Sterilization Process

How do we preform intraoperative cleaning to reduce the potential for the formation of biofilm?

- Wipe the surface of the instrumentation with a sponge soaked in sterile water. - Flush the channels and ports with sterile water.

What type of monitor is an external strip or tape? A. Chemical B. Biological D. Ultrasonic E. Physical

A. An external strip or tape is an chemical monitor.

Which of the following CIs are placed on the outside of a package or container? A. Class 1: Process Indicator B. Class 2: Specialty Indicator C. Class 3: Single-parameter Indicator D. Class 4: Multi-parameter Indicator

A. Class 1: Process Indicator

What does cavitation do?

Cavitation utilizes high-frequency sound waves to form microscopic bubbles that become unstable and implode. This action crates small vacuums that remove debris from instrument crevices and surfaces.

Define Aseptic Technique?

Methods by which microbial contamination is prevented

What has to be included in documentation of each sterilized cycle?

Result must include physical, chemical, and biological indicators, exposure parameters, load number, and operator identification.

True/False A chemical indicator is placed on the inside of the container?

True

True/False Documentation is necessary for each sterilization cycle?

True

True/False Instruments must be completely dry before instrument tray assembly and sterilization?

True

True/False The person who loaded the car into the sterilizer is a part of each load's documentation?

True

True/False Tray weight should be evenly distributed?

True

Examples of aseptic practices?

- Using clean gloves to pick up a bloody sponge for the protection of the user - Using single-use items for the individual patient - Sterilization of reusable items for non-sterile procedures such as sigmoidoscopy

What are two types of mechanical cleaning equipment?

* Ultrasonic cleaners * Washer-disinfector/decontaminators

What is important to know about an instrument set?

- An Instrument set and container must not weigh more than 25 lbs. - Heavier than 25 lbs takes longer drying times, and increases the injury to health care personnel.

What are some unique features of Washer-disinfector decontaminators mechanical cleaning equipment?

- Combines the mechanical, thermal, chemical actions - Is programmed for each cycle to deliver the correct amount of chemical agent at the correct dosage and duration with the water at the correct temperature. -Cycles are specific to the instruments being cleaned

What are some actions to take before transporting instruments?

- Discard sharps into a sharps container. - Discard liquids per federal, state, and local regulations or transport them in a leak-proof container. - Separate sharp instruments from delicate and heavy instruments. - When applicable, follow the manufacturer's instructions for use (IFU) for instruments disassembly prior to transport to the decontamination area. - Moisten instruments with an enzymatic pre-treatment product (disassemble instruments first) or cover with a water-soaked towel.

What is Biofilm?

- Is the accumulation of bioburden, which is composed of bacteria and other biological elements. - Is the result of a tight adhesion of bioburden to the instrument's surface.

Why are we concerned about Biofilm?

- It inhibits the ability of cleaning solutions and disinfectants to effectively decontaminate the instrument - Prevents successful sterilization

What is an unique features of Ultrasonic Cleaners mechanical cleaning equipment?

- Removes soil from hard-to-access areas of an instrument by cavitation

Why is water temperature important? What does cool water do vs hot water?

- Temperature indicators are used in decontamination sinks to ensure that water is in the appropriate temperature range, as determined by the cleaning solution manufacturer. - Cool water is used to prevent blood coagulation on instruments and helps to remove gross soil from instrument crevices, joints, and lumens. -Hot water can denature blood proteins which makes blood removal more difficult. - Detergent manufacturer's IFU provides details on the amount of products needed and appropriate water temperature.

Instrument Tray Assembly

1. Instruments must be completely dry. 2. Instruments are counted as they are strung or placed in the tray. 3. Instruments are placed in the tray to protect them from damage. a. Heavy instruments are placed on the bottom of the tray. b. Delicate and sharp instruments are place on top of all other items. 4. Instruments are opened when placing them on a stringer. 5. Sharp and delicate instruments are protective guards that are steam-permeable and able to withstand heat. 6. Cupped instruments are place with the cupped portion down so as not to collect water. 7. Detachable parts are disassembled. 8. Tray weight is evenly distributed. 9. Instrument tray is wrapped or placed in a rigid container. 10. A chemical/biological integrator is placed inside the warp or container. A chemical indicator is placed on the outside of the wrap or container. 11. The wrapper or tray is labeled appropriately.

Steps to Sterilization

1. Point-of-use treatment 2. Transport to decontamination 3. Cleaning 4. Disinfection 5. Verification of the cleaning process 6. Inspection and testing 7. Instrument tray or set assembly 8. Packaging 9. Sterilization 10. Storage

What is a Biological Indicator (Bls)?

A BI is used to monitor the sterilizer's efficiency and effectiveness. The test demonstrates whether the sterilization conditions were adequate to kill the non-pathogenic spore housed within the BI. A negative BI indicates that the sterilization conditions were met.

Define Biofilm?

A coating of biological organisms and material tightly adhered to the surface of an instrument

What is an appropriate action before transporting contaminated instruments from point-of-use to the decontamination area? A. Discard sharps into a sharps container. B. Keep instruments that can be disassembled in one piece. C. Place sharp instruments with delicate instruments. D. Place a dry towel over instruments.

A. Discard sharps into a sharps container.

Which chemical sterilization method uses a toxic substance that requires aeration? A. Ethylene oxide B. Hydrogen peroxide C. Dry heat D. Peracetic acid

A. Ethylene oxide uses a toxic substance that requires aeration.

Match: Peracetic Acid, Steam, Dry Heat, H2O2 Vapor, Ethylene Oxide A. An item must be fully immersible to undergo this process. B. The most common method of sterilization C. Used on items resistant to moist heat sterilization. D. the byproducts are water and oxygen. E. Aeration is a critical step.

A. Peracetic Acid B. Steam C. Dry Heat D. H2O2 Vapor E. Ethylene Oxide

Explain the different sterilization methods? A. Pressurized B. Low temperature H2O2 gas C. Peracetic acid D. Ethylene oxide E. Dry Heat

A. Pressurized, saturated steam is used to sterile items that are tolerant of high temperatures and moisture. B. Lower temperature H2O2 gas plasma and vapor are used for items that cannot tolerate heat or moisture. C. Items processed with peracetic acid are wet following sterilization and must be used immediately. D. Ethylene oxide is a carcinogen. Items must be aerated before they are removed from the chamber. E. Dry heat is a slow burning process used on items resistant to moist heat processes.

Which of the following PPE is necessary for health care workers in the decontamination area? A. Utility gloves B. N95 respirator C. Fluid resistant shoe covers D. Eye protection or a full face shield

A. Utility gloves C. Fluid resistant shoe covers D. Eye protection or a full face shield

Define Asepsis?

Absence of pathogenic microorganisms

What is NOT included in the record of each sterilization cycle? A. Exposure parameters for the sterilization meth B. General description of the sterilization load C. Physical, Chemical, and biological indicator results D. Operator's identification

B. A general description of the sterilization load is not included in the record of each sterilization cycle.

Which statement about cleaning and decontamination of contaminated surgical instruments and equipment is FALSE? A. Blood removal on instruments is more difficult with hot water. B. All instruments should be submerged in a hot water solution. C. SPD personnel should wear a fluid-resistant gown in the decontamination area. D. The manufacturer's IFU outline the necessary steps for cleaning and decontamination.

B. All instruments should be submerged in a hot water solution.

Which of the following is NOT done when assembling an instrument tray? A. Instruments are counted as they are placed in a tray. B. Instruments are damp when placed in a container or wrapped. C. Instruments are opened when being place on a stringer. D. Instruments are placed with heavier instruments on the bottom.

B. Instruments should NOT be damp when placed in a container or wrapped.

Which step precedes the others? A. Disinfection B. Point-of-use cleaning C. Transport D. Packaging

B. Point-of-use cleaning

Which of the following should be used for instrument cleaning at the point-of-use? A. Sterile saline B. Sterile water C. Sterile enzymatic solution D. Sterile sporicidal solution

B. Sterile water

Which statement about biological indicators (BIs) is FALSE? A. In the event of a positive BI result, the sterilizer is not used until the cause of the BI failure has been determined. B. A BI test for EO sterilization should be performed one a week. C. The BI used must be specific to the sterilization method. D. A BI is run with each sterilization load that contains one or more implants.

B. The EO quality test should be performed at least weekly. The test should be performed with every load.

Which of the following cleaning and decontamination tests reports on blood, proteins, and carbohydrates? A. Specific strips or swabs B. Specific solution vials C. ATP test D. All of the above

C. ATP test

Instrument assembly stipulates that ________________. A. Instruments are closed when placed on the stringer. B. Cupped instruments are placed up in the instrument set. C. Instruments need to be dry when assembled. D. Sharp and delicate instruments are inserted into a peel pack.

C. Instruments need to be dry when assembled.

Which of the following describes bioburden? A. Biological material that adheres to the surface of instruments and inhibits effective cleaning. B. A chemical interaction between blood and cleaning agents. C. The amount of microbial contamination on an instrument surface. D. A physical barrier created by cleaning agents on an instrument surface.

C. The amount of microbial contamination on an instrument surface.

When the IFU for a surgical device, sterilizer, or packaging system conflict, follow the ______________________IFU. A. packaging system B. sterilizer C. device manufacturer's D. biological indicator's

C. When the IFU for a surgical device, sterilizer, or packaging system conflict, follow the device manufacturer's IFU.

Define Sterility?

Complete elimination or destruction of all forms of microbial life

Which IFU (Instructions for Use) is followed if there is conflicting or vague information about the sterilization of an item? A. Sterilizer manufacturer's IFU B. Packaging manufacturer's IFU C. Assembly manufacturer's IFU D. Device manufacturer's IFU

D. Device manufacturer's IFU

Which statement about completely submerging an instrument into the cleaning solution is TRUE? A. It increases the potential of contamination to the worker. B. It increase the risk of splashes and sprays to the worker. C. It reduces the need for instrument disassembly. D. It reduces the risk of chemical and contaminant aerosolization.

D. It reduces the risk of chemical and contaminant aerosolization.

Which of the following statements about sterilization package is TRUE? A. Large items can be peel packed as long as it fits into the pouch. B. Write information on the porous side of the peel pack. C. It is important to allow for billowing or gaping of the sterilization wrap. D. Sterilization wraps can be reusable, woven material or single-use, nonwomen materials.

D. Sterilization wraps can be reusable, woven material or single-use, nonwoven materials.

Inspection and testing evaluates an individual instrument for_____________________. A. Integrity of cables and cords B. Sharpness C. Cleanliness D. Alignment E. All

E. All (Inspection and testing evaluates an individual instrument for cleanliness, sharpness, alignment, and integrity of cables and cords.)

True/False All Sterilized items should be cooled for 30 minutes before being handled?

False

True/False An item's sterility is based on how long it is on the shelf?

False

True/False Cupped instruments are placed with the cup portion up?

False

True/False If one wet pack is found on a sterilization load, all package are considered to be wet packs?

False

True/False Instruments are to be closed when placing them on a stringer?

False

True/False Sharp and delicate instruments are placed inside a peel pack pouch to protect the tips?

False

Geobaillus stearothermophilus is a biological indicator used for ______________________. A. Ethylene oxide sterilizers B. Liquid peracetic acid sterilizers C. Dry heat sterilizers D. All of the above

Geobacillus sterothermophilus is a biological indicator used for liquid peracetic acid sterilizers.

PPE for health care workers in the decontamination area includes?

Head cover, protective eyewear or face shield, mask with fluid protection barrier, water resistant gown, and shoe covers

Definition of asepsis?

Is the absence of infectious organisms

Definition of sterilization?

Is the complete elimination or destruction of all forms of microbial life

Define Bioburden?

The amount of microbial contamination on an instrument

What is the first step of instrument process? A. Cleaning B. Soaking C. Chemical disinfection D. Decontaminator cycle on washer-sterilizer

The first step of instrument process is cleaning.

What does the specific swab or test strip test for? What is the process for these test?

They test for specific contaminants: protein, blood, or carbohydrates. The process is a water moisten swab is wiped on the device surface and if the swab does not change color than the contaminant is not present, if it does then its not clean and must be reprocessed.

What does the test solution vial test for? What is the process for this test?

This test with individual vials that contain solutions that test for specific contaminants. A water moistened swab is wiped on the instrument surface and inserted into a specific vial. If the vial turns a color, than the contaminant is on the instrument and that item must be reprocessed.

What does the adenosine triphosphate (ATP) test for? What is the process for this test?

This tests for ATP, which is present in all organic material. A pre-treated swab is wiped on the item's surface and then inserted into a test device. If the ATP is present, a bioluminescence is created and can be read by the testing device. Depends of the range and then it will pass, caution, or fail.

Match the terms: Cavitation, Chemical Action, Thermal Action, Washer-Disinfector/Decontaminator A. Combination of thermal and chemical actions for instrument cleaning B. Water temperature C. Sound waves that create vacuums that remove debris from crevices D. Cleaning solutions

Washer-Disinfector/Decontaminator A. Combination of thermal and chemical actions for instrument cleaning. Thermal Action B. Water temperature. Cavitation C. Sound waves that create vacuums that remove debris from crevices. Chemical Actions D. Cleaning solutions