CST Chapter 11 Decontamination, Sterilization and Disinfection

Material safety data sheet (MSDS)

A government-mandated requirement for all chemicals used in the workplace. The MSDS describes the formulation, safe use, precautions, and emergency response. The MSDS must be available for each chemical an employee is required to handle in his or her work.

Ethylene Oxide (OD)

A highly flammable gas that is capable of sterilizing an object.

Cobalt-60 radiation

A method of institutional bulk sterilization used by manufacturers to sterilize prepackaged equipment using ionizing radiation.

Case cart system

A method of receiving clean and sterile equipment and preparing it for transportation to a central decontamination area. All equipment is contained within a covered movable storage cart.

Chemical indicator

A method of testing a sterilization parameter. Chemical strips sensitive to physical conditions, such as temperature, are placed with the item being sterilized and change color when the parameter is reached; sometimes called a chemical monitor.

Reusable

A designation used by manufacturers to indicate that a medical device can be reprocessed for use on more than one patient.

Sanitation

A method that reduces the number of bacteria in the environment to a safe level.

Sterilization

A process by which all microorganisms, including spores, are destroyed.

Cavitation

A process in which air bubbles are imploded (burst inward), releasing particles of soil or tissue debris.

Decontaminated

A process in which recently used and soiled medical devices, including instruments, are rendered safe for personnel to handle.

Antisepsis

A process that greatly reduces the number of microorganisms on skin or other tissue.

High level disinfection (HLD)

A process that reduces the bioburden to an absolute minimum.

Cleaning

A process that removes organic or inorganic soil or debris using detergent and washing.

Chemical sterilization

A process that uses chemical agents to achieve sterilization.

Gas plasma sterilization

A process that uses the form of matter known as plasma (e.g., hydrogen peroxide plasma) to sterilize an item. Also referred to as plasma sterilization.

Biological indicators

A quality control mechanism used in the process of sterilization. It consists of a closed system containing harmless, spore-forming bacteria that can be rapidly cultured after the sterilization process.

f. When flashing implants, what indicator is to be included with the implants?

A rapid readout biological indicator is to be included with implants.

Process challenge monitoring

A sealed, harmless bacteriological sample included in a load of goods to be sterilized. The sample is recovered following the sterilization process and cultured to test for viability. This process is also called biological monitoring.

Enzymatic cleaner

A specific chemical used in detergents and cleaners to penetrate and break down biological debris, such as blood and tissue.

-cidal

A suffix indicating death. For example, bactericidal means "able to kill bacteria."

Spaulding system

A system used to determine the level of microbial destruction required for medical devices and supplies based on the risk of infection associated with the area of the body where the device is used. Categories include critical, semicritical, and noncritical.

High-vacuum sterilizer

A type of steam sterilizer that removes air in the chamber by vacuum and refills it with pressurized steam. Also known as a prevacuum sterilizer.

Gravity displacement sterilizer

A type of sterilizer that removes air by gravity.

Event-related sterility

A wrapped sterile item may become contaminated by environmental conditions or events, such as a puncture in the wrapper. Event-related sterility refers to sterility based on the absence of such events. The shelf life of a sterilized pack is event related, not time related.

After the instruments are taken to the clean assembly area, what the next steps for?

Instruments are inspected, assembled, wrapped up or contained for sterilization, labeled and tracked, and then finally sterilized with one of many sterilization methods.

Which of the following body tissues presents a critical risk in the Spaulding system?

Vascular system

Which type of sterilization method requires an aeration?

ethylene gas

Which of the following high level disinfectants could also be used as a sterilizing agent?

glutaraldehyde

2 types of steam sterilizers used in the clinical setting

gravity displacement and dynamic (or high-vacuum sterilizers)

noncritical

intact skin; BP cuff, pulse ox, tourniquet, exam tables

semicritical

mucous membranes and nonintact skin; bronchoscope, thermometer, laryngoscope

Nonwoven

A fabric or material that is bonded together as opposed to a process of interweaving individual threads.

An organization for which standards are developed with the support of the U.S Food and Drug administration.

AAMI

Agency of the federal government that provides research and protocols in all areas of public health.

CDC

Implant

Defined by the U.S. Food and Drug Administration (FDA) as "a device that is placed into a surgically or naturally formed cavity of the human body if it is intended to remain there for a period of 30 days or more."

Ultrasonic cleaner

Equipment that cleans instruments using ultrasonic waves.

Non-critical items

Items that are not required to be sterile because they do not penetrate intact tissues. Patient care items such as a blood pressure cuff and a stethoscope are noncritical.

Evidence-based practice

Methods and procedures proven to be valid by rigorous testing and professional research.

b. How long must you wait for an implant to be sterilized before going back into the patient?

Never immediately before use except in documented emergency situations. A rapid readout biological indicator must be used as well.

Inanimate

Non-living.

Before the washer-sterilizer cycle is finished, the instruments are considered ______________. What is the purpose of the washer-sterilizer?

Nonsterile. The purpose is to process instruments that can take on water turbulence and high pressure steam.

The following are high level disinfection semi-critical items, except:

operating room table and accessories

Which of the following statements is not true regarding the use of peel pouches?

peel pouches are intended for items such as bone ronguers, rasps, and multiple instruments.

class 6; emulating indicators

used for internal pack control of each cycle run, not for overall performance of the sterilizer for all cycles

a. What are prions?

Infectious protein particles capable of Cruetzfeld-Jakob Disease.

bioburden

# of live bacterial colonies on a surface before it is sterilized

What are the AAMI guidelines to prevent TASS?

1. Instruments must be wiped clean. 2. After procedure, instruments must be submerged in sterile water. 3. Single use cannulas should be used. 4. All phacoemulsification components must be flushed before disconnection. 5. Only single use brushes and syringes are used to clean ophthalmic instruments. 6. Items manually or ultrasonically cleaned should be wiped with alcohol before sterilization. 7. All instruments should be inspected thoroughly for residue.

g. How long after flashing implants can they be cleared use?

15 to 30 minutes after the cycle to prevent condensation.

Detergent

A chemical that breaks down organic debris by emulsification (separation into small particles) to aid in cleaning.

Peracetic acid

A chemical used in the sterilization of critical items.

Provides recommended practices and technical information for U.S. medical professionals.

AAMI

Professional association for perioperative nurses.

AORN

Bactericidal

Able to kill bacteria.

Fungicidal

Able to kill fungi.

Germicidal

Able to kill germs (bacteria).

Sporicidal

Able to kill spores.

Viricidal

Able to kill viruses.

Reprocessing

Activities or tasks that prepare used medical devices for use on another patient; these activities include cleaning, disinfection, decontamination, and sterilization.

Woven wrappers

Also called linen or cloth wrappers, these are fabric cloths used to wrap clean, disinfected supplies in preparation for a sterilization process.

Medical device

Any equipment, instrument, implant, material, or apparatus used for the diagnosis, treatment, or monitoring of patients.

Sharps

Any objects used in health care that are capable of penetrating the skin, causing injury.

Personal protective equipment (PPE)

Approved attire worn during the reprocessing of medical devices and the cleaning of patient areas. PPE protects the wearer from contamination by microorganisms.

d. For how many minutes did you set the autoclave to run?

As many minutes as the manufacturer recommends but in this instance 10 minutes as table 11-4 suggests.

c. At what temperature did you run the implants?

At whatever the recommended temperature was that was set by the manufacturer. 270 to 275 degrees in this case as an implant is usually considered a complex power instrument.

Single-use items

Instruments and devices intended for use on one patient only; sometimes called disposable items.

Bacteriostatic

Chemical agent capable of inhibiting the growth of bacteria.

____________ is a skilled, certified profession requiring expertise in the science and practice of materials management, decontamination, and sterilization.

Central processing

Biofilms

Dense colonies of bacteria that adhere tightly to surfaces. Biofilms, which are resistant to chemical disinfectants and scrubbing, are a matrix of extracellular polymers produced by microorganisms. These substances bind the microorganisms tightly to a living or nonliving surface, making them highly resistant to antimicrobial action.

Disinfection

Destruction of microorganisms by heat or chemical means. Spores usually are not destroyed by disinfection.

Washer-sterilizer/disinfector

Equipment that washes and decontaminates instruments after an operative procedure.

a. Define flash sterilization.

Flash sterilization is a outdated term. It is now recognized as Immediate-Use Sterilization to denote the complexity of this process. In essence, it is a process of shortened sterilization for both covered and uncovered items.

International Association of Healthcare Central Service Material Management (IAHCSMM):

International organization that represents Central Service Technicians by providing opportunities for continuing education, professional development, and communication among its members. IAHCSMM offers certification programs for Certified Registered Central Service Technician (CRCST), Certified Instrument Specialist (CIS), and Certified in Healthcare Leadership (CHL).

Immediate-use sterilization

Items to be sterilized shortly before surgery must be processed so they are ready as close to the time of surgery as possible. This is referred to as immediateuse sterilization, previously called flash sterilization.

c. Why is CJD a concern with regard to sterilization methods?

Prions are not destroyed by the usual means of sterilization.

b. What causes CJD?

Prions cause CJD.

Prion

Proteinaceous infectious particle, a unique pathogenic substance that contains no nucleic acid. The prion is transmitted by direct contact or ingestion and is resistant to all forms of disinfection and sterilization normally used in the health care setting.

Contaminated

Rendered nonsterile and unacceptable for use in critical areas of the body.

Central processing technicians

Skilled professionals who specialize in processing and maintenance of medical devices used in the health care facility.

The system that assigns a device a risk category based on the specific regions of the body where the device is used is the ____________ system.

Spaulding

Exposure time

This is the amount of time goods are held at a specific time, temperature, and pressure during a sterilization process. Exposure time varies with the size of the load, type of materials being sterilized, and type of sterilizer. Exposure time is sometimes called the hold time.

Terminal decontamination

Thorough cleaning and disinfection of supplies or an environment such as the operating room suite after patient use. Specific protocols and procedures are used during terminal decontamination.

Accreditation agency for all health care organizations in the United States.

TJC

Organization that oversees compliance with environmental and patient safety regulations.

TJC

c. What other options does the surgeon have if the implant cannot be sterilized?

Talk to the manufacturer and get a recommendation or assistance.

a. Why can't you use another implant?

That implant was made specifically for the patient's needs and specifications. Not checked for accuracy. Do your own work.

Association for the Advancement of Medical Instrumentation (AAMI):

The AAMI is an authoritative source of standards for sterilization and disinfection.

Central Processing (CP) department

The area of the hospital where medical devices and equipment are processed; also called Central Surgical Supply or the Surgical Processing Department.

e. How do you know the instruments have been through the sterilization process when you retrieve them?

The circulator has to don sterile gloves and offer the tray for me to remove the sterile items.

Shelf life

The length of time a wrapped item remains sterile after it has been subjected to a sterilization process.

d. What problems will the patient have if the implant comes back positive?

The load has to be withdrawn from use and the infection control department has to be notified and the event documented. If items have been used in patient treatment, more safety precautions are set up such as notifying the surgeon who used the items.

b. Can you run implants through the flash sterilization process? Explain.

Yes, but they must never be sterilized immediately before use with only one exception. That exception is emergency situations without any other available option. Additionally, a rapid readout biological indicator must be included and used.

____________ is a chemical used to remove microorganisms on tissue.

an antiseptic

class 2; specialty indicators

bowie dick and DART

The following are low level disinfection noncritical items, except:

bronchoscopes (semicritical)

The ____________ is used to transport sterile and nonsterile instruments and equipment to and from the main operating room area.

case cart

The __________ includes a workroom with ample table space for sorting instruments and assembling instrument sets.

clean processing area

reprocessing

cleaning, disinfection, decontamination, sterilization

class 1; single parameter

process indicators (tape or label)

class 4; multiparameter

react to 2 or more parameters, EX- internal chemical indicators printed on a paper strip

class 5; integrating parameters

react to all clinical values over a specified range- most exacting and accurate

Instruments that have _____________ must be disassembled before sterilization.

removable parts

class 3; single parameter

respond to only one critical parameter with an exact value example- heat sensitive pallet

Instrument trays have a perforated bottom so that:

steam can circulate up through the tray and adequately cover all surfaces of the instruments

Items with a lumen should have a small amount of _________ flushed through them immediately before sterilization.

sterile water

Which of the following sterilizers uses peracetic acid?

steris

critical

vascular system, instruments, needles, implants

The washer-sterilizer or washer-disinfector is used to process all instruments that can tolerate

water turbulence and high pressure steam