Chapter 18: Sterilization and Disinfection Test Questions
What are the guidelines for properly loading an autoclave?
1. Do not overload the chamber. Small packs should be placed 1-3 inches apart, and large packs should be placed 2-4 inches apart. The packs should not touch the chamber walls. 2. Ensure that at least 1 inch separates the autoclave trays. 3. Place jars and glassware on their sides. 4. Place dressing in a vertical position. 5. When sterilizing dressing and hard good together, place dressings on the tope shelf and hard goods on the lower shelf. 6. When using sterilization pouches, set the pouches on their sides to maximize steam circulation and to facilitate drying.
What is a disinfectant?
A disinfectant is an agent used to destroy pathogenic microorganisms; however, it does not kill the resistant bacterial spores. Disinfectants are usually applied to inanimate objects.
What is a hazardous chemical?
A hazardous chemical is any chemical that is classified as a health or physical hazard, a simple asphyxiant, a combustible dust, a pyrophoric gas, or a hazard not otherwise classified.
What is a safety data sheet?
A safety data sheet (SDS), previously known as a material safety data sheet (MSDS), provides more detailed information than the container label regarding the chemical, its hazards, and measure to take to prevent injury and illness when handling the chemical. The HCS requires that a current SDS be kept on file for each hazardous chemical used or stored in the workplace. SDSs must be readily accessible to employees and provided to them on request. It is important that the medical assistant review the SDS before working with a hazardous chemical.
What is a semicritical item?
A semicritical item is an item that comes in contact with non intact skin or intact mucous membranes, such as a flexible fiberoptic sigmoidoscope. A frequently used high-level disinfectant is 2% glutaraldehyde (e.g., Cidex, MetriCide). A high-level disinfectant that is growing in popularity is Cidex OPA (ortho-phthalaldehyde). Cidex OPA does not contain glutaraldehyde, which means it is less toxic and is safer to handle.
What is a spore?
A spore is a hard, thick-walled capsule that some bacteria form by losing moisture and condensing their contents to contain only the essential parts of the protoplasm of the cell.
What type of water is used to fill the water reservoir of the autoclave?
Distilled water
What is the advantage of using dry heat to sterilize articles?
Dry heat is less corrosive than moist heat for instruments with sharp edges; it does not dull their sharp edges.
What is the information required by GHS to put on the label of a hazardous chemical?
1. Product identifier: Specifies how the hazardous chemical is identified. This can be (but is not limited to) the chemical name and the code number or batch number. 2. Supplier identification: Supplier identification includes the name, address, and telephone number of the chemical manufacturer. 3. GHS signal word: A signal word is a word used to indicate the relative degree of severity of the hazardous chemical and to alert the user to a potential hazard on the label. There are two possible signal words under GHS: -Danger: Denotes a more severe hazard possible -Warning: Denotes a less serious hazard possible but potentially harmful 4. GHS hazard statement(s): A hazard statement is a phrase that describes the types of hazards associated with a hazardous chemical, including, when appropriate, the degree of the hazard (e.g., Causes damage to kidneys through prolonged or repeated exposure when absorbed through the skin). 5. GHS hazard pictograms: Pictograms consist of standardized graphic symbols that allow employees to quickly identify the types of hazards associated with a hazardous chemical. There are 8 different pictograms representing the health and physical hazards covered in the GHS. 6. GHS precautionary statement(s): A precautionary statement is a phrase that describes recommended measures to be taken to minimize or prevent adverse effects resulting from exposure to the hazardous chemical or from improper storage or handling (e.g., Wear protective gloves/protective clothing/eye protection/face protection). 7. Supplementary information: The manufacturer may provide additional information that it deems helpful, such as directions for use and the expiration date of the chemical.
What are the guidelines that should be followed when sanitizing surgical instruments?
1. Wear gloves during the sanitization process. This protects the MA from blood borne pathogens and other potentially infectious materials (OPIM). Heavy-duty utility gloves should be worn over the disposable gloves to provide protection from the irritating effects of chemical agents and accidental punctures or cuts from sharp instruments. 2. Handle instruments carefully. 3. Follow instructions on labels of chemical agents. Before using a chemical agent such as a chemical disinfectant, an instrument cleaner, or an autoclave cleaner, review the product's SDS, and carefully read the label on the container. Check the label to determine the use, mixing, and storage of the chemical agent. Read and observe precautions listed on the label regarding personal safety, such as the use of glove and eye protection. Also, check the expiration date on the label of the chemical agent. Chemicals have a tendency to lose their potency over time and should not be used past the expiration date. 4. Use a proper cleaning agent. A low-sudsing detergent with a neutral pH should be used to clean the instruments. Commercially available instrument cleaners meet these criteria. These cleaners usually come in a concentrated liquid or powder form and must be diluted with water before use. Never substitute with any other type of detergent. If a detergent with an alkaline pH is used and is not completely rinsed off, it could leave a residue on the instrument. This could result in an orange-brown stain on the instrument that resembles rust. Using an acid detergent can cause staining and permanent corrosion. 5. Use proper cleaning devices. A stiff nylon brush should be used to clean the surface of the instrument. A stainless steel wire brush can be used to clean grooves, crevices, or serrations. A stain on an instrument often can be removed by using a commercial stain remover. Never use steel wool or other abrasives to remove stains because damage to the instrument could occur. 6. Carefully inspect each instrument for defects and proper working condition. After cleaning, rinsing, and drying the instrument, check it for defects and proper working condition as follows: -The blades of an instrument should be straight and not bent. -The tips of the instrument should approximate tightly and evenly when the instrument is closed. -An instrument with a box lock (e.g. hemostatic forceps, needle holders) should move freely but must not be too loose. The pin that holds the box lock together should be flush against the instrument. -An instrument with a spring handle (e.g., thumb and tissue forceps) should have sufficient tension to grasp objects tightly. -The cutting edge of a sharp instrument should be smooth and devoid of nicks. -Scissors should cut cleanly and smoothly. To test for this, the MA should cut into a thing piece of gauze. The scissors are in proper working condition of they cut all the way to the end of the blade without catching on the gauze. 7. Lubricate hinged instruments. Lubricate box locks, screw locks, scissor blades, and any other moving part of each instrument. The lubricant makes the instrument function better and last longer. Use a lubricant that can be penetrated by steam, such as a commercial spray lubricant or a lubricant bath. Lubricate after performing the final rinse (and drying of the instrument); otherwise, the lubricant would be rinsed off the instrument. Never use industrial oils or silicon sprays. These substances are not steam penetrable and can build up on the instrument, affecting its working condition.
What is the purpose of the chemical indicator, autoclave tape?
Autoclave tape contains a chemical that changes color if it has been exposed to steam. The tape is available in a variety of colors, can be written on, and is useful for closing and identifying the wrapped article. Limitations: -Cannot ensure that steam has penetrated to the center of the pack because it's placed on the outside of the pack -Doesn't ensure the item has been sterilized; only indicates that the article has been in the autoclave and that a high temperature has been attained
What is the use of cold sterilization?
Cold sterilization involves the use of a chemical agent for an extended length of time. Only chemicals that are designated sterilants by the U.S. Environmental Protection Agency (EPA) can be used for sterilizing articles. If a chemical agent holds this status, the word sterilant is printed on the front of the container. The item to be sterilized must be completely submerged in the chemical for a long time (6-24 hours depending on the manufacturer's instructions). Prolonged immersion of instruments can damage them. In addition, each time an instrument is added to the instrument container, the clock must be restarted for the entire amount of time. For these reasons, and because this method involves the use of a hazardous chemical, cold sterilization should be used only when an autoclave, gas, or a dry heat oven is not indicated or is unavailable.
State the responsibility of companies that manufacture and distribute hazardous chemicals pertaining to safety data sheets (SDSs).
Companies that manufacture and distribute hazardous chemicals must provide an SDS with every product.
When is ethylene oxide gas sterilization most commonly used?
Ethylene oxide sterilization is a more complex and expensive process than steam sterilization. It frequently is used in the medical manufacturing industry for producing prepackaged, presterilized disposable items, such as syringes, sutures, catheters, and surgical packs.
What are health hazards?
Health hazards include the potential of the chemical to cause acute toxicity, skin corrosion or irritation, serious eye damage or irritation, respiratory or skin sensitization, germ cell mutagenicity, cancer, or reproductive toxicity, or is an aspiration hazard.
What is high-level disinfection?
High-level disinfection is a process that destroys all microorganisms with the exception of bacterial spores. High-level disinfection is used to disinfect semicritical items.
What happens if a sterilization indicator does not change properly?
If an indicator does not change properly, a problem may be present in the sterilization techniques in the working condition of the autoclave. The manufacturer's guidelines for proper sterilization techniques should be reviewed, and the articles should be resterilizes, following these guidelines. If the indicator still does not change properly, the autoclave is in need of repair and should not be used until it has been serviced.
What is the Globally Harmonized System of Classification and Labeling of Chemicals (GHS)?
In 2012 the HCS was revised to incorporate the Globally Harmonized System of Classification and Labeling of Chemicals (GHS) set forth by the United Nations. The GHS is an international standard that provides consistency in the classification and labeling of chemicals through the use of pictograms, signal words, and hazard warnings. The GHS classifies chemicals according to their health and physical hazards. The GHS also requires the use of a standardized format for labeling containers and the development of safety data sheets (SDSs).
Where should sterilization indicators be stored?
Sterilization indicators should be stored in a cool, dry area.
What is sterilization?
Sterilization is the process of destroying all forms of microbial life, including bacterial spores. An object that is sterile is free of all living microorganisms and spores.
What are the advantages of using sterilization pouches?
Sterilization pouches provide good visibility of the contents on the plastic side. Most manufacturers include a sterilization indicator on the outside of the pouch. (You can write on the paper side of the pouch, not the plastic side).
What do sterilization pouches consist of?
Sterilization pouches typically consist of a combination of paper and plastic; paper makes up one side of the pouch, and a plastic film makes up the other side. Sterilization pouches are available in different sizes; the most common sizes (in inches) are 3x9, 5x10, and 7x12.
What is the purpose of the chemical indicator, sterilization strips?
Sterilization strips are commercially prepared paper or plastic strips that contain a thermolabile dye and that change color when exposed to steam under pressure for a certain length of time. Most strips are designed to change color after being exposed to a temperature of 250 degrees F for 15 minutes. The indicator strip should be placed in the center of the wrapped pack, with the end containing the dye placed in an area of the pack considered to be the hardest for steam to penetrate.
What is the process of handling and storing packs of sterilized items?
Sterilized wrapped articles should be handled carefully and as little as possible. If a wrapped article is crushed, compressed, or dropped, the sterility of the contents cannot be assumed, and the pack must be resterilizes. This is known as event-related sterility, meaning that a sterile pack is considered sterile indefinitely unless and event occurs that interferes with the sterility of the article. Sterilized packs should be stored in clean, dry areas that are free from dust, insects, and other sources of contamination. Wrapped articles should be stored with the most recently sterilized articles placed in the back. The medical assistant should thoroughly check each sterilized pack at least twice: before storing it and before using it. If the pack is torn or opened or if it is wet, it is no longer sterile and must be rewrapped and resterilized.
How does the GHS revisions to the HCS benefit employees?
The GHS revisions to the HCS enable employees to quickly obtain and more easily understand information regarding the safe handling and use of hazardous chemicals. This, in turn, assists in preventing injury and illness associated with exposure to hazardous chemicals.
What is the purpose of The Hazard Communication Standard (HCS)?
The Hazard Communication Standard (HCS), first established in 1983, is a requirement of the Occupational Safety and Health Administration (OSHA). The purpose of the HCS is to ensure that employees are informed of the hazards associated with chemicals in their workplace and the precautions to take to protect themselves when working with hazardous chemicals.
What is the use of an autoclave?
The autoclave is dependable, efficient, and economical and can be used to sterilize items that are not harmed by moisture or high temperature.
What is the length of time required for sterilization of articles in the autoclave?
The autoclave is operated at approximately 15 psi with a temperature of 250 degrees F (121 degrees C). The length of time required for sterilization varies according to the item that is being sterilized.
What temperature should the autoclave be operated at?
The autoclave is usually operated at approximately 15 pounds of pressure per square inch (psi) at a temperature of 250 degrees F (121 degrees C). Vegetative forms of most microorganisms are killed in a few minutes at temperatures ranging from 130 degrees F to 150 degrees F (54 degrees C to 65 degrees C), but certain bacterial spores can withstand a temperature of 240 degrees F (115 degrees C) for longer than 3 hours. No organism, however, can survive direct exposure to saturated steam at 250 degrees F (121 degrees C) for 15 minutes or longer.
What does the label of a hazardous chemical include?
The label must include the possible hazards of the chemical and the steps that can be taken to protect against those risks.
What is the most common temperature used for dry heat sterilization?
The most commonly used temperature for dry heat sterilization is 320 degrees F (160 degrees C) for 1 to 2 hours, depending on the article being sterilized.
What is the purpose of wrapping articles?
The purpose of wrapping articles is to protect them from recontamination during handling and storage.
Why must sterilized articles be allowed to dry before being removed from the autoclave?
The sterilized articles are moist and must be allowed to dry before they are removed from the autoclave. Microorganisms can move quickly through the moisture on a wet wrap and onto the sterile article inside, resulting in contamination.
What wrapping material should be used to wrap articles?
The wrapping material should be made of a substance that isn't affected by the sterilization process and should allow steam to penetrate while preventing contaminants, such as dust, insect, and microorganisms, from entering during handling and storage. It should not tear or puncture easily and should allow the sterilized package to be opened without contamination of the contents. A wrapper should not be used if it is torn or has a hole. Examples of wrapping materials used for autoclaving are sterilization paper, sterilization pouches, and muslin.
What is the minimum sterilizing times for items put in the autoclave at 250 degrees F?
Unwrapped articles= 15 minute -Unwrapped nonsurgical instruments -Open glass or metal canisters -Nonsurgical rubber tubing Wrapped articles= 20 minutes -Fabric or muslin -Wrapped trays of loose instruments -Rubber tubing Packs (Large wrapped articles)= 30 minutes -Minor office surgery tray setup (wrapped) Liquids= 30 minutes -Liquids or gels
