STERILIZATION METHODS (EXAM #1)

___________ ______________ is liquid chemical agents which provide an alternative method for sterilization. - Is a type of chemical Sterilant

Activated Glutaraldehyde - Cidex™/Cidex OPA - A high level disinfectant

____________ is a substance that prevents or arrests the growth of microorganisms; term used to describe products applied to living tissue, especially skin

Antiseptic

What is Cidex OPA?

- A high level antimicrobial chemical disinfectant - A type of Activated Glutaraldehyde - Other name is Orthophthaladehyde

What are the most common types of soils found on instruments?

- Blood - Fat - Peritoneal fluid - Synovial fluid - Fibrin found in blood difficult to remove once dried

Describe Immediate Use sterilization

- Can be used for Gravity displacement and for prevacuum - On the same machine but just used on the immediate setting - Called "one trays" - Minimize dry time (still needs at least 3 min of dry time) - Is needed for items that are needed NOW

Describe the containers for Activated Glutaraldehyde

- Must be large enough to hold item and solution - Should be sterile and have lid to prevent splashing and evaporation - Should be placed in a well-ventilated room

Can we use peel pouches inside our sealed containers?

- NO - Because the pouches cannot be positioned to ensure adequate air removal, steam contact and drying

What is some of the personal attire for Decon?

- No one should be working in the decontamination area with damaged/broken skin - Surgical pants with a shirt that is tucked in or a close fitting tunic top is recommended - Attire should be changed every day or whenever it becomes wet, contaminated with blood or other infectious matter, or grossly soiled - Head and facial hair should be covered - Jewelry should not be worn - Acrylic, gel, or ceramic nails are discouraged as this supports bacterial growth

What are the 3 common types of packaging?

- Peel packs (Steam vs Gas Plasma compatible) - Chemguard wrapping - Hard containers/pans

Some more Decon personal attire....

- Shoes or boots worn should be durable to prevent injury if an item is dropped on the foot, while the bottom surfaces should be made of non-skid material or design - Often shoes or boots are liquid-proof to prevent soaking. Shoe covers may be worn, but should be changed when become wet - High filtration masks may be worn to protect from potential airborne particulates - Eye protection required to reduce risk from exposure to chemicals or pathogenic microorganisms - General purpose utility gloves that are heavy-duty, durable, cuffed, and long (perform handwashing after removing gloves) - A liquid-resistant covering with sleeves and a water-resistant apron are worn to prevent contamination of surgical clothing

For _________, ___________, and dry heat allow space between packages and between the items and the walls of the chamber

- Steam / ETO

What goes on during the Inspection/Assembly/& prep phase?

- Visual inspection occurs for all instrumentation to include looking for the presence of residual bioburden. If evident, instrument (ea) or entire set is sent through decontamination again - Instrumentation is checked for functionality - Instrumentation is inventoried and prepared for packaging

1. Cidex -Sterilize= ______ hrs -HLD= _______ min 2. Cidex OPA -HLD= ________ min

1. 10 hrs / 20 min 2. 12

For Steam Sterilization: Temp & time 1. Vegetative forms of most microorganisms are killed in a few minutes between ______ & ______ degrees F 2. Certain bacterial spores will withstand a temp of _________ degrees for more than ______ hours 3. No living thing can survive direct exposure to saturated steam at ______ degrees longer than _______ minutes

1. 130 & 150 2. 240 / 3 3. 250 / 15

List 6 advantages of Sterrad

1. Alternative to ETO sterilization 2. Used for heat and moisture sensitive items 3. Cycle time is approximately 70 minutes 4. Non-toxic and non-carcinogenic 5. Does not require aeration 6. Set up only requires plugging into wall outlet

Name the 4 phases of Steam Sterilizer Operation

1. C: Conditioning of Chamber 2. S: Sterilization 3. (Drying Time Occurs) 4. E: Evacuation of Chamber

Name 4 disadvantages of Steam Sterilization

1. Cannot use on high temperature sensitive items. 2. Timing of cycles must be adjusted for differences in materials and size of load; variables are subject to human error 3. Steam may not be pure. Quality control of steam is critical. A minimum of 97% saturated steam considered optimal for sterilization 4. Safety concerns (high pressure & high temperature) burns/door injury

Explain the steps of the sterilization process

1. Cleaning 2. Rinsing 3. Decontaminating items thoroughly 4. Inspection 5. Assembly 6. Preparation of items 7. Packaging -Selection of proper package, container 8. Sterilization -Proper load configuration -Proper selection of sterilization method, operation and maintenance of sterilizer unit -Proper exposure parameters for sterilization 9. Delivery of high quality steam or other sterilization medium

Name the 4 variable and parameters for ETO

1. ETO gas concentration 2. Temperature 3. Humidity 4. Time

List 5 disadvantages of ETO

1. ETO is a complicated process that must be carefully monitored 2. ETO takes time; long, slow process 3. Requires special expensive equipment; gas is not cheap 4. Aeration time varies depending on type of material 5. Long term exposure to ETO is a known potential carcinogen and mutagen

Name 5 advantages of Steam Sterilization

1. Easiest, safest, surest method 2. Fastest method 3. Least expensive (only uses steam & water) 4 Highly automated, minimal error (machines/computer does all the work) 5. Leaves no harmful residue

List 4 advantages of ETO

1. Effective substitute for most items that cannot be sterilized by heat 2. Effective for items that steam and moisture may erode 3. It completely permeates all porous materials (very effective) 4. Leaves no film on items

Name the 2 types of Steam Sterilizers?

1. Gravity Displacement Sterilizer 2. PreVacuum Sterilizer

Name 3 indications for the use of the gas sterilization ETO

1. Heat sensitive items 2. Moisture sensitive items 3. Electrical, lenses & delicate surgical instruments (like scopes)

What are the 3 levels of Disinfection?

1. High-level disinfection: eliminates all organisms except bacterial endospores 2. Intermediate-level disinfection: inactivates vegetative bacteria, including mycobacteria, most viruses, most fungi, but NO spores 3. Low-level disinfection: most vegetative bacteria some viruses and fungi, but no mycobacteria or spores.

List 9 disadvantages for Activated Glutaraldehyde

1. Items must be thoroughly rinsed before use 2. Cannot adequately monitor effectiveness 3. Solution can become diluted 4. Sterile transfer difficult because items are wet 5. Items cannot be held for sterile storage 6. Caustic if skin contact occurs 7. Causes respiratory and eye irritation 8. Ventilation system requisite 9. Solution containers must be dated-chemicals expire

List 4 disadvantages to Sterrad

1. Not FDA approved for items with lumens less than 3mm in diameter and/or greater than 41cm/12 inches in length 2. Cannot sterilize paper or linen products because cellulose absorbs H2O2 3. Requires special instrument trays 4. Requires specific indicators

List 5 advantages for Activated Glutaraldehyde

1. Penetrates easily and rinses easily 2. Relatively safe for instruments that can be immersed (noncorrosive, nonstaining) 3. Does not damage lenses 4. Not absorbed by rubber or plastic 5. Stable, low volatility

What are the 2 processes of sterilization?

1. Physical 2. Chemical

For Steam Sterilization what is the pressure relationship to saturated steam?

1. Pressure influences Sterilization -Raises temperature of steam (15 psi/250 F; 27 psi/270 F). 2. Pressure alone does not kill microorganisms 3. Altitude effects pressure. - Pressure must be increased ½ pound/1000 feet above sea level

For Steam Sterilization name the 2 methods of destruction?

1. Protein Denaturation - Heat & moisture combine to cause protein to coagulate causing destruction of enzyme-protein system in cells - Water acts as a catalyst to speed reaction 2. Saturated Steam - Combination of heat energy & water (i.e. boiling water bubbles contains saturated steam)

For the Decon environment.... 1. Physically __________ from other areas (i.e. Assembly, Sterile Supply Inventory/SSI) 2. Traffic patterns should be ____________ and controlled. 3. Only authorized personnel wearing the required attire and ___________

1. Separated 2. Monitored 3. PPE

List 4 variables and parameters of Activated Glutaraldehyde

1. Solution activated by adding a powdered buffer 2. Solution is effective at room temperature 3. Items must be totally immersed with no air trapped in lumens 4. Exposure time is 10 hours

List 3 purposes of Sterilization.

1. Sterilization provides highest assurance that an object is free of viable microbes 2. Creation and maintenance of aseptic environment will have a direct influence on outcome of surgical intervention 3. Measures to prevent wound infection include providing instruments, supplies and equipment free of contamination at time of use

What are the 3 methods of sterilization?

1. Thermal 2. Chemical 3. Radiation (ex. Colbalt 60) - most common used methods in hospital setting are Steam (thermal) and Chemical (ETO, Sterrad, Steris, & Glutaraldehyde)

Cont. 5 more disadvantages for ETO

1. Toxic by-product may form (ethylene glycol) in the presence of moisture 2. Repeated sterilizations can increase the residual amount of ETO in porous items 3. ETO is a vesicant and can cause burns of skin and mucous membranes 4. Exposure to ETO can cause both short term and long term health problems 5. Environmental control measures are expensive for controlling emissions of both ETO and the carrier gas.

What are the phases for the Washer Disinfector?

1. Typically provide a pre-wash and/or enzyme treatment to remove or condition soil 2. After wash phase, a rinse phase removes detergent and debris. 3. Next, thermal rinse treatment with a water temperature of 180-203 F is applied for disinfection 4. Additionally, an instrument lubrication treatment can be used, followed by hot air drying

What are 2 safety precautions for Activated Glutaraldehyde?

1. •Workers must protect skin, eyes, and mucous membranes from exposure to the solution 2. Inhaling fumes can cause irritation (be sure to maintain a ventilation system)

____________ is the process of preventing contamination from microorganisms. Relates to procedures and techniques performed in tissues, on materials, or in the environment

Asepsis

__________ ___________ are the mechanical cleaning of medical devices & equipment to remove soil & microorganisms is commonly accomplished using automated cleaning and rinsing processes - Incorporates thermal sanitization and disinfection equipment

Automated Washers

___________ is the relative number of actual or suspected microorganisms that may be found on a specific item or in the environment at a specific time. Must be extremely low to ABSENT for sterilization to be effective

Bioburden

Which physical method of sterilization... - Ethylene oxide gas - Sterrad (Hydrogen peroxide plasma/vapor) - Steris (Peracetic acid solution) - Glutaraldehyde activated solution

Chemical

______________ is the most important step of instrument and equipment preparationà removal of gross contaminants - manually and/or by automated methods - Fundamentally removes soil rather than kills microorganisms

Cleaning & RInsing

_______________ is the use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles - The surface or item is rendered safe for handling, use, or disposal - Contaminated medical devices must be handled and prepared by destroying the causative agent or arresting its growth

Decontamination

Used case carts are sent to SPD via the _________ _____________ to DECON

Dirty Elevator

____________ is a process capable of destroying pathogenic microorganisms; normally used on items that cannot undergo sterilization. Generally chemical agents; three classification schemes that relate to effect of agent against microorganisms.

Disinfection

____________/____________ water should be used for the final rinse

Distilled/deionized - Because the chemicals & minerals present in tap water can damage instruments

_____________ _____________ _____________ can be used to break down and loosen blood and other organic soil to facilitate cleaning - It breaks down complex organic molecules into simpler compounds that are usually water soluble and more easily rinsed away with water

Enzyme presoaking solutions - Enzymatic cleaner is sprayed on all dirty instruments after the case in the OR - If contaminated devices are soaked in an enzymatic solution immediately after use, the liquid should be discarded before transport to the reprocessing area

____________ is the sterilization that uses radio waves combine with hydrogen peroxide to create low temperature gas plasma/vapor that interacts with and destroys microorganisms, including highly resistant spores

Gas Plasma (Sterrad is the brand name)

____________ is an agent that destroys microorganisms, mainly used on inanimate objects. Bactericidal, fungicidal, virucidal, sporicidal, biocidal describe activity

Germicide

Which Steam Sterilizer? - Steam enters from the top of the chamber and displaces air within the chamber. Air is heavier than steam and therefore sinks below the steam. Heat transferred to, contacts, permeates through all contents in next phase of process --> Sterilization

Gravity Displacement Sterilizers - the slower one

_______________ neutralizes glutaraldehyde and OPA high level disinfectant / sterilant solutions and converts the solutions into non-toxic, non-hazardous waste - How to safety get rid of those solutions

Hyde-Out

__________ is the water constant force making contact with the instrument

Impingement

____________ is the process of destroying all microorganisms on an item by exposure to physical or chemical agents, the measure of which is a probability function

Sterilization

______________ - The collecting, receiving, sorting, decontamination cleaning, preparation, packaging, sterilizing, dating, sorting, inventory, and issue of reusable items.

Sterilization Process

Which physical method of sterilization... - Steam under pressure: moist heat - Hot air/dry heat - Microwaves/non-ionizing radiation

Thermal

Which Steam Sterilizer? - A vacuum system pulls most of the air from the load contents in the sterilizer chamber out through the drain in the bottom front floor of the sterilizer. - Steam is injected into the chamber - The drain closes - Pressure increases in the chamber - Pressurized steam and residual air are vacuumed from the chamber - This process occurs 4 times in effort to evacuate the chamber - Heat transferred to, contacts, permeates through all contents in next phase of process ---> Sterilization

Prevacum Sterilizers - the faster one and most commonly used

_____________ _______________ is a mechanical cleaning device designed for fine cleaning of medical devices to remove soil from hard to reach areas - Has to have gross soil removed prior - Instruments of dissimilar metals should be sorted and separated - Work through cavitation - Instruments typically cleaned for 5 minutes in luke warm (90-110 F), mild detergent and water solution - Any detergent used should have low and controlled foam

Ultrasonic Cleaners - Flexible endoscopes, fiberoptic light cables, and some rigid endoscopes must not be placed as the vibration may damage

For Washer Disinfectors.... A _______ ___________ detergent should be used that can be completely rinsed off -So no detergent or debris is left on the instrument

Low Sudsing