Chapter 18 Disinfection & Sterilization

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

1) Date and time of cycle 2) Description of the Load 3) Exposure time 4)Exposure temperature and pressure 5) Results of the sterilization indicator 6) Initials of the operator

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

A stiff nylon brush should be used to clean the surface of the instrument. A stainless steel wire brush can be used to clean grooves, crevices, or serrations.

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

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

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

A large minor office surgery pack requires a longer sterilization time, about 30 minutes, because more time is needed for steam to penetrate to the center of the pack.

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

A longer exposure period is needed with dry heat because microorganisms and spores are more resistant to dry heat than to moist heat and because dry heat penetrates more slowly and unevenly than moist heat.

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

A low-sudsing detergent with a neutral pH should be used to clean the instruments. Commercially available instrument cleaners meet these criteria. These cleaners usually come in a concentrated liquid or powder form and must be diluted with water before use

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

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

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

A problem may be present in the sterilization technique or in the working condition of the autoclave.

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

A safety data sheet (SDS), previously known as a material safety data sheet (MSDS), provides more detailed information than the container label regarding the chemical, its hazards, and measures to take to prevent injury and illness when handling the chemical 1. Identification 2. Hazards Identification: This section includes the hazards of the chemical and the appropriate warning information associated with those hazards and includes the following: • GHS hazard classification of the chemical • GHS signal word • GHS hazard statement(s) • GHS hazard pictograms • GHS precautionary statement(s) 3. Composition/Information on Ingredients: 4. First-Aid Measures 5. Fire-Fighting Measures 6. Accidental Release Measures 7. Handling and Storage 8. Exposure Controls/Personal Protection 9. Physical and Chemical Properties 10. Stability and Reactivity 11. Toxicological Information: This section identifies the toxicological effects that can result from overexposure to the chemical and includes the following: • Route of entry, which indicates how the hazardous chemical can enter the body, including inhalation, skin contact, eye contact, and ingestion • Signs and symptoms of overexposure (e.g., skin irritation, eye damage, lung damage) categorized according to acute and chronic health hazards • Medical conditions that are aggravated by exposure to the hazardous chemical (e.g., asthma, dermatitis) • Indication of whether the hazardous chemical has been identified as a potential carcinogen by the National Toxicology Program (NTP), the International Agency for Research on Cancer (IARC), and OSHA. 12. Ecological Information 13. Disposal Considerations 14. Transport Information 15. Regulatory Information 16. Other Information

What is the purpose of a GHS signal word?

A signal word is a word used to indicate the relative degree of severity of the hazardous chemical and to alert the user to a potential hazard on the label.

hat are the advantages and disadvantages of autoclave tape?

Advantages: 1) adheres to heat 2) variety of colors 3) can be written on Disadvantages: 1) Cannot ensure that steam has penetrated the center of the pack 2)Does not ensure that the items has been sterilized

What is a critical item?

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

Why should instruments be handled carefully?

Instruments are expensive and delicate, yet durable. They can last for many years if handled and maintained properly.

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

It is used to sterilize heat-sensitive items that cannot be sterilized in an autoclave. After items are sterilized with this gas, they must be aerated to remove the toxic residue of the ethylene oxide.

What is event-related sterility?

Meaning that a sterile pack is considered sterile indefinitely unless an event occurs that interferes with the sterility of the article.

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

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

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

Moist heat sterilization tends to erode the ground-glass surfaces of reusable syringes, whereas dry heat does not.

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

Normal tap water contains minerals, such as chlorine, which have corrosive effects on the stainless-steel chamber of the autoclave.

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

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

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

Preventing contaminants, such as dust, insects, and microorganisms, from entering during handling and storage

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

Products used for sanitization, disinfection, and sterilization (e.g., chemical disinfectants, autoclave cleaners) Chemicals used for laboratory testing (e.g., laboratory testing reagents, developing solutions, controls) Pharmaceutical products such as local anesthetics (e.g., lidocaine [Xylocaine]) Front office products (e.g., toner for copying machine and laser printer) Cleaning products (e.g., drain cleaner)

What is the purpose of sanitizing an article?

To reduce to a safe level the number of microorganisms on the article

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

A common intermediate-level disinfectant is isopropyl alcohol, which is frequently used in the form of alcohol wipes. Noncritical items are items that come in contact with intact skin but not with mucous membranes, including stethoscopes, blood pressure cuffs, tuning forks, percussion hammers, and crutches.

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

Biological indicator is a preparation of living bacterial spores. At least once a week.

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

Chemicals have a tendency to lose their potency over time and should not be used past the expiration date.

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

Clostridium botulinum, which causes botulism, and Clostridium tetani, which causes tetanus.

Describe the care an autoclave should receive on a daily/Weekly/Monthly basis:

Daily: 1. Wipe the outside of the autoclave with a damp cloth and a mild detergent. 2. Wipe the interior of the autoclave and the trays with a damp cloth. 3. Clean the rubber gasket on the door of the autoclave with a damp cloth. 4. Inspect the rubber door gasket for damage that could prevent a good seal. Weekly: 1. Wash the inside of the chamber and the trays with a commercial autoclave cleaner according to the manufacturer's instructions, while observing all personal safety precautions. This usually involves the following steps: The water reservoir must be drained first. A soft cloth or a soft brush should be used to clean the chamber. Do not use steel wool, a steel brush, or other abrasive agents because they can damage the chamber. When the chamber is clean, it should be rinsed thoroughly with distilled water. The chamber must be dried thoroughly and the door left open overnight. 2. Wash the metal shelves with an autoclave cleaner, and rinse them thoroughly with distilled water. Monthly: 1. Flush the system to remove any buildup of residue, which could cause corrosion of the chamber lines. Carefully follow the manufacturer's directions in the instruction manual to perform this procedure. 2. Check the air trap jet to ensure it is functioning properly. The air trap jet prevents air pockets from occurring in the chamber, to ensure adequate sterilization. 3. Check the safety valve to ensure it is functioning properly. The safety valve releases pressure in the chamber if it gets too high.

What is the meaning of the following GHS signal words: Danger Warning

Danger - Denotes a more severe hazard is possible Warning- Denotes a less serious- but still potentially harmful- hazard is possible

What is the definition of high-level disinfection?

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

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

High-level disinfection is used to disinfect semicritical items. I.e.: Cidex, MetriCide, Cidex OPA (ortho-phthalaldehyde)

How should sterilization indicators be stored?

In a cool, dry area.

How should the following be positioned in the autoclave? Small packs Large packs Jars and glassware Sterilization pouches

Small packs are best because steam penetrates them more easily. The packs should be packed as loosely as possible inside the autoclave. Jars, glassware, and basins should be placed on their sides in the autoclave with their lids removed. Sterilization pouches should be positioned on their sides to maximize steam circulation and to facilitate the drying process.

What is the purpose of sterilization?

Sterilization is the process of destroying all forms of microbial life, including bacterial spores.

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

Sterilization paper: Advantage: Disposable and inexpensive Disadvantage: difficult to spread open for removal of the contents Sterilization pouches: Advantages: Provides good visibility of the contents on the plastic side. Disadvantage: If the indicator does not change to the appropriate color (as specified by the manufacturer), the contents of the pouch must be resterilized. Muslin: Advantage: Flexible and easy to handle and is considered the most economical sterilization wrap because it can be reused. Disadvantage:

How should sterilized packs be stored?

Sterilized packs should be stored in clean, dry areas that are free from dust, insects, and other sources of contamination.

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

The GHS is an international standard that provides consistency in the classification and labeling of chemicals through the use of pictograms, signal words, and hazard warnings. The GHS classifies chemicals according to their health and physical hazards. The GHS also requires the use of a standardized format for labeling containers and the development of safety data sheets (SDSs).

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

The agent selected depends on the intended use of the item. Articles that penetrate sterile tissue or the vascular system, such as surgical instruments, must be sterilized. Items that come in contact with the skin, such as stethoscopes, blood pressure cuffs, and percussion hammers, should be disinfected.

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

The autoclave is aprox. 15 lbs of pressure per sq. in. (psi) at a temperature of 250F

How should each of the following be checked for defects and proper working condition: blades of an instrument The tips of an instrument instrument with a box lock Cutting edge of a sharp instrument Scissors

The blades of an instrument should be straight and not bent. The tips of an instrument should approximate tightly and evenly when the instrument is closed. An instrument with a box lock (e.g., hemostatic forceps, needle holders) should move freely but must not be too loose. The cutting edge of a sharp instrument should be smooth and devoid of nicks. Scissors should cut cleanly and smoothly. To test for this, the medical assistant should cut into a thin piece of gauze. The scissors are in proper working condition if they cut all the way to the end of the blade without catching on the gauze.

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

The indicator strip should be placed in the center of the wrapper pack, with the end containing the dye placed in an area of the pack considered to be the hardest for steam to penetrate.

What guidelines must be followed when using cold sterilization?

The item to be sterilized must be completely submerged in the chemical for a long time (6 to 24 hours depending on the manufacturer's instructions), each time an instrument is added to the instrument container, the clock must be restarted for the entire amount of time. For these reasons, and because this method involves the use of a hazardous chemical, cold sterilization should be used only when an autoclave, gas, or a dry heat oven is not indicated or is unavailable.

What is the purpose of lubricating an instrument?

The lubricant makes the instrument function better and last longer.

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

The pressure plays no direct part in killing microorganisms; rather, it functions to attain a higher temperature than could be reached by the steam from boiling water.

What is the purpose of the Hazard Communication Standard?

The purpose of the HCS is to ensure that employees are informed of the hazards associated with chemicals in their workplace and the precautions to take to protect themselves when working with hazardous chemicals

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

The sterilizing time should not begin until the desired temperature in the autoclave has been reached. Timing the load is accomplished automatically or manually. Autoclaves with automatic operation begin timing the load automatically when the desired temperature has been reached. With the manual method of operation, the medical assistant must set the timer by hand using a timing control on the front of the autoclave. The medical assistant should not set the timer until the temperature gauge has reached the desired temperature. The articles in the load are not considered sterile unless they have been subjected to steam for the proper length of time at the proper temperature.

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

The ultrasound method offers a safety advantage in that instruments do not have to be handled during the cleaning process. This decreases the incidence of an accidental puncture or cut from a sharp instrument. An ultrasonic cleaner works by converting sound waves into mechanical energy, which creates small bubbles all over the instruments

What are the characteristics of bacterial spores?

They become more resistant to drying, sunlight, heat, and disinfectants than is the vegetative form of the bacterium. Favorable conditions cause the spore to germinate into a vegetative bacterium again that is capable of reproducing.

What information must be included on a hazardous chemical label?

This label must include the possible hazards of the chemical and the steps that can be taken to protect against those risks.

Why should gloves be worn during the sanitization procedure?

This protects the medical assistant from bloodborne pathogens and other potentially infectious materials.

What is the purpose of a sterilization indicator?

To determine the effectiveness of the procedure and to check against improper wrapping of the articles, improper loading of the autoclave, and faulty operation of the autoclave.

What is the purpose of wrapping articles to be autoclaved?

To protect them from recontamination during the handling and storage.

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

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

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

examining tables, laboratory countertops, and walls