Chapter 18: Sterilization and Disinfection

What is a GHS hazard pictogram and what is its purpose?

Hazard pictograms consist of standardized graphic symbols that allow employees to quickly identify the types of hazards associated with a hazardous chemical.

How should a sterilization strip be placed in a wrapped pack?

In the center of the wrapped pack with the end containing the dye placed in an area of the pack considered to be the hardest for steam to penetrate.

What is the purpose of the pressure used in the autoclaving process?

It allows a higher temperature to be attained than could be reached by the steam from boiling water alone.

What information must be included on a hazardous chemical label?

Product identifier, supplier identification, GHS signal word, GHS hazard statements, GHS hazard pictograms, GHS precautionary statements, supplementary information.

List two examples of items that can be disinfected through intermediate-level disinfection. List one example of an intermediate-level disinfectant.

Some items for which intermediate-level disinfection is sufficient are stethoscopes, blood pressure cuffs, tuning forks, percussion hammers, and crutches. Intermediate-level disinfectants are ethyl alcohol and isopropyl alcohol.

What are the characteristics of bacterial spores?

Spores represent a resting and protective stage of the bacterial cell and are more resistant to drying, sunlight, heat, and disinfectants.

List three examples of wrapping materials used for the autoclave and identify an advantage of each type.

Sterilization paper: disposable and inexpensive. Sterilization pouches: provide good visibility of the contents; usually include a sterilization indicator . Muslin: economical because it can be reused; lies flat when opened.

Why shouldn't tap water be used to fill the water reservoir of an autoclave?

Tap water contains minerals which have corrosive effects on the stainless-steel chamber of the autoclave.

What temperature and pressure are the most commonly used to sterilize materials with the autoclave?

Temperature: 250 °F; pressure: 15 psi.

What is the difference between a GHS hazard statement and a GHS precautionary statement?

A GHS hazard statement is a phrase that describes the types of hazards associated with a hazardous chemical. A precautionary statement is a phrase that describes recommended measures to be taken to minimize or prevent adverse effects resulting from exposure to the hazardous chemical or from improper storage or handling.

What is the difference between a health hazard and a physical hazard?

A health hazard includes the potential of the chemical to cause acute toxicity, skin corrosion, or irritation, serious eye damage or irritation, respiratory or skin sensitization, germ cell mutagenicity, cancer or reproductive toxicity, or is an aspiration hazard. A physical hazard includes the potential of the chemical to catch fire, explode, or react with other chemicals or materials.

What is event-related sterility?

A sterile pack is considered sterile unless an event occurs that interferes with the sterility of the article, such as crushing, compressing, or dropping the pack.

What are the advantages and disadvantages of autoclave tape?

Advantages: Is available in a variety of colors, can be written on and is useful for closing and identifying the wrapped articles. Disadvantages: Does not ensure that steam has penetrated to the center of the pack; does not ensure the item has been sterilized.

How does one determine what type of physical or chemical agent to use to destroy microorganisms on an article?

Agent to be employed depends on the intended use of the article.

List one example of an item that requires high-level disinfection. List one example of a high- level disinfectant.

An item requiring high-level disinfection is a flexible fiberoptic sigmoidoscope. A high-level disinfectant is glutaraldehyde.

What is a critical item? List examples of critical items.

An item that comes in contact with sterile tissue or the vascular system.

How often should a biological indicator be used to monitor an autoclave?

At least once a week.

List two diseases that are caused by bacteria that produce spores.

Botulism and tetanus.

List four examples of hazardous chemicals that may be used in the medical office.

Chemical disinfectants, autoclave cleaner, laboratory testing reagents, developing solutions, controls, local anesthetics, copy machine toner, cleaning products.

Why should a chemical not be used past its expiration date?

Chemicals have a tendency to lose their potency over time.

What information does the Centers for Disease Control and Prevention (CDC) recommend be recorded in an autoclave log regarding each cycle?

Date and time of the cycle, description of the load, exposure time, exposure temperature, results of the sterilization indicator, and initials of the operator.

What determines the amount of time required to sterilize articles in the autoclave?

Depends on the type of item being autoclaved.

What is the purpose of a sterilization indicator?

Determines the effectiveness of the sterilization procedure and checks against improper wrapping of articles, improper loading of the autoclave, or faulty operation of the autoclave.

List two examples of items that are disinfected by low-level disinfection.

Examining tables, laboratory countertops, walls.

How does the medical manufacturing industry use ethylene oxide gas sterilization?

For producing prepackaged, presterilized disposable items, such as syringes, sutures, catheters, and surgical packs.

What is the definition of high-level disinfection?

High-level disinfection is a process that destroys all microorganisms with the exception of bacterial spores.

What should be done if a sterilization indicator does not change properly?

The manufacturer's guidelines for proper sterilization techniques should be reviewed and the articles should be resterilized following these guidelines.

Describe the care an autoclave should receive on a daily basis.

The outside of the autoclave should be wiped with a damp cloth and a mild detergent; the interior of the autoclave, trays, and rubber gasket should be wiped with a damp cloth; the rubber door gasket should be inspected for possible damage that could prevent a good seal.

What is the purpose of sterilization?

To destroy all forms of microbial life.

What is the purpose of the Hazard Communication Standard?

To ensure that employees are informed of the hazards associated with chemicals in their workplace and the precautions to take to protect themselves when working with hazardous chemicals.

What is the purpose of a GHS signal word?

To indicate the relative degree of severity of the hazardous chemical and to alert the user to a potential hazard on the label.

Why should instruments be handled carefully?

To prevent damage to the instruments.

Why should gloves be worn during the sanitization procedure?

To protect the individual from bloodborne pathogens and other potentially infectious materials and to protect the hands from the irritating effects of chemical agents and accidental punctures or cuts from sharp instruments.

What is the purpose of wrapping articles to be autoclaved?

To protect them from recontamination during handling and storage.

What is the purpose of sanitizing an article?

To remove organic matter from an article and to reduce the number of microorganisms to a safe level.

List and briefly describe the information that must be included in a Safety Data Sheet.

Identification: Information used to identify the chemical. Hazard Identification: Includes the hazards of the chemical and the appropriate warning information associated with these hazards. Composition/Information on Ingredients: Provides a list of ingredients in the hazardous chemical. First-Aid Measures: Describes the initial care that should be given by an untrained responder to an individual who has been exposed to the hazardous chemical. Fire-Fighting Measures: Provides recommendations for fighting a fire caused by the chemical. Accidental Release Measures: Provides recommendations on the appropriate response to spills, leaks, or releases including containment and cleanup practices. Handling and Storage: Provides precautions that should be taken for safe handling of the chemical and conditions for safe storage of the chemical. Exposure Controls/ personal Protection: Indicates the exposure control limits, engineering controls, and personal protective measures that should be used to protect oneself from the hazardous chemical. Physical and Chemical Properties: Lists the physical and chemical properties associated with the hazardous chemical. Stability and Reactivity: Lists the substances and conditions that the hazardous chemical should be kept away from to prevent a dangerous reaction. Toxicological Information: Identifies the toxicological effects that can result from overexposure to the chemical. Ecological Information: Provides information to help determine the environmental impact of the hazardous chemical if it were released into the environment. Disposal Considerations: Provides guidance on proper disposal of the hazardous chemical. Transport Information: Provides guidance to suppliers for shipping and transporting the hazardous chemical. Regulatory Information: Identifies the safety, health, and environmental regulations specific for the hazardous chemical that is not indicated anywhere else on the SDS. Other Information: Includes other important information such as when the SDS was prepared or when the last known revision was made. Emergency first aid procedures: first aid measures to take if exposed to the chemical. Precautions for safe handling and use: explanation of what to do in case of a spill or leak, method of disposal, and handling and storage of the chemical. Control measures: the precautions to take to protect oneself from the chemical.

Why must a cleaning agent with a neutral pH be used to sanitize instruments?

If the cleaning agent does not have a neutral pH, it could cause a stain on the instrument.

How should sterilization indicators be stored?

In a cool, dry area.

How should sterilized packs be stored?

In clean dry areas that are free from dust, insects, and other sources of contamination. The most recently sterilized articles should be placed in the back.

What effect does moist heat have on instruments with sharp cutting edges?

It dulls their sharp points or edges.

What is the purpose of the Globally Harmonized System of Classification and Labeling of Chemicals (GHS)?

It is an international standard that provides consistency in the classification and labelling of chemicals through the use of pictograms, signal words, and hazard warnings.

List two properties of a good wrapper for use in autoclaving.

It is not affected by the sterilization process and it allows steam to penetrate while preventing contaminants from entering during handling and storage.

What is the advantage of using the ultrasound method to clean instruments?

It offers a safety advantage because the instruments do not have to be handled during the cleaning process, which decreases the incidence of an accidental puncture or cut from a sharp instrument.

Why is more time needed to autoclave a large minor office surgery pack?

It takes longer for the steam to penetrate to the center of the pack.

What is the purpose of lubricating an instrument?

Makes the instrument function better and last longer.

Why is it important that all air be removed from the autoclave during the sterilization process?

When air is present, the temperature in the autoclave is reduced, and a temperature that is adequate for sterilization is not reached.

How should each of the following be checked for defects and proper working condition? a. Blades of an instrument: b. Tips of an instrument: c. Instrument with a box lock: d. Cutting edge of a sharp instrument: e. Scissors:

a. Blades of an instrument: Should be straight and not bent b. Tips of an instrument: Should approximate tightly and evenly when the instrument is closed. c. Instrument with a box lock: Should move freely and not be too loose. d. Cutting edge of a sharp instrument: Should be smooth and devoid of nicks. e. Scissors: Should cut cleanly and smoothly.

What is the meaning of the following GHS signal words?

a. Danger: Denotes a more severe hazard possible. b. Warning: Denotes a less serious hazard possible but potentially harmful.

How should the following be positioned in the autoclave? a. Small packs: b. Large packs: c. Jars and glassware: d. Sterilization pouches:

a. Small packs: With 1 to 3 inches between them b. Large packs: With 2 to 4 inches between them c. Jars and glassware: On their sides with their lids removed d. Sterilization pouches: On their sides or with the paper side up and the plastic side down

What type of brush should be used to clean the following parts of an instrument? a. Surface of an instrument: b. Grooves, crevices, or serrations:

a. Surface of an instrument: Still nylon brush b. Grooves, crevices, or serrations: Stainless steel wire brush

Why is a longer exposure period needed to ensure sterilization when using the dry-heat oven?

Microorganisms are more resistant to dry heat than to moist heat, and dry heat penetrates more slowly and unevenly than moist heat.

Why must a sterilized load be allowed to dry before it is removed from the autoclave?

Microorganisms can move quickly through the moisture on a wet pack and onto the sterile article inside resulting in contamination.

What guidelines must be followed when using cold sterilization?

Only chemicals designated as sterilants by the Environmental Protection Agency can be used for sterilizing articles; the items to be sterilized must be submerged in the chemical for 6 to 24 hours; each time a new instrument is added to the container, the clock must be restarted and the batch processed for the full amount of time; cold sterilization should be used only when sterilization with steam, gas, or a dry-heat oven is not indicated or the required equipment is unavailable.