Sterilization "A" Chapter #8

we have to always check standards and recommended practices for new and updated imformation on what processes?

On the process of prion contaminated devices.

what is one problem about immediate-use?

One problem is making sure the item has been cleaned properly before immediate-use.

CSD has to follow policies and procedures concerning what?

Personal hygiene decontaminating attire assembling hand washing packaging cleaning

Pre-vacuum is referst to as what?

Pre-vacuum

what do you run when you sterilize liquids?

Run a BI in every load and one placed in a duplicate container of solution with a BI hanging from a string.

when "superheating" of steam occurs?

Superheating of steam occurs when "saturated steam at any given temperature is subject to a higher temperature. In othe words, the heat is added to dry steam in the absent of water.

what is a good measure for incoming steam quality?

The incoming steam should be at least 97% dry saturated steam and at most 3% entrained water.

what does the insulated jacket in an sterilizer provides?

The jacket provides heat in the chamber which prevents condensation from forming on the chamber walls. It also helps separate water droplets from the steam before the steam goes into the chamber.

What does AIMI recommends about the enviroment in the sterilization area where sterilizers are located?

The temp. should be 68 to 73 the humidity at 35% to 60% 10 air exchange p/hr under positive air pressure. Document the temp and humidity daily.

what are prions?

These are transmissible pathogenic agents that are smaller than viruses and are extremely resistant to inactivation by heat and disinfecting agents.

what is the wrong way to use this containers to transport clean items to OR?

These containers should not be used to keep items sterile so you cannot sent the unused items to OR for sterile storage.

what to do after these instruments exposed to CDJ has been cleaned and cool?

They should be assembled, packaged, wrapped and ran by the manufacturer's instructions, usually 18 minutes exposure time to 273 to 278 temp. keep a record on the sterilizer log.

what is steam sterilization and other sterilization processes designed for?

This processes types are designed to kill one million bacterial spores.

what varies depending on the sterilization method?

Time and temperature

what happen in the drying phase?

Time usually needs to be 30 minutes. in a dynamic pre-vacuum air removal filtered air is drawn into the chamber. In a gravity displacement sterilizer, heat in the chamber wall causes moisture to evaporate.

how to verify if the sterilization parameters were met?

Use chemical integrators (CIs) in every cycle and biological indicators (BIs) weekly by preferably daily.

what happen is the steam is dry out during steam sterilization?

Without moisture, the effect of dry heat sterilization will cause overheating of materials and could cause sterilization to not occur.

what should you do when you use immediate-use-instruments more than once?

You have to run a biological in every load.

what happen in the exhaust phase?

after exposure, the steam is removed from the sterilizer through the chamber drain line.

what is the name of the germ you are trying to kill during steam sterilization?

geobacillus stearothermophilus.

what are some signs of the impurity of steam during sterilization?

if the steam is not pure, there may be impurities that get into the way of small lumens and block them, or may cause pitting and metal discoloration on instruments that were exposed to steam that was not pure..

what happen in the sterilization, exposure, holding phase?

in here the exposure temp. is maintained for a certain amount of time. e.g. if it is set for 4 min. expopsure the load will be held for 4 min. at the temp. that was set.

what is CJD

it is a disease (fatal) of the nervous system ex: eye, brain, or spinal cord surgery. It is caused by abnormal forms of normal proteins called prions.

when is immediate-use sterilization used?

it is used in an emergency situation such as when an item gets dropped on the floor, it is one of a kind item or needed for the case they are doing.

what happen in the condition phase?

it is when the air is removed from the sterilizer's chamber and steam is injected in: A. pre-vacuum sterilizer where air is removed by one or more vacuum excursions. B. gravity displacement. where steam passively displaces the air through a port or drain in the bottom of the sterilizer.

what is saturated steam?

it is when the steam entering the sterilizer is considered to be a moist steam.

what some manufacturers recommend about the steam cycles?

some manufactures recommend that you run longer cycles; a normal cycle might be 4 min. and an extended cycle could be 15 min. or more.

what type of sterilization are used for items that are not wrapped?

steam sterilization liquid chemical and several other types.

where are sterilizers usually located?

sterilizers are usually located in prep and packing near the sterile storage area.

when using a pre-vacuum autoclave what should be the PSI?

the PSI needs to be at leat 27 pounds in order to force the steam into the packs to sterilize the items.

where is the access area to get to the sterilizers located and what is the recommended temperature and humidity?

the access room is behind the sterilizers, and it has to have a temp of 75 to 85, and 10 negative air exchanges per/hr.

what a higher bio-burden means?

the higher the bio-burden the the more difficult it is to kill all microorganisms. That is why items are cleaned to the best of our ability prior to sterilization.

what dictates the length of the conditioning phase?

the length of the conditioning phase always varies depending on what material is in the load and is controlled by the sterilizer.

what does the person running the cycle check?

the person who run the flasher has to check for receipts, charts or gauges and initial.

what is the requied pressure for your steam sterilizers?

the pressure required is usually 60 to 80 psig (pounds per square inch gauges)

Why is the quality of steam important during sterilization?

the quality of steam supplied to the sterilizer is important to successful sterilization and effective drying. e.g. one measure of steam quality is the relative dryness of the steam.

What are some dissadvantage of steam sterilization?

the steam can be hazardous to certain pieces of equipment because of the heat generated and by moisture or by the purity of steam:

what some medical devices can't withstand on a pre-vacuum cycle?

the temperature or vacuum

what is the right and wrong way to flash sterilize an item properly?

the wrong way will be when some OR staff just rinse the item off and then sterilize the right way is that the items should go to decon first for proper cleaning; all instruments needs to be in an open position after cleaning then returned to OR in a container to be flashed.

what is the diffenrence between the pre-vacuum and gravity displacement sterilizers cycles?

these have the same sterilization cycles but the method for air removal is different.

what type of steam sterilization most hospital use today?

they use pre-vacuum sterilizers and have cycles for gravity displacement.

the higher the temperature the shorter the amount of what is needed?

time e.g. cooking something on 425° rather than 325°

how steam sterilization works?

when items are placed inside the sterilizer, they are at room temperature (cool). When high steam makes contact with the cool items, condensation forms and energy (in the form of heat) is released, heating up the packs.

when do you place a "special prion processing required" warning tag on instruments

when the instruments that come to decon were used on high risk cases.

when do you have a wet pack?

when you have more than 3% liquid water in your pre-vacuum autoclave.

what happens to the steam when your sterilizer is on?

when you sterilizer is on, the steam enters the jacket and remains there until you run a load.

How can you achieve proper sterilization of items?

you achieve this by proper design and operation of the sterilizer and how items are assembled, packaged, and loaded in the sterilizer.

Gravity displacement is refers to as what?

"flash"

where are the flash sterilizers usually located?

-OR -Labor and Delivery -Ambulatory surgery centers.

what is the difference between the gravity displacement and pre-vacuum air removal cycles?

-Pre-vacuum has a mechanical air removal. (it will suck the air out) -gravity displacement use gravity to remove the air (it will push the air down)

how to decontaminate items used in a patiet with CDJ

-You decontaminate just like anything else. -if needed use disposible lumens -do not use powered equipment because there is no data on the effectiveness of cleaning and sterilizing the used items. -after the washer cycle, they need to run unwrapped in the sterilizer.

what are the 2 most important steps after cleaning?

-confine and contain the item after sterilization to avoid contamination

what is the cycle time AIMI recommends for sterilizing CJD contaminated items?

-for a Pre-vacuum sterilizers: 18 minutes at 273 to 278 -for a minimun exposure time in a Gravity displacement sterilizer: 1 hour at 270 -for a extended exposure time in a Gravity displacement sterilizer: 4 1/2 hrs at 250.

what JC recommends that you should do?

-increased your instrument inventory to avoid immediate-use -have a plan for improving and decreasing immediate-use -pay attention to the frequency of immediate-use sterilization -documentation is detailed.

what information does the exception form for premature release of implants should include?

-name of patient -name of the implant -name of the surgeon -reason the implant was released early -what could have prevented the premature release?

what kind of items are sterilize by steam and why?

-surgical trays, almost all metal items and all rubber goods, fabric, glassware and some hard plastic. -the reason is they can withstand high temperatures, pressure and moisture associated with steam.

what documentation should be included in the log for items flashed?

-the date -the sterilizer number -who cleaned the item -the type of device flashed -verification of the manufacturer's instructions were checked -the patient identification -the cycle number -the temperature, exposure time, and cycle type -the results of the CI -the name of the person who removed the items and why you flashed the items.

Name some of the reason of why poor steam quality caused the sterilization process to fail?

-the presence of non-condensable gases generated when the steam is treated with chemicals -inadequate steam pressure is too low for the set temperature. -inadequate time at temperature -incorrect usage and placement of BI PCDs and Bowie-Dick test packs -wet steam can cause wet packs.

what 2 forms needs to be filled out, if you release your implants to OR before the results of the BI were read.?

1. Implanteable device load record which is used to documents all implant loads. 2. Exception form to document premature release of implants before the BI results are ready.

What are the 2 types of sterile solutions?

1. Parental which are administered to the patient by IV 2. External which are used for irrigating, topical application and surgical use.

what are the 4 phases of the pre-vacuum and gravity displacement sterilizers?

1. conditioning phase 2. sterilization, exposure, holding phase 3. exhaust phase 4. drying phase

Name the 2 basic steam cycles and how they work?

1. dynamic air removal cycles are used in a pre-vacuum sterilizer where air is removed by drawing a lot of vacuums. 2. gravity displacement. this occurs where the incoming steam displaces residual air through the drain in the bottom of the sterilizer chamber.

what are the 3 parameter of steam sterilization?

1. saturated steam under pressure. 2. time 3. temperature

what are 3 factors affecting sterilization?

1. the sterilizer or sterilizer system has to be designed to be able to achieve the correct combination of temp. and sterilant concentration. 2. the bio-burden (microbial combination) must be low enough to ensure the item is sterile. 3. Must be adequate contact of sterilant, time will all the items.

what are the minimum exposure times in a High-speed gravity displacement steam for immediate-use-sterilization of porous items, lumens and metals?

270° or 275° for 10 minutes.

what are the minimum exposure times in a Dynamic-air-removal steam for immediate-use-sterilization of non-porous metal or lumened items?

270° or 275° for 3 minutes

what are the minimum exposure times in a High-speed gravity displacement steam for immediate-use-sterilization of metal non-porous or lumened items?

270° or 275° for 3 minutes

what are the minimum exposure times in a Dynamic-air-removal steam for immediate-use-sterilization of porous items, lumens and metals?

270° or 275° for 4 minutes

how does steam sterilizers works?

A steam sterilizer works by having a dedicated supply of steam. e.g. in hospital the steam is generated by a boiler.

who dictate how you sterilize items?

A. Operating Room B. Manufacturers C. CSD

what does AIMI says about parental solutions?

AIMI does not recommend that you sterilize any parental solutions in the hospital for personnel use.

how often AIMI recommends to test your containers?

AIMI recommends you biologically test your containers annually.

who needs to be in-serviced?

Anyone using a flasher or testing a flasher

why is complete air removal during the steam sterilization process important?

Because air and steam do not mix. If air is in the package the steam will not be able to get inside. Because, Air will interfere with steam contact with the device.

why steam sterilizing is the most common way to destroy organism and sterilize items?

Because this method is fast, efficient, cheap, always available, shorter sterilization cycles, simple technology, non toxic and have fewer hazards to employees.

why a new daily log should be maintained for each sterilizer used?

Because you have to be able to trace the items in case the sterilizer did not work.

when does complete air removal occur when using a steam sterilizer?

Complete air removal occur if: the sterilizer is functioning properly, it has good quality steam, the packages are propery wrapped and loaded in the sterilizer, and the correct sterilization cycle is run for the load contents.

What types of sterilization are used for wrapped items?

Ethylene Oxide (EO), low temperature gas plasma dry heat and ozone

What does AIMI recommends about your manufacturer's recommendation?

Follow your manufacturer's recommendation on cleaning, maintenance and sterilization to a T. Meaning if only a gravity-displacement immediate-use-cycle was validated for that device then that's the only cycle that can be used not a pre-vacuum.

what is necessary for every temp setting?

For every temp. setting, you have to have the necessary pressure to reach the temperature. e.g. the higher the temp, the higher the pressure is needed. the lower the temp. the lower the pressure is needed.

what do you run when you flash implants and why?

For implant you have to run a BI in every load Because BI's provide the only direct measure of lethality of a sterilization cycle. Then record the BI's results that were done and the controls that were not run.

For sterilization to occur steam has to what?

For sterilization to occur steam must make direct contact will all surface of the device.

what type of sterilization can not be used on CDJ items

Immdiate-use-sterilization

what AIMI says about steam sterilization for patient care items for immediate-use?

Immediate-use-sterilization quickly sterilize an item because there is not barrier (packaging) to impede air removal and steam penetration.

what JC says about Immediate-use-sterilization?

Immediate-use-sterilization should be used for: -unanticipated situations -turnover instruments for cases.

What happen in a pre-vacuum cycle?

In a pre-vacuum cycle the sterilizer draws one or more vacuums. e.g. a pump will suck out the air from the chamber and the packs.

what is the incubation time of CJD

Incubation time can be 1 year to as many as 30 years long and fatality is almost certain within 7 months after the symptoms are displayed.

how to check the psig pressure on your steam sterilizers?

It can be checked by using a gauge that is usually located in the back of the sterilizes next to the main steam line.

What does AORN says about immediate-use-sterilization?

It does not support the immediate-use-sterilization as a substitute for not having enough instruments.

what is steam sterilization?

It is done by saturated steam under pressure. Steam under pressure sterilizers cooks items quickly and efficiency.

where is the heat-sensing thermometer located at?

It is located in the drain line because it is the coldest part of the sterilizer.

what is sterility?

It is the absence of all forms of microbial life including bacterial spores.

What is "sterility assurance level"?

It means that an item is considered sterile if there is less that one-a-million chance that a visble microbe has survived the sterilization process.

Explain and name what are the minimum exposure times, temperatures, and pressures for steam sterilization of wrapped items?

It means that within the chamber of the autoclave the system is building up a head of steam, which calculated into pressure A. Dynamic-air-removal steam for 4 min. at 270°, 30 min. dry time and 27-30 psi.. B. Dynamic-air-removal steam for 3 minutes at 275° and 28-30 psi. C. Gravity displacement steam for 30 min. at 250° and 15 psi. D. Gravity displacement steam for 15-25 min. at 270° and 27 psi. E. Gravity displacement steam for 10 min. at 275° per 30 psi.

Why all sterilization cycles should be monitored?

It should be monitored to verify the effectiveness of the sterilization process.

what is called the open pan method?

Items that are not wrapped during steam sterilization

what happen if you have less than 3% liquid on your pre-vacuum autoclave?

Less than 3% liquid your will get superheated steam which causes a sterilizer failure due to lack of heat transfer to the load.

how liquids are sterilize in healthcare today and why?

Liquids usually special medication or solution are only placed in a gravity displacement sterilizer because it has a slow exhaust to prevent rupture of the liquid container at the end of the cycle which could hurt the SPD tech.

Is steam sterilizing a better method of sterilization?

No, in all cases but the majority of the instruments used in OR today are steam sterilized.