3-A Sterilization & Disinfection

Wrapped instruments, packs, bulk loads with porous and nonporous items:

1. @ 121 degrees C (250 degrees F) 2. less than 30 mins 3. 15 PSI

Unwrapped metal instruments combined with porous materials:

1. @ 132 degrees C (270 Degrees F) 2. Less than 10 mins 3. 27 PSI

Unwrapped metal instruments:

1. @ 132 degrees C (270 degrees F) 2. Less than 3 mins 3. 27 PSI

System usage forEthylene oxide (EtO) sterilization:

1. Be aware that EtO is highly flammable! 2. Be sure to dry instruments prior to exposure, since this inhibits formation of ethylene glycol during the cycle 3. Aerate all porous items after processing to eliminate the hazard of toxic residues.

Cleaning and preparing the OR after a procedure for equipment, fixtures, and supplies

1. Clean the horizontal surfaces of furniture and equipment used during a procedure with an approved detergent- germicide 2. Clean table accessories such as safety straps, stirrups, table extensions and arm boards, then cover or return to proper storage

Non-woven material for envelope and square fold

1. Composed of a synthetic fiber 2. Available in single- or double-layerd thickness 3. Advantage- Disposable and intended for single use 4. Disadvantage- Higher cost or use

Keeping contamination confined to the sterile area during a surgical procedure by:

1. Confine contamination to as small an area as possible 2. Dispose of spoiled sponges in red biohazard bags 3. Do not place soiled sponges on draped sterile table 4. Place all disposable sharps in a puncture-resistant biohazard container 5. keep all trash and linen off floor

Cleaning and preparing the OR after a surgical procedure, General rules:

1. Consider all items that have come in contact with the patient and/or sterile field contaminated 2. Follow standard precautions for cleanup, using eye protection, gown, and gloves

Cleaning the operating room prior to the first surgical procedure of the day:

1. Damp dust using a clean, lint-free cloth moistened with detergent- germicidal or disinfectant 2. Damp dust all horizontal or flat surfaces in the OR 3. Clean lights and overhead tracks; they quickly become contaminated with dust, debris, and pathogens

Postoperative decontamination pre-rinse phase:

1. Disassemble instruments with removable parts to expose all surfaces for cleaning 2. Open all hinged instruments to expose box locks and serrations 3. Begin initial instrument decontamination immediately after completion of surgical procedure(s)

Intraoperative or concurrent decontamination:

1. Follow standard precautions when handling contaminated instruments 2. Keep all instruments used during the surgical procedure free of gross soil by wiping with moistened sponge

Sterilization tray and case:

1. Generally used to package and sterilize instrument sets 2. Cost effective because they are reusable and easy to maintain

Cleaning and preparing the OR after a procedure for suction

1. Have the circulator disconnect suction tubing to eliminate contamination of the wall or portable suction outlet. 2. Properly seal and dispose of disposable suction containers/canisters in a color-coded biohazard bag. 3. Gel or Solidify suction contents using isolyzer gel.

Disadvantages for peracetic acid systems:

1. Immersible instruments only 2. Restricted quantity of instruments per cycle

Disadvantages of Hydrogen peroxides gas/plasma sterilization:

1. Limited ability to penetrate scopes, cellulose paper and linens, especially wrappers. 2. May require extensive preparation of items prior to sterilization

Hydrogen peroxide gas/plasma sterilization general principles:

1. Occurs when hydrogen peroxide is electrically pr magnetically activated to create a plasma vapor that is highly sporadical 2. Destroys microbes by interfering with the cell membrane, nucleic acids, and enzymes 3. Destroys a broad spectrum of microorganisms

Cleaning and preparing the OR after a procedure for Instruments:

1. Open, disassemble, and place instruments in perforated trays 2. cover instruments for transport to a central cleanup area within the surgical suite or to Central Processing for terminal sterilization if the washer-sterilizer is not adjacent to the OR

Packaging material requirements:

1. Proves flexible, durable, and memory-free to prevent folding back along the folding creases. 2. Resistes the wear-and-tear of normal handling and can withstand physical conditions in a sterilizer 3. Remains free of holes, punctures , and excessive wear

Packaging characteristics:

1. Provides a strong, impermeable barrier to microorganisms and prevents the penetration of dust particles. 2. Allows adequate air removal and steam penetration for steam sterilization 3. Maintaining content sterility though proven seal integrity.

Advantages of Hydrogen peroxides gas/Plasma sterilization:

1. Provides dry, nontoxic, low-temp sterilization in a relatively fast 60 min cycle time 2. no toxic residues 3. Environmentally safe by-products; water and oxygen 4. No aeration time required

Prevent any introduction of microorganisms to patients or staff by:

1. Reducing bioburden created by surgical intervention. 2. Reduce possibility of surgical patient cross contamination 3. Reduce the risk of transmission of pathogens. 4. Prevent nosocomial infections in subsequent surgical patients

Wrapping technique for envelope and square fold:

1. Sequential double wrapping with two single layer sheets to create a package within a package

Manual method (hand wash)

1. Sock soiled, grooved instruments in detergent-germicidle to prevent excessive drying to soil 2. Handle sharp or delicate instruments separately 3. Completely immerse instruments in a deep basin with noncorrosive cleaning detergent in warm water. 4. scrub instruments with serrations and box locks with a brush to remove all soil 5. rinse instruments thoroughly to ensure there is no detergent residue

Central Decontamination processing area:

1. Wear PPE at all times when washing, decontaminating, and using chemical disinfecting agents 2. Use plain, clean, distilled water for cleaning 3. Remoce excessive bioburden from instruments by placing them in the washer-sterilizer or manually hand washing each item 4. Place instruments with crevices, serrations, box locks, and ratchets in the ultrasonic cleaner after completion of the washer-sterilizer cycle to facilitate the removal of small particles and debris from entire instrument

Loading:

1. arrange all packages in sterilizer in loose contact on a vertical edge to allow free circulation 2. Place nonporous items on the lowest shelves of the rack in combined loads 3. Orient rigid containers so they lie flat on the shelves of the sterilizer. Do not stack!

Advantages for Peracetic Acid systems:

1. environmentally safe by-products; acetic acid, oxygen, and water 2. Relatively short cycles provides better turn-around times 3. Prove to be anticorrosive for some metal spores

Ethylene oxide (EtO) sterilization general principles and guidelines:

1. is a colorless gas that can be used at its full concentration or comes as a compound with inert chemicals. 2. Used for pressure- and temperature-sensitive equipment which cannot stand steam sterlization

Peracetic acid systems:

1. utilizes peracetic acid and an anticorrosive agent to react with various cellular systems, destroying microbes 2. Most commonly used to sterilize endoscopes

Peracetic acid system usage:

1.To ensure items sterilized with peracetic acid are adequately rinsed with sterile water prior to use 2. may cause serious injury if not handled, neutralized, and rinsed properly

After removal from the sterilizer, the freshly items should be left untouched on the loading cart for ____ to _____ mins for aeration

30 to 60

Mechanical aeration (preferred method)

8 hours to 12 hours at 50 degrees to 55 degrees C or 12 to 16 hours at 38 degrees C

Used only for immersible instruments that do not contain copper, brass, or zinc

Acetic and practice acid

Used primarily for fiver optic, and temperature-sensitve instruments with rubber or plastic components.

Activated glutaraldehyde

Infection prevention through the inhibition of microbial growth on objects

Antisepsis

the final stage of cleaning the OR after a procedure

As a wet vacuuming alternative, flood the floor with a high-level detergent-disinfectat solution. Use freshly laundered, clean mops, after one-time use, remove mop heads and place in a laundry hamper or linen bag.

Principles of containment of microbial contamination on animate surfaces.

Aseptic technique

Distribution of instruments into instrument sets or procedure trays for packaging and placement in sterilizer racks.

Assembly

Environmental safety crew terminally clean all operating rooms when

At least once every 24 hours, regardless of room usage

Liquid, gas, or plasma agent; used primarily for heat-intorlerant instruments

Chemical sterilization

1. Pulls air from sterilizing chamber VIA vacuum 2. Replaces air with steam that immediately penetrates the items. 3. Primary issue is transport of the newly sterilized items back into the sterile field without contamination

Flash Autoclave

@ 270 degrees to 275 degres F 27 PSI, with no drying time 3 min for nonporous items 10 mins for porous items

Flash Autoclave

Provides nontoxic, dry, low- temp sterilization

Gas

1. Pulls air from sterilizing chamber VIA vacuum 2. Replaces air with steam that immediately penetrates the wrapped items 3. Assists in the removal of moister from wrapped items and decreases the drying period 4. Increases shelf life

Pre-vacuum

Involves the inspection, assembling, and packaging of instruments and supplies prior to terminal sterilization or disinfection

Preparation, Assembly, and packaging phase

Metal or plastic riding closed containers with a removable stainless steel mesh or perforated basket

Rigid containers

Never soak instruments in

Saline solution since chloride ions cause rapid metal corrosion

Means of reducing microbes

Sanitization

Reusable woven textile composed of a high-quality cotton or combination of polyester and cotton with a thread count of at least 140

Woven material

Ambient Aeration

up to 7 days at room temperature of 18 degrees and 22 degrees C (65 degrees - 72 degrees F ) depending on the type of item and wrapper

Actual or suspected relative number of microorganisms found in an area or on an item

Bioburden

Actual or suspected relative number of microorganisms found in an area or on an item.

Bioburden

Microbial resistance to antimicrobial agents

Bioresistance

The immediate disinfection process following discharge of infections material from the body of an infected person or after contamination of articles by an infectious agent.

Concurrent Disinfection

Cleaning and preparing the OR after a surgical procedure for Linen:

Dispose of used or soiled non woven disposable linen in a fluid-impervious linen bag

Phase begins with the removal of the initial gross contaminants, such as blood and debris, by wiping the instruments as it is used on the sterile field.

Decontamination

The process for removing contaminants form an object that has been exposed to hazardous materials, such as infectious material and blood, chemicals, or radioactive substances

Decontamination

Chemical agent that destroys microorganisms

Disinfection

The chemical or physical process of destroying all microorganisms, expect spore bearing ones

Disinfection

Items are either sequentially wrapped with two woven or non woven wrappers or wrapped with a single double thickness wrap

Double-wrapped

Thick, protective, plastic wrap used to cover a sterile package and to prolong the shelf life of a sterilized package.

Dust cover

Provides low-pressure, low-temperature sterilization for delicate instruments; used primarily for delicate instruments, or those with plastic or porous materials, and electric or compression tools

Ethylene Oxide Gas (EtO)

Any occurrence that compromises the sterility of the package

Event-related sterility

@ 250 degrees to 245 degrees F 15 to 17 PSI 15 to 30 mins All air must be removed or it will reduce the steam's ability to destroy microbes

Gravity Displacement

Primarily used to sterilize wrapped or unwrapped instruments, linen packs, and solutions in specially designed flasks

Gravity Displacement

Water is heated to a boiling point of 212 degrees F, additional heat energy evaporates and the water forms steam

Gravity Displacement

Steam enters at the top of the chamber and drives the heavier air out an escape valve at the bottom of the chamber

Gravity displacement

used Primarily for heat-and moisture-sensitvie items

Hydrogen peroxide gas plasma

Provides immersible instruments with a wide antimicrobial treatment

Liquid

Open inner space in a tube, which can be in an endoscope, catheter, or needle; a hollow cavity in an organ or blood vessel; can also be a unit of invisible, transit light that is generally described as a measure of brightness

Lumen

The hand washing or instruments in the in the processing area to remove any residual blood or debris before high-level disinfection or terminal sterilization

Manual cleaning

The initial cleaning by machine using some version of washer

Mechanical Cleaning

Use good _________ __________ and an approved ________________ chemical disinfectant to clean all furniture and equipment.

Mechanical Friction High-level

Any instrument with moving parts must be lubricated following cleaning.

Milking

Uses pressurized steam; used primarily for metal instruments

Moist heat

@ 270 degrees to 276 degrees F 27 to 30 PSI 15 to 20 mins minimum 4 min exposure time

Pre-vaccum

Composed to two different materials, paper on one side, plastic on the other

Paper-plastic peel pack

Combination of paper and clear plastic used to package single, odd-shaped, or small items

Peel packs and pouches

Destroys all microbes and spores by disrupting DNA; primarily used for commercially sterilized, pre-packaged items

Physical irradiation

Cleaning and preparing the OR after a procedure for Waste

Place all potentially infectious waste products in approved, puncture-resistant, biohazard "red bags"

Initial immersion in a basin of enzymatic detergent, distilled water, or water with a low subbing detergent helps to loosen gross contaminants from instruments.

Pre-rinse or soaking

System usage for Hydrogen peroxide gas/plasma sterilization:

Primarily used for heat- and moisture- sensitive items such as endoscopes and fiber-optic cameras

Durability of the product against heat, pressure, chemicals, etc

Sensitivity

Peracetic acid system considerations:

Should not be used to sterilize instruments that contain copper, brass, or zinc because toxic salts may form which can cause injury to patients

Primary variables with this system are Temp, Pressure, and length of exposure.

Steam sterilization

Prevention of microbial contamination on intimate surfaces.

Sterile technique

The process of destroying pathogenic and non pathogenic microorganisms including viruses, fungi, and all forms of bacteria and their spores by using sterilant or sporadical agents

Sterilization

Composed of rigid anodized aluminum, stainless steel, polymer, or a polymer-metal combination which cannot be punctured.

Sterilization tray and case

Sterility is an event-related shelf-like practice. This practice recognizes that the product should remain sterile until some event causes the item to become contaminated

Storage phase

The physical or chemical sterilization process that renders an item free from all living microorganisms, including spores.

Terminal and final sterilization phase

The process of rendering all articles, materials, and their immediate physical environment incapable of conveying infectious agents to other persons after the patient has left the room

Terminal disinfection

Termical disinfection at the operating rooms at the completion of the daily schedule

Terminally clean and restock all scrub sinks, sub sterile and utility areas.

Most efficient and least expensive method for temperature-tolerant instruments

Thermal sterilization

Keeps dissimilar metals separate to avoid potential electrolysis resulting in etching of instruments

Ultrasonic cleaner

Provides a cleaning process, not a thermal or chemical disinfection or sterilization process.

Ultrasonic cleaner

Uses the cavitation method where high-intensity sound waves create, then implode tiny bubbles, causing negative pressure that dislodges debris from instrument surfaces.

Ultrasonic cleaner

Uses high frequency sound waves to generate tiny bubbles that clean the serrations, crevices, and lack boxes of instruments that are difficult to clean with other methods.

Ultrasonic cleaning

If mops are used,

Use a clean mop head for each room and discard in a laundry hamper or plastic bag

Items are considered clean and have been exposed to an intermediate level of disinfection, but are not considered sterile after the process has been competed

Washer-decontaminator

Cleans items to at least an intermediate disinfected level, making the items safe for handling but not immediately ready for use.

Washer-sterilizer

Selects a low-suds, free-rinsing detergent with pH value near 7.0

Washer-sterilizer