Chapter 10 - Decontamination, Sterilization, and Disinfection

Step 1 in the Reprocessing cycle

Point of use cleaning

Immediate-use steam sterilization (IUSS)

Rapid sterilization of instruments to be used immediately. This process was previously called flash sterilization

What is immediate-use processing?

Refers to the sterilization of certain items that must be sterilized as close to the time of surgery as possible, formerly called flash sterilization

Contaminated

Rendered nonsterile and unacceptable for use in critical areas of the body

Step 2 in the Reprocessing cycle

Sorting and disassembly

Step 5 in the Reprocessing cycle

Sorting and inspection

Step 8 in the Reprocessing cycle

Storage

Accreditation agency for all health care organizations in the United States.

TJC

What is DART?

The daily air removal test is an air detection test performed for high-vacuum sterilizers.

Sterile Processing Department (SPD)

The hospital department where medical devices and equipment are reprocessed; this process may also take place in a Central Processing (CP) department

Bioburden

The number of contaminating microbes on an object

What is bioburden?

The number of viable organisms in or on an object or surface.

Environmental cleaning

The process of cleaning the surfaces in patient care areas, including the operating room. This includes floors, cabinets, equipment, lights, and furniture

Exposure time

This is the amount of time goods are held in specific conditions during disinfection or the sterilization process. Exposure time varies with the size of the load, type of materials being sterilized, and the type of agent used. Exposure time is sometimes called the hold time

Why are sterile packages given a lot number?

To identify items that have been included in a sterilization load that may have yielded a positive biological or mechanical control test.

What is the purpose of wrapping instruments for sterilization?

To maintain a sterile environment following autoclaving

Step 7 in the Reprocessing cycle

Wrapping

What is terminal disinfection?

a thorough cleaning of the room with disinfectant solution after transmission-based precautions are discontinued

What is the minimum exposure time for a wrapped tray of instruments of 270ºF? a. 15 b. 20 c. 30 d. 45

a. 15

An organization for which standards are developed with the support of the U.S. Food and Drug Administration a. AAMI b. AORN c. CDC d. TJC

a. AAMI

___ is a chemical used to remove microorganisms on tissue a. An antiseptic b. A disinfectant c. Sterilization d. All of the above

a. An antiseptic

The ___ includes a workroom with ample table space for sorting instruments and assembling instrument sets a. Clean processing area b. Decontamination area c. Sterile back table d. Case cart system

a. Clean processing area

The following are high-level disinfection semi-critical items, except: a. Operating room table and accessories b. Respiratory therapy equipment c. Bronchoscopes d. Anesthesia equipment

a. Operating room table and accessories

Instruments that have ___ must be disassembled before sterilization a. Removable parts b. Ratchets c. Sharp edges d. Blades

a. Removable parts

The system that assigns a device a risk category based on the specific regions of the body where the device is used is the ___ system a. Spaulding b. Sterilization c. Dewey d. Maslow

a. Spaulding

Instrument trays have a perforated bottom so that: a. Steam can circulate up through the tray and adequately cover all surfaces of the instruments b. They are easier for the surgical team to handle c. The instruments are easily put into sets by central processing d. The towels in the instrument sets cannot be damaged by the steam

a. Steam can circulate up through the tray and adequately cover all surfaces of the instruments

Which of the following sterilizers uses hydrogen peroxide gas plasma cassettes? a. Sterrad b. Flash c. Ethylene oxide d. Steam

a. Sterrad

During surgery, if there is blood spilled on the floor in the operating room, what should the circulator do? a. Wipe and clean up area with a hospital-grade disinfectant b. Call housekeeping c. Cover it d. Do nothing

a. Wipe and clean the area with a hospital-grade disinfectant

Which is used to monitor air in the chamber of high-vacuum sterilizers? a. Bowie Dick b. Chemical indicator c. Mechanical indicator d. External chemical indicator

b. Chemical indicator

Which of the following statements is not true regarding the use of peel pouches? a. Items wrapped in peel pouches must not be placed inside an instrument tray b. Double pouches are unneccessary and may prevent sterilization of the item. c. The item in the pouch should clear the seal by at least 2 inch d. Peel pouches are intended for items such as bone rongeurs, rasps, and multiple instruments

b. Double pouches are unnecessary and may prevent sterilization of the item

Which of the bacteria used to monitor steam sterilization effectiveness? a. Bacillus subtilis b. Geobacillus stearothermophilis c. Stearothermophilis c. Stearothermophilus bacilllusd. Geobacillus subtilis

b. Geobacillus stearothermophilis

The washer-sterilizer or washer-disinfector is used to process all instruments that can tolerate a. Heat b. Water turbulence and high-pressure steam c. Strong disinfectant d. Cold solution

b. Water turbulence and high-pressure stream

What is the exposure time for a wrapped tray of instruments at 250ºF? a. 15 minutes b. 20 minutes c. 30 minutes d. 45 minutes

c. 30 minutes

The following are low-level disinfection noncritical items, except: a. Operating room table and accessories b. Furniture in the surgical suite c. Bronchoscopes d. Blood pressure cuffs

c. Bronchoscopes

The ___ is used to transport sterile and nonsterile instruments and equipment to and from the main operating room area. a. Crash cart b. Elevator c. Case cart

c. Case cart

___ is a skilled, certified profession requiring expertise in the science and practice of materials management, decontamination, and sterilization. a. Perioperative nursing b. Anesthesiology c. Central processing d. Certified nurse's aides

c. Central processing

Which type of sterilization method requires an aeration? a. Steam b. Steam under pressure c. Ethylene oxide d. Gas plasma

c. Ethylene oxide

Which of the following high-level disinfectants could also be used as a sterilizing agent? a. Gas plasma b. Peracetic acid c. Glutaraldehyde d. Steam

c. Glutaraldehyde

Which is the cleaning process that removes devris from instruments in a process called cavitation? a. Cobalt-60 b. Peracetic acid c. Ultrasonic d. Hydrogen peroxide

c. Ultrasonic

Which of the following body tissues presents a critical risk in the Spaulding system? a. Hands b. Intact skin c. Vascular system d. Mucosal membranes

c. Vascular system

Organization that oversees compliance with environmental and patient safety regulations a. AAMI b. AORN c. CDC d. TJC

d. TJC

Routine cleaning of the operating room at the close of surgery each day is: a. Environmental b. Decontamination c. Damp dusting d. Terminal

d. Terminal

Detergent

A chemical that breaks down organic debris by emulsification (separation into small particles) to aid in cleaning

Peracetic acid

A chemical used in the sterilization of critical items

Antiseptic

A chemical used to remove microbes from the skin

Terminal cleaning

A daily process in which exposed surfaces of the operating room are cleaned and disinfected

Reusable

A designation used by manufacturers to indicate that a medical device can be reprocessed for use on more than one patient

Physical monitor

A device that automatically provides output on the physical parameters of the sterilization process. Output includes printouts, gauges, and a digital display

Nonwoven

A fabric or material that is bonded together as opposed to a process of interweaving individual threads

Material Safety Data Sheet (MSDS)

A government-mandated requirement for all chemicals used in the workplace. The MSDS describes the formulation, safe use, precautions, and emergency response

Ethylene oxide (EO)

A highly flammable gas that is capable of sterilizing an object

Ionizing radiation

A method of bulk sterilization used by manufacturers to sterilize prepackaged equipment using cobalt-60 radiation

Chemical indicator (CI)

A method of testing a sterilization parameter. Chemical strips sensitive to physical conditions, such as temperature, are placed with the item being sterilized and change color when the parameter is reached; sometimes called a chemical monitor

Case cart system

A method of transporting surgical supplies and equipment to and from the instrument processing and supply areas

Low-level disinfection

A method used to disinfect patient care items that contact only the skin

Sterilization

A process by which all microorganisms, including bacterial spores, are destroyed

Cavitation

A process during ultrasonic cleaning in which air bubbles implode (burst inward), releasing particles of soil or tissue debris

High-level disinfection (HLD)

A process that reduces the bioburden to an absolute minimum

Cleaning

A process that removes organic or inorganic soil or debris using friction, detergent, and water

Chemical sterilization

A process that uses chemical agents to achieve sterilization

Gas plasma sterilization

A process that uses the form of matter known as plasma during the sterilization process

Biological indicator (BI)

A quality control mechanism used in the process of sterilization. It consists of a closed system containing harmless, spore-forming bacteria that can be rapidly cultured after the sterilization process

Enzymatic cleaner

A specific chemical used in detergents and cleaners to penetrate and break down biological debris, such as blood

-cidal

A suffix indicating death

Spaulding system

A system used to determine the level of microbial destruction required for medical devices and supplies. Each level is based on the risk of infection associated with the area of the body where the device is used

Bowie-Dick test

A test that identifies air leaks and ineffective air removal in the steam sterilization process

Gravity-displacement sterilizer

A type of steam sterilizer that removes air by gravity

High-vacuum sterilizer

A type of steam sterilizer that removes air in the chamber by vacuum and refills it with pressurized steam.

Event-related sterility

A wrapped sterile item may become contaminated by environment conditions or events, such as a puncture in the wrapper. This refers to sterility based on the absence of such events. The shelf life of a sterilized pack is event related, not time related.

Provides recommended practices and technical information for U.S. medical professionals.

AAMI

Professional association for perioperative nurses

AORN

Sporicidal

Able to kill spores

Reprocessing

Activities or tasks that prepare used medical devices for patient use

Woven wrappers

Also called linen or cloth wrappers, these are fabric cloths used to wrap clean, disinfected supplies in preparation for a sterilization process

Prion

An infectious protein particle that is a unique pathogenic substance containing no nucleic acid. The prion is resistant to most forms of disinfection and sterilization normally used in the health care setting

Reposable

An instrument that may be reprocessed a limited number of times. After the specific number of reprocessing events, the instrument must be withdrawn from use

Medical device

Any equipment, instrument, implant, material, or apparatus used in the diagnosis, treatment, or monitoring of patients

Sharps

Any objects used in health care that are capable of penetrating the skin, causing injury

Personal Protective Equipment (PPE)

Approved attire that acts as a complete barrier between the wearer and the environment

Step 6 in the Reprocessing Cycle

Assembly

Agency of the federal government that provides research and protocols in all areas of public health

CDC

Bacteriostatic

Chemical agent capable of inhibiting the growth of bacteria

Step 3 in the Reprocessing cycle

Cleaning the instruments (ultrasonic cleaner)

Turnover

Cleaning, disinfection, and preparation of the operating room between patients

Why doesn't a control monitor determine that sterilized goods are sterile?

Control monitors only indicate that goods have been exposed to the sterilization method

Step 4 in the Reprocessing cycle

Decontamination

Implant

Defined by the U.S. Food and Drug Administration (FDA) as "a device that is placed into a surgically or naturally formed cavity of the human body if it is intended to remain there for a period of 30 days or more"

Biofilm

Dense colonies of bacteria that adhere tightly to surfaces

Disinfection

Destruction of microorganisms by heat or chemical means. Disinfection does not produce sterility because not all microbial forms are destroyed in the process

Washer-sterilizer/disinfector

Equipment that washes and decontaminates instruments so that they can be safely handled by personnel

Risk of Isopropyl alcohol (70%-90%)

Flammable; can damage lensed instruments

Level of disinfection of Formalin (37% formaldehyde)

High

Level of disinfection of Glutaraldehyde (2%) and Stabilized hydrogen peroxide (6%)

High (critical items)

What disinfectant is approved for cleaning blood spills in the surgical suite?

Hypochlorite

Single-use items

Instruments and devices intended for one-time use on one patient only

Level of Disinfection of Isopropyl alcohol (70%-90%)

Intermediate (some semi-critical and noncritical items)

Level of disinfection of Iodophor (free iodine in a detergent-disinfectant solution)

Intermediate to low, depending on concentration

Why are instruments processed in the washer-decontaminator sterilizer?

It is equipment that washes and decontaminates instruments so that they can be safely handled by personnel.

Uses of Isopropyl alcohol (70%-90%)

Limited; no longer used as a general disinfectant

Level of disinfection of Phenolic detergent compounds

Low