Fund Ch. 10

biofilm

*composed of dense colonies of microbes that are attached to surfaces *extremely resistant to physical cleaning and chemical removal *can be a source of infection

cleaning at the point of use

*during surgery and immediately afterward *instruments and equipment kept free of blood and debris to prevent caking and drying *helps reduce biofilm *cannulated (hollow tubes) periodically flushed w/water *Saline NOT used on any stage, it causes pitting, rusting and corrosion

instrument cleaning and decontamination

*prevent cross contamination, decontamination area is completely separate from areas where clean equipment is being processed *deionized or distilled water are used for rinsing *compressed air for dying

quality control monitoring

*procedures and methods for reprocessing medical devices to ensure patient safety by checking, recording, and reporting *Human factor, Is the person following the correct procedures? Are they using PPE?

sterilization

*process that results in the complete destruction of all forms of life on an object *no "levels " of sterility, either sterile or not sterile

Cobalt-60 radiation

-Most equipment available prepackaged from a manufacturer has been sterilized w/this process -destroys all microorganisms through destruction of the DNA

steam sterilization

-Most widely used effective and efficient method of sterilization in the health care setting -has a central chamber where goods are placed and mechanism for creating extremely high pressure

Peracetic acid sterilization

-chemical made up of 35% peracetic acid, hydrogen peroxide, acetic acid, sulfuric acid, and water -used in a closed commercial processing system that is frequently used for fiber-optic endoscopes -inactivates many cell systems through a chemical process called, oxidation -converts to acetic acid (vinegar) and oxygen

Vaporized hydrogen peroxide sterilization (VHP)

-during process, hydrogen peroxide is exposed to a vacuum -creates a vapor that is forced into the central chamber where the goods have been loaded -items must be clean and dry for VHP

high vacuum sterilizers

-modern steam sterilizer -quickly and forcefully evacuates air from the chamber and replaces it with bursts or pulses of steam

HLD (high level disinfection) Spaulding system

-most effective process for destroying microbes, bacteria on surface -does not destroy bacterial spores -used only for instruments that will be used in semi-critical areas of the body -chemical used are glutaraldehyde and ortho-phthalaldehyde ex) nonintact skin and mucous membranes

ethylene oxide (EO) loading and sterilization

-packages must not touch the bottom or top of the chamber -must be placed loosely not their side -preprogrammed for exposure time, temperature, and aeration parameters -operated from control panel by trained CP technologist

LLD (low level disinfection) Spaulding system

-performed on equipment that comes in contact with intact skin but not mucous membranes or tissue deeper than the skin -used a s cleaning agent in environmental decontamination ex)blood pressure cuffs, stethoscopes

ethylene oxide (EO) precautions

-prolonged occupational exposure causes respiratory damage -wear a dosimeter badge that measures EO exposure

Ozone Sterilization

-uses a molecular form of oxygen (three oxygen atoms) -low heat of moisture and heat sensitivity instruments and equipment though a process of oxidation -4 phases that repeat -environmentally safer -sterilization tiem exceeds 4 hours

phase of steam sterilization

1. Conditioning: air is removed from the chamber and replaced with steam 2. Exposure or holding time (kill time): goods in the chamber are exposed to superheated steam at a precise temperature and duration 3. Exhaust and drying: Pressure in the chamber is reduced and the load is exposed to cool air -remain in chamber for 15-30 min after cycle -must remain on sterilizer racks for cooling

equipment tracking

1. Date of processing 2. Name of the item 3. lot control number 4. batch number 5. employee initials 6. department to receive the package All info written by hand on the outside of wrapped package, placed on sealing tape

Closed Sterilization Containers

1. Hold equipment for sterilization 2. Safe for vapor, gas, or steam sterilization 3. Not to be used for instrument storage in work area 4. Check filter expiration date before hand 5. Container should match sterilization method

Reprocessing instruments and equipment depends on?

1. Human factor: knowledge and skills are applied at each stage of the reprocessing cycle 2. Technical factor: aspects of sterilization must be monitored to ensure that the conditions required for sterilization have been met

Sorting instruments

1. Must be broken down into parts and separated by weight and complexity 2.Cleaned before disinfected (performed by hand, ultrasonic cleaner, followed by automated washer/disinfector/sterilizer

Transportation of soiled instants to decontamination area

1. Must be transported to decontamination in closed containers or closed case cart

reprocessing cycle steps

1. Point of use cleaning: ST prevents the buildup of blood and tissue debris on instruments 2. Sorting & disassembly: end of procedure, ST sorting the instruments an disassembling those with multiple parts 3. Cleaning the instruments 4. Decontamination 5. Sorting and inspecting: separate by type and inspected for damage, malfunction, incomplete cleaning 6. Assembly 7. Wrapping

Vaporized hydrogen peroxide cycle phases

1. Vacuum phase: air is evacuated from the chamber to reduce the pressure 2. Injection phase: liquid hydrogen peroxide is injected 3. Diffusion: hydrogen peroxide vapor disperses 4. Plasma phase: radio-frequency energy breaks apart hydrogen peroxide vapor -exposure time 30-60min -aeration not necessary -Hydrogen peroxide converted to water & oxygen

parameters for steam sterilization

1. achieved according to the temperature, pressure, and exposure time 2. requires specific concentration of moisture "steam quality": Too little, can be burned Too much, leaves items wet and results in contamination 3. water is converted to steam at 212*F (100*C) 4. Steam contains more than 97% water is necessary for sterilization

hand cleaning instruments

1. delicate instruments, soaked in enzymatic detergent 2. temp over 140*F (90*C) 3. held under water line to prevent release of airborne droplets 4. Suction devices & tubing, cleaned w/soft, narrow brush 5. Suction tips, cleared w/stylet fine wire to push out debris

cloth wrappers

1.Reusable: woven from high quality cotton or combo cotton & polyester 2.Woven: sufficiently dense too protect goods from contamination porous enough to allow penetration of steam or gas thread count must be at least 140 3. Two double thickness: 280 tread count, used to wrap items All inspected on a light table to detect any pinholes or tears

Washer-sterilizer/disinfector

After hand washing or ultrasonic cleaning, instruments go in full cycle of immersion in a water batch and forceful water spary

Bacillus atrophaeus

EO sterilization is used for ______ bacteria

decontamination attire (PPE)

Must be worn in compliance w/ OSHA includes: 1.Protective eyewear or face shield 2. Mask 3. Cuffed gloves, approved for chemicals 4. Full protective body suit w/waterproof apron and sleeves 5. Waterproof shoes and covers

Geobacillus stearothermophilus

Ozone sterilization is used for _______

According to manufactures specifications

Peracetic acid is used for ______

event-related sterility

based on the principle that sterilized items are assumed sterile, unless environmental conditions or events interfere with the integrity of the package. No longer sterile: 1. sign of exposure to liquid (water stain) 2. wrap is torn, punctured 3. pack has been stored in location that have no environmental controls (vermin) 4. Pack has been transported using a soiled or open system

peel pouch (sterilization pouch)

combination synthetic and paper wrappers double sided bags made from medical grade paper and transparent polypropylene - polymethylene

chemical indicators

commercial prepared paper strips or tape are chemically treated to change color when exposed to specific parameters of the sterilization process such as temperature and concentration of chemical sterilant

process monitoring

divided into categories according to the mechanism of the system. Physical Chemical Biological also referred to as indicators, Chemical Indicators (CIs)

Class 6 (indicator for steam sterilization)

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

wrapping methods using cloth and synthetic materials

envelope technique and the square wrap

FDA (US Food and Drug Administration)

federal agency responsible for the regulation of medical devices, drugs, food, and cosmetics

biohazard transport container

heavy plastic tray fitted with safety locks that prevent leakage and allow contaminated instruments to be safely transported to decontamination *for high temperature and chemicals *labeled w/Red or orange biohazard label *washed within 20 minutes

Sterile Processing Department (SPD)

high volume reprocessing takes place in the health facility *all instruments and equipment used in surgery are transferred here

ethylene oxide (EO)

highly flammable liquid that, when blended with inert gas, produces effective sterilization by destroying the deoxyribonucleic acid (DNA) and protein structure of microorganisms -used in 100% pure form, blended w/carbon dioxide gas, or mixed w/hydrochlorofluorocarbons (HCFCs) -used to sterilize items that are heat and moisture sensitive -operates on low temperature -preferred moisture 25%-80% -Aeration in same chamber is critical step in processing

reposable

instruments or components are those that may only be reprocessed a specific number of times. ex)robotic instruments, scissors *ST must ensure these instruments are not discarded accedentally

Class 5 (indicator for steam sterilization)

integrating parameter this class includes indicators that react to all critical values over a specified range in the sterilization process. these are most exacting and accurate of all indicators

SPD & CPD (Sterile Processing Department) & (Central Processing Department)

management teams in infection control develop ways to implement the standards and monitor the outcomes, whereas the actual tasks are performed by perioperative and SPD staff

Class 4 (indicator for steam sterilization)

multiparameter these are represented by multivariable indicators that react to two or more parameters ex) internal chemical indicators printed on a paper strip

sterile processing technicians

personnel responsible for SPD are skilled, certifiable profession that requires expertise in the science and practice of materials management, decontamination, and sterilization

terminal decontamination

process in which instruments and supplies are processed so that they are safe for staff to handle during subsequent stages of reprocessing

disinfection

process that removes most but not all microbes on inanimate surfaces (nonliving) surfaces only

AORN (Association of perioperative Registered Nurses)

profession association for perioperative nurses that performs research and publishes standards and guidelines of practice for all areas of perioperative care

prion

protein particle that is not a cell and is not related to bacteria or viruses *causes, CJD (Creutzfeldt-Jakob disease) *not destroyed by normal means of mechanical or chemical sterilization *rapidly adherent to dry stainless steel but less viable in the presence of moisture

mechanical monitoring

provide immediate feedback on parameters such as: time (duration of the cycle) temperature Moisture output is recorded and displayed by printout, gauges, and digital readings

CDC-HICPAC (Centers for disease control and Prevention-Healthcare infections control practices advisory committee)

provide research and protocols in all areas of public health and infection control, including those in the professional environment

AAMI (Association for the Advancement of Medical Instrumentation)

provides recommended practices and technical information for the US medical professions

reprocessing

refers to all the steps necessary to render soiled medical devices, including surgical instrument, safe for use on the patient

contaminated

refers to any surface or tissue that has common contact with a potential or actual source of microorganisms

ophthalmic instruments

require special handling in order to prevent toxic anterior segment syndrome also know as TASS 1. during surgery, instruments should be wiped clean w/ a lint free sponge and water 2. at the end of surgery, instruments must be immediately submersed in sterile water 3. Single use cannulas, should be used if possible. If not, cannulas must be flushed w/sterile water immediately 4. all phacoemulsification tips, tubing, hand-pieces, must be flushed 5. Single-use brushes and syringes are used to clean, discarded after 6. Items that have been manually or ultrasonically cleaned should be wiped w/ alcohol before sterilization 7. All instruments be inspected thoroughly fro residue before sterilization

Class 3 (indicator for steam sterilization)

single parameter this class includes indicators that respond to only one critical parameter with an exact value. ex)heat sensitive pellet

Geobacillus stearothermophilus

steam is used for ________ bacteria

instrument milk

steel instruments may by dipped n a combined lubrication and protective Final stage in cleaning and decontamination

reprocessing cycle

step by step procedure that follows an exact protocol. *Start at the point of surgery and ends with equipment that is ready and safe for the patient

terminal cleaning

takes place daily in OR removal of organic soil from all exposed surfaces of the critical and semi-critical areas of the OR

Disinfection

the destruction of some but not all types and forms of microorganisms on an inanimate object Not sterilization

cycle

the entire process of heating, pressurizing and timing the load

complexity of methods and materials mean?

the instrument manufactures recommendations for a sterilization process should be followed exactly

bioburden

the number of live bacterial colonies on a surface before it is sterilized (buildup)

Single-use items

those meant to be used on one patient, only once

Low Risk is assigned to Non-Critical items

those that come in contact with intact skin ex)blood pressure cuff, stethoscope

High Risk is assigned to Critical items

those that come in contact with sterile body tissues such as internal organ systems and the vascular system ex)surgical instruments, hypodermic needles

Intermediate Risk is assigned to Semi-Critical items

those used on nonintact skin or mucous membranes. *Any device in this category requires HLD ex)tubes, rectal or vaginal instruments

air detection

to test and monitor the efficiency of the high vacuum steam sterilizer (DART) daily air removal test, performed using a Bowie-Dick monitor

environmental disinfectants

used for routine low level disinfection and environmental decontamination

loaner instruments

used on loan form sources outside the health care facility by industry representatives *should be processed first by decontamination then sterilization method

ensure smooth mechanical action

Power equipment = oil Steel equipment = lubrication

Reprocessing cycle

Procedure required to prepare instruments is called

Spaulding system

Provides health care professionals a way to determine if a patient care device requires sterilization, disinfection, or only surface cleaning to remove traces of organic soil *system is based on the level of risk for infection associated with that part of the body *high and low level (HDL & LDL)

CDC (Center for disease control and prevention)

Provides research and protocols in all areas of public health

ultrasonic cleaning

Removes debris by a process called cavitation. High frequency sound waves are generated through water bath, causing tiny air bubbles trapped within debris to implode Uses enzymatic cleaner

ECRI Institute

Research and consulting organization that applies scientific research to determine which medical procedures, devices, drugs, and processes are best for patient care.

Close of surgery steps

ST separates equipment by: 1. Sharp - proper container 2. Delicate - instruments that require hand washing, placed in tray or basin 3. Heavy - on the bottom and light on top 4. Non-immersible 5. Immersible - water that was used to soak the instruments during surgery is suctioned off before transport

Class 1 (indicator for steam sterilization)

Single parameter Process indicators can be tape or label indicting only that and individual item or until was directly exposed to the sterilization process.

Class 2 (indicator for steam sterilization)

Specialty indicators these are used for specific tests that measure parameters. Bowie Dick and Daily air removal tests for the presence of pure air (no steam) in the sterilization chamber

TJC (The Joint Commission)

The accreditation agency for all health care organizations in the U.S. It oversees compliance with environmental and patient safety regulations and enforces compliance with standards

cleaning

The process of removing dirt, dust, blood, or other kinds of organic debris with detergents and mechanical action (scrubbing or washing)

AST (Association of Surgical Technologists)

The professional organization of surgical technologists that publishes guidelines for many practices in the perioperative setting

lot control number

Used to identify items that have been included in a sterilization load that may have yielded a positive biological or mechanical control test

Bacillus subtilis

Vaporized gas plasma is used for _______ bacteria

antiseptic

a chemical used to remove microorganisms or skin or other tissue

ionizing radiation

a method of bulk sterilization used by manufacturers to sterilize prepackaged equipment using cobalt-60 radiation

bacteriostatic

a process or chemical that inhibits bacterial colonization (growth) but does not destroy bacteria

HLD (High level disinfection)

a process that reduces the bio burden to an absolute minimum

antisepsis

a process using surgical hand rubs and soaps

completely free of microbes

all instruments used in a surgical procedure must be sterile and

packaging systems used in sterilization

all items are pressurized by steam, ethylene oxide, ozone, or gas plasma methods

Gas plasma sterilization

A process that uses the form of matter known as plasma during the sterilization process.

Classes of indicators for steam sterilization

A system of 6 classes job indicators used for quality assurance with steam sterilization.

Biological indicators

Harmless bacteria encased in self contained unit. Placed in selected loads After sterilization it is retrieved and placed in incubator. Determines whether the parameters were effective in the destruction of microbes in the load. Administered at least weekly. Always use for implants or prosthesis sterilization. If the results are positive results show the whole load needs to be reprocessed starting with decontamination. Uses enzyme that binds to spores. Enzyme measured after sterilization. Used for high pressure steam and ETO sterilization. Results obtained in 1 to 4 hours. *The bacteria used during biological monitoring differs according to the sterilization

Methods of sterilization

High temperature steam under pressure Ethylene oxide (EO) gas Hydrogen peroxide gas plasma Hydrogen peroxide vapor Peracetic acid vapor Ozone Dry heat Ionizing radiation

Geobacillus stearotermophilus enzyme (fluorescence testing)

Immediate-use steam sterilization is used for _____

immediate use steam sterilizer (IUSS)

In the past, called FLASH sterilization (IUS) -High speed pre-vacuum sterilizer is used in the OR for immediate use -extremely high temperatures to achieve short cycle - used only when no alternative is available -Implants are not sterilized in IUS, except in emergency and must be monitored w/biological system

Single-Use Non-woven Materials

Intended for one time use Material: Spun, heat-bonded fibers such as polypropylene Light weight fabrics require the same treatment as woven wrappers. (4 thickness for complete protection) Valuable for wrapping heavy items, flat basins, or trays. Don't use paper derived from cellulose because it breaks down during sterilization and makes it hard to open and distribute goods.