A: initially taling
* B: initially increased rate
* C: initially increased rate
* D: initially alert - can become unconscious
* E: irritable, confused, pale
79
hypoglycaemia tx
* glucose: sugar of any description
* glucagon 1 milligram IM injection if unconscious - side effects nausea and headache
80
seizures/fits ABCDE
* A: compromised
* B and C depending on cause
* D: unresponsive
* E: seizure activity, incontinence
81
seizures/fits tx
* ensure safe environment
* if repeated or prolongued (longer than 5 mins) consider midazolam 10milligrams via buccal mucosa
* allows muscle relaxation, slows down nerve signals to brain
* SE: hypotension, respiratory depression, disinhibition
82
syncope ABCDE
* A: compromised
* B: reduced rate
* C: reduced rate and pressure
* D: unresponsive
* E: pale, clammy
83
syncope tx
* elevate legs
* recover quite quickly - if not different cause not a faint
