CRCST Certification exam (Week 1-3)

When checking the strength of HLD chemicals, incorporate the following steps. First, monitor chemicals approved for multi-use to assure active ingredients remain (above the MRC/MEC or below the MRC/MEC)? Second, test the chemical whenever it is what? Third, (Always or Never) top off the basin of solution or AER reservoir containing the solution.

1. Above MRC/MEC (minimum recommended concentration) 2. activated, diluted, or opened 3. Never

What instrument has jaws that should fit together and not overlap? You should check the tool's __________ for signs of wear on both signs of the hinged area, as bioburden can be easily caught in them.

1. Hemostats 2. Box Locks

When inspecting the outer casing of the battery, look for bent or missing ________________; cracks in the housing that allow moisture to come in contact with the inner cell packs, resulting in permanent damage; and evidence of moisture and corrosion, which may appear as staining on the towels in the tray.

1. Terminals

When delivering instruments to the OR, check each set to ensure the _____________ are in proper condition and external indicators have changed to the appropriate color before sets are delivered. Additionally, make arrangements with OR personnel to ensure items are delivered on time and to the appropriate receipt area. Finally, when placing in a cart for delivery, be careful to keep each case separated by ___________________.

1. Wrap and locks 2.patient and surgeon or procedure Additional info: when delivering processed loaner instruments, label carts with the same patient and physician or procedure information for fast identification.

HLD should only be performed in what areas? The room should have ____________that allow for the correct amount of air exchanges as well as safeguards for chemical exposure, such as eye washing stations and proper PPE.

1. designated reprocessing areas 2. Engineering controls

The most common problems associated with the processing of electric powered equipment include moisture entering the unit during (cleaning or sterilization), damage to electric parts during (cleaning or sterilization), ad condensation entering the equipment when the seal wears out.

1. during cleaning 2. during sterilization

When handwashing, how long should hands be scrubbed?

20 sec

Central service technicians typically use how many types of cleaning agents to remove organic and inorganic residues?

4 Reasoning: Water, detergents, enzymes, and enzymatic detergents.

How many people contract healthcare-associated infections each year?

700,000

If soiled items are not picked up as scheduled and in a timely fashion, it could lead to....

A shortage of equipment and instrumentation for another procedure.

How can pyrogens be described?

A substance produced by bacteria that can cause fever.

What is the absence of microorganisms that cause disease?

Asepsis

Standards and Guidelines. Definition?

Best practices that may be required by a facility or as part of accreditation but are not required by law

What should the temperature be in the decontamination area?

Between 60-65 degrees F Reasoning: For comfort of personnel wearing PPE and to inhibit the growth of most microorganisms.

A part on an instrument that is sticky or resistant may indicate what?

Bioburden, misalignment, or need for lubrication

The 4 different traffic areas that require specific PPE

Biohazard areas, restricted areas, clean assembly area, and sterile storage area.

Supercut, or microgrind, scissors are identified by which color handle?

Black

Hepatitis B is a virus that is transmitted by which fluid?

Blood

Who must be consulted for requirements to transport contaminated items off site?

Department of Transportation (DOT)

Biofilm can develop when it is allowed to what?

Dry

How can CS personnel interrupt the mode of transmission of a causative agent?

Eliminate the agent

Pre-treatment of moisture compatible devices can involve what?

Enzymatic agents Reasoning: Hot water can make blood and other debris harder to remove. Cool water and enzymatic agents soften and break down dried blood and other organic material.

All microorganisms will cause harm to humans. T or F?

False

Allowing soiled items to dry will make cleaning easier. T or F?

False

Anaerobic bacteria require oxygen. T or F?

False

The transport vehicle used for taking soiled items back to central service can also contain clean items that were not used in the OR. T or F?

False

The box lock is the part of a hemostat that locks and holds it in position. T or F?

False Reasoning: The box lock is the point where an instrument connects and pivots.

When using the disinfectant glutaraldehyde, latex gloves should be worn. T or F?

False Reasoning: CSTs should wear gloves when working with any HLDs. Specifically, butyl or nitrile gloves are used with glutaraldehyde, rather than latex gloves.

Isopropyl alcohol must remain in contact with an object for 2-3 minutes for effective disinfection. T or F?

False Reasoning: Isopropyl alcohol can be used as an antiseptic on living tissue or a disinfectant on inanimate objects where it must remain in contact for 5-10 minutes to be effective.

Point of Use cleaning separates instrument sets or multiple part items. T or F?

False Reasoning: Point of Use cleaning keeps instrument sets or multiple part items together

The decontamination area should have positive airflow. T or F?

False Reasoning: The decontamination area must have negative airflow with the expectation that air exchange with adjacent areas takes place no less than 10 times per hour.

Instrument lubrication is performed prior to cleaning to protect surfaces. T or F?

False Reasoning: After cleaning, lubrication is one of the final steps in the decontamination process.

When labeling or marking instruments, tape should be wrapped around the item two-and-a-half times then the autoclave should be used to bond the tape. T or F?

False Reasoning: Instrument labeling requires that the tape is wrapped around the item 1.5 times followed by bonding using the autoclave.

Clean stainless steel in a to and fro motion against the grain to prevent scratching. T or F?

False. Reasoning: stainless steel and aluminum should be cleaned in a to and fro motion IN THE DIRECTION OF THE GRAIN to prevent scratching.

Which is a low to intermediate-level disinfectant? Organic material iodophors Phenolics Chlorine

Phenolics Reasoning: Chlorine and Iodophors are intermediate-level disinfectants, and phenolics are low to intermediate-level disinfectants, which lose their effectiveness when exposed to organic material.

Documentation is part of _______________ procedures undertaken by the facility to comply with ____________

Quality assurance. Accreditation agencies.

What prevents the spread of infectious microorganisms through policies such as not eating or drinking in restricted work areas and getting the hepatitis B vaccine?

Safe work practices

What accelerates rusting and pitting and may void instrument warranties?

Saline Reasoning: Pitting or corrosion on a stainless steel instrument is caused by numerous solutions, including saline, peroxide, bleach, iodine and many soaps and detergents. Of these, saline is often used inappropriately as a soaking or rinsing agent. Be aware that saline accelerates rusting and pitting and may void instrument warranties.

What substances can cause damage to a surgical instrument?

Saline, hand soaps, and dish soaps

What should be worn during transport of items after they have been prepared at the point-of-use?

Scrubs Reasoning:CS technicians who pick up contaminated items must wear gloves during pickup and handling of items. However, gloves are removed, and hands are washed before leaving the pickup station. If there is ever a potential of a splash, spill, or aerosol exposure, PPE should be worn as well. Otherwise, scrubs are sufficient for transport through hospital or facility corridors.

High-level disinfection is a process that eliminates many pathogenic microorganisms and is appropriate and effective for (Critical/ semi-critical/noncritical) devices, such as some endoscopes and respiratory and anesthesia equipment.

Semi-critical

What process will completely destroy all forms of microorganisms?

Sterilization Reasoning:While decontamination and disinfection will eliminate most microorganisms to a safe level, sterilization is the only process that will completely destroy microorganisms.

Instructions for Use (IFU's) are required by who?

The Food and Drug Administration (FDA)

When should items needed for a surgical procedure be pulled from sterile storage?

The day before surgery

To choose the proper chemical for high-level disinfection, refer primarily to what?

The instrument or device IFU

Which disinfection process uses heat to kill bacteria but does not eliminate spores?

Thermal disinfection

Which is true about items used in patient care or treatment?

They are considered contaminated

Instruments are cleaned using which type of motion?

To and Fro

What are the goals of point-of-use preparation?

To remove gross soil, to prevent damage, and to keep others safe

A sterile or surgical consciousness means always adhering to the rules of asepsis and maintaining an awareness of all the possible risks for contamination in your department. True or False?

True

All medical instruments and devices are considered contaminated when they are opened whether or not they have been used and when they enter the decontamination area. true or false?

True

Any instruments that need repair should be reported to CS by the user before cleaning. T or F?

True

Cleaning instructions for surgical instrumentation are obtained from the manufacturer. T or F?

True

During inspection, surgical instrumentation is measured and inspected for cracks, chips, and bioburden. T or F?

True

Follow facility protocols for the maximum time scopes can remain in storage. Scopes that are stored for longer times must be reprocessed before use. T or F?

True

IFU's are used along with the facility's count sheets. True or false?

True

Instruments with cutting blades should be inspected for nicks, chips, or damage because these can hamper the ability to cut or keep blades from working correctly. T or F?

True

Point-of-use cleaning separates reusable sharps from other instruments. T or F?

True

Quaternary ammonium is incompatible with soap and can be deactivated by organic material. T or F?

True

Some bacteria require higher temperatures than others to grow. T or F?

True

Staff and visitors can carry microorganisms into processing areas, increasing the potential for environmental contamination. T or F?

True

Sterile items must never be placed along outside walls. True or False?

True

Tools that are not disposable should be high level disinfected an sterilized daily. T or F?

True

You must practice standard precautions and assume that all patients have microorganisms that can cause infection. true or false?

True

After setting up the disinfection work area, the next step in the workflow is reading the label for correct use and the preparation instructions for proper mixing. T or F?

True Reasoning: After setting up the disinfection work area, the disinfectant label is read for correct use, reviewing the IFU and preparation instructions for proper dilution, mixing instructions, temperature, water quality, and pH required.

Precleaning should begin immediately following the completion of the procedure, in the procedure room. T or F?

True Reasoning: Blood and soil that dries can facilitate microbial growth and increase the risk of biofilm formation, which can double every 20 to 30 minutes. Once biofilm grows, it is difficult or impossible to remove.

The goal of the cleaning process is to completely remove soil, such as fats, proteins, lubricants, and biofilm, and any natural secretions, fecal matter, blood, and tissue to facilitate successful high-level disinfection or sterilization. T or F?

True Reasoning: Flexible endoscopes are probably the most difficult cleaning process to perform because we are trying to clean something that we cannot see to facilitate HLD and sterilization. This process will aim to remove soil, such as fats, proteins, lubricants, and biofilm, as well as natural secretions, fecal matter, blood, and tissue.

The most common problems associated with processing pneumatic equipment include corrosions of internal components from steam condensation or immersion in solutions, internal corrosion from bioburden due to improper cleaning, and physical damage from mishandling. T or F?

True Reasoning: In addition, other problems associated with processing pneumatic/air equipment include lack of proper preventive maintenance and failure of air hoses due to sterilization issues. For example, heat breaks down the rubber components and o-rings, which may cause air leaks.

Most manufacturers recommend connecting the cable to the hand piece of electric powered instruments during cleaning. T or F?

True Reasoning: Since electrical devices must never be immersed, most manufacturers recommend connecting the cable to the hand piece during cleaning to prevent fluid invasion.

Tissue forceps have teeth. T or F?

True Reasoning: Tissue forceps use their teeth to assist in grasping body tissue.

A careful inventory and inspection of loaner instruments should be performed as soon as sets are received in CSSD. T or F?

True Reasoning: When the instruments arrive, they should be documented and tagged with the date, surgeon name, patient name or ID number, and procedure.

When using mechanical washers, trays are separated and covers are left open or removed. T or F?

True Reasoning: When using a mechanical washing device, keep in mind that the washer racks should never be overloaded. Any instruments processed should first be disassembled; trays with covers should be left open and separated if there is more than one tray; small delicate instruments should be placed in perforated baskets; and a low-foaming detergent is used.

What is the purpose of an osteotome?

Used to cut or shave bone Reasoning:Osteotomes are stainless steel instruments that are used to shave or cut bone during a surgical procedure.

What is a proper method to clean an instrument's suction lumen?

Using the proper-size brush Reasoning: A suction stylet is used during surgery to unclog the lumen if necessary, but the only cleaning tool used on the lumen is the proper-size brush before it is measured and inspected.

Which material is used to test surgical scissors that are 3.5 inches in length?

Yellow test material Reasoning: Red and orange test materials are used for surgical scissors over 4 inches in length; yellow test material is used for those 4 inches or shorter in length; and an index card is used to test Kerrison rongeurs and bone cutting instruments.

When using an Automatic Endoscope Reprocessor (AER) with an automatic cleaning cycle, the endoscope must still be manually cleaned to remove all traces of ________ and, if necessary, recleaned to prepare the scope for HLD or sterilization.

soil

One problem associated with battery-powered instruments is that batteries will often _______________ if the device is damaged by steam. A. corrode and contaminate the instrument B. overcharge and blow out the instrument immediately C. Lose the ability to hold a charge

C. Lose the ability to hold a charge Rationale: While batteries do require special care and handling, they will lose the ability to hold a charge if the device is damaged by steam, not overcharge. Batteries will also sometimes lose their ability to hold a full charge as they age.

Once cleaning is verified, sterilization or high-level disinfection should be performed according to the IFUs of the __________ A. equipment manufacturer B. equipment manager C. endoscope D. chemical or sterilant manufacturer

C. endoscope

Regulations

Mandatory and required by law

Biofilm is a substance that is like a matrix that protects __________ from being killed by the disinfectant and can prevent detergents from removing the soil that is there.

Microbes

Instruments and devices must be dried completely since what can impede sterilization?

Moisture

What objects are considered sharps?

Needles, blades, and knives.

What type of airflow should be present in the decontamination area?

Negative airflow

What is the pH for detergents used in most cleaning processes?

Neutral pH Reasoning: The most effective detergent in most cleaning processes has a neutral pH, which is 7; a pH below 7 is acidic; and a pH above 7 is alkaline.

Which part of the cell controls the function of the cell?

Nucleus

Once items flow to sterile storage, which is the most common area served by sterile storage?

Operating room (OR)

Which department generates the most need for central services?

Operating room (OR)

To protect healthcare workers from exposure to bloodborne pathogens, which of the following is required?

PPE

What are the 5 rules of asepsis?

1. Any item used for patient care or that is visibly soiled must be considered contaminated. 2. If the item has been cleaned with a detergent disinfectant, it is both clean and decontaminated. 3. Sterile items are devices processed by steam, dry heat, ethylene oxide, or other sterilization methods to kill all microorganisms 4. Dirty, clean, and sterile items must be separated at all times. 5. If clean or sterile items come into contact with dirty items, they must undergo the entire reprocessing cycle, starting with decontamination.

Which is the first step in the sterilization process?

Cleaning

To prevent coagulation of proteins, pre-rinsing of items for decontamination is completed with which type of water?

Cool water Reasoning: Cool water between 80 and 109 ̊F, or 27 and 43 ̊C.

Which patient care category of the Spaulding Classification System includes items that are introduced directly into sterile areas of the body, including the bloodstream? (critical, semi-critical or non critical)

Critical

Which area in the Central Service Department receives soiled items?

Decontamination

For protection in the decontamination area, which of the following should be worn by the CST?

Fluid resistant gowns

The most common sources for transmitting infectious microorganisms such as HIV, Hepatitis C, or emerging pathogens such as C. difficile, are from human to ________ and _________ to human

From human to human and surface to human

Which of the following is a high-level disinfectant (HLD)? Quats Chlorine Glutaraldehyde Alcohol

Glutaraldehyde Reasoning: Glutaraldehyde; ortho-phthalaldehyde, or OPA; hydrogen peroxide; and peracetic acid are all HLDs, with OPA being the most effective for high-level disinfection of medical instruments.

Surgical instruments made of Tungsten carbide have what color handles?

Gold Reasoning: Tungsten carbide is gray, but the handles are gold in color. For instance, gold-handled scissors are made of this material.

Which is an infection contracted by a patient while in the hospital?

Health-care associated

Biofilm can be very difficult to remove and is nearly impossible to remove if allowed to set during what?

High level disinfection (HLD)

What is a high-level, broad-spectrum disinfectant used on both hard and soft surfaces?

Hydrogen Peroxide