terms & definitions pt 1: Flashcards
(186 cards)
1
Q
What is sterile processing?
A
Centralized distribution of supplies to all customers in the hospital.
2
Q
What is the one-way workflow?
A
Its the movement of soiled instruments from dirty to clean.
1. Decontamination (soiled)
2. Preparation packaging sterilization (clean)
3. Sterile storage (sterile)
3
Q
What is the purpose of a one-way workflow?
A
To prevent cross-contamination.
4
Q
What is the temperature, humidity, and air exchange in the decontamination area?
A
Decontamination temp: 60-65 degrees F.
humidity: 30-60%
air exchanges: 10 per hour
5
Q
What is the temperature, humidity, and air exchange in the prep and pack area?
A
Prep and pack temp: 68-73 degrees F.
humidity is 30-60%
air exchanges: 10 per hour.
6
Q
What is the temperature, humidity, and the air exchange in the sterile storage area?
A
Sterile storage temp: 75 degrees or lower.
humidity is less than 75%
air exchange is 4 per hour.
7
Q
What do you wear in the decon area?
A
Decon: (full PPE) scrubs, hair cover, shoe cover, gown, eye goggles, face shield, gloves, and face mask.
8
Q
What do you wear in the assembly and sterile storage?
A
Assembly and sterile storage: scrubs and hair cover.
9
Q
What do you wear in the OR?
A
OR: scrubs, hair cover, and face mask may be required.
10
Q
What do you wear in the normal traffic areas?
A
Normal traffic areas: regular street attire.
11
Q
Processing cycle.
A
1) use
2)return
3) identify
4) clean
5) assemble
6) package
7) sterilize
8) store
9) deliver
12
Q
Cleaning?
A
AAMI defines this process as removing contamination to prepare an item for use or processing.
13
Q
Decontamination?
A
Making contaminated instruments or equipment safe to handle by physically or chemically removing harmful microorganisms.
14
Q
3- sink setup (first sink?)
A
Wash sink- water with detergent.
15
Q
3- sink setup (second sink?)
A
Intermediate rinse sink- plain/ critical water.
16
Q
3- sink setup (third sink?)
A
Final rinse sink- critical water
17
Q
Preparation/ packaging/ sterilization area.
A
Items are inspected, assembled, packaged, and prepared for sterilization under positive air pressure.
18
Q
Contamination.
A
The state of being soiled or infected by contact with infectious organisms or other material.
19
Q
Standard precautions.
A
Treat everyone and everything as infected/contaminated
20
Q
Hospital-acquired infection.
A
An infection that isn’t present when a patient is admitted but acquired after 3 days in a healthcare facility is called an HAI.
21
Q
Negative air flow.
A
Air flows into a room from other surrounding areas. pressure is less than other adjacent areas.
22
Q
Positive air pressure.
A
Maintains airflow out of a room. Helps with keeping all dust particles and microorganisms out.
23
Q
What are the 2 flat wrapping techniques and the 2 folds?
A
Wrapping techniques- Sequential & Simultaneous
Fold techniques- Square fold & Envelope fold
24
Q
Wrapped pans of instruments should not exceed ____ in weight.
A
16 lbs
25
What is the maximum weight for containerized instrument sets recommended by AAMI/ANSI?
25 lbs
25
Wrapped basin sets should not exceed _____ lbs.
7 lbs
26
What is a wet pack?
Containers with moisture after the sterilization process is complete.
27
Sterility (time-related)
Package is considered sterile until a specific expiration date is reached.
28
Sterility (event-related)
Items are considered sterile unless the integrity of the packaging is compromised or suspected of being compromised.
29
Name the 4 things that event-related sterility depends on.
1) Quality of the wrapping material.
2) Handling procedures.
3) Storage and transport conditions.
4)Number of times the package has been handled (4 times)
30
Name 4 concerns when it comes to packaging.
1) Moisture contamination.
2) Dirt, dust, and debris.
3) Physical damage
4) Breakdown of packaging material due to wear of age.
31
Sterile storage temps should be at 1. ___ and 2.___ and relative humidity should be maintained between 3. ____
Temperature should be maintained between 72 degrees Fahrenheit and 78 degrees Fahrenheit. Relative humidity shall be maintained between 30% and 60%.
32
Sterile items should be stored at least 1.___ away from exterior walls, 2. _______ above the floor and from the ceiling.
1. 2 inches
2. 8-10 inches
33
Why do we use lubricants on instruments?
Extends the life of instruments and makes it easier for surgeon to use.
34
Where is the lubricant applied? Please explain.
Lubricants are applied to hinges, moving parts, or sliding areas of instruments.
35
What are the two common stain tests?
1. Gram stain (purple is gram positive) (pink Is gram negative)
2. Ziehl-Nelson (acid-fast stain) (bright red)
36
How do bacteria reproduce?
By a process called binary fission.
37
Spore
Bacteria with thick walls that survive harsh conditions; a resistant
form of bacterium.
38
1st part of the chain of infection.
Caustive agent- microorganism that causes infection.
39
2nd part of the chain of infection.
Reservoir of the agent- where the infectious agent stays.
40
3rd part of the chain of infection.
Portal of exit- where the infectious agent leaves.
41
4th part of the chain of infection.
Mode of transmission- method of transfer from reservoir to susceptible host.
42
5th part of the chain of infection.
Portal of entry- path used to enter susceptible host.
43
6th part of the chain of infection.
Susceptible host- person fighting off infection.
44
What does the FDA regulate?
The manufacturers of all medical devices.
45
Class I medical devices
Low risk, no pre-market approval. [EX: ultrasonic cleaners]
46
Class II medical devices
Medium risk, needs 510k [EX: Sterilizers]
47
Class III medical devices
High risk, requires pre-market approval. [EX: heart valves]
48
What is a 510k application VS pre-market approval?
510k application is used when there are changes in the product.
Pre-market approval is done when there is a new product being released.
49
Due to the safe medical devices act of 1990, healthcare facilities are required to report events to the FDA and manufacture within ____ working days.
10
50
The first class for the FDA recalls?
Class I- High risk, causes serious health and or death.
51
The second class for the FDA recalls?
Class II- Medium risk, causes temporary health problems.
52
The third class for the FDA recalls?
Low risk, low chance of causing health issues.
53
What is the CDC?
Centers for Disease Control- Federal agency that issues infection control guidelines.
54
EPA
Environmental Protection Agency- Established in 1970, it enforces laws on air, water, and environmental protection.
55
DOT
Department of Transportation- regulates labeling and transport of hazardous and biohazardous waste.
56
OSHA
Occupational Saftey and Health Administration- protects workers from job-related illnesses and injuries.
57
AAMI
Association for the Advancement of Medical Instrumentation- Develops recommended practices and standards.
58
ANSI
American National Standards Institute- Sets safety and quality standards for various industries.
59
AORN
Association of Operating Room Nurses- Dedicated to providing optimal care to the surgical patient.
60
APIC
Association for Professionals in Infection Control and Epidemiology- A voluntary global group focused on infection prevention and control.
61
ISO
International Standards Organization- Globally based non-govermental standards organization.
62
Joint Commission
An independent nonprofit setting healthcare standards, ensuring safety, and inspects facilities.
63
NFPA
National Fire Protection Association- sets global fire safety standards to reduce fire hazards.
64
USP-NF
United States Pharmacopeia- National Formulary
sets standards for packaging, labeling, bacteriological purity, pH, and minerals.
65
WHO
World Health Organization- Combats infectious diseases and promotes the general health of the people of the world.
66
SGNA
Society of Gastroenterology Nurses and Associates- A nonprofit organization that sets standards & guidelines for flexible endoscope processing.
67
Any items brought in by the vendors should be kept in the ______
Breakout area.
68
Asepsis
The absence of microorganisms that cause disease.
69
Aseptic Technique
Any activity or procedure that prevents infection or breaks the chain of infection.
70
Surgical Asepsis
Procedures to remove or prevent microorganisms.
71
What are the 5 basic principles of asepsis?
1- Know what is dirty
2- Know what is clean
3- Know what is sterile
4- Keep the 3 conditions separate
5- Remedy contamination immediately
72
What causes hard water stains?
Calcium and Magnesium
73
What causes rainbow stains on stainless steel?
Silicates
74
Purified water should have a PH of _____
6.5-7.5
75
What is reverse osmosis?
Water diffuses through a semipermeable membrane to remove impurities.
76
What are enzymes?
Catalysts that break down or "digest" large organic molecules to facilitate their removal.
77
Protease
Enzymes that break dow proteins.
78
Lipase
Enzymes that break down fats.
79
Amylase
Enzymes that break down starches.
80
What is the preferred transportation method? why?
Closed transport system to avoid cross contamination.
80
Free rinsing
Removal of any residue of cleaning agents and chemicals remaining after the cleaning process.
81
What is a surfactant?
A surface-acting agent that lowers the surface tension of a liquid so it can penetrate deeper.
82
Chelating agent
Chemicals that hold hard water minerals in solution and prevent soaps or detergents from reacting with minerals.
83
Water temperatures should be below ______ to prevent coagulation.
140 degrees F
84
Name 8 items that should not be placed in the ultrasonic cleaner.
1. Chrome-plated instruments
2. Ebonized intruments
3. Plastic
4. Cork
5. Glass
6. Wood
7. Chrome
8. Rubber
85
What process is used for untrasonic cleaners? Explain please.
Cavitation process- Ultrasonic vibrations create bubbles that implode, removing debris from small, hard-to-reach areas.
86
What process is used for mechanical washers?
Impingement- spray force of water.
87
Shelf life
Length of time a disinfectant can be properly stored till expired.
88
Use life
Length of time or number of times disinfectant can be used until efficiency (strength) or disinfectant is diminished.
89
What is MEC and what level should it be at?
MEC is a test used to check the effectiveness of the chemical concentration level. Which should be at 0.3% or higher for OPA.
90
The Spaulding Classification System
Categorizes medical devices based on risk to determine the required level of disinfection or sterilization.
91
Name 3 types of PSI (Powered surgical instruments)
1. Electrically powered instruments
2. Pneumatic powered instruments
3. Battery powered instruments
92
What is an AER
Automatic Endoscope Reprocessors- They clean, disinfect, and rinse flexible endoscopes.
93
Name 5 advantages of using AERS
1. Timed cleaning
2. Consistent exposure
3. Timed contact
4. Air flush cycle
5. Use of copius rinse water
94
What is a leak test?
A leak test is done to check for holes on the scopes' shaft.
95
How is a leak test done?
By closing all port openings with proper caps and inflating the endoscope shaft with air or submerging them in water to detect bubbles.
96
What are the different endoscope channels?
1. Instrument Channel
2. Suction Channel
3. Optical Channel
4. Air/ Water Channel
(Some flexible scopes have separate air and water channels.)
97
Laryngoscope
To visualize the larynx.
98
Esophagoscope
To visualize the esophagus.
99
Colonoscope
To visualize the large intestine.
100
Sigmoidoscope
to visualize the lower part of the large intestine.
101
Esophagogastro Duodenoscope
To visualize esophagus, stomach and duodenum.
102
Brochoscope
To visualize the tracheobronchial tree.
103
Gastroscope
To visualize the upper GI tract and stomach.
104
Laparoscope
To visualize the abdominal cavity.
105
Cystoscope
To visualize the urethra and bladder.
106
Flash sterilization
Sterilizing unwrapped instruments quickly for immediate use in emergencies.
107
What are the 3 types of flash sterilization cycles?
1. Gravity displacement
2. Pre-vacuum
3. Express
108
What are the phases for flash sterilization?
1. Condition
2. Exposure
3. Exhaust/ Dry
109
Chemical Indicator vs Class 5 intergrator
Chemical indicator reacts to one or more parameters.
Class 5 intergrator montiors all critical parameters
110
What should immediate use steam sterilization (IUSS) documentation contain?
1. Patient's name
2. Contents of the flash cycle
3. Type of sterilization cycle
4. Cycle parameters
5. Reason for flash sterilization
6. Signature of staff person responsible for the release of the load
111
Case cart system
An inventory system using a cart prepped for one surgical case, common in operating rooms.
112
Case cart pull sheet/ pick list
A list of items needed for a specific procedure, used by central service techs to prepare surgical sets.
113
Textine packaging materials should be held at room temp of 1.____ and a relative humidity of 2____ for a minimum of 3._____ prior to sterilization.
1. 64-72 degrees F
2. 35-70%
3. 2 hours
114
1. ______ likes cold temps, 2. ______ likes moderate temps, and 3. ______ likes warm temps.
1. Psychrophiles
2. Mesophiles
3. Thermophiles
115
Trays must be 1. ____ or 2. _____ bottom to ensure good circulation.
1. Perforated
2. Meshed
116
To properly decontaminate, instruments must be 1. _____ and 2. _______ to the smallest part.
1. Opened
2. Disassembled
117
Bowie Dick Test
Also called the Residual Air Removal Test, it's done daily to check for air leaks or poor air removal in the sterilizer.
118
Negative BI results shouldnt be the only one depended on to prove all items in loads are sterile, also check for what?
Chemical Indicators
Class 5 integrators
Mechanical moniter printout
Bowie dick test results
119
Conduction
Heat transfer from one part of an item to another.
120
Convection
Heat transfers from one point to another as gas or liquid circulates.
121
Saturated steam
Steam that contains the maximum amount of water vapor.
122
What is the time frame for items to cool down before use.
30-60 minutes.
Heavier items can take several hours,
123
Validation
Manufacturer procedures to prove a process consistently makes sterile products.
124
Verfication
Facility procedures to confirm the manufacturer's validation works in their setting.
125
Name 4 factors that impact sterilization.
1. Type of microorganisms present
2. Number of microorganisms present
3. Amount and type of soil present
4. Amount of protection the medical devices provide.
126
Aeration
A process in which a device is actively subjected to moving air.
127
What is the aeration time for ETO sterilized items?
8 hours at 140 degrees F
12 hours at 122 degrees F
128
When transferring loads to the aerator 1.____ do not 2._____ the load to prevent from inhaling any fumes.
1. Pull
2. Push
129
Gas plasma kills by what process?
Oxidation
130
Regulation
Mandatory law or rule that is issued by a governing body.
131
Standard
Method of defining basic parameters for process, products, services, and measurements.
132
Regulatory Standard
A required standard set by law; not following it can lead to legal penalties.
133
Voluntary Standard
Benchmark that is strongly recommended
134
Statue
Written and enforceable law enacted by a governing body.
135
Donning (putting on) PPE
1. Shoe covers
2. Gown
3.Mask/respirator
4. Goggles
5. Face shield
6. Gloves
136
Doffing (removing) PPE
1. Shoe covers
2. Gloves
3. Face shield
4. Goggles
5. Gown
6. Mask/ respirator
137
The role of environmental housekeeping in SPD
- Floors should be wet mopped at least daily
- Horizontal work surfaces such as counters and worktables should be cleaned at least daily
- Light fixtures or their cover should be cleaned at least every 6 months.
-Walls, cabinets, and racks should be cleaned on regularly scheduled basis
138
Point of use preparation does what for instruments?
Helps prolong the life of instruments.
Makes the cleaning process easier.
139
Emergency eyewash/shower equipment
Should be accessible within 10 seconds or 100 feet of potential chemical exposure.
140
Manual cleaning
Physically remove deposits using water between 80°F–109°F to prevent protein coagulation.
141
Wetting agent
A substance that lowers liquid surface tension, helping it spread or penetrate solids more easily.
142
Detergents
Substances that loosen and remove soils, lower surface tension, and keep dirt suspended during cleaning.
143
When cleaning aluminum or stainless steel, a "to and from" motion in the direction of the grain should be used rather than a circular motion.
This will help to prevent scratching the surface of the item and causing damage.
144
Mechanical washers
Automated equipment used to clean, decontaminate, or disinfect and dry medical devices.
145
Medical waste categories
General trash
Regulated medical waste
Hazardous waste
Low-level radioactive waste
146
Regulated medical waste
- Represents risk to public health and environment.
- Sharps
- Selected isolation- biological waste and discarded materials.
- Pathological waste- human tissue, organs, and body parts
- Human blood
147
Disinfectant
A chemical that kills most pathogens but not spores; not a sterilant.
148
Antisptics
A solution that slows bacterial growth, used topically and on living tissue.
149
Disinfection
The destruction of nearly all pathogenic microorganisms on an inanimate surface.
150
Thermal disinfection
The use of heat to kill all organisms except spores.
151
Sterilization
Destroys all microbial life, including bacteria, viruses, spores, and fungi.
152
Bactericidal
Relating to the destruction of bacteria.
153
Effectiveness of disinfectants depends on several factors, including:
1. Type & amount of microorganisms
2. Contact
3. Time
4. Temperature
5. pH
6. Water quality
7. Device material
8. Positioning of device
154
Quats- Quaternary Ammonium Compounds
Low-level disinfectant for surfaces like floors and walls. Denatures proteins, disrupts membranes, and is not ideal for central service use.
155
Phenolics
Intermediate to low-level disinfectant that penetrates cell walls, clumps proteins, and has lasting effects. Commonly used in housekeeping.
156
Alcohol
70% isopropyl alcohol; fast-acting, no residue, denatures proteins. Used post-disinfection to flush endoscopes and aid drying.
157
Halogens
Chlorine and iodine are intermediate-level disinfectants.
Chlorine: for dialysis machines, baths, bathrooms, and laundry.
Iodine: for skin prep; can corrode metal.
158
Glutaralydehyde
High-level disinfectant for semi-critical devices like endoscopes.
Kills by protein alkylation, clear (turns green when activated), strong odor.
Requires good ventilation (10 air exchanges/hr).
Reusable for 14–28 days, test with strips (1.5% MEC).
Disinfects in 25 mins, sterilizes in 6–10 hrs, used manually or automatically.
159
Opa- Ortho Phthalaldehyde
High-level disinfectant with no strong odor.
Needs good ventilation (10 air exchanges/hr).
Soak: 12 min at 68°F (manual) or 5 min at 77°F (AER).
Not a sterilant; kills by alkylation.
Requires lots of rinsing.
No activation is needed. Reusable for 14 days, 2-year shelf life.
MEC: 0.3%.
160
Two categories of sterility packaging
Reusable
Disposible
161
Objectives of the packaging process
Allows sterilant penetration, maintains sterility, and enables aseptic opening.
162
Resuable sterilization materials
Woven textiles.
Rigid sterilization containers.
163
Disposable sterilization materials
1. Pouches
2. Nonwoven wrap
164
Muslin
Plain-weave cotton or cotton/poly blend with ~140 threads per inch.
165
Superheating
Occurs when steam is hotter than saturated steam at the same pressure.
166
Linen packs size limit
12x12x12.
Weigh no more than 12 lbs.
Max density not to exceed 7.2 lbs.
167
Packaging used for steam sterilization
Must be capable if withstanding high temps of 250-270-275.
Must allow air removal and steam penetration and must permit drying.
168
Packaging used for ETO (Ethylene oxide)
Allows gas sterilant in and removal of residue through aeration.
169
Packaging used for gas plasma.
Containers that hold and protect instruments during sterilization, storage, and transport.
170
Kraft-Type Papers
A medical grade paper packaging material used for numerous sterilization applications.
171
SMS Spunbond
Meltblown
Spunbond
Non-woven packaging material, which is the most popular flat wrap.
172
Papers/pouches that contain cellulose:
Not for gas plasma sterilizers—cellulose absorbs sterilant and blocks penetration.
173
Paper plastic pouches/ SMS wraps
Acceptable for use with steam and EtO sterilization processes.
174
Spunbond polyolefin
Plastic/ SMS wraps
Used in gas plasma sterilization (Tyvek pouches); no cellulose, so it's compatible with hydrogen peroxide.
175
Wicking Material
An approved absorbent material that allows for air removal, steam penetration, and facilitates drying.
176
Package labeling should include:
Description of contents.
Initials of assembler.
Lot control number.
Sterilizer ID and cycle.
Date/Time.
177
Packaging materials should be held :
At room temp of 64-72 degrees F
Humidity ranging from 35%-70%
For a minimum of two hours before sterilization.
178
FIFO
First in first out.
179
3 agencies that have established standards, guidelines, and recommendations for IUSS
1. AAMI
2. AORN
3. Joint Commission
180
IUSS gravity Cycle
Single Instrument comprised of metal and without lumens
3 Minutes @ 270 degrees F
181
IUSS gravity cycle
Complex or lumened instruments
Mixed load
10 Minutes @ 270 degrees F
182
Preset express cycle
4 minutes @ 270 degrees F with 3 minutes drying time, total cycle time of 12 minutes.
183
Why is pre-cleaning the most important part of the decontamination process?
Up to 99% of microorganisms on an instrument can be removed with thorough cleaning.
184
Incubation temp for geobacillus stearothermophilus is
122-140 degrees F
