Periop 101 Sterilization and Disinfection module

During the assembly process, instruments should be placed in a specifically designed container that restricts the penetration of the sterilizing agent and prevents trapping of air. T/F

-F, instruments should be arranged in sets and placed in a tray with mesh or perforated bottom or specifically designed container that permits penetration of the sterilizing agent and prevents the trapping of air.

List the minimum exposure times for gravity displacement steam sterilizers -250F -270F -275F -Drying time

-Packaged items: --30@ 250F --15@ 270F --15-30m dry time -textile packs --30@250F --25@270F --dry time of 15m -nonporous items to be immediately used **only using manufacturer times and recommendations for that specific item -Mixed load of porous and non porous items **see device and container manufacturer instructions

What must be placed between stacked or nested items during steam sterilization?

-absorbent towel or other porous material so that steam contacts all surfaces

Define a semicritical item and how it must be cleaned

-are those that come in contact with mucous membranes and do not ordinarily penetrate body surfaces. i.e. endoscopes that are passed through natural body orifices, anesthesia equipment like a laryngoscope hand and blade, and respiratory equipment. -items falling into this category should receive high level disinfection. the rationale is that an intact mucous membrane usually resists common bacterial spores but may be susceptible to other organisms

Describe a washer decontaminator/disinfector

-can be single or multi-chamber tunnel units. the cycles differ, but generally include a pre-rinse, enzyme soak, wash with detergent, ultrasonic cleaning, sustained hot water rinse, a deionized final rinse, liquid germicidal rinse, and dry cycle. some have lubrication cycle. *benefit is hands free wash

Disassembly, cool-water rinse, enzymatic wash, and use of appropriate detergent are principles used in: -decontamination -steam sterilization -high level disinfection -gas plasma sterilization

-decontamination

Which implant goes with which surgery? -Teflon and Dacron patches -Stapedectomy prostheses -synthetic mesh -ventriculoatrial shunts -scleral buckles and bands ---- A- ENT B-general sx C- Neuro sx D. Opthalmic sx E. CV sx

1:E 2:A 3:B 4:C 5:D

An integrator is a multiparameter indicator designed to measure which of the following parameters? -pressure, steam, temp -temp, time, presence of steam -pressure and sterility

B- provides a response to defined combinations of temp, time and presence of steam

In which sx wound category would a total abdominal hysterectomy be classified? -clean -clean contaminated -contaminated -dirty

B- the surgery entered the genitourinary tract under controlled conditions so not clean, not contaminated bc there was no evidence of infection or contamination or specified break in sterile technique

Shelf life is related to: SATA -exposure to external events -methods of sterilization -type of packaging material used -number of personnel who may have handled the package -time from initial sterilization

**check p 71-72

What are some details and concerns in using Ethylene Oxide and Chloroflrocarbons to sterilize?

-health care organizations now use 100% concentrations of EO or EO in mixtures with inert diluent gasses like CO2 and HCFC's for EO sterilization procedures. In the past, EO was mixed with CRCs to reduce fire and explosion hazards. -because of concerns about the effect of CFCs on the ozone layer, they are no longer being produced in the US. In 2015, the EPA began regulation of HCFCs and production was terminated. As such, 100% concentrations of EO will continue to be available.

Define a critical item and why it must be sterilized

-include instruments or objects that are introduced into the human body either into or in contact with the bloodstream or normally sterile area of the body. i.e. surgical laproscopic instruments, implants, cardiac catheters. -Items in this category must be sterilized before use. If all microorganisms are not removed, including bacterial spores the risk for infection is high. if sterilization is not feasible, these items must receive high level disinfection.

Define a noncritical item and how it must be cleaned

-noncritical items are those that come in contact with the unbroken skin of the patient. i.e. BP cuffs, bedpans, pulse ox -these items should receive intermediate or low level disinfection because the intact skin serves as a barrier to most microorganisms

List the minimum exposure times for dynamic air-removal steam sterilizers -270F -275F -Drying time

-packaged instruments --4@270F --3@275F --Dry for 20-40m at 270F --Dry for 16m at 275F -textile packs --4@270F --3@275F --dry for 5-20m at 270F --dry for 3m at 275F -nonporous items **only using manufacturer times and recommendations for that specific item -mixed loads of nonporous and porous items **see device and container manufacturer instructions

Describe a washer/sterilizer

-process instruments through several cycles- cold water pre rinse, high tem wash with alkaline detergent, neutralizing cycle, final rinse, sterilization. *gross burden must be removed before or it will bake in *instruments must still be flash sterilized

What are the 4 variables that EO sterilization is dependent on?

-proper exposure of 2-10 hours -Temp of 100-140F -chamber humidity of 45-75% -use of the gas concentration required by the system being used *failure of one of these affects probability of achieving sterilization

Describe an ultrasonic cleaner

-remove fine debris through a process called cavitation. Ultrasonic energy is passed through a water bath, creating bubbles that implode. This creates suction action that pulls debris away from instrument surfaces. The instruments must be clean and free of gross debris before being placed in the ultrasonic cleaner or the energy will be absorbed by larger clumps, undermining the process

Match the device with its description -ultrasonic cleaner -washer decontaminator/disinfector -washer/sterilizer ---- -process instruments through several cycles. instruments are not considered prepared for subsequent use -allows hands free processing. renders instruments safe for handling -removes fine debris through cavitation

-ultrasonic= removes fine debris -washer decontaminator/disinfector= hands free processing with instruments safe for handling -washer/sterilizer, processes instruments through several cycles but they are not considered prepped for use after.

Match the indicator type to the description of its use or function: -Class 1 -Class 2 -Class 3 -Class 4 -Class 5 -Class 6 ---- A- integrating, reacts to all critical parameters over a specified range of sterilization cycles. performance has been correlated to the performance of the stated test organism under labled conditions of use B- Emulating, reacts to all of the critical parameters of a specific cycle C- reacts to two or more of the critical parameters of sterilization D- Bowie-Dick, detects air leaks, ineffective air removal, and presence of noncondensable gases. used in dynamic air removal sterilizers E- demonstrates the package has been exposed to the sterilization process to distinguish between processed and unprocessed packages F- process indicator that reacts to a single parameter of sterilization

1:E 2:D 3:F 4:C 5:A 6:B

Based on what you have learned about wound classification, in what category would acute appeticitis or cholecyctitis be classified? -Class I, clean -Class II, Clean contaminated -Class III, contaminated -Class IV, dirty or infected

C, acute inflammation of any organ without frank pus present such as acute appendicitis or cholecystitis is a Class III contaminated wound.

After completion of the steam sterilization cycle, wrapped, sterilized items should be: -placed on a metal table until cooled -used immediately -left untouched to cool for 30-60 minutes -left untouched to cool for 15-30 minutes

C- after steam sterilization items should not be moved or touched for 30-60 minutes until they have cooled down to room temp

Surgical conscience demands the recognition of improper practices observed during surgery by: -the surgeon -anesthesiologist -the periop nurse -any member of the health care team

D- and the ability to report one's own breaks in technique so that corrective action can be taken

Because the process of chemical disinfection destroys blood, tissue and mucous there is no need to decontaminate used sx instruments before chemical disinfection. T/F

F- items should be thoroughly cleaned and decontaminated before disinfection. Debris, blood, mucous, and tissue will interfere with the action of the disinfectant.

T/F Sterile technique is defined as "comprises methods that are designed to exclude all microbes".

False the use of specific actions and activities to prevent contamination and maintain sterility of identified areas during operative or other invasive procedures.

Match each class of surgical wound with the type of surgery: -Gastrectomy -Compound Fracture -Perforated viscera -Hernia sx

Gastrectomy= Class II Compound Fracture= Class III Perforated Viscera= Class IV Hernia Sx= Class I

When would an enzymatic wash be used?

In removing debris on items heavily soiled with protein or fat, or if the soil has dried on

Discuss sterilization of implants

Should not be sterilized using immediate-use steam sterilization because of possible pt complications. Careful planning, appropriate packaging, and inventory management can eliminate the need for immediate-use steam sterilization of implantable medical devices

** Define the following by matching definition with term: -disinfection -decontamination -sterilization -high-level disinfection ---- 1. use of physical or chemical means to remove, inactivate, or destroy bloodborne or other pathogens on a surface or item. 2. the process of destroying all microorganisms on a substance by exposure to physical and chemical agents, complete elimination of all forms of microorganisms 3. a process that destroys all microorganisms with the exception of high numbers of bacterial spores 4. a chemical or physical process of destroying all pathogenic microorganisms, except spores on inanimate objects.

find the answer in the module on p21