Asepsis vs sterilization?
Asepsis - absence of infectious organisms
Sterilization - complete elimination or destruction of all forms of micribial life
Steos to sterilization?
Point of use treatment Transport to decontamination Cleaning Disinfection Verification of cleaning process Inspection and testing Instrument teay or set assembly Packaging Sterilization Storage
Manufacturers instructions are a resource for?
Use Maintenance Cleaning Decontamination Assembly Packaging Sterilization Storage
What is sterilization for surgical items determinded by?
Instrument design
Sterilization cycle
Equipment that is included in sterilization load
Packaging system
When in doubt anout how to sterilize or package items what instructions should you follow?
Device manufacturers instructions for use
What is the first step to decontamination process?
Point of use treatment
(Intra op cleaning)
Reduces formation of biofilm
Wiping instruments with a sponge soaked in sterile water
Flushing the channels and ports with sterile water
Biofilm vs biodurden
Biofilm - accumulation of bacteria and other biological elements that creates a tight adhesion to instrument surface
Bioburden - amount of microbial contamination on an instruments surface (biological elements)
Biofilm strength is determined by?
Type of bioburden
How much is present
Resistance of the microorganisms
Actions before transport of instruments?
Discard sharps
Discard liquids
Separate instruments: sharp, delicate, heavy
Follow manufacturers instructions for disassembly
Moisten instruments sterile water or pre enzymatic pre treatment
When and how to transport items?
Done ASAP
closed container/cart
- leak proof
- can contain all contents
- biohazard label
Manual cleaning?
Removal of organic and inorganic soil from equipment
First step of decontamination
Water temp for decontamination?
Cool water - prevents coagulation of blood
Hot water - makes removal more difficult
Follow manufacturer’s instructions when using detergent
Submersion of instruments?
Any instrument that can be should be fully emerged
- reduces risk of splash or spray
- avoids aerosolization
Mechanical cleaning?
Follows manual cleaning
Provides consistent concentrations of cleaning solutions Temp control Standardized washing and rinsing Easier monitoring Decreased risk of exposure
Types of mechanical cleaning?
Washer-disinfector - mechnical and thermal action of machine with chemical action of cleaning agent
Ultrasonic - mechanical cleaning method removes soil from hard to access areas
- high frequency sound waves (cativation)
What do you inspect after cleaning?
Cleanliness Sharpness Complete assembly Alignment Cord/cable integrity Functioning capability
3 types of testing by decontamination?
Swab or strip - swab surface and monitor for color change
Solution vial - swab surface and place in vial and monitor for colour change
ATP - pre treated swab on surface and insert into test device
Assembly of tray steps?
Completely dry Count items Placed to protect from damage Ratchets open Protective guards on sharp/delicates Cupped instruments placed down Dissassembly of detachable parts Evenly distributed tray weight Indicators placed inside and out Wrapped or placed in container Label
Weight of set?
Cannot exceed >25lbs
- longer drying times
- increased risk of injury
Compatibility of packaging?
Packaging needs to be compatible with sterilization method
Ex. Hydrogen peroxide requires non woven pouches or reusable containers cause it can be absorbed by porous wraps which affects sterilization
Chemical indicators?
Test sterilization
Monitor presence of 1 or more sterilization parameters
Can be:
Internal - verify one or more of the conditions have been met
External- verify packaging has been exposoded to sterilization process
Chemical indicator classes?
1 - process indicator ex tape
2 - specialty indicator ex tests for air
3 - single parameter ex reacts to one parameter (steam time/temp)
4 - multiparameter ex reacts to 2 or more
5 - integrating indicators ex package has been exposed to all critical elements
6 - emulating indicator ex reacts to all critical parameters
Biological indicators?
Used to monitor efficacy of sterilizer
Quality test to ensure non pathogenic spores housed within BI were killed
- run each day and every load with impants
If test neagtive conditions were met
If positive report immediately and do not use sterilizer
Package labels
Sterilizer tracking
Cycle identification
Personnel involved
Description of contents
Steam sterilizers? And 2 types?
Most common
Uses pressurized saturated steam
- Dynamic air removal - vacuum pulls out air
- Gravity displacement - removal of air by gravity
- air is replaced by steam
Chemical sterilization and types?
Items that cannot handle high heat and moisture
Hydrogen peroxide - vapor, low temp
Peracetic acid - items must be immersed
Ethylene oxide - toxic/carcinogen
Dry heat - causes coagulation of proteins, requires high temps
Storage of items?
Limit exposure to: Dust Air movement Pests/vermin Humidity Handling Temp extremes
Event related elements that affect shelf life?
Packing of item
Storage conditions
Transport
Frequency and methods of handling
Why is wet instruments bad?
Moisture creates pathway for microorganisms to enter processed package
Wet = contaminated
Causes of wet packs?
Sterilizer malfunction
Incorrect loading of instrument cart
Storage conditions
Packaging errors
5 physical parmeters for sterilization?
Time Temp Pressure Humidity Gas concentration
Spaulding classification system
Critical - used in sterile tissue
Semi critical - touches intact skin or mucous membranes
Non critical - touches intact skin
4 parameters that affect steam sterilization?
Steam saturation
Pressure
Time
Temp
Bowie dick test tests for what?
Air removal
Drying time for sterilized instruments?
1hr
Internal vs external indicators?
Internal - states if parameters have been met
External - cannot say if sterile. States package has been exposed to sterilization process
Define disinfection?
A chemical or physical process of destroying ALL pathogenic microorganisms except spores
High - kills some spores but not CJD (mad cow)
Intermediate
Low
Immediate use steam sterilizer
For urgent/unplanned need
No implants
