Sterilization Flashcards
(179 cards)
1
Q
Antiseptic
A
Chemical used to remove microorganism a on the SKIN or other tissue
2
Q
Biofilm
A
Composed of dense colonies of microbes that are attached to surfaces
3
Q
Disinfection
A
Process that removes most but not all microbes on inanimate surfaces. Most are not safe for use on tissue
4
Q
Terminal Cleaning
A
Removal of organic soil from all exposed surfaces of the critical and semi-critical areas of the operating room. Occurs daily.
5
Q
Terminal Decontamination
A
Process in which instruments and supplies are processed so that they are safe for staff to handle subsequent stages of reprocessing.
6
Q
Spaulding system
A
Provides healthcare professionals with a way to determine if a patient care device requires sterilization, disinfection, or cleaning.
7
Q
Describe the levels of the Spaulding system.
A
High risk assigned to critical items (those that come in contact with sterile body tissue) all items must be sterile.
Intermediate risk is assigned to semi-critical items (items used on nonintact skin or mucus membranes) High level disinfection.
Low risk assigned to non-critical items (those that come in contact with intact skin) low level disinfection
8
Q
List the Eight steps of the reprocessing cycle.
A
- Point of use cleaning
- Sorting and disassembly
- Cleaning the instruments
- Decontamination
- Sorting and inspection
- Assembly ( put in trays)
- Wrapping
- Storage
9
Q
Procedures and methods for reprocessing medical devices must be monitored to ensure patient safety. Monitoring means ______, __________, and __________.
A
Checking, recording, and reporting
10
Q
Quality control includes monitoring two factors. Name them.
A
Technologies and human factors
11
Q
Single use item
A
An item meant to be used on a single patient one time.
12
Q
When receiving loaner instruments, are they considered sterile? Why or why not?
A
No, sterility must not be assumed. The conditions under which the instruments were transported and stored are unknown. They must be taken to decontamination and then sterilized by the approved method.
13
Q
The purpose of point of use cleaning is what?
A
To reduce the biofilm that is adhered to the instrument
14
Q
What is used to clean instruments during point of use cleaning and why?
A
Water. Saline can cause rust, pitting, and corrosion of the instruments.
15
Q
During sorting and disassembly, what needs to be separated?
A
Sharps, heavy instruments on the bottom and lighter ones on top, and dedicated.
16
Q
When transporting instruments to decontamination, regardless of the transportation system, they must all have what?
A
A red or orange biohazard label
17
Q
the ideal time for instruments to be washed within from the end of surgery is?
A
20 minutes
18
Q
Describe the PPE for decontamination attire
A
protective eyewear, mask, cuffed gloves approved for contact with chemicals, full protective body suit or gown with a waterproof apron and sleeves, waterproof shoes and covers
Must be non-penetrable by liquid
19
Q
During the sorting stage, items are grouped in 10 different categories. Name them.
A
- Non-immersive equipment and instruments
- Instruments with sharp points or edges
- Gaskets, screws, pins, and other small parts
- Heavy instruments
- Delicate instruments
- Heat and pressure sensitive instruments
- Instrument containers
- Basins and cups
- Tubing, suction tips, or other hollow instruments
- Instruments needing repair or replacement
20
Q
For instruments that could be damaged in an automated washer-sterilizer, such as delicate instruments, how are they cleaned?
A
They are soaked in an enzymatic detergent
21
Q
At what temperature do enzymatic detergents deactivate?
A
140 F or 90 C
22
Q
Why should instruments remain under the water line during cleaning?
A
To prevent the release of contaminated airborne droplets
23
Q
After hand cleaning instruments, do they need to be rinsed prior to decontamination?
A
Yes in distilled or deionized water to remove all traces of detergent and debris
24
Q
How does an ultrasonic cleaner remove debris from instruments?
A
By cavitation
25
Define Cavitation
High frequency sound waves are generated through a water bath causing tiny air bubbles trapped within the debris to implode, releasing the debris from the instrument
26
The ultrasonic cleaner uses what liquid to wash the instruments?
An enzymatic detergent
27
Before instruments can be placed in an ultrasonic cleaner, what must happen?
All instruments must be fully open and all channels or stopcocks must be open
28
How often does an ultrasonic cleaner need to be cleaned? What is used?
Each day, the sink must be emptied, dried, and wiped down with 70% alcohol.
29
Are instruments considered decontaminated after the ultrasonic cleaner?
No, they are clean, not decontaminated. They are still not safe to handle with hands.
30
A washer sterilizer is also called
A washer disinfector
31
Describe the full cycle of a washer sterilizer
Immersion in water bath with forceful water spray, some have ultrasonic phase, load is rinsed and dried.
32
Can steel basins, bowls, or containers be placed in the washer sterilizer?
yes, but not with instruments. They must be process separately to prevent damage.
33
Some instruments require oils for the internal mechanisms of power equipment, but oil can not be used as a surface lubricant. Why?
The sterilization process can not penetrate oil
34
What is instrument milk? When is it applied to instruments?
Lubricant and protectant for instruments. After the cleaning and decontamination phase
35
Ophthalmic instruments require special reprocessing to help prevent what?
TASS- Toxic anterior Segment syndrome
36
What is TASS
An acute inflammatory condition in which the anterior segment of the eye becomes damaged. Possible damage to the intraocular tissue and loss of vision.
37
TASS most often occurs after what surgery?
Cataract surgery
38
What are the 6 causative factors of TASS?
1. Contaminated ultrasonic cleaners
2. Contaminated instruments
3. Detergent and enzymatic cleaner residue on instruments
4. Use of glutaraldehyde during sterilization
5. Incomplete instrument cleaning resulting in residue from viscoelsatic material (used during cataract surgery)
6. Steam impurities occurring during sterilization.
39
Name the seven guidelines for processing ophthalmic instruments to prevent TASS.
1. During surgery, wipe instruments with clean lint free sponge.
2. Immediately after surgery, instruments should be completely submersed in sterile water.
3. Single use cannulas should be used.
4. All phacoemulsification tips, tubing, hand pieces, and other components must be flushed before they are disconnected at the close of surgery
5. Single use brushes and syringes are used to clean ophthalmic instruments
6. Items that have been hand cleaned or ultrasonic ally cleaned should be wiped with ancho before sterilization
7. All instruments should be inspected for residue prior to sterilization.
40
Define prion
Protein particle
41
Prions are highly infective in what body system?
Central nervous system
42
Prions are not destroyed by normal mechanical or chemical means of sterilization. During surgery on patients with known or highly suspected prion diseases, what is done to lower the risk of prions adhering to instruments?
Instruments are kept moist throughout the surgical procedure, preparation, and transport of equipment to the decontamination area. Prions adhere rapidly to dry stainless steel but are less viable in the presence of moisture.
43
There are four methods to sterilize instruments that have come in contact with prions. What are they?
1. Pre vacuum sterilization at 273 F for 18 minutes.
2. Pre vacuum sterilization at 273 F for one hour.
3. Immerse in 1 N NaOH (1 N NaOH is a solution of 40g NaOH in 1 L water) for 1 hour, remove and rinse in water then transfer to an open pan and autoclave (121 C gravity displacement sterilizer or 134 C porous or pre vacuum sterilizer) for 1 hour.
4. Immerse in 1 N NaOH for 1 hour, heat in a gravity displacement sterilizer at 121 C for 30 minutes and then clean and subject to routine sterilization.
44
prior to assemble an instrument tray, instruments must be inspected for what 5 things?
1. Soil
2. Stains
3. Corrosion
4. Function
5. Structural soundness
45
Instruments are placed in trays with perforated bottoms to allow sterilants to circulate up through the tray. What can be placed on the bottom of these trays to prevent damage to the instruments/
A cloth towel or paper without cellulose.
46
Prior to STEAM sterilization ONLY, what should be done to instruments with a lumen?
They should be flushed with sterile distilled water
47
The primary purpose of a wrapping system is what?
To protect the item from contamination after sterilization.
48
Reusable cloth wrappers are made of what?
High quality cotton or a combination of colon and polyester.
49
Woven wrappers must have a thread count of what for an effective wrapper?
Two wrappers of 140 thread count or 280 single count
50
All cloth wrappers must be laundered before use. Why?
To ensure a minimum level of moisture in the cloth, which prevents superheating during sterilization.
51
Prior to the use of woven wrappers, they must be inspected. How is this done?
On a light table to detect pinholes or tears in the cloth.
52
Disposable no woven wrapper used for one time use are made of what?
Polypropylene
53
Peel pouches are made from what?
Medical grade paper and transparent polypropylene-polymethylene
54
Each package must be properly labeled. A proper label includes what 6 pieces of information?
1. Date of processing
2. Name of the item
3. A lot control number
4. Batch number
5. Employee initials
6. The department to receive the package
55
Monitors do not guarantee or ensure sterility. What do they do?
They are intended only to verify that the conditions required for sterilization have been achieved.
56
There are different methods of monitoring. Describe digital monitoring?
Provides immediate feedback of parameters such as time, temperature, and moisture. Output is recorded and displayed by printouts, gauges, and digital readings on the front panel of the equipment.
57
Describe Chemical indicators
Commercially prepared paper strips or tape are chemically treated to change color when exposed to specific parameters of the sterilization process such as temperature and concert reaction of chemical sterilants.
58
Describe biological indicators
Harmless bacteria encased in a self-contained unit.
59
What is the only test which can ensure effective sterilization occured?
Biological indicators
60
How often are biological indicators used?
At least once weekly in all sterilizers. Always used when an artificial implant or prosthesis is sterilized.
61
Name the bacteria used during the as a biological monitor during steam sterilization, immediate-use steam sterilization, and ozone sterilization.
Geobacillus stearothermophilus
62
Name the bacteria used during biological monitoring in dry heat and EO sterilization and vaporized gas plasma sterilization.
Bacillus subtilitus
63
To test and monitor the efficiency of the high-vacuum steam sterilizer, a test called the _______ is performed using a _________ monitor.
Daily air removal test (DART)
| Bowie-Dick
64
For the DART test, a special package of correctly wrapped towels that are taped with heat sensitive chemical monitor tape and is stacked how high?
10 to 11 inches
65
An unsatisfactory DART indicates a failure in what?
In the vacuum pump system or a defect in the gasket of the sterilizer door
66
What is the most widely used, effective and efficient method of sterilization?
Steam sterilization
67
How does steam sterilization occur?
Steam under pressure coagulated the nucleic acids and proteins that make up the cell's genetic and enzymatic material. Pressurized steam also destroys the cell's resilient outer wall and bacterial spores.
68
Steam sterilization is achieved according to what 3 things?
Temperature, pressure, and exposure time.
69
What are the three distinct phases in all types of steam sterilizers?
1. Conditioning or preconditioning. -Air is removed from the chamber and replaced with steam.
2. Exposure or holding time - goods in the chamber are exposed to superheated at a precise temperature and duration.
3. Exhaust and drying- pressure in the chamber is reduced and the load is exposed to cool air.
70
What is the difference between gravity displacement steam sterilizers and high-vacuum sterilizers?
The way in which the steam is placed in the chamber. Steam is injected in the chamber and displaces the air through a drain. *Based on the principle that air is heavier than steam.
High-vacuum quickly and forcefully evacuates air from the chamber and replaces it with bursts or pulses of steam
71
Steam quality refers to what?
The amount of moisture in the steam
72
Steam that contains what percentage of water is necessary for sterilization to be achieved?
97%
73
Water is converted to steam at what temperature?
212 F or 100 C
74
The presence of orange, white, brown, or black spots on sterilized items may indicate what?
The presence of excess minerals in the water supply.
75
A system of six classes of indicators is used for quality assurance with steam sterilization. Describe the six classes.
```
Class 1 (single parameter): tape or label indicating only that the item was exposed to the sterilization process.
Class 2 (Specality indicator): Bowie Dick and DART
Class 3 (single parameter): indicators that respond to only one critical parameter with an exact value. Heat-sensitive pellet that melts at a specific temp.
Class 4 (multi parameter) multi variable indicators that react with two or more parameters. Internal chemical indicator printed on a paper strip.
Class 5 (integrating parameters) indicators that react to all critical value of a specified range in the sterilization process.
Class 6 (emulating indicators) for internal pack control of each cycle run, not for the overall performance of the sterilizer for all cycles.
```
76
What class of indicators used for quality assurance with steam sterilization is the most exacting and accurate of all indicators?
Class 5
77
How should linen packs be placed in the steam sterilizer?
On their sides.
78
Packs and instrument trays should be placed how in the sterilizer? Small items?
So they do not touch or touch loosely.
| Placed crosswise over each other.
79
Where should heavy packs be placed in a steam sterilizer?
At the periphery of the load, where steam enters the chamber.
80
Where should basins or other containers with a smooth surface be placed in a steam sterilizer?
On the bottom of the load, on their sides
81
Why is it important to let times that have been in a steam sterilizer run through the dry cycle?
To prevent condensation.
82
If a package is wet after being steam sterilized, it is _____. Because?
Contaminated because moisture wicks bacteria from a nonsterile surface onto a sterile surface.
83
Immediate- use sterilization is used when?
Only when no alternative is available.
84
When can implants be sterilized in an immediate use steam sterilizer?
Only in a documented emergency and a rapid readout biological indicator must be used.
85
Wrapped instruments in a gravity displacement steam sterilizer at 250 F are sterilized how long? 270 F? 275?
30 minutes
15 minutes
10 minutes
86
Textile packs are placed in the gravity displacement steam sterilizer at 250 F for how long? 270 F?275F?
30 minutes
25 minutes
10 minutes
87
Wrapped utensils are placed in the gravity displacement steam sterilizer at 250 F for how long? 270 F? 275 F?
30 minutes
15 minutes
10 minutes
88
Wrapped instruments are placed in a Prevacuum steam sterilizer for how long at 270 F? 275 F?
4 minutes
| 3 minutes
89
Textile packs are placed in a Prevacuum stream sterilizer at 270 F for how long? 275 F?
4 minutes
| 3 minutes
90
Wrapped utensils are placed in a steam sterilizer at 270 F for how long? 275F?
4 minutes
| 3 minutes
91
Metal instruments (nonporous, without lumens) are placed in a gravity displacement immediate-use steam sterilizer at 270 F to 275 F for how long?
3 minutes
92
Porous items with lumens and complex power instruments are placed in a gravity displacement immediate use steam sterilizer at 270 to 275 F for how long?
10 minutes
93
Metal instruments (nonporous without lumens) are placed in a dynamic Prevacuum steam sterilizer at 270 F to 275 F for how long?
4 minutes
94
Nonporous/ mixed porous and nonporous items are placed in a pressure pulse/ steam flush immediate use steam sterilizer at 270 F to 275 F for how long?
4 minutes
95
What is EO? How does it sterilize?
Ethylene Oxide. Destroying DNA and protein structures.
96
What is ethylene oxide mixed with to be used as a sterilants?
Carbon dioxide gas or hydro chlorofluorocarbons (HCFC)
97
What items are sterilized using EO?
Heat and moisture sensitive items. Delicate instruments including microsurgical instruments and those with optic systems.
98
Why is ethylene oxide dangerous?
It is highly flammable.
99
What is the temperature range for a Cold EO cycle?
85-100F or 29-37-7 C
100
What is the temperature range for a warm EO cycle?
130-145 F or 54-63 C
101
What is the preferred moisture content for EO sterilization? Why is moisture necessary?
25 to 80% moisture. Humidity is required to make spores less resistant to the EO gas.
102
Exposure to EO gas can cause what? Long term occupation exposure hazards?
Burns to skin and mucus membranes. Respiratory damage.
103
Ethylene oxide can react with different chemicals. What will occur if this happens?
They will disintegrate or create other toxic chemicals.
104
Good that have been sterilized with EO must undergo an aeration cycle. Why?
This allows all traces of EO to dissipate.
105
Where does aeration occur?
In the same chamber as the sterilization process
106
If there is EO reside on instruments after sterilization, should they be rinsed with water?
No! This is dangerous and will create harmful byproducts
107
After decontamination, instruments are prepared for EO sterilization how?
They are inspected to ensure they are clean and they are fully dried.
108
What items cannot be EO sterilized?
Acrylics and pharmaceutical items
109
What types of wrappers are not suitable for EO sterilization?
Made with natural fibers combined with nylon and rayon, polyester, and polyvinyl chloride. Double wrapped peel pouches are not suitable.
110
Other than EO, what is another method to sterilize heat and moisture sensitive items?
Vaporized hydrogen peroxide.
111
How does vaporized hydrogen peroxide sterilize items?
It interferes with the cell membrane, genetic material, and cell enzymes.
112
What cannot be processed by gas plasma sterilization?
Cloth and cellulose products
113
Name the 3 metals that are comparable with gas plasma sterilization.
Stainless steel 300 series
Aluminum 6000 series
Titanium
114
Name 3 nonmetals that are compatible with gas plasma sterilization.
Glass
Silica
Ceramic
115
What wrappers are compatible with gas plasma sterilization?
Types or Mylar
116
What are the 4 phases of gas plasma sterilization?
1. Vacuum phase- air is evacuated from the chamber to reduce pressure.
2. Injection phase- liquid hydrogen peroxide is injected into the central chamber, where it is vaporized.
3. Diffusion phase- hydrogen peroxide disperses throughout the load.
4. Plasma phase- Radiofrequency energy breaks apart the hydrogen peroxide vapor, creating a plasma cloud containing free radicals and ultraviolet light. The compounds recombine into oxygen and water and are dissipated from the chamber.
117
How long does vaporized hydrogen peroxide sterilization occur?
30 to 60 minutes
118
What is peracetic acid solution composed of?
35% peracetic acid, hydrogen peroxide, acetic acid, sulfuric acid, and water.
119
What is peracetic acid frequently used to sterilize?
Fiber optic endoscopes
120
How does peracetic acid inactivate different cell processes?
Oxidation.
121
The final products after peracetic acid sterilization are what?
Acetic acid (vinegar) and oxygen.
122
Does peracetic acid leave a chemical residue?
No, but it must be rinsed throughly form instruments.
123
Ozone sterilization utilizes a molecular form of oxygen at ________ heat for sterilization of what type of instruments?
Low heat for heat and moisture sensitive items
124
Ozone sterilizes instruments through what process?
Oxidation
125
What can be sterilized using the ozone method?
rigid diagnostic instruments, stainless steel and synthetic substances such as PVC, silicone and polytetraflurorethylene (PTFE, Teflon)
126
Ozone is not approved to sterilize what?
Implants
127
Most equipment available prepackaged from a manufacturer has been sterilized by what method?
Ionizing radiation (cobalt 60 radiation)
128
Cobalt 60 radiation sterilizes how?
Destruction of DNA
129
What type of items are sterilized by cobalt 60 radiation?
Sharps, sutures, sponges, disposable drapes, anhydrous materials such as powders and petroleum goods.
130
Define event related sterility.
Sterilized items are assumed to be sterile while wrapped unless environmental conditions or events interfere with the integrity of the package.
131
A pack is no longer sterile if one of what four things occur?
1. The pack shows signs of exposure of liquid.
2. The pack is torn, punctured, or otherwise damaged.
3. The pack has been stored in a location that has no environmental controls.
4. The pack has been transported using a soiled or open system.
132
High level disinfection are used on what?
Flexible and rigid endoscopes.
133
Disinfectants work how?
Changing cell proteins (desaturation) or by drying (desiccation) them.
134
What are the four factors that can affect a disinfectant's activity?
1. Concentration of the solution
2. The bio burden of an object
3. Water hardness and pH
4. Presence or absence of organic matter on the item
135
Where can information about chemicals be found?
Material Safety Data Sheet
136
What information does a material safety data sheet contain?
It describes the chemical, potential hazards, and what to do if the chemical comes in contact with the skin or is splashed into the eyes.
137
What level of disinfectant is Glutaraldehyde?
High
138
Is Glutaraldehyde a sporidical, bactericidal, viricidal, or tuberculocidal?
Yes, Yes, Yes and Yes after 20 minutes
139
What weakens glutaraldehyde?
Unintentional dilution if instruments are wet when immersed. By the presence of organic matter.
140
How long can glutaraldehyde be used?
14 days
141
Safe levels of glutaraldehyde in the air are what?
Under 0.2ppm.
142
After sterilization or disinfection of instruments in glutaraldehyde, what must occur before they can be used?
They must be completely rinsed with sterile distilled water
143
Another name for orthophthaladehye 0.55% is what?
Cidex OPA
144
Cidex OPA is what level of disinfectant? What is it used on?
High, immersive medical devices.
145
Describe the disinfection process using Cidex OPA?
Instruments are throughly cleaned, dried and placed in the solution for 12 minutes at 20 C. An automatic endoscope reprocess or can achieve HLD in 5 minutes.
146
After disinfection with Cidex OPA, what must occur before the instruments be used?
They must be rinsed with water 3 times.
147
Phenol is also called? What level of disinfectant is this? Is it sporidical, tuberculocidal, fungicidal, viricidal, or bactericidal?
Carbolic acid, low, No, Yes, Yes, Yes, and Yes
148
What is the risk of using phenol?
It can be very toxic. It has a noxious odor and causes skin lesions and respiratory irritation.
149
What level of disinfectant is quaternary ammonium compounds, quats? Is it fungicidal, bactericidal, sporidical, or viricidal?
Low. Yes, yes, no, no
150
What are the two most common quaternary ammonium compounds?
Benzlkonium chloride and dimethyl benzyl ammonium chloride.
151
What weakens quaternary ammonium compounds?
Hard water.
152
Hypochlorite is what level of disinfectant? Is it sporidical, tuberculocidal, bactericidal, or viricidal?
Low. Yes, Yes, No, No
153
Hypochlorite is effective against what?
HIV
154
What weakens hypochlorite?
Organic material. It is deactivated and the area is encouraged to be cleaned prior to using the disinfectant.
155
Can hypochlorite be used on instruments?
No. They are corrosive.
156
What is a common example of hypochlorite? Hypochlorite must be diluted to prevent what?
Bleach. Respiratory irritation and skin burns.
157
Alcohol is what level of disinfectant? Is it sporidical, bactericidal, tuberculocidal, or viricidal?
Intermediate. No, Yes, Yes, Yes
158
What is alcohol effective against?
Cytomegalovirus and HIV
159
What are the two components of alcohol? At what percentage is it effective?
Ethyl alcohol and isopropyl alcohol
160
What are the hazards of alcohol?
It is corrosive to stainless steel, drying when used routinely. Highly flammable and volatile.
161
What is the routine decontamination of the surgical suite before the workday?
Damp dusting the surgical lights, furniture, and fixed equipment in the OR. A clean, lint-free cloth and a hospital grade chemical disinfectant are used.
162
During the surgery, how should blood spills be handled?
They should be removed promptly with a hospital grade disinfectant.
163
How should contaminated items be handled?
In a no-touch method. In a way to protect the person who is handling the specimen.
164
How are specimens transported out of the OR?
In a leak-proof container.
165
After the surgery, what area of the room needs to be cleaned?
3 to 4 foot area around the sterile field on the floor, pads of the OR table and under them, under or table, all soiled equipment, spot clean walls, doors, surgical lights, and ceilings. All contaminated items are removed from the room.
166
What is the pressure for steam sterilization at 250 F?
15 to 17 psi
167
What is the pressure for steam sterilization at 270 F?
27psi
168
Dry heat sterilization is used for what items?
Anhydrous oils, petroleum products and talc.
169
How long does it take to sterilize products using EO?
2 to 3 hours, but the entire process can take up to 16 hours with aeration.
170
What is activated glutaraldehyde also called? What is sterilized this way?
Cidex, endoscopes, and plastics and rubber
171
How long does it take Cidex to sterilize instruments?
10hours
172
Hydrogen peroxide sterilization takes place is what sterilizer?
Sterrad
173
At what temperature does hydrogen peroxide sterilization occur? How long does this take?
104 F using radio frequency waves. About 1 hour. This is a dry cycle.
174
Peracetic acid sterilization occurs in what sterilizer?
Steris
175
Peracetic acid sterilization is for what type of sterilization? At what temperature and how long does it take?
Immediate use only, 131 F for 20-25 minutes. Cycle takes 30-35 minutes.
176
Woven textile drape packs should not exceed what dimensions and what weight? How should they be folded and packaged?
12x12x20 weigh no more than 12 pounds and be fan folded, packaged loosely.
177
What is the maximum weight for a pack of surgical instruments?
16 pounds
178
Large packs should be separated how far apart in a steam sterilizer?
2 to 4 inches
179
Iodophors is germicidal in how many minutes?
20
