Decontamination, Sterilization, and Disinfection Chapter 10

Current methods of sterilization in the health care setting include:

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

PPE include ____________________________.

- Protective eyewear or full face shield - Mask - Cuffed gloves approved for contact with -chemicals - Full protective body suit or gown with a waterproof apron and sleeves - Waterproof shoes or covers

The thread count must be at least ____________ for an effective wrapper.

140 threads per square inch.

Each day the sinks must be emptied and dried. The chambers are then wiped down with _______________ % alcohol.

70%

Detergent

A chemical that breaks down organic debris by emulsification (separation into small particles) to aid in cleaning.

Peracetic acid

A chemical used in the sterilization of critical items.

Terminal cleaning

A daily process in which exposed surfaces of the operating room are cleaned and disinfected.

Reusable

A designation used by manufactures to indicate that a medical device can be reprocessed for use on more than one patient.

Physical monitor

A device that automatically provides output on the physical parameters of the sterilization process. Output includes printouts, gauges, and a digital display.

Nonwoven

A fabric or material that is bonded together as opposed to a process of interweaving individual threads.

Stylet

A fine wire that is passed through the instrument to push out debris.

Material Safety Data Sheet (MSDS)

A government-mandated requirement for all chemicals used in the workplace. The MSDS describes the formulation, safe use, precautions, and emergency response.

Ethylene oxide (EO)

A highly flammable gas that is capable of sterilizing an object.

Cobalt-60 radiation

A method of institutional bulk sterilization used by manufactures to sterilize prepackaged equipment by ionizing radiation.

Chemical indicator

A method of testing a sterilization parameter. Chemical strips sensitive to physical conditions, such as temperature, are placed with the item being sterilized and change color when the parameter is reached; sometimes called a chemical monitor.

Case cart system

A method of transporting surgical supplies and equipment to and from the instrument processing and supply areas.

Sterilization

A process by which all microorganisms, including bacterial spores, are destroyed.

Sterilzation

A process by which all microorganisms, including bacterial spores, are destroyed.

Cavitation

A process during ultrasonic cleaning in which air bubbles implode (burst inward), releasing particles of soil or tissue debris.

Terminal decontamination

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

Decontamination

A process in which recently used and soiled medical devices, including instruments, are made safe for personnel to handle.

High-level disinfection (HLD)

A process that reduces the bioburden to an absolute minimum.

Cleaning

A process that removes organic or inorganic soil or debris using friction, detergent, and water.

Chemical sterilization

A process that uses chemical agents to achieve sterilization.

Gas plasma sterilziation

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

Biological indicator

A quality control mechanism used in the process of sterilization. It consists of a closed system containing harmless, spore-forming bacteria that can be rapidly cultured after sterilization process.

Process challenge monitoring

A sealed, harmless bacteria sample included in a load of goods to be sterilized. The sample is recovered following the sterilization process and cultured to test for viability.

Enzymatic cleaner

A specific chemical used in detergents and cleaners to penetrate and break down biological debris, such as blood.

-icdal

A suffix indicating death. For example, bactericidal means "able to kill bacteria."

Spaulding system

A system used to determine the level of microbial destruction required for medical devices and supplies. Each level is based on the risk of infection associated with the area of the body where the device is used.

Bowie-Dick Test

A test that identifies air leaks and ineffective air removal in the steam sterilization process.

Gravity-displacement sterilizer

A type of steam sterilizer that removes air by gravity.

High-vacuum sterilizer

A type of steam sterilizer that removes air in the chamber by vacuum and refills it with pressurized steam. Also known as a prevacuum sterilizer.

Event-related sterilty

A wrapped sterile item may become contaminated by environmental conditions or events, such as a puncture in the wrapper. Event-related sterility refers to sterility based on the absence of such events. The shelf life of a sterilized pack is event related, not time related.

Medical device

Any equipment, instrument, implant, material, or apparatus used in the diagnosis, treatment, or monitoring of patients.

Sharps

Any objects used in health care that are capable of penetrating the skin, causing injury.

Personal protective equipment (PPE)

Approved attire that acts as a complete barrier between the wearer and the environment.

Sterilization pouches or peel pouches

Are double-sided bags made from medical-grade paper and transparent polypropylene-polymethylene.

Instrument sets

Are groups of instruments that are needed for a specific type of surgical procedures.

Sorting and disassembly

At the end of the procedure, the scrub prepares the soiled instruments for the next stage by sorting the instruments and disassembling those with multiple parts.

Bacteriostatic

Chemical agent capable of inhibiting the growth of bacteria.

Disinfectant

Chemical used for inanimate (nonliving) surfaces only.

Implant

Defined by the U.S. Food and Drug Administration (FDA) as "a device that is placed into a surgically or naturally formed cavity of the human body if it is intended to remain there for a period of 30 days or more."

Biofilm

Dense colonies of bacteria that adhere tightly to surfaces.

Disinfection

Destruction of microorganisms by heat or chemical means. Disinfection does not produce sterility as not all microbial forms are destroyed in the process. (spores)

Intermediate risk/Semi-Critical items

Devices used on nonintact skin or mucous membranes. Any device in this category requires high-level disinfection. Ex. endotracheal tubes and airways, rectal instruments, and vaginal instruments.

Washer-sterilizer/disinfector

Equipment that washes and decontaminates instruments so that they can be safely handled by personnel.

T/F Disposable sharps such as scalpel blades, needles, and other disposable instruments are disposed of in the trash.

False All sharps are disposed in puncture-proof containers to prevent injury. A sharps container.

T/F Instruments are placed in a separate basin, with the lighter ones on the bottom and the heavy ones on top.

False heavy ones on bottom and lighter ones on top.

Creutzfeldt-Jakob Disease (CJD)

Fatal disease caused by prions. Highly infective in central nervous system tissue. Prions are not destroyed by normal means of mechanical or chemical sterilizations.

Centers for Disease Control and Prevention (CDC)

Federal agency that provides research and protocols in all areas of public health.

Process monitoring is divided into categories according to the mechanism of the system. List the categories.

Physical Chemical Biological

Anitsepsis

Process using a chemical to remove microorganisms from skin or other tissue.

Association of periOperative Registered Nurses (AORN)

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

Association of Surgical Technologists (AST)

Professional organization of surgical technologists that publishes guidelines for many practices in the perioperative setting.

Association for the Advancement of Medical Instrumentation (AAMI)

Provides recommended practices and technical information for the U.S. medical professions. Standards are developed with support of the FDA.

Immediate-use steam sterilization (IUSS)

Rapid sterilization of instruments to be used immediately. The process was previously called flash sterilization.

Contaminated

Rendered nonsterile and unacceptable for use in critical areas of the body.

ECRI Institute

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

The Spaulding system differentiates methods of sterilization for an item based on:

Risk of infection

Close of Surgery

Scrub separates the equipment by category: Sharp Delicate Heavy Non-immersible Immersible

Evidence based Practices

Standards for the sterilization and disinfection of instruments, devices, and equipment in the perioperative environment are _____________________________.

Critical/high risk items are those that contact:

Sterile tissues

Clean

The absence of visible soil on a surface.

The Joint Commission (TJC)

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

U.S. Food and Drug Administration (FDA)

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

Sterile Processing Department (SPD)

The hospital department where medical devices and equipment are reprocessed; this process may also be in a Central Processing (CP) department.

Bioburden

The number of contaminating microbes on an object.

Environmental cleaning

The process of cleaning the surfaces in patient care areas, including the operating room. This includes floors, cabinets, equipment, lights, and furniture.

Point-of-use cleaning

The scrub prevents the build-up of blood and tissue debris on instruments during the surgical procedure.

Toxic anterior segment syndrome (TASS)

This is an acute inflammatory condition in which the anterior segment of the eye becomes damaged, with possible injury to the intraocular tissue and loss of vision.

Exposure time

This is the amount of time goods are held in specific conditions during disinfection or the sterilization process. Exposure time varies with the size of the load, type of materials being sterilized, and the type of agent used. Exposure time is sometimes called the hold time.

T/F All instruments opened on the sterile field must be processed regardless of whether they were used in the surgical procedure.

True

T/F All loaner instruments should be processed first by decontamination and then by sterilization method approved for those particular instruments by the manufacturer.

True

T/F Biological monitors are always used when an artificial implant or prosthesis is sterilized.

True

T/F The contaminated equipment is placed on a covered or closed transportation cart for transfer to the decontamination area.

True

Storage

Wrapped sterile instruments are stored in a specific way and place to prevent their contamination during storage.

Peel pouches are intended only for ________________ instruments and devices.

lightweight

Virus

nonliving infectious agent.

Biological controls should be administered at least once ___________________ in all sterilizers.

weekly

Non-critical/low risk items come in contact with:

Intact skin

Antiseptic

Is a chemical used to remove microorganisms on skin or other tissue.

High risk/Critical items

Items that come in contact with sterile body tissues such as internal organ systems and the vascular system. All medical devices in this category must be sterile. Ex. surgical instruments, vascular cannulas, and hypodermic needles.

Low risk/non-critical items

Items that only come in contact with intact skin. These require cleaning with a low-level disinfectant. Ex. Blood pressure cuff, and stethoscope.

Centers for Disease Control and Prevention-Healthcare Infection Control Practices Advisory Committee (CDC-HICPAC)

Join federal agencies that provide research and protocols in all areas of public health and infection control, including those in the professional environment.

Monitoring

Means: checking, recording, and reporting.

Semi-critical/intermediate risk items come in contact with:

Non-intack skin or mucous membranes

Cleaning the instruments

Instruments are cleaned to remove tissue and other debris in preparation for the next phase.

Bactericidal

Able to kill bacteria.

Sporicidal

Able to kill spores.

Reprocessing

Activities or tasks that prepare used medical devices for use on another patient.

Woven wrappers

Also called linen or cloth wrappers, these are fabric cloths used to wrap clean, disinfected supplies in preparation for a sterilization process.

Prion

An infectious protein particle that is unique pathogenic substance containing no nucleic acid. The prion is resistant to most forms of disinfection and sterilization normally used in the health care setting.

Decontamination

Instruments are put through a rigorous process of washing and decontamination to make them safe for handling.

Turnover

Cleaning, disinfection, and preparation of the operating room between patients.

Quality control

Includes monitoring the technologies (steam sterilizer or instrument washer) used in reprocessing, as well as the human factor (person following the correct procedure, do they understand the process, are they protecting themselves from injury during the process)

Single-use items

Instruments and devices intended for one-time use on a patient only.

Sorting and inspection

Instruments and other devices that have been decontaminated are separated by type and inspected for damage, malfunction, or incomplete cleaning.

Assemble and Wrap

Instruments are assembled in standardized sets according to a specific type of surgery. Instrument sets or single items to be sterilized by steam or gas are wrapped in a prescribed way to protect their sterility following reprocessing.