Sterile Processing CBSPD Test
Joint Commission
"Tracer Methodology"
(M) SDS
"right to know"
if a sterilizer has successfully killed all bacterial spores in a BI
"test" and should result negative
NEVER "____ ____" just to refill one jug of liquid(detergent) to another
"top off"
during cycle counts items that have a large dollar value but are not frequently used are classified as
'A' items
artificial nails in SPD?
(CDC) No, potential for fungal contamination
a biological indicator is placed in a LTGP/hydrogen peroxide unit
(minimum) daily, preferably every load
used to remove severe stains on stainless steel instruments; do not routinely use in manual bath; very corrosive; can cause irreversible damage
(organic) acid detergent
low temp friendly peel pouches...
(spunbound) Polyolefin-Plastic combo (gas plasma); contain NO cellulose
cerebrum
*center of consciousness; largest part of brain
liver
*largest INTERNAL organ; produces and secretes digestive enzyme bile
small intestine
*longest part of GI tract; receives chyme; liver and pancreatic secretions breaks down chyme; absorbs nutrients and transports waste to large intestine
occupational exposure limit for HLD is ._____ ppm; routine monitoring of employees is req'd
.05 ppm
HLD Glutaraldehyde has a ceiling threshold of
.05ppm
there is ___ chemical indicator in each ppk so it can be seen
1
appropriate measure of space instrument should have within a ppk to include several ppk being slotted side by side on a rack
1 inch
medical grade marking tape should wrap around instrument...
1 to 1.5 times
should be left between an item packaged for sterilization and the inside edges of a peel pouch
1"
colored marking tape (if authorized) is to circumference area
1-1.5 times
1 micron=
1/25 thousandths of an inch
most bacteria (size)
1/25 thousandths of an inch (microns)
fingernails should be
1/4 inch or less
nails must be
1/4" or shorter; avoid artificial nails
air exchanges per hour (decon)
10
prep/packaging environmental conditions
10 air exchanges under positive pressure, 68-73 degrees F, humidity 50% (not less than 35%), appropriate PPE; all packaging material should be held at this temp and humidity for 2 hours prior to sterilization
average sonic time
10 mins (sometimes more)
Decontamination Air Exchange Requirement
10 per hour
Prep Assembly and Packaging Air Exchange Requirement
10 per hour (same as decon)
travel time to eyewash station
10 seconds
eyewash stations should be placed with ______ seconds or _____ meters of potential chemical exposure
10 seconds; 30 meters
BI spore content
10-6
an item is considered sterile if Sterility Assurance Level reaches
10-6
ideal level of silicates in water used for cleaning
100 ppm
tap water should ideally have a concentration of
100ppm or less
ideal level of silicates in water
100ppm or less; tap water should ideally have same(100ppm or less)
air exchanges, prep/assembly
10ph under positive pressure
Major body systems
11; Skeletal, Muscular, Nervous, Endocrine, Circulatory; Cardiac, Lymphatic, Digestive, Integumentary, Respiratory, Reproductive, Urinary
OSHA recommends no more than ____ EtO canisters to be stored in a flammable cabinet
12
average Cidex OPA (HLD) soaktime
12 mins
maximum size and weight of textile pack
12"x12"x20" and 12 lbs
correct incubation temp range for biological indicators used in steam sterilization
131-140 F
average ideal atmospheric pressure prevac steam sterilizers at sea level
14.7psi
initial AMW cycles use water at a temp under ______ degrees F
140 degrees F
suspected prion exposure instrumentation may require (cycle)
18 min @273 F prevac steam cycle
final AMW cycle uses treated water at _____ degrees F
180 degrees F
first of five major steps for flexible endoscopes
1st *Leak testing; if require underwater testing=DI/treated water and NO detergent; test failure (call mfg for instruction on returning for repair; decon first)
for steam- a BI is ran with
1st load of the day and with implants
rigid containers are considered class _____ devices and regulated by _______
2 (II); FDA
geobacillus stearothermophilus; bacillus atrophaeus
2 most common biological spores involved in SPD sterilization
sequential wrap
2 thin wraps used 1 after the other
shelving in sterile storage must be kept
2" from wall
considered most appropriate for high level disinfection of semi critical devices
2% activated glutaraldehyde
which solution is generally considered MOST appropriate for HLD of semi-critical devices?
2% activated glutaraldehyde
a plastic maintenance dust cover (thickness)
2-3 millimeters
changing sharps containers when they are _______ full help prevent sharp injuries.
2/3
bones in the adult body
206
adult body consist of _____ bones
206; plus ligaments and cartilage
if unfortunate event were to occur
24 hours to file incident report
Any injury to an employee; documented and reported within _____ hours in an ________________
24 hours; incident report
overall weight for rigid container; not to exceed
25 lbs
appropriate sterilization cycle for an autoclave load containing a basin set, a minor surgery set and twelve towel packs
270 degrees F for 4 mins, 30 PSI, and 30 mins dry time
minimum pressure steam autoclave must reach in chamber
27psi
rigid sterile containers need at least ____ chemical indicators, preferably ____
2; 4
second of five major steps for flexible endoscopes
2nd Decontamination; manual pre-cleaning req'd (enzyme cleaner with treated water in small bath for ONE scope and DO NOT REUSE, followed by single use sponges (same goes for camera, cords etc); single use brushes used for only one scope and discard; rinse then dry(soft/lint free) scope; *on to pass through window for sterilization OR continue to step 3
how many consecutive test should be performed for steam (autoclave) sterilizer once it is installed/relocated, after a malfunction, the unit is turned off completely
3
spiral, round and rod like
3 basic shapes of microbes
transportation, regulation, protection
3 main functions of the circulatory system
saturated steam entering sterilizer should have _____% of entrained water
3%
sterilizer setting for bowie dick dart
3.5-4 @270 F dynamic air removal
average steam cycle
3.5-4 mins @270 F, 20-30 mins of dry time
Decontamination Humidity Requirement
30-60%
Prep Assembly and Packaging Humidity Requirement
30-60% (same as decon)
(AAMI) sink in SPD decon
36" from floor, 8-10" deep
AAMI recommendations on manual cleaning sinks
36" from floor; 8-10" deep (some may have pre-measured line for detergent vs water ratio)
minimum # of air exchanges per hour in sterile storage
4 @ positive pressure
minimum exposure time, temp and pressure for prevacuum steam sterilization of wrapped items
4 mins @270 F and 28-30 psi
Clean/Sterile Storage Air Exchange Requirement
4 per hour
the inventory of medical and surgical supplies can represent up to ____% of a facility's operating budget
40%
used to manufacture osteotomes
400 series stainless steel
average soak time for manual bath
5-10 minutes (sometimes more)
VRE can survive on hard surfaces for ___-___ days and on the hands for ____________
5-7; hours
prior to use any medical grade item (including rigid containers) must have ______________ testing performed; FDA approved via ________K certification; this testing should be executed even ____________ device is purchased
510; before
FDA official document needed for any medical device
510K
normal concentration of hydrogen peroxide in a LTGP sterilizer
59%
related concentration for h2o2 in LTGP
59%
Decontamination Temp Requirement
60-65 Degrees (F)
most effective concentration for alcohol based antiseptics
60-95%
alcohol based hand antiseptics
60-95% concentration, only recommended if hands are not visibly soiled
Prep Assembly and Packaging Temp Requirement
68-73 Degrees (F)
average pH
7
average targeted pH of typical enzymatic detergent used, pure water and human blood
7
basin sets should not exceed ____ pounds
7
sterile storage humidity should not exceed
70%
Clean/Sterile Storage Temp Requirement
75 Degrees (F) or lower
temp in sterile storage should not exceed
75%
water in the ultrasonic should be replaced every ______ hours or when visibly dirty
8
OSHA mandated employees TWA for EtO
8 hours
temperature; manual bath
80-110 degrees F; not to exceed 140 deg F (cause enzyme to become inactive)
SPD should be capable of planning for approximately ____% of the total needs of a unit
90%
saturated steam should possess a relative humidity level of
97-100% for effective steam sterilization
incoming saturated steam should be within
97-100% range of dryness
if you have a fever your temp would be above
98.6 F
minimum exposure time for wrapped goods in a dynamic air removal steam cycle
@275 F; 28-30 psi; 3 mins
assembly of instrument set according to ________ standards
AAMI
Agencies that set standards
AAMI, CDC
inventory management strategy that indicates store room controls should first address the relatively few items with the greatest value
ABC analysis
reprocess flexible endoscopes by means of special connectors enclosed with a chemical agent (usually peracetic acid, glutes or OPA); Liquid Chemical Sterilant(LCS); use correct tubing; watch for kinks; perform req'd pre-manual cleaning; * attach all channel connectors according to mfg instructions; NOT for rigid endoscopes
AER
Fire Safety
ALL equipment (including personal) should be safety checked by Biomedical Engineering Dept. and approval label attached before use
develops nationally recognized standards , recommended practices and guidelines for perioperative setting
AORN
AAA
Abnormal Aortic Aneurysm
acromi/o-
Acromion (ext of shoulder bone)
ANT
Anterior
ACL
Anterior Cruciate Ligament
AVR
Aortic Valve Replacement
Appendicular skeleton
Appendages
AERs
Automatic (flexible) Endoscope Reprocessors
ex/o-
Away from, external, outward
bony and cartilaginous parts that support and protect head, neck and trunk
Axial skeleton
BKA
Below the Knee Amputation
BMT
Bilateral MyringoTomy
BSO
Bilateral SalpingoOopherectomy
removing both fallopian tubesand ovaries
Bilateral SalpingoOpherectomy (BSO) (reproductive)
BTM
Bilateral Tubes w/ Myringotomies
Bx
Biopsy
No EPA registered products are available for inactivating C.Diff spores BUT
Bleach (hydrochlorite solution) has been shown to decrease rates of C.Diff contamination on environmental surfaces
BSE
Bovine Spongiform Encephalopathy; mad cow disease
transferred person to person, affects GI tract, may be decreased on surfaces with hypochlorite (bleach)
C. Diff
removing vein from lower limb to bypass blocked coronary artery
CABG (circulatory)
Two groups that certify
CBSPD (Cerification board for sterile processing and distribution, IAHCSMM (International association of healthcare central service material management)
promotes health by controlling/preventing disease
CDC
dental instruments
CDC recommends critical and semi-critical items that are NOT heat sensitive be steam sterilized after cleaning; HEAT sensitive semi-critical items should be cleaned and HLD; lumen is oiled* (gravity sterilization)
Cx
Cancelled
Types of muscle tissue
Cardiac; Smooth; Skeletal
CTR
Carpal Tunnel Release
CTS
Carpal Tunnel Syndrome
chain of infection
Causative agent, reservoir of agent, portal of exit, mode of transportation, portal of entry, susceptible host
Sterile processing is A.K.A
Central Material Service, Sterile Processing Service, Central Service, Sterile Processing Department
CSF
Cerebral Spinal Fluid
Modes of Disease Transmission
Contact; direct(physical contact), indirect(inanimate objects(fomites) and ventilation), droplets(respiratory secretions), airborne; Vehicles (air, food, water)
CABG
Coronary Artery Bypass Graft
Spaulding Classification
Critical (exposed to sterile areas of the body; must be sterile); Semi-Critical (touches mucous membranes; recommended sterile or high level disinfected); Non Critical (touch the skin; can be cleaned or disinfected; less than high level disinfection)
enforces laws; transportation of medical waste
DOT
before setting instruments in sonic cleaner
Degas (remove the air)
Dx
Diagnosis
D&C
Dilation and Curettage
sterile and clean items dispensed, window
Dispatch
infection control is the responsibility of
Dr's, RN's, surgical techs and SPD techs
fifth of five major steps for flexible endoscopes
Dry (*more critical to HCF using EtO); scope may be flushed with 70% alcohol to facilitate drying
before a pesticide can be marketed and used must be evaluated and registered by
EPA
creates and enforces laws; clean air, water and land
EPA
responsible for approving new environmental disinfectants prior to their being sold to HCF
EPA
which agency would approve the disinfectants used on floors and walls in the sterile processing department
EPA
would approve disinfectants used on floors and walls in SPD
EPA
Government Agencies
EPA, FDA, OSHA
Agencies that issue regulations
EPA, FDA, OSHA and State health departments
responsible for regulating EO
EPA,FDA
EEG
ElectroEncephaloGram
ESS
Endoscopic Sinus Surgery
two categories chemical families are divided into
Environmental Disinfectants; High-Level Disinfectants
layers of skin (superficial to deep)
Epidermis, Dermis, Hypodermis (subcutaneous)
plastic paper peel pouches used for steam and ______; NOT compatible with low temp plasma (____________)
EtO; Sterrad
OSHA required 8 hr TWA for each low temp sterilization process
EtO= 1.0ppm/ LTGP H2o2= 1.0ppm/ Ozone= 0.1ppm
discipline dealing with what is good or bad and with moral duty and obligation
Ethics
EUA
Exam(ination) Under Anesthesia
EXC
Excision
EXPL
Exploration
Ex Lap
Exploratory Laparotomy
Ex-Fix
External Fixation
agency; requires medical devices mfg to provide instructions on how to process
FDA
chemical and biological indicators must be cleared by
FDA
chemical and biological indicators must be cleared by which agency?
FDA
pre/post market medical device requirements, "medwatch", device classification and recall
FDA
a proper full gallon chemical agent disposal will most likely need to be communicated with
FDA and or EPA
IFU
FDA requires these specific instructions on how to clean and sterilize products
surgical N-95 mask
FDA- cleared as surgical mask, NIOSH certified as respirator; have all the qualities of N-95 along with evaluation for fluid resistance, flammability and biocompatibility
rotating stock to ensure that the oldest supplies are used first
FIFO (First In First Out)
to ensure the end of a scope lens is not foggy/smudged; recommended testing item
FRD (NOT alcohol-micro cat like scratches)
NFPA Red Diamond
Flammability
FB
Foreign Body
Fx
Fracture
FTSG
Full Thickness Skin Graft
HLD; used on critical and semi-critical, immersible devices; most common formulation is Cidex; should NEVER be used as an environmental disinfectant (not a cleaning agent; possible requirement for employees to be routinely monitored for exposure levels; this HLD has ceiling threshold of .05ppm
Glutaraldehyde
disease caused in the course of being treated in a hospital
HAI/Nosocomial infection
Nosocomial Infection
HAI; disease caused in the course of being treated in a hospital
Confidentiality
HIPAA (Health insurance portability and accountability act)
low level disinfection is level needed for destruction of
HIV
kills most microorganisms but not necessarily spores
HLD
mycobacteria (method of destruction)
HLD
Ortho-phthaldehyde (OPA)
HLD; contains .55% ortho-phthaldehyde; one formulation known as Cidex OPA; items must be thoroughly cleaned, rinsed and dry; residual soil will show a blue stain on improperly cleaned instrument; patients skin can be discolored by chemical residue if not thoroughly rinsed 3 separate times
third of five major steps for flexible endoscopes
HLD; if HCF authorizes this method
HWR
HardWare Removal
HCF
HealthCare Facility
responsible for 90,000 deaths per year in the US according to CDC
Healthcare Acquired Infections; HAIs
Handheld instruments (7 basic categories)
Hemostats (clamps), scissors, needle holders, forceps (tissue/dressing), retractors (handheld/self retaining), laparoscopic instruments, miscellaneous instruments
a liver biopsy would be performed to test for....
Hepatitis C
ortho-phthaldehyde is a (disinfectant)
High Level Disinfectant
HLD
High Level Disinfection
semi-critical items require
High Level Disinfection
the process that kills most microorganisms but not necessarily spores
High Level Disinfection
when processing a never before seen instrument follow mfg
IFUs
passivation layer can damaged by ...
Improper handling of instruments (dumping on table, scratching surface (metal brushes), wrong cleaning agents, chemicals (saline, bleach, hard water, flash sterilization); Stains (electrolysis, high alkaline deteregent, iodine, solutions (NACL), caked on blood)
requisitions filled and delivered as they are received
In Demand distribution system
(Right OR Left) IHR
Inguinal Hernia Repair
INS
Insertion
NFPA Yellow Diamond
Instability
IM
Intra-Medullary (femur/humerus)
IOC
IntraOperative Cholangiogram
I & D
Irrigation & Debridement
provides standards and evaluations for HCF, conducts onsite inspections, "Tracer Methodology"
Joint Commission
medical grade kraft paper can not be used with
LTGP
cotton gauze sponges should not be processed in
LTGP sterilizers
no implants in
LTGP/LTHP only autoclave
Lap Appy
Laparoscopic Appendectomy
LAVH
Laparoscopic Assisted Vaginal Hysterectomy
Lap Chole
Laparoscopic Cholecystectomy
LROU
Lateral Rectus both eyes
when a new medical device is purchased and received in spd tech must have
MFG IFU before processing
ALL contaminated items arriving to decon from OR, wards etc
MUST be containerized with lid during transport
Personal Protective Equipment (PPE)
MUST be worn to protect from blood and bodily fluid
MROU
Medial Rectus both eyes
A combining vowel (o) is dropped or added to aid in pronunciation of a
Medical term
MIS
Minimally Invasive Surgery
minimum concentration of a liquid chemical sterilant/HLD that achieves the claimed microbicidal activity
Minimum Effective Concentration (MEC)
Portals of Entry
Mucous membranes (respiratory, GI, Genitourinary, conjunctiva); Skin (broken, hair follicles, sweat glands); Parenteral Tissue (injections, bites, cuts and wounds)
Salmonella, M.tuberculosis, E.coli, streptococcus
Multi-Drug Resistant Organisms
a soap dispenser (wall-mounted or portable) should __________ be on or around the same sink used for decontaminating instruments; includes alcohol based waterless solutions
NEVER
a thermometer is _______ classified as a critical medical device
NOT
basin/bowls should _________ be inside instrument sets
NOT
NFPA
National Fire Protection Association
Cell structure
Nucleus>Cell Wall>Cell Membrane>Cytoplasm>Cilla and Flagella
bloodborne pathogen exposure regulated by
OSHA
eyewash stations must be available for emergency use
OSHA
exposure control plan
OSHA designed to protect employees against exposure to bloodborne pathogens
Responsible for regulating EO gas
OSHA, EPA
are involved with regulation and control of EtO when used as a sterilant (not CDC)
OSHA,EPA and FDA
Ergonomics
OSHA; fitting the job to the worker, prevent injuries before they occur
Standard Precautions (FKA Universal Precautions)
OSHA; handling infectious material as if they were infectious
hemi-
One half
OH
Open Heart
ORIF
Open Reduction Internal Fixation
limits developed by OSHA to indicate the maximum airborne concentration of a contaminant
Permissable Exposure Limit (PEL)
PMR
Posterial Medial Release
PLIF
Posterior Lumbar Interbody Fusion
removing disc tissue pressing on lower spine, inserting piece of bone between vertebra and fusing area with plates and screws
Posterior Lumber Interbody Fusion (PLIF) (skeletal)
P>A>S>S (operation of fire extinguisher)
Pull the pin; Aim the nozzle; Squeeze the handle; Sweep the stream over base of fire
PASS (use of fire extinguisher)
Pull. Aim, Squeeze, Sweep (base)
PA
Pulmonary Artery
used for cleaning inanimate environmental surfaces and floors
Quaternary Ammonium Compounds (QUATs)
Environmental Protection Agency (EPA)
Registers and regulates environmental disinfectants, controls emissions into the air and water, regulates the manufacture and sale of EO gas
RACE
Remove/Rescue, Alarm, Confine/Contain, Extinguish
R>A>C>E (fire safety)
Remove/Rescue; Alarm; Contain/Confine; Extinguish
main function is to supply oxygen to the body and remove carbon dioxide from the body; *the area where homeostasis (regulation) of pH occurs in the body
Respiratory system
REV
Revision
RCA
Root Cause Analysis
a repair to the muscles and ligaments of the shoulder joint
Rotator Cuff Repair
repair to muscles and ligaments of the shoulder joint
Rotator Cuff Repair (muscular)
OSHA Hazard Communication Standard
SDS must be available for each chemical in the dept
manufacturers instructions for processing
SPD tech must have this information before processing a new medical device
Surgical Site Infections (SSI)
SPS must do their part in their duty to prevent
STSG
Split Thickness Skin Graft
SAD
SubAcromial Decompression
SSI
Surgical Site Infections
Evironmental Controls
Temp, Humidity and Air exchange requirements
TMJ
Temporal Mandibular Joint
TAL
Tendon Achilles Lengethening
TOSI; for mechanical washers
Test Object Surgical Instruments; amber color wipes clean
Making an opening into thoracic cavity to give surgeons access to lung and heart
Thoracotomy
TDC
Thyroglossal Duct Cyst
T & A
Tonsillectomy & Adenoidectomy
TAH
Total Abdominal Hysterectomy
THA
Total Hip Arthroplasty
TSA
Total Shoulder Arthroplasty
TASS
Toxic Anterior Segment Syndrome; patient could go blind, have severe infection, need to have special antibiotics/surgery
TEE
TransEsophageal Echocardiogram
TUR
TransUrethral Resection
TURP
TransUrethral Resection of Prostate
TSE
Transmissible Spongiform Encephalopathies
resistance barriers
UNBROKEN skin and mucous membranes
UDT
UnDescended Testicle
UPJ
UreteroPyloric Junction
UPPP
UvuloPalatoPlasty
typical order of LTGP process
Vacuum, Injection, Diffusion, Plasma and Vent
VRE
Vancomycin Resistant Enterococcus
VDO
Varus Derontational Osteotomy
furthers international cooperation in improving health conditions
WHO
Decontamination Area
Where soiled items are received and cleaned. *All levels for the same tray should be labeled w/a tag to identify the level number and set to which it belongs.
classify bacteria by color change (red/pink, purple/blue)
Ziel-Nelson and Gram Stain
all loads containing implantable devices should be monitored with
a biological indicator
to avoid TASS spd tech in decon should use
a fresh bath in manual bath and ultrasonic and eye instrument cycle in automated washer
is required for rinsing when a high alkaline detergent is used in a mechanical washer
a neutralizing acid
Immediate Use Steam Sterilization (IUSS/Flash) may be used when
a one of a kind, emergently needed instrument underwent contamination
susceptible host
a person or animal that lacks the ability to resist infection by infectious agent
steam gun
a powered nozzle on a long stick(wand); used to clean wheels on patient care equipment, clean case carts, stretchers, etc.; to avoid steam burns wear appropriate PPE (rubber boots and heat resistant gloves)
Regulation
a principle, rule, or law designed to control or govern behavior.
-esis
a process
simultaneous wrapping means to wrap an instrument set with
a single non-woven wrapper, double ply, bonded at the edges
fiberoptic light cables should be cleaned with
a soft cloth and detergent
surfactants
a surface acting agent that lowers the surface tension of a liquid so it can penetrate deeper and prevent debris from being re-deposited (suspension)
may be placed in the bottom of a tray to aid in the drying of wrapped instrument sets
a towel
lapar/o-
abdomen
peritoneum
abdominal lining covering internal organs
an instrument tray for a laparotomy procedure must include an
abdominal retractor
gram positive organisms (rods/bacilli)
ability to slow down metabolism and become dormant when environment threatened; form (endo)spores
-ago, -esis, -ia, -iasis, -osis
abnormal condition, disease
-sclerosis
abnormal hardening
-stenosis
abnormal narrowing
prion
abnormal protein
supra-
above
hyper-
above, excessive
supra-
above, upper, excessive
towels/liners in bottom of/under tray ....
absorb moisture to prevent condensation, facilitate drying; protects instruments; prevents tears in wrapper
items to be separated inside instrument sets; be placed in ________________ non packaging material (surgical towels, autoclavable bags, medical grade kraft paper, pouch rolls); chemical indicators/integrator inside
absorbent
not all materials are __________________ for all types of sterilization
acceptable
teeth
accessories of mechanical chewing
powered equipment should be lubricated
according to mfg instructions
acetabul/o-
acetabulum (hip socket)
best used for removing mineral rust deposits from metal instruments; average soak time 15-30 mins
acid
acceptable means of marking instruments
acid based etching; heat fused nylon (color coding/dipping); laser etching; marking tape
a solution with a pH of 3
acidic
pH is a measure of
acidity/alkalinity
trans-
across
trans-
across, through
Ethical Actions
actions that conform to accepted and professional standards of conduct.
sterile storage should be located
adjacent to sterilization area
EtO requires
aeration after processing
aerobic bacteria
aerobes; require free oxygen to grow
bacteria that requires oxygen to grow
aerobic
mycobacterium
aerobic, non-spore forming, non-moving, rod-shaped organisms; usually found in soil
sometimes __________ sterilization, mfg'd sterile items can be placed in plastic bag labeled w/ tray name THEN attached outside sterilized tray (cooled if autoclaved) THEN tray and plastic bag placed inside dust cover
after
PCE should be cleaned and disinfected
after every use
post-
after, behind
anti-
against
liners (soaker sheets) are placed flat on the bottom of mesh tray to
aid in drying of wrapped sets
vertically soaking and cleaning lumened instruments prevents
air bubbles from forming
negative pressure
air exhausted directly to the outside
bowie dick test id used to detect
air leaks or insufficient air removal
bowie dick dart is used to verify
air removal mechanism is functioning properly in steam sterilizer
drains in pre-vacuum and gravity displacement sterilizers are placed at the bottom front of the sterilizers because..
air tends to concentrate at the bottom of the chamber
no ________ for sterrad incubator, visually read
alarm
________________ is not recommended for testing/cleaning of scope lens due to causing micro cat like scratches on lens surface
alcohol
a solution with a pH of 13
alkaline
pH of 9 or more
alkaline
multi-step process in a mechanical washer; to reduce the potential for instrument corrosion
alkaline wash, acid rinse, regular rinse
EtO gas kills microorganisms by
alkylation
the process by which Ethylene Oxide destroys microorganisms
alkylation
acrylic nails are not permitted in prep and packaging because they can....
allow fungus to grow beneath them
sigmoidoscope
allows for visual inspection of lower part of large intestine
gastroscope
allows for visual inspection of upper digestive tract
engraving should not be used to mark surgical instruments because
allows microbes to harbor
par-, para-
alongside, near, beyond
intermittent suction
also known as wagenstein or gomco, uses intermittent suction to gently suction out the stomach
Minimum Effective Concentration (MEC) test
also referred to as minimum recommended concentration; req'd before each use of solution; is the minimum concentration of a liquid chemical sterilant/HLD that achieves the claimed microbicidal activity; commercial test strip; date of expiration must be on container
can be used as a simple test to check functioning of ultrasonic cleaner
aluminum foil
test for ultrasonic place __________ __________ in unit; if working correctly there will be small pinholes from cavitation and numerous creases in foil
aluminum foil
HLD may be neutralized with
ammonia
proper neutralizing agent for HLD spill
ammonia
basin sets should be prepared for sterilization with
an absorbent material between each basin
a diagnostic may be required to run in an AER with PA prior to
an actual load being run
wicking material
an approved absorbent material that allows for air removal, steam penetration and facilitates drying; non woven
a confidential medical evaluation must be performed when
an employee is exposed to blood/body fluid
Standard
an established norm determined by opinion, authority, research and/or theory.
tetanus and botulism classified as
anaerobic bacteria
refers to the form and organization of body parts
anatomy
bowls, kidney basins, medicine cups and the like should be placed
angled to the upside down position to facilitate drainage and avoid condensation
host
animal, plant or human that supports the growth of microorganisms
tarsals
ankle; metatarsals and phalanges form ankle and foot
used topically to prevent or inhibit growth of microorganisms on living tissue
antiseptics
ano-
anus
patient care equipment or devices
any medical equipment designed by the mfg to be reused for multiple patients
when using sequential wrapping method
apply one wrapper followed by a second one
when using the sequential wrapping method...
apply one wrapper followed by a second one
used when disinfecting patient care equipment or possibly environmental surfaces
approved clorox bleach wipes
when selecting size for peel pouches...
approximately 1" of space between item and edge; do not use paper clips, staples, pins, rubberbands
Powered Surgical Instruments (PSI)
are NOT to be cleaned using a mechanical cleaning process(ultrasonic, washer); manual ONLY
brachi/o-
arm
axill/o-
armpit
circum-
around
peri-
around
carries blood away from the heart
arteries
Coronary Artery Bypass may be performed on a patient with ..
arteriosclerosis
coronary artery bypass surgery may be performed on patients with....
arteriosclerosis
arteri/o-, arter/o-
artery
under standard precautions, all blood and other potentially infectious material are handled
as if they were infectious
for testing of rigid sterilization containers, the BI should be placed
as recommended by MFG of container
large intestine
ascending colon; transverse colon; descending colon; sigmoid colon; rectum; forms, stores and expels feces through anus
absence of microorganisms that cause disease
asepsis
double peel packs are mainly used for ___________ presentation in OR
aseptic
a technician in decon notices that maintenance worker did not remove barrier attire when leaving the area to get tools, the technician shoulppd
ask the maintenance person to remove barrier attire when leaving the area
eyebrow, facial muscles, eyelids, eyelashes, conjunctiva and tear ducts
associated structures of eye
microorganisms can wick into package that is still moist
at the end of a steam cycle
separated by mitral (bicuspid) and tricuspid valves
atria and ventricles
atri/o-
atrium
append-
attach
employees should be trained in the appropriate
attire to wear when performing specific tasks
300 series stainless steel
austenictic
paper-plastic peel pack and/or paper-plastic tip protector are not allowed inside
autoclave rigid container set or soft textile wrap
thermal disinfection can be accomplished with the use of _______________ _________________, washer decontaminators, washer disinfectors
automated washers
powered surgical equipment should not be cleaned using
automated washing/ mechanical process
major divisions of nervous system
autonomic/involuntary nervous system; voluntary nervous system
Emergency eyewash stations
available within 10 seconds/30 meters of chemicals; hands-free; test regularly and document, 0 4 gallons of water.
damage to medical/surgical supplies stored in the receiving area can be avoided by
avoiding temperature and humidity extremes
ab-
away from
dis-
away from
ex-
away from, out
sternum found in (skeleton)
axial
rod shaped bacteria
bacilli
used to test for: dry heat sterilization and EtO
bacillus atrophaeus
binary fission
bacterial reproductive process that takes place when a mother cell divides into two daughter cells
cover garment in prep area because of
bacterial shedding from arms
jackets in prep and packaging prevent
bacterial shedding from bare arms
dys-
bad
water with EtO
bad combination, deleterious to patient, no water should remain in lumens of endoscope, channels or any area prior to processing
tendon
band of tissue connecting muscle to muscle
ligament
band of tissue that connects bones
an integral part of tracking system
bar-coding of instrument sets
powered surgical instruments (PSI)
battery powered, electrical and air power (pneumatic)
to prevent needlestick injuries
be aware of visible surroundings; needles and other conatminated sharps should never be recapped, purposely bent or broken by hand
pre-
before
always wash hands (when?)
before and after going on duty, before and after meals, after using bathroom, after sneezing/coughing into hands, after handling soiled items(garbage), before and after gloving, etc
cleaning/sterilization instructions requested from MFG
before the item is purchased
rigid sterilization containers must be biologically tested
before they are purchased
ante-
before, forward
fore-
before, in front of
retro-
behind, backward, back of
initial water in manual bath should not be too hot (temp)
below 140 F
infra-
below, beneath
hypo-
below, deficient
pron/o-, pronat/o-
bent forward
inter-
between
temperature on ultrasonic water
between 100-140 degrees F
ultra-
beyond, excess
chol/e-
bile
liver produces
bile
bacterial reproductive process; cell divides
binary fission
blood, tissue and/or body fluids on surgical instruments
bioburden
number of microorganisms on contaminated item
bioburden
disposable sharps removed and properly disposed of in
biohazard labeled rigid container
soiled items held in user dept for pick up must be stored in designated area and labeled with
biohazard sinage
Regulated Medical Waste (RMW)
biohazardous waste or infectious medical waste (contaminated by blood, body fluids or other potentially infectious material); requires special handling and treatment prior to disposal
monitoring method, verifies that conditions within the load were adequate to kill bacterial spores
biological
vial containing spore test cycles/loads within a sterilizer
biological indicator
department that checks surgical electrical equipment/ personal use prior to use
biomedical engineering department
microgrind, supercut, supersharp blades
black rings/handles **NOT to be confused w/ ebonized
cyst/o-
bladder, cyst, sac of fluid
sodium hypochlorite
bleach
-rrhage, -rrhagia
bleeding, abnormal excessive fluid discharge
vesic-
blister
connective tissue fluid; moves throughout the circulatory system; erythrocytes (red)/ leukocytes (white)
blood
hem/o-, hemat/o-
blood
vascul/o-
blood vessel, little vessel
bioburden
blood, tissue and or body fluids on surgical instruments; number of microorganisms on a contaminated item
contaminated surgical instruments should be transported to decon immediately to prevent...
blood/body fluids/other contaminates from drying; extended drying will damage instruments over time
(OSHA) hospital's exposure plan helps protect employees against exposure to
bloodborne pathogens
Under OSHA, a hospital's exposure control plan is designed to help protect employees against exposure to these
bloodborne pathogens
steam BI for gravity displacement
blue
titanium
blue
will be obvious on an improperly cleaned instrument that has been disinfected in ortho-phthaldehyde
blue stain
in non table top steam sterilizers steam is generating in
boiler
steam itself is generated in the
boiler of the autoclave
oste/o-, os-, ost-
bone
stapes
bone in inner ear
red blood cells develop
bone marrow
metatarsals
bones in the feet
metacarpals
bones in the hands
femur, patella, tibia, tibula (appendicular)
bones of lower limb
humerus, radius, ulna (appendicular)
bones of upper limb
carpals
bones of wrist
ambi-
both
paper liner/towels may retain moisture; do NOT use _________ mat and liner
both
OU
both eyes
when sorting, heavy instruments on __________, light instruments on _______. (same for prep and assembly)
bottom, top
rigid sterilization containers are complex containers w/ these parts...
bottom; inner basket; top; a gasket aligned inside top (w/no gap); latches (to secure closed); filters (vary by size; single use); valves (reusable/filterless)
chemical indicative pack, no spore, tested on 2nd cycle of autoclave to determine air removal
bowie dick dart
in qualification testing of steam sterilizers, to establish a baseline for the sterilizers performance, a BI PCD should be performed before
bowie dick test
weakest part of instrument, most likely to find cracks and most difficult to clean
box lock
ONE of the largest organs in the body; controls all movement; monitors and maintains all body systems
brain
cerebro-
brain
main control unit of central nervous system
brain
central nervous system
brain and spinal cord
CJD prion exposure can effect
brain and spinal cord, instruments can not be run in IUSS/flash/low temp *prevac steam autoclave only
Nucleus
brain of cell; where DNA is found
microbiology
branch of biology; deals with microorganisms and their effects on other living organisms
etiology
branch of science; studies the cause of and origins of disease/abnormal conditions
catabol/o-
break down
proteolytic
breakdown of blood soil
proteolytic enzyme
breaks down blood soils
mamm/o-
breast
mast-
breast
sternum
breast bone
pneum/o-, pneumon/o-
breath
spiro-
breathe
Short bones
bridges (metacarpals)
titanium instrumentation identified via
bright blue color
NOT a requirement for bacteria to survive
bright light
urethra
brings urine from bladder to outside the body
example of flexible endoscope
bronchoscope
instruments used for respiratory system
bronchoscopes; tracheostomy sets
proper gloves for HLD
butyl
Decon gloves
butyl; double gloving does NOT compensate
hospital non disposable scrubs must be laundered
by the facility
calcane/o-
calcaneus (heel bone)
you are taking a used IV pump from a nursing unit to be reprocessed the nurse tells you not to take it because there is an emergency admission and the patient will need it (ethically correct action)
call your department to have a clean pump brought up to the unit right away
small sets
can be on non perforated trays; tilt on edge in sterilizer to prevent puddle/ condensation (kidney basins, bowls etc)
instrument demagnetization
can be prevented by keeping dissimilar metals separated
jewelry not recommended in spd
can get caught in moving equipment
loose fitting clothing and jewelry should not be worn in SPD because it....
can get caught in moving equipment
carcin/o-
cancerous, cancer
resistant to heat and chemicals
capsule
breathing process removes
carbon dioxide
the breathing process removes __________ gases from body cells
carbon dioxide
longitudinal serrations
carmalt
stainless steel instruments are not approved to be ran in
cart washing machine
chondr/o-, chondr/i-
cartilage
usually used to manage instruments and supplies for individual surgical procedures; generally prepared for one special surgical case, not used for general supply replenishment
case cart system
compounds that contain a positive electrical charge
cationic
Creutzfeldt-Jakob Disease (CJD)
caused by prions; not a virus
pitting
caused by saline, potassium, chloride, blood or other compounds; detergent residue or high pH; metals with dissimilar composition processed together; electrolysis
mechanical process by which ultrasonic cleaner works
cavitation
process used by ultrasonic cleaner
cavitation
alveoli-
cavity
used to remove cement
cebatome
basic fundamental unit of life
cell
cyt/o-, -cyte
cell
nucleus
cell's brain
smallest unit possessing the basic characteristics of life
cells
should not be processed in LTGP
cellulose based sponges (or any of the like; non cellulose based only)
nervous system composed of two major parts
central nervous system (brain an spinal cord); peripheral nervous system (nerves that connect brain and spinal cord to other parts of body)
largest part of the brain
cerebrum
largest part of the brain, controls mental activities and movement
cerebrum
part of brain responsible for consciousness
cerebrum
3 parts of brain
cerebrum, cerebellum, brain stem
steam is exhausted from the sterilizer through the
chamber drain line
if PPE gets soaked with blood or other infectious material....
change immediately!
during inspection of syrgical instruments, all handheld surgical instruments must be
checked for cleanliness and proper function
bowie dick test is considered (monitoring process)
chemical monitoring process
passivation
chemical process; final stage of surgical grade instrument; provides corrosion resistant layer "finish" by forming thin transparent CHROMIUM OXIDE film; steam sterilization and regular use of water soluble based lubricant (milk) reinforces protective coating
MSDS provide health and safety hazard and risk information on..
chemicals
Material Safety Data Sheets provide health and safety hazard and risk information on what?
chemicals
sequestering/ chelating agent
chemicals that hold, remove or inactivate hard water minerals
pect-
chest
thora/o, thorac/o-
chest
thoraco-
chest
Chain of command
chief operating officer, VP nursing, sterile processing manager, SPD lead tech, SPD processing tech, SPD inventory tech, SPD case cart tech
should NEVER be used to remove gross soil on instruments
chlorine
should never be used to remove gross soil on instruments
chlorine
removing gallbladder
cholecystectomy (digestive)
layer on a surgical instrument created by passivation
chromium oxide
finished processed layer; intended to make instrument corrosion resistant
chromium oxide layer
autoclave tape is considered (indicator class)
class 1
indicators tapes, indicator dots on tamper locks and load cards (with CI on its edge) are examples of
class 1 externally visible chemical indicators
bowie dick dart test, have a categorized parameter of its own and are classified under
class 2
integrating indicators ("integrators") are classified under
class 5 steam parameters
chemical indicators/integrators for instrument sets should be at least class 4+, usually __________ ____; placed inside __________ package to be sterilized
class 5; every
emulating indicator
class 6
Fire extinguisher for ordinary combustibles
class A
ordinary combustibles
class A
flammable liquids
class B
electrical equipment
class C
combustible metals
class D
transport containers
clean and disinfect between use
all devices processed by LTGP must be
clean and dry
staff member brings several contaminated trays to spd on a cart and request replacement trays be put on same cart. Tech should....
clean and dry the cart and send it to distribution for trays
a staff member brings several contaminated trays to SPD on a cart and request that replacement trays be put on the same cart. The technician should....
clean and dry the transport cart and send it to distribution for trays
items being unloaded from the steam sterilizer should be handled with
clean hands
first step when instrument needs to be sterilized for immediate use
clean instrument according to mfg instructions
all items with lumens
clean manually with snake brush of appropriate size and length; makes direct contact with all walls of lumen; inspection is critical; brush from small end to larger end, make sure not blocked; reverse flushing
people flow in spd
clean to dirty
containers are to be disassembled and ______________ after each use; manually, mechanical washer/cart washer
cleaned
powered equipment should be
cleaned as specified by manufacturer
supplies contaminated with blood and body fluids that require sterilization should be
cleaned, dried and passed on to the processing area for assembly, packaging and sterilization
new/ repaired instruments must be ____________/_____________ prior to use
cleaned/decon'd
the first and most important step in the decon process is_____________, followed by thorough rinsing.
cleaning
acceptable method of deceon of an item used on a patient
cleaning w/ detergent solution then using an appropriate disinfection agent
inspecting in prep/pkg look for
cleanliness, functionality, completeness
thromb/o-
clot
coagul/o-, coagulat/o-
coagulation (clotting)
water in initial manual bath that is too hot (above 140 F) can cause
coagulation and inactivate enzymatic detergent
high heat in manual bath may cause
coagulation of blood still on instrument/device
3 main shape classifications of bacteria
cocci (round), bacillus (rods), spirillum (spirals)
cry/o-
cold
bluish-gray stains
cold sterilization solution being used outside MFG guidelines
bluish gray stains
cold sterilization solution being used outside manufacturers guidelines
Quality Assurance (QA)
collection of data and identification of issues
col/o-
colon
colo-
colon
most effective means of reducing spread of C.diff
combination of hand hygiene and contact isolation
Class D Fire Extinguisher
combustible metals
jaws
come in contact with patient; some with serrations, some carmalt
co-
come together
deionized water
commonly used as a final rinse; the process by which ions with an electrical charge are removed from water
all low/intermediate level disinfectants are NOT
compatible for any given equipment/environmental surfaces
opened but unused instrument sets should be
completely reprocessed
organs
complex structures with specialized functions within the body
the most cost efficient and cost effective method for inventory control in SPD ordering and data generation
computerized inventory control system
parameters of gas sterilization in 100% EtO sterilizer are
concentration, exposure time, humidity and temp
parameters for ozone sterilization
concentration, temp, time
primary reason items are allowed to cool on a sterilizer cart before being placed in storage
condensation and contamination may result if items are moved to cooler areas when they are still warm
4 phases steam sterilizer (prevac)
condition, sterilization, exhaust, drying
gradual heating of packs
conditioning phase
gradual heating of packs occurs during
conditioning phase of steam sterilization cycle
phases within LTHP cycle
conditioning, sterilization, aeration
dry heat uses a heat process called
conduction
autonomic/involuntary nervous system
conducts impulses to smooth muscle, cardiac muscle and glands; controls heart rate and breathing
spinal cord
conducts nerve impulses; center for spinal reflexes; provides two way communication between brain and body
HIPAA deals with
confidentiality
humerus, radius, ulna
connect at elbow joint
femur, tibia, fibula
connect at knee joint
loaner instruments must be
considered contaminated and must be completely reprocessed; Never take another's 'word' for it that they are clean; manufacturer's IFU should be followed; do not guess
red tagged instruments(before being sent for repair) and opened but not used items
considered contaminated; need to be completely reprocessed/ decontaminated
Hepatitis A
considered food related disease
pelvis
consist of sacrum, coccyx and hip bones
a loaner instrument has been contaminated during a procedure and the OR wants to sterilize it in IUSS (first step)
consult MFG written instructions for approved sterilization methods and parameters
the effectiveness of any chemical disinfection process depends on...
contact time, concentration of solution and temperature of the solution
floor trays
contain instruments/supplies for entire procedure
enzyme based detergents
contain organic substances that assist in the breakdown of protein soils and blood
cholera is transmitted by
contaminated food and water
state of being soiled or infected by contact with infectious organisms or other material
contamination
state of being soiled/infected by contact with infectious organisms
contamination
in sterile storage, temp is 70 F and humidity is 69% (what should be done)
continue with routine activities
-stalsis
contraction, constriction
a BI used as a comparison to test and not intended to have a bacterial spore killed, due to not being ran
control and should result positive
-stasis, -static
control, maintenance of a constant level
describes general environmental conditions of SPD sterile storage
controlled temp and humidity, limited traffic
Traffic Control
controlling access to SPD
steam sterilization uses a heat process called
convection
allow heat/steam to _______ before taking instruments from autowasher
cool
in regards to plastic maintenance dust covers, item within should be
cooled to prevent condensation
kerat-
cornea
___________ protectors can be used in place of towels to prevent tears
corner
all packages must be labeled completely and _____________ prior to sterilization; avoid mistakes; name, destination, initials of preparer; using non toxic ______________ marker
correctly; permanent
cortic/o-
cortex, outer region
non toxic permanent pen/marker should be used to write on data cards, ___________ sheets, and tray list
count
in one layer trays there need to be ____ chemical indicators; 1 in center/pack bottom, 2 caddy corner and 1 on _______ ________
count sheet
multipart instruments; if to remain disassembled all parts must be present and listed on ___________ ___________
count sheet
permanent, no toxic ink should be used on
count sheets and external sterilization tape
transport containers should prevent spillage
covered/enclosed (case) carts, bins with lids, sterilization containers with solid bottom, impermeable bags
laparoscopic instruments (*include robotic instruments)
cracked insulation can cause electrical shock/burns
making an opening into skull to access brain
craniotomy (skeletal)
would be considered high risk for special prion processing
craniotomy set
instruments used for the nervous system
craniotomy sets; cervical fusion discs; laminectomy sets
skull
cranium and facial bones
-ostomy
create an opening
instruments that enter sterile tissue; implants; surgical instruments
critical; sterilization
in sets selected protrude susceptible instruments should be in...
cuffed towels (if HCF allows), kraft type popcorn bags or foam
in sets all instruments should _________ in the same direction
curve
lateral sides of pouches should not be ________ to fit inside inner pouch
cut
paper tray liners may be ______ to fit bottom of tray
cut
a textile (soft) wraps edges can not be
cut to accommodate a smaller instrument set
-otomy
cutting into
part of cell where food molecules aer received, processed and used
cytoplasm
part of cell where food molecules received, processed and used
cytoplasm
clean horizontal work surfaces and floors....
daily
floor and work surfaces should be cleaned
daily
temp and humidity in decon should be monitored
daily
the drain line basket in a steam sterilizer is cleaned
daily
transportation carts cleaned
daily
floors mopped...
daily, not swept
black dots noted in a fiberoptic cable during inspection indicate
damage to glass rod
black dots in fiberoptic cable shaft indicate...
damage to the glass rod; renders useless, unserviceable
Morals
deal with or relate to principles of right and wrong behavior.
necr/o-, -necrosis
death
lumens should be checked for cleanliness and blockages when arriving from _____________ to prep
decon
major physical areas of SPD
decon, assembly and sterile processing, sterile storage and distribution
sequence for work flow where devices are processed
decon, assembly, packaging, sterilization, sterile storage
soiled items are received and cleaned
decontamination
the use of physical/chemical means to remove, inactivate or destroy blood borne pathogens on the surface of an item
decontamination
doffing must be done within_________ _________
decontamination room
correct sequence for the traffic workflow areas in which medical devices are processed
decontamination>assembly>packaging>sterilization>sterile storage
dermis
deeper than epidermis; *contains nerves and blood supply
hypodermis (subcutaneous)
deepest layer of skin
Immunity
defensive response of the body to antigens; Acquired (active vs passive)
process by which spd tech fills a clean/new ultrasonic bath (may not have an instrument set during this initial run)
degassing
instruments; manually cleaned/decontaminated by hand, wiped down with soft lint free cloth and it's enzymatic detergent bath is low suds/foam action
delicate instruments (camera, light cord, flexible endoscope etc)
requires the using department be responsible for maintaining inventory levels; labor intensive
demand distribution system
gather information
dendrites
every healthcare facility has an organizational structure or chart that outlines...
departmental authority relationships
organizational structure chart that outlines...
departmental authority relationships
used to harvest skin grafts and reshape skin surfaces
dermatome
nerves and blood supply (layer of skin)
dermis
assist in the removal of calcium, magnesium and certain other cations in hard water
descaler
laparoscopic instruments
design presents special challenges to cleaning process; must be disassembled for cleaning; check outer sheath for cracks
rigid sterilization containers
designed to hold medical devices for sterilization, storage, transportation and aseptic presentation of contents (ANSI/AAMI ST 77)
self retaining retractors are usually
designed with spring (mechanical design) that keeps them open to retract
why electrical etching/engraving is never used on instruments
destroy passivation layer and allow microbes to harbor
prior to disinfection PCE should be cleaned with
detergent
water hardness can impact the effectiveness of ____________which may cause staining and possible rust to instruments.
detergent
color result of chemical placard must be complete uniformity to be considered a "go", if not notify supervisor
determination of bowie dick dart
Root Cause Analysis (RCA)
determines underlying cause of adverse events; used after incident to uncover primary cause
process by which ions with electrical charge are removed from water; commonly used as final rinse
dionized water
principal route of nosocomial infections
direct contact
principle route of nosocomial infection
direct contact
devices with lumens/cannulations may be flushed w/ treated water prior to sterilization; ONLY if you are to place in steam sterilizer ___________________ ________________; not recommended to utilize/keep water that lumen instrument may have inside from automated washer
directly after
before multipart instrument is manually cleaned
disassembled according to IFU then soaked in water with enzymatic detergent
before any item with multiple parts is cleaned it must be ______________
disassembled as directed by the manufacturer
disposable sharps should be removed and ____________ in the appropriate containers at ________; watch for those that slip past and report it!
discarded; POU
when floor trays are opened and not used all disposable items must be ________________ and instruments completely _________________
discarded; reprocessed
failure to wear PPE in decon can result in
disciplinary action
-pathy
disease
patho-
disease
pathogenic
disease producing
pathogen
disease producing microorganisms
equipment w/ electrical cord that is cracked, frayed or broken should be
disinfected and sent out for repair
3rd sink in three sink method
distilled/ de-ionized water as final rinse to aid in preventing staining
National Institute for Occupational Safety and Health (NIOSH)
division of CDC; oversees airborne control/respiration masks
If a device is labeled as belonging to one area of SPD
do NOT borrow from one area of SPD to another
anaerobic
do NOT require oxygen to grow
Examples of recommended practices
documents developed by IAHCSMM, SGNA, AORN
peracetic acid
does not end in "hyde" but still HLD; not recommended in cancer patients
how to avoid biofilms
don't allow instruments to soak (in enzymatic detergent) for a prolonged time frame; 5-10 mins unless specified longer via instruments IFU; Never store instruments wet, dry after cleaning
Irregular bones
don't fit any specific category (pelvis)
to avoid wet load
door cracked 2-4" open for 20-30 mins before removing
only paper-plastic peel packs (no tyvek) may be utilized to
double peel pack an instrument
coldest location inside the steam sterilizer chamber
drain line
if a item needs to be corrected/removed from sterilization load record
draw a line through item followed by your initials
petrolatum gauze dressings would be sterilized in
dry heat
what sterilization method would be appropriate for petrolatum gauze dressings?
dry heat
BI Spore Bacillus Atrophaeus is used for
dry heat and EtO
information not required to be recorded on a HLD record
dry time
selected sterilization time is not a factor affecting
dry time in a steam sterilizer
item configuration must promote_____________
drying
towel/ instrument liner/ mat on bottom of mesh tray aid in __________ of wrapped instrument sets
drying
aeration
dryong phase
more than 90% of C. Diff HAIs occur
during or after antimicrobial therapy
chemical indicator/integrator should be placed within
each package to demonstrate whether conditions were adequate to achieve sterilization
work stations to be cleaned ..
each shift
inspection of handheld instruments; check for
each time they are handled, assembly/prep/packaging; cleanliness, function (sharpness, working order), alignment, tension of ratchet, cracks (box lock), burrs/nicks, loose screws/broken welds, loss of plating (sometimes, s/n, catalogue #, nomenclature)
myringo-
ear
organ of hearing
ear
oto-
ear
tympanic membrane located in
ear
micro drill
ear surgery; drives small wires through bone
"pakistan"
easily missed disposable instrument; almost all instruments with this name are disposable; Exceptions: army-navy, some dental, and a few others)
used for laser procedure
ebonized instruments
ordering the optimum quantity based on historical data
economical order quanity
must be sterilized on _______; paper to plastic- plastic to paper
edge
Alcohols
effective antiseptics AND sanitizers; kill variety of bacteria, mycobacteria and fungi; set/wet/contact time 5 mins; NOT effective against spores and some hydrophilic viruses; evaporates quickly and flammable; may damage latex, rubber and plastics; solvent; instruments with lenses should NOT be soaked in this (scratches in lens surface)
cubit/o-
elbow, forearm
powered instruments
electric, air(pneumatic), battery; dermatone, cebatome, micro drill
Class C Fire Extinguisher
electrical equipment
NOT authorized on stainless steel instruments
electrical etching/engraving
LTGP sterilizers require a special
electrical outlet for installation
a laparoscopic instrument with cracked/nicked insulation can cause
electrical shock/burns
kidneys
eliminates wastes and helps maintain water and chemical balance
lot control numbers are used to
enable recall following sterilization failure
all contaminated items arriving must be
enclosed with lid during transport to decon
ductless glands; secretes hormones
endocrine system
used to view internal organs through very small openings
endoscopic instruments
Department Of Transportation (DOT)
enforces laws relating to transportation of medical wastes
an exhaust hood over the EtO gas sterilizer is an example of
engineering control
instruments must never be
engraved
-megaly
enlargement
chemical indicator tape
ensure tape is of ample length; not too long, not too short; place stamps on tape not wrap itself; do NOT use pins, staples, paper clips
uterus
environment for implantation of egg and development of fetus
substance that acts as a catalyst in living organisms, regulating the rate at which life's chemical reactions proceed, *without being altered in the process; reduce the activation energy needed to start these reactions.
enzyme
contain organic substances that assist in the breakdown of protein soils and blood
enzyme based detergents
prior to transport to decon
enzyme spray/ moisture maintenance; damped to soaked wet towel apllied over or wrapped around the instruments/devices; sterile water; NO SALINE
test used to decipher rust vs stain
eraser test
when testing a scissor for sharpness it is important to make several cuts (mid way up to tip) with
esmark, commercial booklet of red/yellow rubber band sheath or possibly facial tissue
flexible tube, moves food to stomach via peristalsis
esophagus
brain stem
essential functions controlled
standard
established norm based on theory
standard
established norm determined by opinion, authority research and theory
OSHA
establishes PEL for chemicals
SGNA
establishes standards for processing flexible endoscopes
AAMI
establishes sterilization standards based on opinion, research and theory
practice of doing the right thing
ethics
distribute instruments ____________ in the tray
evenly
a stamp dating system where items are considered sterile unless the integrity of the package is compromised
event related date
sterilier #, load # and date sterilized
event related sticker
multi level sets should have a chemical indicator in _________ _________
every level
integrity of sterile package should be inspected
every time it is handled
unless mfg states otherwise, stainless steel instruments are to be lubricated
every time it receives full circle of treatment (usually accomplished in automated washer cycle)
all materials are not designed to be acceptable for
every type of sterilization
multi-color (rainbow) stains
excessive heat, hot spot in autoclave
multi-color (rainbow) stains
excessive heat; hotspot in autoclave
-ectomy
excision, surgical removal of
relaxed, after being maintained
exhaust phase
must be checked before releasing an item to fill a sterile supply order
expiration date, whether the package is damaged, and verification of chemical indicator
Dry heat
exposure time 2 hours @320 F
proper cleaning chemical disposal will more than likely need to be communicated with FDA/EPA
exposure to cleaning chemicals, disinfectants and other chemicals in raw sewage
the time for which the steam sterilizers chamber is maintained (can't drop) within the specified range for temperature, sterilant concentration, pressure and humidity
exposure/sterilization phase
prions (method of destruction)
extended sterilization
sensory organs
extensions of the nervous system that allow perception of environment
purpose of evenly distributing large sets of instruments
extra condensation will make the set more difficult to dry
spores can survive
extreme heat, lack of water and exposure to many toxic chemicals and radiation
flexible endoscopes
extremely difficult to clean because of the numerous small channels (lumens) and size (some more than 6 feet long); most are semi-critical (possible low temp sterilization); only those trained for, should reprocess
ophthal-
eye
residue on _______ instruments can cause TASS
eye
using a lighted magnifying lamp to visualize defects limits...
eye fatigue
chemical indicators/integrators are necessary to be placed in each level of multi-layer tray for the operator/users
eye-view when opened
blephar/o-
eyelid
blepharo-
eyelid
sense of sight
eyes refract and focus incoming light waves onto photoreceptors in back of eye
not a necessary requirement of a requisition
facility phone number
Unethical Professional Conduct
failure to conform to moral standards or policies.
salping-
fallopian tube
tachy-
fast, rapid
adip/o-
fat
lipid/o-, lip/o-
fat, lipid
vagina, fallopian tubes, uterus, mammary glands
female reproductive organs
gynec/o-
female, woman
femor/o-
femur (thigh bone)
Lower limb bones
femur, tibia, fibula, patella, tarsals
pyrogens
fever producing substances once circulated in the blood
eyeball
fibrous and vascular tunics, retina; sclera; cornea;iris; pupil; retina
respiratory system function
filters, warms and humidifies air breathed in
ileum
final portion of small intestine
(3 sink method) 3rd sink
final rinse- distilled/deionized water (to aid in preventing stains)
-dactyl
finger
digit
finger or toe
in the final steps of hand washing fingers should be rinsed with
fingertips up
manual and/or automated mechanical cleaning
first step in decon process
Ergonomics (OSHA)
fitting job to worker, prevent injuries before they occur
-pexy
fixation
thread like tails, help bacteria move through liquids
flagella
NFPA Red Diamond
flammability
Class B Fire Extinguisher
flammable and combustible liquids
not classified as a 'terminal sterilization'
flash/IUSS
do not stack rigid containers during sterilization (unless directed by mfg) should be ________ on cart
flat
4 basic types of bone
flat, irregular, short, long
approved to be cleaned by AER
flexible endoscopes
Practice Cleaning
floor;mopped daily, horizontal areas (prep, storage, etc); weekly, air circulated vents; monthly, light fixtures; bi-annually
-rrhea
flow
-dema
fluid
_________ corners of count sheet, do not staple
fold
frenu-
fold
in double peel packs inside pack should never be ______________ over
folded
in regards to measure the ratio of detergent vs water (manual bath batch and ultra sonic) ALWAYS
follow manufacturer guidelines; type of water; too little= won't have full effect that instruments deserve; too much= can oversaturate instruments, cause damage and inactivation
inanimate object involved in spread of infection
fomite
nails, tissues and money are examples of
fomites
pod/o-
foot
Critical
for sterile areas, must be sterilized
Loaner Area
for the receipt and return of instruments borrowed for specialty procedures.
if used instruments in the basin are not clearly visible ______________ should be used to pick them up
forceps
carpals, metacarpals, phalanges
form wrist and hand
quadr/i-, quadr/o-
four
Skeletal system
framework for body; protects internal organs
measuring scissors
from screw point to tip of blades
front/o-
front
enzymatic detergents; spray/foam/gel
fully concentrated
Physiology
functions of body parts
Cell
fundamental unit of life; smallest and most numerous structure of body; performs all processes needed for life
-stomosis, -stomy
furnish with a mouth or outlet, new opening
-desis
fuse, bind, tie together, surgical fixation
chole-
gall bladder
cholecyst/o-
gallbladder
water that has been contaminated by feces of humans and animals MOST notably responsible for
gastrointestinal disease
eye instruments; if processed in mechanical (automated) washer, do not clean with .....
general surgery instruments; preferred use of gentle cycle; thoroughly rinse and inspect cannulas multiple times; final rinse should be sterile, distilled or deionized water
rigid endoscopes
generally cleaned manually and separately to prevent cross contamination; 1x use on detergent bath with soft cloth or impregnated sponge (goes for flexible scopes, cameras and the like); auto washer and ultrasonic will damage
(some) AMW cycles
gentle; quick; instrument; orthopedic; utensil (glass items)
used to test for: regular steam sterilization(autoclave), sterrad, V-pro & ozone
geobacillus stearothermophilus
2 common biological spores
geobacillus stearothermophilus and bacillus atrophaeus
aden-
gland
pituitary, pineal, thyroid, parathyroids, adrenal, pancreas, thymus
glands of endocrine system
PPE ALWAYS donned LAST
gloves
gluc/o-
glucose (sugar)
should not be used as environmental disinfectant
glutaraldehydes
contra-
going against, opposite
tungsten carbide
gold handle
tungsten carbide identifier
gold handles
an effective case cart system requires
good communication
escherichia coli (E.coli)
gram negative organism; frequent cause of infections of the bloodstream, urinary tract, GI tract
pseudomonas
gram negative organism; responsible for infections in lower respiratory tract, burns, urinary tract, ear and eye
salmonella
gram negative organism; sources include eggs, poultry and dairy
microorganism, has the ability to slow metabolism and become dormant
gram positive bacillus
staphylococci
gram positive cocci; common cause of nosocomial infections; MRSA
staphylococcus aureus
gram positive coccus
Clostridium Difficile (C. Diff)
gram positive, spore forming, anaerobic bacillus; spread occurs from person to person or contamination of patient care environment; affects GI-colon; difficult to eradicate, spores can be highly resistant to disinfectants; can survive on dry surfaces for many weeks or months
can be used to sterilize liquids
gravity sterilization
before instruments are processed in ultrasonic
gross soil should be removed
before instruments processed in ultrasonic
gross soil should be removed manually
it is important to control humidity in sterile storage to prevent
growth of microorganisms
sepsis
growth of pathogenic bacteria in living tissue
ginge-
gums
sense of taste
gustatory
PPE Donning order
hair covering, shoe covers (*hand hygiene), gown, mask, goggles/faceshield, gloves
Bouffant or Cap
hair covering; changed daily; if non-disposable, facility must launder
semi-
half
include chlorine and iodine based compounds; low to medium level disinfectant; can have a set time of approx. 5 mins; corrosive to metal, rubber and some plastics
halogens
sodium hypochlorite (bleach) is one division of (disinfectants)
halogens
which group of disinfectants does sodium hypochlorite belong to?
halogens
CDC
hand hygiene, isolation procedures, environmental infection control and disinfection and sterilization
classification of surgical instruments
handheld, powered, endoscopic, laparoscopic
alcohol based hand antiseptics are acceptable only if
hands are not visibly soiled
an emergency eyewash station must allow for
hands free operation
silicates
hard, glassy mineral substance; occurs in a variety of forms; all natural water supplies contain some dissolved 'silica'
NOT all microorganisms are
harmful to human body
dermatome
harvest skin grafts and reshape skin surfaces
tap water
has been treated and acceptable for drinking; filtered/softened
distilled water
has been treated to remove ions, making it free of minerals
this is a high patient census and there is no PCA pumps available for distribution (action)
have staff check units more frequently
cephal/o, -ceps
head
cranium
head
NFPA Blue Diamond
health hazard
aud-, audi/o-, audit/o-
hearing
4 chambered organ pumps blood through body
heart
cardi/o-, card/o-
heart
function of autonomic nervous system
heart rate
therm/o-
heat
super heating
heat added to dry steam in the absence of water
cauter/o-, caut/o-
heat, burn
K-Pad
heating pad using hot water to provide heat, there are a variety of pad sizes
in sets ___________ instruments on bottom
heavier
_____________ individual items of large metal mass should be wrapped in _______________ material to absorb moisture/enhance drying
heavy; absorbent
calcaneous
heel bone
hand held retractors must be
held open manually
gram stain; Ziehl-Neilson stain
helps identify different types of bacteria via color change
grasp, hold/occlude tissue
hemostat (kelly, crile); dressing (smooth) forceps; tissue forceps (typically w/teeth); bone holding forceps
healthcare workers are most likely to be infected by
hepatitis B
liver biopsy would be performed to check for
hepatitis C
anodized aluminum may be affected by the use of
high alkaline detergents
peracetic acid, glutes or OPA
high level disinfectants
brown/orange stains
high pH surface deposits, improper soaps and detergents, baked on blood, soaked in saline
washer- decon/disinfector unit in a cycle of decon may contain
higher (alkaline) pH level detergent (9-11)
regarding steam sterilization , higher temps require
higher pressure
surgical (OR) grade
highest grade of steel and quality; reusable
tenac/i-
holding fast, sticky
ratchet
holds instrument closed; difficult to clean
People Flow
how people move through the department or processing area. *Clean to Dirty
Work Flow
how the work progresses through the department or processing area. *Dirty to Clean
principal living reservoir of human disease
human body
humer/o-
humerus (upper arm bone)
Upper limb bones
humerus, radius, ulna, carpals, metacarpals and phalanges
processed flexible endoscopes should be ...
hung vertically with no coils in the scope in a well ventilated, dust free cabinet for 12-14 days (depending) after that must be reprocessed
visual means of monitoring the humidity in sterile storage area
hygrometer
in neck between lower jaw and larynx; doesn't articulate w/another bone (axial)
hyoid bone
used to regulate body temp
hypo/hyper thermia machines
patient cooling machine
hypo/hyper thers mia machine
corrugated cardboard boxes
ideal for logistically transporting medical supplies/equipment; Bugs love to hide/live on areas in between
change manual bath batch
if seen as too visibly soiled (even after 1st set decon'd); after a "numbered" time use (MAX AVG 8 hours); and selected instrument sets (1x use of small bowl for camera, scope, light cord etc. *if HCF doesn't have commercial sponge)
you receive a text message while you are assembling instruments set (best action)
ignore until on break
ili/o-
ilium (pelvic bone)
incident reports should be filed
immediately
ability of the body to specifically counteract antigens
immunity
white blood cells provide
immunity
valve type rigid containers could _____________ aeration, not usually recommended for EtO/low gas plasma sterilization cycles
impede
decon PPE, not absorbing, leak/water proof
impervious
mechanical process by which an automated washer works
impingement
MUST be sterilized WITH accompanying biological indicator....
implants
dark brown/black stains
improper detergents, dried blood
most likely to damage passivation layer
improper handling
if an IV, feeding pump or the like is to be transported through the hospital to spd it is to be
in a covered cart or a closed plastic bag
if a requisition is not made, no supplies are issued
in a demand requisition system
for manual lubrication, surgical instruments should be placed
in a lubricant solution then room air dried
EtO PCD (biological test pack) placed
in geometric center of load
fomite
inanimate (non living) object involved with the spread of an infection
aside from paper product soaked in blood, paper should NOT be disposed of in biohazard container due to
incineration process
apparatus for maintaining favorable growth for BI
incubator
if disinfectant dries on the surface before specified exposure time has elapsed, the process becomes __________________
ineffective
seps/o-
infection
-itis
inflammation
oral cavity
ingest food, mix w/ saliva and swallow
breathing
inhalation and expiration; exchange of air between atmosphere and alveoli of lungs
bacteriostatic disinfectants
inhibit the growth of microorganisms (w/out destroying them) during processing and when dry, leave behind a protective film on the processed item; reactivated when in contact w/ moisture; could cause tissue damage if reactivated by body fluids; rinsing may be recommended for these disinfectants
cochlea is part of
inner ear
tympan-
inner ear
retina
inner most layer of eyeball
may not be folded to accomodate fitting in outside pack
inner peel pack
tungsten carbide
inserts/tips; strong metal; gold handles
SPD tech can play a role in fire prevention by
inspecting insulation on reusable laparoscopic instruments
spd tech can play a role in fire prevention by
inspecting insulation on reusable laparoscopic instruments
NFPA Yellow Diamond
instability
may be run for 1st (actual) load containing a PCD (autoclave steam sterilizer) cycle
instrument container (sets)
poor water quality can contribute to
instrument corrosion, staining, spotting, increased microbial levels
permanent, non toxic ink should be used to write on
instrument count sheets and tray lists
-tome
instrument for cutting
-scope
instrument for visual examination
hinged instruments that "stick";milk; already incorporated to a washer/decon cycle; one type stays on one side of SPD other stays on it's side; 30 second to 1 minute average set time; autoclavable; do NOT wash after for prep assembly design
instrument lubrication product
main HCF won't allow _____________ in cart washer
instruments
instrument magnetization happens when...
instruments are exposed to motorized devices (magnetic pad/ needle counters)
sternal saws, open heart instruments, coronary dilators
instruments used for circulatory system
thyroidectomy set
instruments used for endocrine system
myringotomy set(ear); cataract set(eye); corneal transplant set(eye)
instruments used for sensory organs
total hip and knee sets; osteotomes; screw sets
instruments used for skeletal system
cystoscopes; ureteroscopes
instruments used in viewing urinary system
Sharps
instruments/devices with points/blades
-graph
instrumnet used to record
class 5 indicator
integrating indicator
fungi (method of destruction)
intermediate level disinfection
nonlipid, small viruses (method of destruction)
intermediate level disinfection
phenolics
intermediate to low environmental disinfectant; carbolic-acid based; effective against vegetative bacteria, fungi, and TB; bacteriostatic and leave a residue
entero-
intestine
infection
invasion of body tissue by microorganisms which multiply and produce a reaction
disadvantage of exchange cart system
inventory is duplicated
can represent 40% of HCF operating budget
inventory of medical surgical supplies
a rough indication of the effectiveness of the inventory system, evaluated by inventory turnover, percent of back orders and availability of critical items
inventory performance
smooth muscle
involuntary movement; slower to contract and relax; common throughout body systems (e.g. digestive tract)
low to intermediate disinfectants
iodine (generally used as skin antiseptic); should not be used to disinfect medical devices that will be used in patients
EPA, FDA, OSHA and state DOH
issue regulations
most unique feature of an integrating chemical indicator
it's ability to perform in parallel to a biological indicator
part of the steam sterilizer that produces heat inside the chamber to prevent condensation from forming on the chamber walls
jacket
the two pressure gauges on a steam sterilizer measure the pressure in the ..
jacket and the chamber
arthr/o-
joint
articul/o-
joint
where two bones meet/articulate
joint
dating system; records date as the number of days that have elapsed since January 1st; commonly used for items deemed as expiration sensitive
julian (time related) date
Joints
junctions between bones; articulation
designed to reduce storeroom inventory
just in time
stockless distribution systems aka
just in time distribution systems
instrument damage/protection
keep in designated location on tray during transport; do not stack unless in rigid container; protect delicate items w/ fine, sharp tips; heavy instruments on bottom of tray; separate rigid/flexible endoscopes from instruments
Defense mechanisms
keep us healthy
hemostats (clamps)
kelly, crile; used primarily to clamp arteries, may be used to dissect tissue
nephro-
kidney
pyelo-
kidney
reno-
kidney
organs of the urinary system
kidneys, ureters, urinary bladder, urethra
bacterialcidal disinfectant
kill microorganisms but do not leave a film on device surface
-cidal
killing
-cide
killing
patella
knee bone
patella
knee cap
miscellaneous instruments
knife handles, towel clips, sponge forceps
all levels of the same tray should be
labeled to identify the level number and set to which it belongs
biohazard sinage
labeled with biohazard label; alert personnel that they contain potentially biohazardous material
missing items in set must be __________ on outside of set and reported to ___________ for approval to still use set
labeled; supervisor
smooth muscles
lack striations
instruments used for digestive system
laparoscopes, sigmoidoscope, colonoscope, laparotomy set
instruments used for the reproductive system
laparotomy sets; vaginal delivery sets; vasectomy set
too many _______ items can cause extra condensation, make drying difficult or cause item to rip through
large
tibia
large bone in lower leg
humerus
large bone in upper arm
femur
large bone in upper leg
colon
large intestine
sigmoid
large intestines
macro-
large, abnormal in size or length, long
radius
larger bone in lower arm
fundo-
largest part of organ
when double paper plastic pouching is permitted the inner pouch must
lay flat inside the outer pouch
epidermis; dermis; hypodermis
layers of integument
should not be worn as PPE when manually decontaminatiing flexible fiber optic endoscope
lead apron
OSHA requires that containers for potentially infectious materials be
leak proof
prior to manual cleaning of flexible endoscope (first step)
leak test
prior to manually cleaning a flexible endoscope it MUST be ______________________
leak tested
not a method for checking the visual clarity of a rigid endoscope
leak testing
lev/o-, levat/o-
left
OS
left eye
adductors
leg muscles
when lifting heavy items which muscles should bear the most weight?
legs
when lifting heavy objects which muscles should bear the weight?
legs
shelf life
length of time a disinfectant can be properly stored, after which it must be discarded
use life
length of time or number of times used after which the efficiency of a disinfectant is diminished
phac/o-, phak/o-
lens
advantages of LTHP vs LTGP
less number of lumen restriction, more number of cycles ran via cylindrical cartridges, more options of running various temp sensitive items
Clean/Sterile Storage Humidity Requirement
less than 70%
the technician is asked to remove an arthroscopy sat from the aerator four hours prior to completion of aeration time. The supervisor is not available, what should the technician do?
let the set complete and borrow a set from another hospital
the technician is asked to remove an arthroscopy set from the aerator four hours prior to the completion of aeration time, the supervisor is not available, what does the tech do?
let the set complete the aeration cycle and borrow a set from another hospital
you note a co-worker has hair hanging out of their surgical cap while assembling sets (action)
let them know the hair is visible
Cellular>Tissue>Organ>System
levels of organization of body
bio-
life
plastic paper peel pouches used to package single, ________ weight items
light
psychrophiles
like cold temperature; 59-68 degrees F
thermophiles
like warm temperature; 122-158 degrees F
each time the ultrasonic is drained it should be cleaned and disinfected with a ________ ________ ___________ soaked in ________% alcohol; to be effective the alcohol should remain wet for _____ minutes
lint free cloth; 70%; 10 mins
automated mechanical washer detergents are usually in _____________ form and low suds/foam producers
liquid
hepat/o-
liver
organ that produces bile
liver
produces bile
liver
vectors
living things responsible for causing disease (insects/rodents)
improper ____________ of washers is a major contributor to cleaning failures
loading
area for receipt and return of instruments borrowed for specialty procedures
loaner area
hyoid bone
located in neck; supports tongue and swallowing; only bone NOT articulated w/another
lumb/o-
loin
carmalt
longitudinal; lengthwise from tip
-lysis
loosen
instrument lubrication product "milk"
loosens instrument box locks, screw locks, scissor blades and any other metal on metal moving part
should be placed on each package sterilized and on the sterilization load record
lot control numbers
use appropriate temperature when sealing autoclave vs ______ temp; usually 100 degree difference; check quality of seal; no lumps/gaps/folds (allows microbes to harbor)
low
according to spaulding classification, a non critical device requires
low level disinfection
in regards to OSHA and PPE, gloves are still necessary when dealing with
low level disinfection
level of disinfection needed for destruction of HIV
low level disinfection
lipid, medium sized viruses (HIV) (method of destruction)
low level disinfection
vegetative bacteria (method of destruction)
low level disinfection
Quaternary Ammonium Compounds (QUATs) AKA a 'wetting agent'
low level environmental disinfectants; effective against gram-positive bacteria but ineffective against some gram-negative microorganisms, lipid viruses and spores; are bactericidal; used for inanimate environmental surfaces (*floors, walls and furniture); should be mixed with distilled water
dark brown/black stains
low pH(less than 6) acid stain; may be caused by improper detergents, dried blood
cavitation
low pressure bubbles in a cleaning solution burst inward(implode) to dislodge soil from instruments
when it comes to enzymatic detergent..
low suds/foam
cotton gauze cannot be used in which sterilization process?
low temp gas plasma
double peel packs are not allowed for ______ ______ ppks; steam _______________ only
low temp; autoclave
considering majority of PCE only touches a patients skin, approach of cleaning
low to intermediate level disinfection
Environmental Disinfectants
low to intermediate; usually used on nonliving surfaces/ inanimate objects (devices/surfaces); NEVER use on surgical instruments
ventricles
lower chambers; force blood out of heart into arteries
floor grade
lower grade of steel and quality; mirror/shiny finish
mandible
lower jaw bone
infer/o-
lower of body
pylorus
lower opening of stomach
the reorder point
lowest amount of stock
chemical agent that loosens metal on metal moving parts
lubrication/ "milk"
optional feature of ultrasonic; not all HCF will have this; ideal for laparoscopic instruments
lumen cleaner
LTHP (VPro Maxx) involves
lumen cycle (55min), non lumen cycle (28min), flexible cycle (35min)
inspection and verification of adequate cleaning is difficult with instruments that have
lumens
inspection and verification of adequate cleaning is difficult with instruments with...
lumens
pulm/o-, pulmon/o-
lung
pleuro-
lungs
supin/o-
lying on the back
HLD gloves must be
made of thick utility/butyl rubber; 12-18 mil in thickness
Martensitic stainless steel (400 series)
magnetic, CAN be heat hardened, harder; scissors, forceps, osteotomes, chisels
digestion and absorption
main functions of digestive system (GI tract)
cerebellum
maintains balance
instrument loss
major financial burden for facility; AORN recommends ALL surgical instruments be counted after each case for inventory control
HCF Environments
major source of a variety of pathogens
if the OR request instruments for an emergency ruptured aortic aneurysm, the technician should send....
major vascular instruments
if the operating room request instruments for an emergency ruptured aortic aneurysm, the tech should send
major vascular instruments
How to know if High Level Disinfectant...
majority end in "hyde"; one exception peracetic acid
cardiac muscle
makes up heart; contracts automatically; involuntary and rhythmical
craniotomy
making an opening into the skull to access the brain
Myringotomy
making incision into tympanic membrane (eardrum) to permit fluid to drain and placing small tubes in membrane to permit continuous drainage
testes, seminal vesicles, prostate gland, bulbourethral glands
male reproductive organs
seminal vesicles and bulbourethral glands part of
male reproductive system
Compliance w/a regulation is
mandatory/required by law
forceps
manipulate and grasp tissue, sponges and dressings; must align during testing or is unservicable
first step in decontamination
manual and or automated , mechanical cleaning
typical operational order of average stainless steel instruments
manual clean>rinse>(ultra)sonic>rinse>automated washer(have incorporated rinsing and drying)>to prep
when sorting items in decon psi require
manual cleaning
typical operational order of stainless steel instruments in decon process
manual cleaning, (rinse), ultrasonic (rinse), washer/decon, (rinse)
first step in decon
manual cleaning; three sink method
poly-
many, much
no ________/_______ on soft textile wrap itself!
marking/ writing
myel-
marrow
400 series stainless steel
martensitic
3 basic principles of packaging
material must allow sterilant to reach contents, material must provide good barrier to keep out microorganisms, package must be able to be opened aseptically (w/out contamination)
basic principals of packaging
materials must allow sterilant to reach the contents, must be able to be opened aseptically (without contamination), must be a barrier for microorganisms
limited use instruments
max number of uses per mfg
with respect to rigid sterilization container testing; defines the sterilizers ability to sterilize under actual use conditions
maximum load testing
failure to remove all air from a package to be steam sterilized
may result in poor steam penetration
detergents can have single enzyme or complex
means more to enzymatic detergent bath
disease not spread by droplets
measles
pH level
measure of acidity or alkalinity
angstrom=
measure visible light
2nd step in decon; after manual cleaning and rinse
mechanical application of a thermal or chemical disinfection process
cleaning verification effectiveness products would be used on
mechanical washers
cleaning verification effectiveness products would be used on _______________
mechanical washers
textile wrappers made of...
medical grade/approved wicking material
all healthcare professionals must be properly trained in the handling of
medical waste
fascio-
membrane
protect membrane between bones and soft tissue of central nervous system
meninges
often pathogenic to humans because they grow best at body temp
mesophiles
steam load with mixed fabric and metal
metal below fabric
when a steam sterilizer load contains a mixture of fabric and metal items, where should the items be placed?
metal items below fabric items
compatible packaging; dry heat
metal, glass, aluminum foil
stacking of rigid containers in a steam sterilizer is permitted when
mfg provides technical data showing that it is acceptable
used in ear surgery and for driving very small wires through bone
micro drill
HCF medical waste
microbiology lab waste, pathology and anatomy waste, blood/body fluid specimens, blood products and sharp items
bacteria measured in
microns
microorganisms measured in
microns
minute living things too small to be seen with the naked eye
microorganisms
some but not all _______________ are harmful to your body
microorganisms
microbiology deals with
microorganisms and their effect on other living organisms
spores
microorganisms capable of forming thick (shell-like) wall around themselves to survive in adverse conditions
bacteria, viruses, fungi, protozoa and microscopic algae
microorganisms include
bloodborne pathogens
microorganisms that can be present in human blood and body fluids; are capable of producing disease in humans
chemical indicator goes in ___________ of basin set
middle
mes-, meso-
middle
smallest bones in body found in
middle ear
clamps used for hemostasis are also designed to
minimize damage to tissue
proper stock rotation is most effective to
minimize frequent reprocessing of sterile supplies
stock rotation and frequent evaluation of stock levels will
minimize the need for reprocessing and prevent outdates
adding chemicals to the boiler feed water
minimizes contaminates
flush and brush lumened instrument in decon
minimum 3xs or until completely clean
temperature and humidity in the decon area should be
monitored daily
a non cellulose filter (rigid container) can not be used
more than once
envelope fold
most common; used on small/medium items
Hepatitis B
most effective method of infection control is to be vaccinated before exposure; HCF must offer vaccination at no cost to employee
if it ends in "ase"
most likely an enzyme
water that has been contaminated by human feces and animals
most notably responsible for GI disease
carry messages from brain to organs and muscles
motor nerves
digestive process begins in
mouth
stomato-
mouth
-kinesis
movement
tongue
moves food around; assist w/swallowing
Semi-Critical
mucous membranes, high level disinfected
when loading mechanical washer, do not process ___________-_________ trays assembled! remove each level and treat as an individual tray
multi-level
after ultrasonic cleaning check _____________ instruments to make sure vibrations did not loosen screws
multi-part
disassemble instruments with ___________ parts (if indicated by mfg); containerize small parts
multiple
wet load
multiple packages in the same load found with excess moisture
my/o-
muscle
fibrill/o-
muscle fiber, nerve fiber
inferior oblique
muscle in eye
myocardium
muscle tissue of the heart
quadriceps
muscles found in legs
if proper ergonomics is not occuring
musculoskeletal disorder can occur
sterilization maintenance covers AKA dust covers
must be 2-3mm thick; specifically designed to keep dust, moisture and other contaminants out of sterile packages; NOT a sterile cover; self sealing/heat sealed; use correct size, remove air before sealing, wash hands prior to packaging, use gloves
transporting contaminated items
must be appropriately handled, confined and contained after use and during transport to decon; separation/segregation of clean and contaminated during transport
Everything entering Decon
must be cleaned before leaving
Any item that fully enters decon room....
must be cleaned by SPS techs prior to leaving
main disadvantage of using rigid sterilization container systems
must be disassembled, processed, reassembled and checked before each use
when the jaws of stainless steel needle holder (non tungsten carbide) become worn
must be discarded
policies and procedures for correct handling of sterile supplies
must be made available to distribution personnel
confidential medical evaluation
must be performed any time employee is exposed to blood or other body fluids
ideal packaging characteristics
must be tamper evident, be the right size, protect instrument from physical damage, be durable and resist tearing/puncturing, allow for aseptic presentation
if a wrapper is used as a sterile field
must extend 6" over the edge of the table
BI test vs control
must have same lot number
cause of tuberculosis
mycobacteria
responsible for leprosy
mycobacterium leprae
cause of tuberculosis
mycobacterium tuberculosis
count sheet/ tray list include...
name of instruments, type, size, quantity, mfg, catalog number; outside tray in mini dust cover (AORN; each facility decides)
-atresia
narrowing
proxim/o-
near
detergents used in ultrasonic should be low suds foam and have a ______ _______ pH
near nuetral
cervix
neck of spine or uterus
cervic/o-
neck, cervix (neck of uterus)
instruments received from surgery red tagged (broken)
need to be cleaned before going for repair
aspirate (inject/infuse)
needles, trocars, cannulas
refers to air exhausted directly outside
negative pressure
the ventilation system should be designed to maintain
negative pressure; air coming into decon, not bad decon air flowing out (to prep or other areas); directly exhausted to the outside
removal of kidney
nephrectomy (urinary)
neuro-
nerve
autonomic system
nerves communicate w/visceral organs
peripheral nervous system
nerves connecting brain and spinal cord to the other outside parts of the body
AMW, first the alkaline wash, then a _________________ acid rinse, then a regular (_____________ water) rinse, dry then off to prep
neutralizing; treated
instrument lubrication (typically decon side)
never use oil based; do not wipe off, allow to dry; unless otherwise stated by mfg lubricate instrument every time it's used; Application: manual/mechanical (washer/disinfector)
routine biological testing of steam sterilizers should be performed
no less than weekly
due to incineration
no paper in biohazard containers, unless saturated (soaked/dripping) with blood; same for gloves, booties and other PPE
for removing stubborn soils and stains; can be difficult to remove; must be thoroughly washed with detergent and thoroughly rinsed
non abrasive cleaning agents
items to be sterilized in low temp gas plasma must be packaged in
non cellulose based material; tyvek
compatible packaging; ozone
non cellulosic wrap(paper), certain containers
majority of patient care equipment classified under (spaulding)
non critical level
Austentic stainless steel (300 series)
non magnetic, can NOT be heat hardened, more corrosion resistant than 400 series; bowls, basins, malleable retractors
Physical Environmental Controls
non porous wood doors, shelves, etc
for marking sterilization tape use
non toxic permanent marker (sharpie)
acceptable for steam sterilization
non woven wraps
come in contact with intact skin; reusable medical equip; patient care equip
noncritical; low to intermediate level disinfection
Unrestricted Areas
normal traffic areas; hospital corridors, most offices, locker rooms, and general public areas (cafeteria, waiting rooms); street clothes may be worn in unrestricted areas
lacri-
nose
naso-
nose
rhin/o-
nose
rhino-
nose
upper respiratory system
nose, nasal cavity, pharynx, sinuses and larynx
a patient contracts an infection from an improperly sterilized surgical instrument... example of?
nosocomial infection
can not be prevented by increasing length of patients stay
nosocomial infection
patient contracts an infection from improperly sterilized surgical instrument (example of)
nosocomial infection
non-
not
turbidity
not clear/transparent because of stirred up sediment/solids; when stirred= clouded/obscured
square fold
not common; used on larger containers
brown/orange stains
not rust; result of high pH surface deposits; may be caused by improper soaps/detergents, baked on blood, soaking in saline
overall weight for rigid containers
not to exceed 25 pounds
if spill of HLD were to occur
notify chain of command and refer to (M)SDS
functional center of cell governs activity and heredity
nucleus
the functional center of a cell that governs activity and heredity
nucleus
DNA found in
nucleus (brain) of cell
effectiveness of disinfection
number and location of microorganisms (bioburden); resistance of microorganisms to disinfectant; concentration and potency of the disinfectant
function of gastrointestinal system is to provide
nutrients
OSHA has a great effect on the SPD by it's regulation of..
occupational exposure, airborne contaminants, bloodborne pathogens and workplace hazards
whether utilizing low temp, steam or EtO tape, it is recommended to apply what is necessary to be written
off to the side (tape on table), never while on wrapping material
mesophiles
often pathogenic to humans because they grow best at body temperature; 68-113 degrees F
________ will not allow penetration to the surface of instrument; hydrophobic
oil
detergents can not have/be ____ _____
oil based
Class K Fire Extinguisher
oils/fats in cooking appliances
sense of smell
olfactory
paper-plastic peel pouches should be placed
on edge (paper-plastic-paper-plastic)
ppk items in steam
on edge, paper to plastic
VRE can survive
on hard surfaces 5-7 days, on hands for hours
supplies should never be stored
on the floor
for steam sterilization, basin sets should be positioned
on their side
in a mixed load of (wrapped) textile sets and rigid metal sets, textile packs should be placed
on top rack
if a biological test is performed daily, how often is it necessary to incubate a control biological indicator?
once a day and if a new lot number is used
to prevent cross contamination, many MFG will only allow a cord device, flexible scope, rigid scope, camera, light cord or the like to be used (cleaning)
once in manual bath/batch of diluted deteregent and once via a pre-impregnated sponge (w/detergent) to include one time use of disposable snake brush
uni-
one
2 or more rigid pans on sterilizer racks going to be run need to be placed flat...
one above the other in a respected separate rack
viruses
one of a group of minute infectious agents that grow ONLY in living tissues/cells; require living host to multiply; not composed of cells
non woven wrapping materials ...
one time use; slightly shrink during steam; excellent barrier against microorganisms; available in multiple sizes and thickness; prone to damage(heavy trays/improper handling); **cannot be cut to accomodate size
simultaneous wrap
one time wrap; double bonded
loaner instrument sets can be placed inside rigid sterilization containers
only with mfg instructions
all instrument joints should be fully ___________ during manual cleaning, sonic and w/d
open
in sets all instruments in _______ position
open
open hinged instruments must stay__________ through decontamination process
open
urethra
opening from the bladder to the meatus
PPE is NOT __________ and ___________ fit.
optional, MUST
main gastrointestinal tract organs responsible for digestion
oral cavity, pharynx, esophagus, stomach, small intestine, large intestine
items on stringer recommended to follow.....
order on count sheet
Class A Fire Extinguisher
ordinary combustibles
used to remove severe stains on stainless steel instruments
organic acid detergent
microbe
organisms of microscopic/submicroscopic size; generally include viruses, rickettsiae, bacteria, algae, yeasts and molds
complex structures with specialized functions within the body
organs
system level
organs which together perform complex functions for the body
medicine cups should not be placed in basin set unless they can be ________________ to ensure drainage of condensate (concave facing down)
oriented
blue stain would be obvious on improperly cleaned instrument that has been disinfected with
ortho-phthaldehyde
PSI saw attachments
oscillating (side to side), sagittal (back and forth), reciprocating (push and pull)
during _____________ the solution outside the cell passes through the cell wall into the cell; if disinfectant is too weak or too strong, this process will not occur
osmosis
CBSPD
other than IAHCSMM, certification for sterile processing
epidermis
outer layer of skin
implant labels are provided for placement on ___________ of set
outside
ecto-
outside, outer, on
female reproductive organs
ovaries
oophor-
ovary
source of sterilization mechanism for both hydrogen peroxide sterilants (sterrad/VPro) to include ozone
oxidation
3 main aspects; ozone (O3)
oxygen, water and electricity
a solution is considered nuetral
pH 7
a cleaning solution is considered alkaline
pH 9
name of stainless steel instruments to look out for due to possibly being disposable
pakistan
when placing paper plastic pouches in a sterilizer, pouches should be positioned
paper facing plastic
non infectious medical waste
paper towels, nonwoven wraps not contaminated with dripping blood or other potentially infectious materials, urine; considerable trash; do not require special colored bags
requires the use of a pre determined inventory list
par level inventory distribution system
the computerized locked supply system is a variation of
par level system
fixed inventory level aka
par-level inventory
serrations
paralell grooves
an infection caused by a needle stick enters through
parenteral tissue
removing salivary gland because of a tumor formation
parotidectomy (digestive)
humerus (skeleton)
part of appendicular skeleton
duodenum
part of small intestine
mixing recommendations usually referred to in____________
parts
ppm
parts per million
biggest difference in instrument manufacturing process
passivation
final stage in mfg a 'finishing' of surgical grade instrument
passivation
surgical grade instruments, if properly cared for, will last longer than floor grade instruments bc they have a ...
passivation layer
disease producing microorganisms
pathogen
few microorganisms are__________
pathogenic (disease producing)
PCA pump
patient controlled anesthesia. used to allow patient to administer pain medication as needed
scapula, clavicle; connects bones of the arms, aids in arm movement (appendicular)
pectoral girdle
connects bones of the legs to the axial skeleton; sacrum and coccyx (tail bone) (appendicular)
pelvic girdle
human reservoirs
people harbor organism and transmit directly or indirectly
may possibly be used in AER
peracetic acid
device being sterilized in LTGP can only be touching
perforated sterilizing rack
validation
performed by MFG
employees should be trained in appropriate attire to be worn when_________
performing specific tasks
somatic system
peripheral nerves communicate w/ skin and skeletal muscles
Semi-Restricted Areas
peripheral support areas to OR, hallways to OR, SPD clean assembly and sterile storage; surgical scrub attire and hair covers required
when marking use non toxic ___________ pen, does not run
permanent
an ongoing inventory management system
perpetual inventory system
tracks all incoming and issued supplies to determine, on an ongoing basis the quantity of supplies in storage
perpetual inventory system
-ac, -al, -ar, -ary, -ic, -ical, -ine, -ior, -ory, -eal, -ary, -ous, -tic
pertaining to
-emia
pertaining to blood, blood condition
-scopic
pertaining to visual examination
refers to the function of specific body parts
physiology
master gland, helps control activities of endocrine glands
pituitary gland
master gland; located in brain; coordinates all activities of endocrine system
pituitary gland
not part of reproductive system
pituitary gland
a broken glass suction bottle is returned to decon. what do you do?
place it in appropriate rigid container
broken glass returned to decon..
placed in appropriate rigid container
large sets
placed in perforated/ mesh baskets; can be placed flat in sterilizer
when sorting, heavy instruments and delicate instruments (e.g. microsurgical) should be
placed in separate trays
sterile trays that may be subjected to storage challenges should be
placed in sterility maintenance cover
when sterilizing two large basins with smaller bowls in the same set, the chemical indicator should be
placed in the top and bottom of basins
steam sterilizer load with linen packs only, packs should be
placed on their edges
when a steam sterilizer is loaded with linen packs only, the packs should be
placed on their edges
NOT part of the final preparation of PCE
placement of disassembled parts into a plastic bag
fungi
plant-like; can cause serious illness/death in immunocrompromised people
do not place paper _________ pouches inside instrument trays (rigid/textile soft wrapped); ppk
plastic
soft _________ or __________ brushes preferred/recommended
plastic/nylon
write on ___________ side of peel pouch (if HCF allows, possibly sterilization tape/ auto print labels); write on indicator tape NEVER on _______________ material
plastic; packaging
AMW detergent of neutral pH (7) is used for
plastics, aluminum and anodized aluminum containers
ear
plays role in equilibrium and balance; consist of the smallest bones of the body
prep of decon soiled items is initially performed at
point of use
rigid sterilization container filters, some paper, some ______________; neither to be reused
polyethylene
compatible packaging; low temp gas plasma
polyolefin wrap, tyvek(non-cellulose), *specific rigid containers
robotic instruments
popular brand, davinci; requires special cleaning protocols; have flush ports (to flush ports and faucet); manual cleaning involves multiple steps (scrubbing(several intricate moving parts), flushing, priming/u.sonic cleaning, rinsing, drying, (possible) lubricating; a prolonged manual soak and ultrasonic set time may be (and usually is) required
unacceptable in any zone of SPD/OR, related perioperative setting
porous wood furniture related material
sterile storage ventilation system must be under
positive pressure
black stains
possible exposure to ammonia
devices known/suspected to be contaminated with prions
posterior eye tissue, brain tissue and spinal cord tissue are considered to be high risk; when sent to CS/SPD for reprocessing, they should be identified by means of a form, tag or other label placed inside/outside the container or basket of instruments, followed by an extended heat sterilization; powered equipment or equipment requiring low temp sterilization SHOULD NOT be used in procedures involving high risk tissues as such
avoid soaking lumened instruments for lengthy periods
potential formation of biofilms
pH
potential hydrogen
when sorting items in decon; require manual cleaning
powered equipment
ethics
practice of doing the right thing
_____ & _______ filtered water helps to eliminate pyrogens, foreign body reactions or medical complications in patients and prevents spotting as the instruments dry
pre & post
water purification usually involves
pre and post filtration
(3 sink method) 1st sink
pre soak/washing- tap water and detergent
a bowie dick test should be performed on which type of sterilizer
pre vacuum steam
if grossly soiled items cannot be cleaned immediately
precleanse spray then keep moist with a soaked towel
first step of decon; should be at operator's Point Of Use
precleanse; enzyme spray
(3 sink method) 2nd sink
preliminary rinse- tap water
cleaned items are inspected, assembled and packaged
prep/assembly (pkging)
depress/o-
press down
necessary to attain the high temp needed in a steam sterilizer
pressure
necessary to attain the high temperature needed in a steam sterilizer
pressure
bowie dick should be performed in
prevacuum steam sterilizer
tip protectors
prevent damage of delicate items, stops protruding and keeps tips open; can be made of silicone, rubber, paper-plastic, foam
warm up jackets are recommended to be worn in prep and packaging for the purpose of....
preventing bacterial shedding from bare arms
bronchus
primary branch of trachea
direct contact
principal route of nosocomial infection
regulation
principle, rule or law; control or govern behavior
Professional Ethics
principles of conduct governing an individual or group.
morals
principles of right and wrong behavior
abnormal/ misfolded protein
prion
cause of CJD
prions
spongiform encephalopathy is caused by
prions
MFG IFUs must be obtained
prior to a medical device being cleaned and processed
cannulate/drain
probes, catheters, drains; cannulas
steps for performing a task
procedure
-tomy
process of cutting
mammary glands
produce milk for nourishment of child after birth
salivary glands
produce saliva to cleanse teeth and dissolve food chemicals; mucous used to lubricate pharynx
reason for mfg to possibly assign expiration date to a sterile medical device
product degradation
reason for a mfg to assign an expiration date to a sterile medical device
product degredation
count sheets (inventory) ...
promote accountability
ANSI
proposes standards from members such as AAMI; enhancing the global competitiveness and quality of life
containerized packaging systems are most commonly used to
protect surgical instrument sets during steam sterilization
Flat bones
protective shells (ribs)
bony encasement
protects central nervous system
OSHA
protects workers from occupationally caused illness and injuries
Occupational Safety Health Administration (OSHA)
protects workers; OSHA standards are required by law; sets occupational exposure limits for all chemicals in the workplace under mSDS (material safety data sheet); "right to know"; Emergency eyewash stations
breaks down blood soils
proteolytic enzyme
shank
provide closing force
main role of spd
provide dependable reliable services to enhance quality of patient care
function of gastrointestinal system
provide the body with nutrients
power nozzles; vegetable sprayer
provide water and/or detergent to flush lumen devices
hypo/hyperthermia machine
provides heat or cooling to warn up or cool a patients body temp
SPD Responsibilities
providing dependable, reliable services to enhance the quality of patient care. Instruments sets, patient care equipment, and other medical devices must be processed and distributed in an accurate and timely manner so that patient care is not adversely affected.
when veins vs. arteries are reversed in the concept of blood flow
pulmonary; bluish color of vein indicate blood needs oxygen
supply item usually requested, battery operated and used to flush and suction wound site of I&D
pulse lavage
emerson pump
pump to provide suction to the chest
IV pump
pump used to control the delivery of intravenous fluids and medication, can be macro or micro
feeding pump
pump used to deliver tube feedings to a patient
circulatory system
pumps blood (tissue) throughout the entire body and removes waste products
heart
pumps more than 10 gallons of blood a minute through arteries and veins; has 4 chambers
-centesis
puncture, to remove fluid
not an element of distribution system
purchasing
gram positive stain
purple/blue
pyo-
pus
fever producing substances, cause complications in patients especially if water is not pre and post filtered
pyrogens
dead microorganisms on soil or organic debris left on surgical instruments after sterilization can form...
pyrogens, foreign body reactions or medical complications in patients
muscles found in legs
quadriceps
collection of data and identification of issues
quality assurance program
Long bones
raise and lower (humerus and femur)
needles/sharps in decon should never be
recapped
pharynx
receives food and transports to esophagus
stomach
receives food from esophagus; mixes with gastric juices; moves chyme to duodenum
vagina
receives penis and is birth canal
Function of CS/SPD
receives, cleans, decontaminates, assembles, inspects, disinfects, sterilizes reusable medical and surgical devices
first to accept responsibility for all supplies in the facility
receiving area
floor trays should be prepared using ...
recipe cards; outside pack; id's contents
important for spd tech to learn anatomy and physiology in order to
recognize where instruments are used
it is important for SPD tech to learn anatomy and physiology in order to
recognize where instruments are used
tympanoplasty
reconstructing the ear drum so sound waves can be sent to the middle and inner ear
-gram
recording
procto-
rectum
grow and develop in bone marrow
red and white blood cells
gram negative stain
red/pink
when cleaning an IV pump it is important to use a germicide on the pump surface in order to...
reduce bioburden present on the equipment
surface wetting agent
reduces/lowers surface tension; breaks up and disperses solid/liquid soils from item being clean; suspends soil and clumps so they can wash away easily
OSHA Standard 29 CFR 1910.1030
regarding bloodborne pathogens
Non-restricted hallways, offices, cafeteria etc
regular street attire
Food and Drug Administration (FDA)
regulates all medical devices. MedWatch (recalls); approves reprocessing of single use devices; require IFU (instructions for use)
EPA
regulates disinfectants, clean air & water act, mfg and sale of EO
principal, rule or law used to control/govern behavior
regulation
rule designed to govern behavior
regulation
cationic
relating to compounds that contain a positive electrical charge; exhibits germicidal properties
anionic
relating to compounds that have a negative electrical charge; form a large group of synthetic detergents
sterile items that are protected from the environment have been proven to
remain sterile indefinitely
descaler
removal of calcium, magnesium and certain other metal cations in hard water (= to CLR)
nephrectomy
removal of kidney
ureters
removal of urine from kidneys to bladder
cebatome
removes cement
parotidectomy
removing a salivary gland because of a tumor formation
orchiectomy
removing a testicle
Coronary Artery Bypass Graft
removing a vein from the lower limb to bypass a blocked coronary artery of the heart
recommended performance check for automated washer
removing and cleaning drain basket daily; verifying spray arms are moving
cleaning and decontamination are important because
removing as many microorganisms as possible before the sterilization process enhances the probability of bacterial kill
Bilateral SalpingoOopherectomy
removing both fallopian tubes and ovaries
tonsillectomy
removing lymph tissue in the pharynx (throat)
Cholecystectomy
removing of gallbladder
Carpal Tunnel Repair
removing tissue displaced bone in wrist area to release pressure on median nerve
foginess without successful remedy w/ anti-fog..
renders useless, unserviceable
in a hurry to leave for an appointment you forget to punch out (action)
report this to your supervisor the next day
If blood splash exposure(esp to orifice) or needle/sharp stick occur
report to HCF direct chain of command immediately; immediately "milk" with warm soapy water prior to heading to ER: employee confidential medical evaluation is to follow
if bowie dick test fails the first time
report to supervisor for further instruction
when/if wet pack is noted when steam sterilizer is unloaded
reprocess the items
genitalia
reproductive organs
compliance with OSHA
required by law
medical device reporting regulation
requires HCF to report deaths or serious injuries from medical devices
right to know standard
requires employers to have SDS for chemicals
N95 mask
respirator filtering mask with thicker design to protect above average surgical mask; must fit-test (HCF respiratory therapy dept); may help protect against H1N1, SARS, tuberculosis and ebola; Not recommended for children or people with facial hair
the majority of HLD are ___________ ___________, use in well ventilated areas; use exhaust hoods vented to the outside
respiratory irritants
pulmonary capillaries are found in the
respiratory system
plastic sterilization bags are generally used to package
respiratory therapy equipment
plastic sterilization bags are generally used to package...
respiratory therapy items
one of the most common portals of exit in transmission of disease
respiratory tract
pathogens that cause tuberculosis, whooping cough, pnuemonia, measles, mumps and smallpox are discharged through
respiratory tract
skeletal muscle
responds to stimulation by contracting and relaxing; voluntary; striated; *attached to bone by a tendon
infection control is the _____________ of everyone who works in healthcare
responsibility
penrose drain
retract spermatic cord during IHR
when preparing instruments from a dissection set for processing in a washer/decontaminator the instruments should be positioned with the ....
retractors on the bottom of basket and hand held instruments on the top
if instrument in prep has missed bioburden on it....
return ENTIRE set
while delivering sterile supplies to multiple nursing units, the tech is asked to take an opened/used tray to decon, best procedure?
return for the used tray after completing all deliveries using the appropriate collection cart
woven wrapping materials...
reusable (100% cotton/blend); muslin; launder between uses and de-lint; out date at 30 days; QA process (track # of uses, poor barrier properties)
de-
reversal of, without
the diffusion (flowing) of water through a semi permeable membrane to eliminate impurities
reverse osmosis
bluish-black stains
reverse plating may occur; when two different types of metals are ultrasonically processed together(e.g. stainless steel and chrome processed together)
cost/o-
rib
separated by septum
right and left chambers
OD
right eye
disposable sharps must be disposed in
rigid biohazard container
AER is not for
rigid scopes
if using paper plastic peel pouches these do not go inside ____________/ ________ __________ instrument sets
rigid/soft wrapped
____________ after ultrasonic cleaning prior to placing in automated washer
rinse
prior to placing an instrument set from one mechanical unit to another.......
rinse
one method of preventing biofilm formation in lumens is to
rinse the lumens with distilled water and dry them well
a tray of instruments has been brought to decon in a saline solution (action)
rinse with water then clean in usual manner
unless otherwise directed, an item high level disinfected in glutaraldehyde must be
rinsed a minimum of two times
just as cleaning is the most important step in the decontamination process, _________________ is the most important step in the cleaning process; removes loosened soils and debris
rinsing
due to several intricate moving parts the amount of time that's authorized to go in ultrasonic is extended past the normal avg set time, rather it's between 15-30 mins in duration
robotic instruments
bacillus
rod shaped bacilli
ppk available in ________ to alllow for cutting to desired length
rolls
palate
roof of mouth
cocci
round/spherical shaped cocci
glutaraldehyde requires
routine employee monitoring for exposure levels
need to be separated from instruments in it's pan prior to being ran in an automated washer
rubber mats
-rrhexis
rupture
-cyst
sac
AMW detergent of alkaline (9-11)
safe for stainless steel instruments; needed for mechanical washers for removing heavy organic soil followed by neutralizing (acid) rinse along with water at a higher temp to maximize the effectiveness of the final detergent action
CS/SPD has responsibility for ensuring surgical instruments are ...
safe, clean, sterile and in proper working order
instruments should NEVER be soaked in; salt from this liquid will cause damage
saline
hom/o-
same, similar
Finishes of handheld instruments
satin (reflects light); shiny; black (ebonized) bland, absorbs light for laser procedures
Pectoral girdle
scapula and clavicle connect bones of arms and aids movemnet
cut/incise (sharps)
scissors (curved; designed to cut flesh); knives/scalpels; chisels; osteotomes
abrad/o-, abras/o-
scrape off
raph/o-
seam, suture
-crine
secrete
seminal vesicles
secrete fluid as a medium for sperm
bulbourethral glands
secrete substance to coat lining of urethra, neutralize pH of urine and lubricate penis in preparation for coitus
pancreas
secretes pancreatic juice for digestion; regulates blood sugar
prostate gland
secretions assist sperm mobility
retract tissue/organs
self retaining (designed w/ spring to keep open); handheld (skin hooks, bone hooks)
some peel pouches _________-__________, some _________ _________
self-sealing; heat sealed
come in contact with intact mucous membranes; non invasive endoscopes; endotracheal tubes
semi-critical; HLD; sterilization although desirable is not absolutely necessary
proper action in prep/assembly if an instrument within a set still has noticeable gross contamination
send back entire set for complete disinfection reprocessing
if a reusable sterile basin set that is not in a plastic protective covering is dropped on the floor
send it to be reprocessed
voluntary nervous system
sensation; mental function; skeletal muscle contractions
alg/e, algi/o, alg/o-, algesi/o-
sensitivity to pain
carry information to the brain
sensory nerve
unexpected occurrence involving death/serious injury; may specifically include loss of limb/function
sentinel event
hand washing facilities must be ______ from sinks used to decontaminate instruments
separate
before any instrument pans with multiple layers enter either sonic or washer decon/disinfector
separate to allow each layer to receive cleansing it deserves
AMW, keep layers of instruments (sets/pans) ___________________!
separated
before transport to decon reusable sharps and instruments actively used in procedure should be
separated/segregated from other instruments
the growth of pathogenic bacteria in living tissue
sepsis
two types of wrapping methods
sequential and simultaneous
SCD
sequential compression device. used to provide alternating compression to the lower extremities to help prevent the formation of blood clots. also known as DVT deep vein thrombosis machine
wrapping methods
sequential wrap; simultaneous wrap; square fold; envelope fold
AAMI
sets standards for CS/SPD; major resource for healthcare guidelines
gonads
sex glands
-plasty
shape
acu/o-
sharp, severe, sudden
Handled only if wearing PPE; all injuries that occur MUST be reported immediately
sharps
all decon rooms need to be accommodated.....
sharps bag and rigid container
are considered to be the most contaminated PPE, donned and doffed first
shoe covers
first item to be placed on when donning PPE
shoe covers
order of applying PPE
shoe covers>hand hygiene>gown>mask>face shield/goggles>gloves
advantages of LTGP sterilizing unit
short sterilization times, no warm up, no DART, no dry time, no necessary aeration
any injury to employee no matter how slight
should be documented in an incident report
medical waste requiring storage
should be kept in labeled, leak proof, puncture resistant containers under conditions that minimize or prevent foul odors; May be handled by janitorial
Training
should be standardized
glutaraldehydes
should never be used as an environmental disinfectant; require routine employee monitoring for exposure levels
scapula
shoulder blade
clavicle
shoulder bone in front
____________ mats as liners (small/delicate items) keep in place
silicone
remove ______________ mats prior to loading mechanical washer
silicone
protozoa
single celled (animal-like) microorganisms
protozoa
single celled organisms
fungi include
single celled yeast
fungi include
single celled yeasts
Hand washing
single most effective way to prevent infection; 15 second minimum
disposable instruments
single use; do NOT reprocess
chain of infection
six steps; causative agent, reservoir of the agent, portal of exit, mode of transmission, portal of entry, susceptible host
types of muscle tissue
skeletal (striated, voluntary), smooth (involuntary, digestion associated), cardiac (heart, involuntary)
function of the voluntary nervous system
skeletal muscle contractions
function of voluntary nervous system
skeletal muscle contractions
cutane/o-
skin
derma-
skin
largest organ OF the body
skin
largest organ of body
skin
Non-Critical
skin or contact indirectly, low-intermediate disinfection
floor trays usually consist of..
skin prep, anesthesia, instruments, drapes and towels, gauze and cotton balls
Integumentary system
skin, hair, glands and nails
comprised of the cranium and facial bones (axial)
skull
covers brain
skull
crani/o-
skull
cranio-
skull
axial skeleton
skull, hyoid, vertebral column and thoracic cage
Axial skeleton
skull>hyoid bone>vertebral column>thoracic cage
sterility assurance level (SAL)
slight probability of a viable microorganism being present on a product unit after sterilization
brady-
slow
micr/o-, micro-
small
ulna
small bone in lower arm
fibula
small bone in lower leg
ileo-
small intestine
disadvantages of LTGP sterilization units (with 24 hr BI)
small units, lumen and legth restrictions, long bio read outs once in incubator
-ula
small, little
cochlea
snail like structure in middle ear
Portals of Exit
sneezing, coughing (Respiratory); feces, saliva (GI tract); secretions from penis and vagina, urine (Genitourinary tract)
equipment to be processed and distributed in a timely manner
so that patient care is not adversely affected
orthopedic instrumentation
soak in a lipolytic or multi enzyme solution; U.sonic cleaning usually recommended (many MFG recom. extended cycle); connect flexible reamers to sonic irrigators if directed by MFG- always follow their instructions; Kerrison ronguers- especially problematic (kerrisons that cannot be opened for cleaning should be routinely cleaned by instrument repair service)
distal end of a rigid endoscope should be cleaned with a
soft bristled brush
clostridium botulinum is harbored in
soil
major non living reservoirs of infectious disease
soil and water
bottom shelf within sterile storage
solid
wash ___________ pans separately; do not place over instruments
solid
Sterile storage racks MUST be
solid bottom, 2" from wall, 18" from ceiling or sprinkler (deflector plate), 8-10" from floor to prevent dirt/dust/splashing when cleaning
manufacturer verified device for testing ultrasonic
sonocheck
commercial products to verify cleaning process outcomes for either ultrasonic/automated washer
sonocheck (u.s.), aluminum foil (u.s.), TOSI (u.s. and a.w.)
verify effectiveness of ultrasonic cleaners
sonocheck or related commercial test strips (to include aluminum foil method)
reservoirs of infection
source of disease causing organisms must be present
NFPA White Diamond
special hazard information
muscles
specialized cells responsible for contractions in the body
PPE
specialized clothing, protect against hazard
exchange cart is not considered a
specialty cart
testes
sperm cells and male sex hormones formed
shape of streptococcus
spherical
shape of cocci can be
spherical/round
soaking is not recommended from POU to transport because of the potential for ____________
spillage
sprilillum
spiral and corkscrew
shape of spirochete
spiral like
spirochetes
spiral-like shape; found in water, sewage, soil and decaying organic matter; reason water in SPS decontamination needs to be looked at being treated (filtered, softened, distilled, sterile, etc.)
spleno-
spleen
a microorganism that is resting and has a hard, shell like outer covering
spore
in order to test the effectiveness of some sterilization cycles ______________ are within a biological indicator vial
spores
microorganisms; form a thick shell to survive adverse conditions
spores
used to test effectiveness of sterilization cycles
spores
prior to disposal in rigid sharps container
spores deemed not to be used may be recommended to be 'killed" via it's processing method (sharps container because containerized with glass inside plastic)
SMS
spunbound meltblown spunbound
two folding techniques of a soft wrapped item
square (larger items) and envelope (small to medium items)
manufacturing material of choice
stainless steel; shiny/mirror finish, matte/satin finish
personnel who collect/process PCE should observe
standard precautions
training should be
standardized
major cause of healthcare acquired infections
staph aureus
Examples of gram positive bacteria
staphlococcus, enterococcus and streptococcus
Homeostasis
state of equilibrium; conditions within cells must remain stable
Recommended Practices
statements of sound principles of practice based on scientific data and opinions of experts.
recommended practices
statements of sound principles of practice based on scientific data and the opinion of experts
BI Spore Geobacillus Stearothermosphilus is used for
steam (autoclave), LTGP
for autoclave sterilization to occur
steam must make contact with all surfaces
most cost efficient sterilization method
steam under pressure
to kill the remaining microorganisms on metal surgical instruments within SPD, the most cost effective sterilization method is generally considered to be....
steam under pressure
geobacillus stearothermophilus used for
steam, sterrad, VPro and ozone
procedures
steps for performing a task are defined
for a soft wrap that is too small...
sterilant can reach but susceptibility for contamination on slightly exposed areas
for a soft wrap that is too big...
sterilant penetration can be prevented/inhibited along with air removal
Restricted Areas
sterile procedures are performed; surgical scrub attire, hair covering and mask required
absence of all microbial life including spores
sterility
______________________ will not compensate for poor cleaning
sterilization
absence of ALL microbial life (including spores) is accomplished via
sterilization
bacterial spores (method of destruction)
sterilization
process by which all forms of microbial life including spores are destroyed
sterilization
verify correct container for _________________ process selected (sterrad different)
sterilization
lot control numbers should be placed on each package sterilized and on the...
sterilization load record
holding/maintained phase of steam
sterilization phase
all devices should be able to be ____________ in the same cycle
sterilized
used in open heart surgery
sternal saw
Thoracic cage
sternum and 12 pairs of ribs; protect organs of chest and upper abdomen
a small cut is noted in the cord of an IV pump (action)
still clean, disinfect, tag and send to biomedical engineering and immediately out of circulation
gastr/o-
stomach
-lith
stone
litho-
stone
best method of action if you receive blood/body splash to mouth/eyes, needlestick or cut in your dept
stop what you're doing immediately cleanse w/warm soapy water, report in same facility's ER/ED and notify your chain of command
all play a role in how bones support other body systems
storage of minerals, growth of blood cells and protection of internal organs
urinary bladder
storage sac for urine
septoplasty
straightening or removing cartilage and/or bone in the nose when the nasal septum is deformed, injured or fractured
appendix
structure in lower intestines
Anatomy
structure, form and organization of body parts
oral suction
suction machine used to suction out upper respiratory tract, uses continuous suction
autoclave loads require
sufficient dry time and proper loading prior to set's steps of storage/distribution
steam at a temp which exceeds that of a saturated steam (in the absence of water) at the same pressure; also referred as 'dry steam'
super heat
epidermis
superficial protective layer
when heat is added to steam without increasing moisture content
superheated steam
when heat is added to steam without increasing moisture content, the steam is called...
superheated steam
scissors with black handles referred to as
supersharps
hyoid bone
supports the body and functions in swallowing
ultrasonic should contain ______________ to bind with the soils and hold them in suspension after they are removed from the instruments
surfactants
_____________ instruments represent a large portion of the HCF budget
surgical
containerized packaging systems are most commonly used to protect
surgical instrument sets
PPE in decon
surgical scrub attire; to be laundered by facility; bonney suit; dedicated shoes
Decontamination area attire
surgical scrubs and OSHA required PPE
Clean assembly and sterile storage attire
surgical scrubs and hair covering
Operating room
surgical scrubs, hair covering and masks
-rrhaphy
surgical suturing
-cele
swelling
-edema
swelling
coccyx
tail bone
multipart instrument
take apart during decon! ; follow manufacturer guidelines
latches/locks applied as a final closure on the ends of rigid containers are known as
tamper-evident seals
water that has been treated and is acceptable for drinking
tap water
1st sink in 3 sink method
tap water and detergent (pre-soak/washing)
2nd sink in three sink method
tap water( for preliminary rinsing)
lacrim/o-
tear, tear duct, lacrimal duct
-dontia
teeth
Accessory digestive organs
teeth, tongue, salivary glands, liver, pancreas
accessory digestive organs
teeth, tongue, salivary glands, liver, pancreas
a coworker is observed taking dressing supplies for use at home (first action)
tell him/her that this is not the right thing to do
critical parameters for heat sealing paper-plastic pouches
temp, pressure and dwell time
when sealing peel pouches, use correct _______________ to seal
temperature
connects muscle to bone
tendon
teno-
tendon
achilles
tendon at base of leg at heel
hamstring
tendon in leg
drains in pre vacuum and gravity displacement sterilizers are placed at the bottom front because the air
tends to concentrate at the bottom of the chamber
FRD test
test to see if fog is smudge/ permanent
orchio-
testes
must be placed on their sides in the steam sterilizer in order to facilitate air removal and steam penetration
textile packs
packaging means...
textile wrappers, plastic paper pouches (ppk), rigid sterilization containers
compatible packaging; ethylene oxide (EtO)
textile, nonwovens, polyolefin wraps, paper plastic pouches/rolls, tyvek (all plastic pouches), polyethylene, most rigid containers
compatible packaging; steam
textile, nonwovens, polyolefin wraps, paper-plastic pouches/rolls, rigid sterilization containers
AAMI recommends that rigid sterilization containers be biologically tested before purchase and annually to verify
that the sterilizer is able to sterilize the contents
immunity
the ability of the body to specifically counteract antigens
asepsis
the absence of pathogenic microorganisms that cause disease
reverse osmosis
the diffusion (flowing) of water through a semi-permeable membrane to eliminate impurities that it contains
Ethics
the discipline dealing with what is good and bad and with moral duty and obligation.
if too many microorganisms remain after the cleaning process when high level disinfecting a device
the disinfection process might not be effective
does not depend on cost of chemical
the effectiveness of any chemical disinfection process
when a positive BI demonstrates a sterilization process failure and the failure is the result of an operator error
the error should be corrected and the load reprocessed
most important factor in preventing bacteria from contaminating sterile packages
the handling of packages
principal living reservoir of human disease
the human body
a gauge on the main steam line, usually located at the back of the sterilizer tells you the steam pressure as it is entering
the jacket
if hydrogen peroxide is mixed with even a drop of water in LTGP
the load can abort
mode of transmission
the method of transfer of an infectious agent from the reservoir to a susceptible host
causative agent
the microorganism that causes an infectious disease
American Medical Association (AMA)
the most important organization related to healthcare ethics.
economical order quantity
the optimum amount of a supply to order
portal of exit
the path by which an infectious agent leaves the reservoir
portal of entry
the path used by an infectious agent to enter a susceptible host
reservoir of the agent
the place where an infectious agent (microorganism) can survive
the two gauges on a steam sterilizer measure
the pressure in the jacket and the chamber
condensation
the process by which a gas or vapor changes to liquid; leads to microbe build up, which leads to patient infection
AAMI's definition of cleaning
the removal of contamination from an item to the extent necessary for further processing or for it's intended use
cleaning
the removal of contamination from an item to the extent necessary for further processing or for the intended use (AAMI ST79)
AAMI's definition of cleaning
the removal of contamination from an item to the extent necessary for further processing or it's intended use
a batch of detergent diluted with recommended type and amount of water will have ______ _______ effect on the 5th instrument set being decon'd as the 1st
the same
Degassing ultrasonic
the solution in the ultrasonic after filling with water and the amount of detergent recommended should be run on an empty cycle each time water is changed
impingement
the spray force action of pressurized water in an automatic washer against instruments being processed to physically remove bioburden
sterility maintenance cover should be placed on sterile items when
the sterile items cool to room temp
thermal disinfection
the use of heat to kill all organisms except spores
decontamination
the use of physical or chemical means to remove, inactivate or destroy bloodborne pathogens on the surface of an item (OSHA)
automatic washers clean via
thermal disinfection (use of heat to kill) and spray force action (impingement)
NOT classified as critical medical device
thermometer
outside shipping cartons should not be brought into SPD because
they are often biologically contaminated
shipping cartons are not acceptable in sterile storage because
they can harbor bacteria
surgical grade instruments, if properly cared for, usually last longer than floor grade instruments because
they have a passivation layer
the MAIN disadvantage of using rigid steriliztion container system
they must be disassembled, processed, reassembled and checked before each use
all contaminated items must be handled as if...
they represent the worst case scenario
biofilms
thick masses of cells and and extracellular material; adhere ti the surface of any object that comes in contact with non sterile water (including distilled/dionized water); form a protective slimy film making cleaning, disinfection and sterilization difficult if not impossible
sternum, 12 pairs of ribs; protects chest and upper abdomen
thoracic cage
making opening into thoracic cavity to give access to lungs and heart
thoracotomy (respiratory)
effective sterilization begins with
thorough cleaning
fourth of five major steps for flexible endoscopes
thorough rinse (3x or 30 secs) to remove all HLD via treated water
flagella
thread like tails; help bacteria move through liquids
pharynx
throat
tracheo-
throat
thyro-
thyroid
if a non-perforated tray is used for the sterilization of instrument sets, it must be
tilted in the sterilizer rack
parameters for LTGP (VPro)
time, temp and hydrogen peroxide concentration
parameters for LTGP sterilization
time, temp, hydrogen gas plasma
3 parameters of steam autoclave sterilizer
time, temp, pressure
hyoid
tiny bone in neck
measuring hinged instruments
tip of finger rings to end of jaws
measuring retractors
tip of handle to tip of blade, length and width of retractor blade (several measurements needed)
eye instruments should not be placed on top of each other in tray and ________ should not protrude through basket
tips
cut with dissecting scissors
tissue
retractors hold back
tissue/organs
sterilization
to accomplish the absence of all microbial life (including spores)
purpose of insulation on laparoscopic instrumentation
to avoid unwanted electrical shock/burns when cauterizing
-clast
to break
-tripsy
to crush
excis/o-
to cut out
purpose of tungsten carbide insert on a needle holder
to hold suture needle better
purpose of packaging....
to maintain sterility until opened for use
overall role of SPD
to provide dependable service to enhance patient care
syn-
together, with, union, association
gloss-
tongue
sterilant penetration can be inhibited by using a wrapper that is
too large
follow mfg guidelines for enzymatic detergent
too much/too little can render ineffective
odon-
tooth
proximal
top of limb; opposite distal
alcohol is used as
topical antiseptic or a sanitizer (shelves, bins etc)
lacer/o-, lacerat/o-
torn, mangled
most efficient distribution system
total exchange cart
ad-
toward
medial
toward center of body; opposite lateral
distal
toward end of limb
superficial
toward surface of skin; opposite deep
inferior
toward the feet
superior
toward the head
lower respiratory system
trachea, bronchial tree, lungs
place sterile items in a plastic bag/tote bin when
transporting by hand
fallopian tubes
transports egg to uterus
esophagus
transports food to stomach by peristalsis
esophagus
transports food to the stomach
when a rep brings an outside vendor set it should be
treated as contaminated and sent through entire process
when handling surgical instruments, final rinse in cleaning should be done using
treated water
when handling surgical instruments, the final rinse should be performed using______________
treated water
delt/o-
triangle
ureter
tube connecting bladder and kidneys
esophagus
tube from throat to stomach
-oma
tumor
metal-bristled brush can be used to clean
tungsten carbide jaws of needle holders
not clear because of stirred up sediment
turbid(ity)
"ban the fan"
turbulent air flow, re-circulate dust and microorganisms, interferes with maintaining air pressures
bi-
two
di-
two
bluish-black stains
two different types of metals ultrasonically pressed together
ear consist of
tympanic cavity and membrane; malleus, incus, and stapes; eustachian tube connects middle ear to throat; cochlea (organ of corti)
type of organism to be killed helps determine....
type of disinfectant that should be used
manual cleaning detergents
typically of neutral pH; available in liquid, solid, powder; follow the manufacturer instructions and measure accurately
acceptable packaging material for low temp gas plasma
tyvek
ebonized instruments(due to texture flaking) and plastic trays(absorb sound waves) are not recommended for use in ____________ ; hinged instruments must be in open position; not recommended to clean in 'strung' position
ultrasonic
plastic rigid set containers are not recommended for the _______________ cleaner
ultrasonic
gross soil should be removed prior to placing instruments in _____________ ______________
ultrasonic cleaner
due to the aerosol of microbes CS/SPD personnel are to ALWAYS brush/clean devices
under the surface of the water
to prevent aerosols, submersible instruments should be brushed
under the surface of the water
sub-
under, less, below
sentinel event
unexpected occurrence involving death/serious physical or psychological injury within hospital
bacteria are
unicellular
instruments of ______________ metals should not be placed together in the same tray for processing (e.g. stainless steel should not be placed with aluminum, copper, or brass instruments
unlike
an-, ana-
up, apart, backward
epi-
upon, above
atria
upper chambers; receive blood back from veins
maxilla
upper jaw bone
connect kidneys to urinary bladder
ureters
regulates pH and volume of body fluids; controls red blood cell production and blood pressure; removes salts and nitrogenous waste from body; helps to maintain normal concentration of water and electrolytes
urinary system
categories of instruments are categorize according to _________
use
opthamology instruments; to avoid TASS
use fresh new batch of enzymatic detergent in both bath and sonic (if manuf. states sonic is even ok to use for these instruments); followed by thorough rinsing via deionized/treated water!
sequential compression device (SCD)
used for circulation support for prevention of clots
iodophors
used for skin antisepsis; should never be used for cleaning instruments
laparoscopic instruments
used minimally invasive surgery; selected ways to test serviceability
High Level Disinfectants
used on devices that will come into contact with patients; kills most organisms but not necessarily spores
needle holders
used primarily to hold suture needles; testing: 2-0 nylon (ethilon) tug
cart washer
used to clean and sanitize metal surgical case carts, supply carts and with a special loading rack, any sterilization container; provides wash (with detergent of MFG choice), rinse and dry cycles (some- acid rinse with MFG choice); used also to clean rigid containers and filter covers; just the separate containers itself
scissors
used to cut/dissect tissue, cut dressing/suture; testing: esmark/facial tissue (several cuts in test material)
finger rings
used to grasp instrument and control jaw action; can be open/closed, round/oval
retractors
used to hold back tissue and organs
colonoscope
used to visualize the entire large intestine
bronchoscopes
used to visualize the tracheobronchial tree
cystoscope
used to visualize urethra and bladder
MRSA
usually transmitted by healthcare workers due to poor/infrequent handwashing, or w/ pateients who have been on antibiotic therapy for a long time; Methicillin Resistant Staph Aureus
Antiseptics
usually used topically to prevent, arrest or inhibit the growth of microorganisms on living tissue
if glass device is authorized to be ran in automatic mechanical washer (cycle)
utensil cycle
hyster/o-
uterus
colp/o
vagina
MFG performs
validation
the manufacturer performs ________ for a product, the facility end user performs _______.
validation; verification
system level of organization
various numbers and kinds of organs which together perform complex functions for the body
living things responsible for causing disease
vectors
lyme disease is transmitted by
vectors
lyme disease transmitted by
vectors
phleb/o-
vein
ven/o-
vein
veno-
vein
would not be included in the routine inspection of an instrument
vendor identification number
end user performs
verification
cover spinal cord
vertebrae
vertebral column
vertebrae separated by discs; lumbar, thoracic and cervical spine
26 ring shaped bones (cervical, thoracic, lumbar) (axial)
vertebral column
instruments with lumens should be soaked
vertically
any instruments that arrive with lumens should be soaked _________ NOT ___________
vertically; horizontally; flush and brush 3x or until clean
angio-
vessel
vaso-
vessel
-oscopy
viewing
influenza caused by
virus
prions
virus-like; cause variety of neurodegenerative diseases of humans and animals; have affinity for eye, brain and spinal cord tissues; *VERY difficult to kill by usual sterilization methods (considering HCF's willingness to reprocess- extended exposure time in steam)
minute infectious agents, grow only in living tissues/cells, require living host to multiply
viruses
organisms of microscopic/ submicroscopic size include
viruses, rickettsiae, bacteria, algae, yeasts and molds (microbe)
a manual cleaning bath can be used for a max of 8 hours unless
visibly soiled or for opthalmology instruments
plastic paper peel pouches are used to _______________ contents; ppk'd in prep for user's "________________ ________ ________"
visualize; "position of use"
laryng/o-
voice box
larynx
voice box
Association of peri-Operative Registered Nurses (AORN)
voluntary; develops nationally recognized standards, recommended practices and guidelines for peri-operative setting
Society of Gastroenterology Nurses and Associates (SGNA)
voluntary; established standards for effective processing of flexible endoscopes
The Joint Commission (TJC) formally (Joint Commission on Accreditation of Healthcare Organizations (JCAHO))
voluntary; establishes accrediting standards and conducts onsite inspections; annual competency testing
World Health Order (WHO)
voluntary; furthers international cooperation in improving health conditions
Association for Professionals in Infection Control (APIC)
voluntary; international organization dedicated to prvention and control of infections
Center for Disease Control and prevention (CDC)
voluntary; promotes health by preventing and controlling disease; publishes recommendations and guidelines; hand hygiene (15 second minimum); NO artificial nails; classifies medical devices according to Spaulding
American National Standards Institute (ANSI)
voluntary; proposes standards to include enhancing the global competitiveness and quality of life
Association for the Advancement of Medical Instrumentation (AAMI)
voluntary; sets standards for CS/SPD
clean as scheduled and document..
walls, vents, ceiling fixtures, cabinets, shelving
requirements for bacteria to survive
warmth, food, and water
if a technicians skin is exposed to liquid ethylene oxide (first)
wash the exposed area with large amounts of soap and water
lumened items must be _________ and _________ by hand and thoroughly rinsed with treated water (deionized/distilled)
washed and flushed
recommended lubricants for use on surgical instruments
water based
unless sink turns off automatically after hand washing
water should be turned on via disposable towel and turned off using a different disposable towel
(enzymatic) detergent
water soluble cleansing agent composed of "surface wetting agent"
light and dark spots
water spots from allowing instruments to air dry
hydr/o-, hydra-
water, fluid
spirochetes are found in
water, sewage, soil and decaying organic matter
Cells require
water; food; oxygen; heat; pressure; Do NOT require cold
impervious
waterproof/water resistant; ideal against chemicals and bloodborne pathogens in decon
box lock
weakest part; most likely to find cracks; most difficult to clean
ALL personnel entering decon MUST_______ ________
wear PPE
anyone entering the prep area must
wear proper attire
floors in prep should be
wet mopped daily
SPD should be, due to possibility of dust kick up when sweeping
wet-mopped daily
policies
what a department must do
laparoscopic instruments should be reassembled for sterilization
when recommended by mfg
sterile packs are most vulnerable to contamination
when the package is still hot
Preparation and Packaging Area
where cleaned items are inspected, assembled, and packaged.
Sterile Stores
where items for patient care from outside manufacturers are stored. Sometimes referred to as Medical Supply Distribution, Central Supply, or similar designation.
Patient Care Equipment Clean-Up Area
where patient care equipment is cleaned and disinfected.
Dispatch
where sterile and clean items are dispensed.
Sterile Storage Area
where sterile items are stored until needed.
Case Cart Area
where sterile supplies (trays and/or sterile items from outside manufacturers) are kept and picked for surgical cases.
Sterilization Area
where terminal sterilization is performed.
ability of disinfectant to perform correctly depends on
whether it remains wet (in contact) for the required amount of time
the ability of a disinfectant to perform depends on ...
whether it remains wet for the stated amount of time
the ability of a disinfectant to perform most efficiently depends on
whether it remains wet for the stated amount of time
not required documentation in high level disinfection records
whether item was completely dry
HLD recording
whether item was completely dry (or not); not necessary to be recorded; it's on YOU
responsible for providing immunity
white blood cells
broncho-
wind pipe
trachea
wind pipe
can cause microabrasions which allow microbes to harbor; not recommended; can damage instruments; Exception; tungsten carbide
wire brushes
when cleaning, brush ________ serrations NOT against!
with
aesthet/o-
with feeling
when preparing instruments from a dissection tray for processing in a washer/decon, instruments should be positioned
with retractors on the bottom and handheld instruments on the top
sym-
with, together, joined together
endo-, end-
within, inner
intra-
within, inside
an-
without
warm up jackets
worn to prevent hair and bacterial shedding from bare arms
simultaneous wrapping means
wrap an instrument set with a single, non-woven wrapper, double ply, bonded at edges
carp/o-
wrist bone (carpals)
