Week 4 sterile processing
Tabletop Sterilizer
-Clinical and dental office use -operate per ifu -use water and electrical heat -timer activated with heat level -valve allows steam release when complete
TJC (The Joint Commission) Requirements
-Documentation for tracking purposes -proper performance of IUSS -quality control to ensure safeguards
Ethylene Oxide (EtO)
-Technology used for sophisticated and delicate instruments -is a toxic gas that keep microorganisms from reproducing and results in its death -Eto can penetrate many different materials: paper, plastic, Tyvek PO pouches, and most container systems
Oxidation
-adding oxygen to a chemical compound -used with hydrogen peroxide and ozone methods
Ozone (O3)
-avoid the need to handle a sterilant -O3 generated within sterilizer -specific requirements for use, size and length of lumens
ozone is compatible with
-compatible with most reusable devices, and reusable packaging
label packaging should include:
-description of content -name/initials of assembler -lot/ load control number -cycle number -date -expiration date
3 types of immediate-use steam sterilization
-gravity displacement -dynamic air removal: high speed vacuum & steam flush-pressure pulsing process -Express
Hydrogen peroxide vapor
-has 4 phases -fast cycle (28-55 minutes) -compatible with a wide range of devices: telescopes, cameras, instruments with lumens , 100% polypropylene packaging
Which packaging material is not compatible with hydrogen peroxide sterilization?
Cellulose-containing material
How often should the sterilizer's drain, or strainer, be removed and cleaned?
Daily
Regarding set and rack placement, similar items requiring the same cycle parameters should be grouped _______________-. Items should be spaced so steam can move around freely around each pack and be exhausted ______________ Remember, if packages are packed to _____________on the sterilizer cart, water can become trapped between the packages.
[together], [more easily], [tightly]
Phase
a distinct period, or stage, in the sterilization process
Documentation should include
-load number -items processed -quantity -specific description of the item: type of instrument -reason fro IUSS - patients info -operators info -cycle parameters -date and time -results of biological testing -inconclusive. non-responsive CI's
hydrogen peroxide gas plasma
-low sterilization method -uses oxidation -safer than Eto -Faster turnaround time -used with endoscopes
Vaporized hydrogen peroxide (VHP)
-low-sterilization method - uses oxidation - faster turnaround time - used with items with and without lumens
Pre-vacuum steam sterilizer
-operate at 270 degrees F or 135 degree C -air removed by sequence of pressure and vacuum -bowie dick test performed daily when empty
Ethylene Oxide Cartidges
-placed inside chambers that are smaller than 10 cubic feet -punctures the cartridge to release the gas -this process last about 2in a half hours and has 5 stages -any employee who works in sterilization and is working with Eto has to wear a device that monitors exposure levels and notify's the person when its hit the exposure limit -standards are set by OSHA for the permissible exposure standard
steps of sterilization
-precleaning -decontamination ( preformed in area adjacent to OR in PPE) -Sterililization PPE is removed -transport
Safety Data Sheet (SDS)
-provided by chemical manufacturer -provides detail of chemical -includes handling methods and potential hazards -provides information on what to do accidental exposure -must be posted or made available to personnel using the product
Ozone o3
-recieved clearance by FDA in 2003 -no sterilant to handle -longer cycle of 4in 1/2 hours -items can be used as soon as cycle is complete do not require long aeration phase
ozone is not compatible with
-sealed ampules -liquids -natural rubbers, latex, or woven fabrics
Hydrogen peroxide
-used in more than one system -gas plasma using oxidation -Safer than Eto -five-phase cycle -cycle time faster -by products are nontoxic
When is a low temperature process used for sterilization at the point of use?
A device is heat sensitive
Which of the following is required with ozone sterilization?
A longer cycle
Which process is used with EtO?
Alkylation
Which of the following packaging materials are acceptable to use with EtO sterilization?
All of the above
Which statement best describes competency?
Completion of a task up to the standards required
Which of the following are three of the main phases of a terminal steam sterilizer?
Conditioning, exposure, and exhaust
Which organization requires proof of efficacy for every sterilization system?
FDA
sterility assurance level (SAL)
FDA and CDC minimum requirement must be met. Lowest probability of a variable microorganisms being present after sterilization
When sterilizing items with IUSS at the point of use, it is not necessary to preclean the item due to the urgency of it being needed.
False
A rigid, closed sterilization container or tray should be used for the following steam sterilization cycles: ___________________________.
[pre‑vacuum, pulsing gravity‑displacement, and gravity displacement].
Which of the following are recommendations of both the Association of periOperative Registered Nurses (AORN) and The Joint Commission (TJC)?
IUSS must be minimized or decreased
Immediate-use steam sterilization should be utilized in accordance with __________________ guidelines, ______________ policies and procedures, and in strict compliance with validated written instructions provided by manufacturers of ____________________________.
[professional], [facility] , [devices, sterilization equipment, containers, and textiles].
The following is a true statement about cleaning instruments prior to immediate-use steam sterilization:
[the item should be disassembled and thoroughly cleaned to remove contaminants].
Bioburden
Is the amount, or number of microorganisms on a contaminated object
Which of the following statements is true about IUSS?
It is a process used only when the need is immediate and there is not enough time for the wrapped method
Which of the following is the most common reason for sterilization failure?
Lack of steam contact with the device
Once a wet pack is discovered, it should be removed from the load, and the load should be _______________. A __________________________ should be initiated into the cause, and a _______________ of the load may be initiated.
[quarantined], [problem solving process] , [recall]
Time-weighted Average
Maximum amount of exposure allowed in a 8-hour day, training required for safe use of toxic chemicals to reduce exposre
Which organization sets the standards for the minimum exposure level with low-temperature sterilization methods?
OSHA
barrier packaging
Packaging that provides a barrier from microorganisms and allows aseptic presentation of the product at the point of use
The following is a false statement about immediate-use steam sterilization: immediate-use steam sterilization ________________________.
[represents the shortest time for an item in the OR to be transferred to the sterilizer].
Which best describes a surveying agency?
Reviews and monitors the IUSS process to ensure high standards are met
Flash sterilization, now known as ____________________________, has been implicated in increasing a patient's risk for infection. Many facilities perform flash sterilization in a misguided effort to sterilize items quickly to avoid _____________________________.
[immediate‑use steam sterilization], [buying additional surgical instruments]
Cycle parameters vary according to (the) __________________________.
[instrument manufacturer's instructions].
immediate-use steam was originally intended for use _____________________ such as when, _____________________.
[only in an emergency], [when one‑of‑a‑kind instruments become contaminated].
When the sterilization cycles are complete, care should be taken to avoid contamination. Do not ___________________________.
[open and remove items prior to entering the OR]
What can be the result of a high amount of bioburden on an item to be sterilized?
The item will be more difficult to sterilize
Permissible Exposure Limit (PEL)
The maximum amount or concentration of a chemical that a worker may be exposed to under OSHA regulations.
Terminal sterilization
The method that takes place in the central service or another department. The device or instrumentation is sterilized in its final container or package and sent to sterile storage until it is ready to be used
Quality Control
There are various methods to measure production quality. it may be completed using a statistical technical or sampling method
When can implantable devices be processed using IUSS?
There is a system in place to track the device to the patient
In a steam sterilizer unit, where is the coolest location?
Thermostatic trap
When loaded in the sterilizer, which of the following applies to basin sets?
They are placed on edge
The following is a false statement about preventing wet packs with proper set and rack placement:
[place paper and plastic pouches flat or parallel to shelf].
Internal wetness is often associated with incorrect pack _________________ items that are wet before _________________ and insufficient ______________ during the dry cycle.
[preparation], [sterilization], [air removal]
Which of the following is a correct statement of why CS personnel need to understand the anatomy of a sterilizer?
To understand how the sterilizer operates
Which is the best way to transport items processed using immediate-use-steam sterilization?
Use a rigid container designed for IUSS
point of use processing
When a device used in a procedure or surgery is processes near the patient care area immediately before reuse. This is accomplished using either immediate-steam sterilization or heat-sensitive processing
_________________ indicators cannot verify sterility, but they can be used to detect ___________________________, such as air leaks, inadequate temperature, or wet steam, as well as ____________________, such as packaging errors.
[Chemical], [equipment malfunctions], [work practice issues]
_____________________________ should never receive immediate-use steam sterilization.
[Devices that are sold sterile and intended for single‑use only]
_______________ results from biological indicators indicate only that the sterilization cycle delivered appropriate parameters, not that everything in the load is sterile.
[Negative]
Sterilization is a process that destroys or eliminates ____________________ by physical or chemical methods.
[all forms of microbial life]
Preparation and packaging is a vital component of the sterilization process. Items must be placed in materials and containers that are _____________________ the sterilization process.
[compatible with]
Sterilization indicators are used to determine whether an item has been ______________________. There are three types of indicators used: ___________________________. Process indicators must be used in accordance to the ______________________.
[exposed to the proper sterilization process], [physical, chemical, and biological], [method of sterilization].
Devices or equipment that are sensitive to ________________ must undergo low temperature sterilization.
[heat or moisture]
Steam sterilization is the most common form of _____________ sterilization. It is preferred for critical instruments that are not damaged by _______________________. Examples of steam sterilizers include table top and ___________________.
[high temperature] , [heat, steam, pressure, or moisture],[gravity air displacement].
Residual Eto
amount of remaining sterilants after sterilization
Competency
is the ability to complete a task or skill successfully and efficiently to the standards required. Staff members who perform IUSS must be evaluated to determine their skill in the task
Bowie Dick Test
is the process completed at the same time everyday to test the vacuum function of a sterilizer
ethylene oxide
does not use oxidation. toxic gas. used for delicate and sophisticated instruments
All low-sterilization methods can use the same packaging methods.
false
Ethylene oxide is a toxic gas used for high-temperature sterilization.
false
It does not matter whether an item is processed using a standard steam sterilization cycle or an extended cycle.
false
The design of the medical device and the amount of soil and microorganisms present do not impact the effectiveness of sterilization.
false
When the sterilization process is complete:
inspect sterile packages for integrity and check physical, chemical, and biological monitors
Surveying agency
is an organization that closely monitors IUSS. They ensure that the process is being completed by the healthcare facility to the high standards required -The joint commission (TJC) -Center of Medicare and medicaid services (CMS)
IUSS or Immediate-use-steam-sterilization
is designed for processing an item at the point of patient care when there is a need for immediate use IUSS was previously called flash sterilization
The following is a true statement about low temperature sterilization:
it uses either gas or vapor, or liquid immersion
advantages of steam sterilization
low cost quick cycles simple technology no residue or byproduct on device
External wetness is usually associated with a source ______________ the pack.
outside
Hydrogen peroxide are not compatible with
paper plastic pouches, and muslim wraps,
Break out
pre-sterilized items purchased from outside vendors arrive to medical facility in outer shipping containers. is when items are removed from the outer container before the commercially sterilized item are brought into sterile storage areas.
Dynamic air removal sterilizers
remove air from the chamber using mechanical systems, when used for IUSS drying time is reduced and operate at a higher temperature than gravity-air. must reach temp of 270-275 degrees f or 132,2 -134 degrees c
Byproduct
secondary product produced or leftover as a result of another process
The following is a false statement about sterilization:
sterilization must be performed on semi‑critical equipment
Pre-conditioning
takes place before the sterilization cycle. it is so that the proper temperature and relative humidity in the sterilizer chamber
Hydrogen peroxide are compatible with
tray and container systems from manufacturer and Tyvek peel pouches
Before an item is placed in a liquid chemical in the sterilizing process, it must be cleaned.
true
IUSS documentation should include the name of the item, the name of the patient on which it is being used, and the sterilizer ID number and cycle used.
true
If packages are improperly wrapped or improperly loaded in the sterilizer, it can result in wet packs.
true
Low-temperature sterilization, including EtO, O3, and hydrogen peroxide plasma gas and vaporization, are monitored using biological, physical, and chemical indicators.
true
Saturated Steam
type of steam that contains the maximum amount of water vapor
Aeration
used with EtO, exposes packages to moving air for removal of residual toxins
low temperature sterilizers
uses gas or vapor such as: -Ethylene oxide -hydrogen peroxide -ozone -liquid immersion
gravity displacement
uses gravity in the conditioning phase to displace air and replace with steam. doesn't typically include a drying time. must reach temp of 250 degrees f or 121 degrees c
high temperature sterilizers
uses steam, and dry heat
Low-Temperature Process
when an item to be sterilized is heat sensitive. IUSS cannot be used
