Sterile Processing CBSPD Test

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Joint Commission

"Tracer Methodology"

(M) SDS

"right to know"

if a sterilizer has successfully killed all bacterial spores in a BI

"test" and should result negative

NEVER "____ ____" just to refill one jug of liquid(detergent) to another

"top off"

during cycle counts items that have a large dollar value but are not frequently used are classified as

'A' items

artificial nails in SPD?

(CDC) No, potential for fungal contamination

a biological indicator is placed in a LTGP/hydrogen peroxide unit

(minimum) daily, preferably every load

used to remove severe stains on stainless steel instruments; do not routinely use in manual bath; very corrosive; can cause irreversible damage

(organic) acid detergent

low temp friendly peel pouches...

(spunbound) Polyolefin-Plastic combo (gas plasma); contain NO cellulose

cerebrum

*center of consciousness; largest part of brain

liver

*largest INTERNAL organ; produces and secretes digestive enzyme bile

small intestine

*longest part of GI tract; receives chyme; liver and pancreatic secretions breaks down chyme; absorbs nutrients and transports waste to large intestine

occupational exposure limit for HLD is ._____ ppm; routine monitoring of employees is req'd

.05 ppm

HLD Glutaraldehyde has a ceiling threshold of

.05ppm

there is ___ chemical indicator in each ppk so it can be seen

appropriate measure of space instrument should have within a ppk to include several ppk being slotted side by side on a rack

1 inch

medical grade marking tape should wrap around instrument...

1 to 1.5 times

should be left between an item packaged for sterilization and the inside edges of a peel pouch

colored marking tape (if authorized) is to circumference area

1-1.5 times

1 micron=

1/25 thousandths of an inch

most bacteria (size)

1/25 thousandths of an inch (microns)

fingernails should be

1/4 inch or less

nails must be

1/4" or shorter; avoid artificial nails

air exchanges per hour (decon)

prep/packaging environmental conditions

10 air exchanges under positive pressure, 68-73 degrees F, humidity 50% (not less than 35%), appropriate PPE; all packaging material should be held at this temp and humidity for 2 hours prior to sterilization

average sonic time

10 mins (sometimes more)

Decontamination Air Exchange Requirement

10 per hour

Prep Assembly and Packaging Air Exchange Requirement

10 per hour (same as decon)

travel time to eyewash station

10 seconds

eyewash stations should be placed with ______ seconds or _____ meters of potential chemical exposure

10 seconds; 30 meters

BI spore content

10-6

an item is considered sterile if Sterility Assurance Level reaches

10-6

ideal level of silicates in water used for cleaning

100 ppm

tap water should ideally have a concentration of

100ppm or less

ideal level of silicates in water

100ppm or less; tap water should ideally have same(100ppm or less)

air exchanges, prep/assembly

10ph under positive pressure

Major body systems

11; Skeletal, Muscular, Nervous, Endocrine, Circulatory; Cardiac, Lymphatic, Digestive, Integumentary, Respiratory, Reproductive, Urinary

OSHA recommends no more than ____ EtO canisters to be stored in a flammable cabinet

average Cidex OPA (HLD) soaktime

12 mins

maximum size and weight of textile pack

12"x12"x20" and 12 lbs

correct incubation temp range for biological indicators used in steam sterilization

131-140 F

average ideal atmospheric pressure prevac steam sterilizers at sea level

14.7psi

initial AMW cycles use water at a temp under ______ degrees F

140 degrees F

suspected prion exposure instrumentation may require (cycle)

18 min @273 F prevac steam cycle

final AMW cycle uses treated water at _____ degrees F

180 degrees F

first of five major steps for flexible endoscopes

1st *Leak testing; if require underwater testing=DI/treated water and NO detergent; test failure (call mfg for instruction on returning for repair; decon first)

for steam- a BI is ran with

1st load of the day and with implants

rigid containers are considered class _____ devices and regulated by _______

2 (II); FDA

geobacillus stearothermophilus; bacillus atrophaeus

2 most common biological spores involved in SPD sterilization

sequential wrap

2 thin wraps used 1 after the other

shelving in sterile storage must be kept

2" from wall

considered most appropriate for high level disinfection of semi critical devices

2% activated glutaraldehyde

which solution is generally considered MOST appropriate for HLD of semi-critical devices?

2% activated glutaraldehyde

a plastic maintenance dust cover (thickness)

2-3 millimeters

changing sharps containers when they are _______ full help prevent sharp injuries.

2/3

bones in the adult body

206

adult body consist of _____ bones

206; plus ligaments and cartilage

if unfortunate event were to occur

24 hours to file incident report

Any injury to an employee; documented and reported within _____ hours in an ________________

24 hours; incident report

overall weight for rigid container; not to exceed

25 lbs

appropriate sterilization cycle for an autoclave load containing a basin set, a minor surgery set and twelve towel packs

270 degrees F for 4 mins, 30 PSI, and 30 mins dry time

minimum pressure steam autoclave must reach in chamber

27psi

rigid sterile containers need at least ____ chemical indicators, preferably ____

2; 4

second of five major steps for flexible endoscopes

2nd Decontamination; manual pre-cleaning req'd (enzyme cleaner with treated water in small bath for ONE scope and DO NOT REUSE, followed by single use sponges (same goes for camera, cords etc); single use brushes used for only one scope and discard; rinse then dry(soft/lint free) scope; *on to pass through window for sterilization OR continue to step 3

how many consecutive test should be performed for steam (autoclave) sterilizer once it is installed/relocated, after a malfunction, the unit is turned off completely

spiral, round and rod like

3 basic shapes of microbes

transportation, regulation, protection

3 main functions of the circulatory system

saturated steam entering sterilizer should have _____% of entrained water

sterilizer setting for bowie dick dart

3.5-4 @270 F dynamic air removal

average steam cycle

3.5-4 mins @270 F, 20-30 mins of dry time

Decontamination Humidity Requirement

30-60%

Prep Assembly and Packaging Humidity Requirement

30-60% (same as decon)

(AAMI) sink in SPD decon

36" from floor, 8-10" deep

AAMI recommendations on manual cleaning sinks

36" from floor; 8-10" deep (some may have pre-measured line for detergent vs water ratio)

minimum # of air exchanges per hour in sterile storage

4 @ positive pressure

minimum exposure time, temp and pressure for prevacuum steam sterilization of wrapped items

4 mins @270 F and 28-30 psi

Clean/Sterile Storage Air Exchange Requirement

4 per hour

the inventory of medical and surgical supplies can represent up to ____% of a facility's operating budget

40%

used to manufacture osteotomes

400 series stainless steel

average soak time for manual bath

5-10 minutes (sometimes more)

VRE can survive on hard surfaces for ___-___ days and on the hands for ____________

5-7; hours

prior to use any medical grade item (including rigid containers) must have ______________ testing performed; FDA approved via ________K certification; this testing should be executed even ____________ device is purchased

510; before

FDA official document needed for any medical device

510K

normal concentration of hydrogen peroxide in a LTGP sterilizer

59%

related concentration for h2o2 in LTGP

59%

Decontamination Temp Requirement

60-65 Degrees (F)

most effective concentration for alcohol based antiseptics

60-95%

alcohol based hand antiseptics

60-95% concentration, only recommended if hands are not visibly soiled

Prep Assembly and Packaging Temp Requirement

68-73 Degrees (F)

average pH

average targeted pH of typical enzymatic detergent used, pure water and human blood

basin sets should not exceed ____ pounds

sterile storage humidity should not exceed

70%

Clean/Sterile Storage Temp Requirement

75 Degrees (F) or lower

temp in sterile storage should not exceed

75%

water in the ultrasonic should be replaced every ______ hours or when visibly dirty

OSHA mandated employees TWA for EtO

8 hours

temperature; manual bath

80-110 degrees F; not to exceed 140 deg F (cause enzyme to become inactive)

SPD should be capable of planning for approximately ____% of the total needs of a unit

90%

saturated steam should possess a relative humidity level of

97-100% for effective steam sterilization

incoming saturated steam should be within

97-100% range of dryness

if you have a fever your temp would be above

98.6 F

minimum exposure time for wrapped goods in a dynamic air removal steam cycle

@275 F; 28-30 psi; 3 mins

assembly of instrument set according to ________ standards

AAMI

Agencies that set standards

AAMI, CDC

inventory management strategy that indicates store room controls should first address the relatively few items with the greatest value

ABC analysis

reprocess flexible endoscopes by means of special connectors enclosed with a chemical agent (usually peracetic acid, glutes or OPA); Liquid Chemical Sterilant(LCS); use correct tubing; watch for kinks; perform req'd pre-manual cleaning; * attach all channel connectors according to mfg instructions; NOT for rigid endoscopes

AER

Fire Safety

ALL equipment (including personal) should be safety checked by Biomedical Engineering Dept. and approval label attached before use

develops nationally recognized standards , recommended practices and guidelines for perioperative setting

AORN

AAA

Abnormal Aortic Aneurysm

acromi/o-

Acromion (ext of shoulder bone)

ANT

ACL

Anterior Cruciate Ligament

AVR

Aortic Valve Replacement

Appendicular skeleton

Appendages

AERs

Automatic (flexible) Endoscope Reprocessors

ex/o-

Away from, external, outward

bony and cartilaginous parts that support and protect head, neck and trunk

Axial skeleton

BKA

Below the Knee Amputation

BMT

Bilateral MyringoTomy

BSO

Bilateral SalpingoOopherectomy

removing both fallopian tubesand ovaries

Bilateral SalpingoOpherectomy (BSO) (reproductive)

BTM

Bilateral Tubes w/ Myringotomies

Biopsy

No EPA registered products are available for inactivating C.Diff spores BUT

Bleach (hydrochlorite solution) has been shown to decrease rates of C.Diff contamination on environmental surfaces

BSE

Bovine Spongiform Encephalopathy; mad cow disease

transferred person to person, affects GI tract, may be decreased on surfaces with hypochlorite (bleach)

C. Diff

removing vein from lower limb to bypass blocked coronary artery

CABG (circulatory)

Two groups that certify

CBSPD (Cerification board for sterile processing and distribution, IAHCSMM (International association of healthcare central service material management)

promotes health by controlling/preventing disease

CDC

dental instruments

CDC recommends critical and semi-critical items that are NOT heat sensitive be steam sterilized after cleaning; HEAT sensitive semi-critical items should be cleaned and HLD; lumen is oiled* (gravity sterilization)

Cancelled

Types of muscle tissue

Cardiac; Smooth; Skeletal

CTR

Carpal Tunnel Release

CTS

Carpal Tunnel Syndrome

chain of infection

Causative agent, reservoir of agent, portal of exit, mode of transportation, portal of entry, susceptible host

Sterile processing is A.K.A

Central Material Service, Sterile Processing Service, Central Service, Sterile Processing Department

CSF

Cerebral Spinal Fluid

Modes of Disease Transmission

Contact; direct(physical contact), indirect(inanimate objects(fomites) and ventilation), droplets(respiratory secretions), airborne; Vehicles (air, food, water)

CABG

Coronary Artery Bypass Graft

Spaulding Classification

Critical (exposed to sterile areas of the body; must be sterile); Semi-Critical (touches mucous membranes; recommended sterile or high level disinfected); Non Critical (touch the skin; can be cleaned or disinfected; less than high level disinfection)

enforces laws; transportation of medical waste

DOT

before setting instruments in sonic cleaner

Degas (remove the air)

Diagnosis

D&C

Dilation and Curettage

sterile and clean items dispensed, window

Dispatch

infection control is the responsibility of

Dr's, RN's, surgical techs and SPD techs

fifth of five major steps for flexible endoscopes

Dry (*more critical to HCF using EtO); scope may be flushed with 70% alcohol to facilitate drying

before a pesticide can be marketed and used must be evaluated and registered by

EPA

creates and enforces laws; clean air, water and land

EPA

responsible for approving new environmental disinfectants prior to their being sold to HCF

EPA

which agency would approve the disinfectants used on floors and walls in the sterile processing department

EPA

would approve disinfectants used on floors and walls in SPD

EPA

Government Agencies

EPA, FDA, OSHA

Agencies that issue regulations

EPA, FDA, OSHA and State health departments

responsible for regulating EO

EPA,FDA

EEG

ElectroEncephaloGram

ESS

Endoscopic Sinus Surgery

two categories chemical families are divided into

Environmental Disinfectants; High-Level Disinfectants

layers of skin (superficial to deep)

Epidermis, Dermis, Hypodermis (subcutaneous)

plastic paper peel pouches used for steam and ______; NOT compatible with low temp plasma (____________)

EtO; Sterrad

OSHA required 8 hr TWA for each low temp sterilization process

EtO= 1.0ppm/ LTGP H2o2= 1.0ppm/ Ozone= 0.1ppm

discipline dealing with what is good or bad and with moral duty and obligation

Ethics

EUA

Exam(ination) Under Anesthesia

EXC

Excision

EXPL

Exploration

Ex Lap

Exploratory Laparotomy

Ex-Fix

External Fixation

agency; requires medical devices mfg to provide instructions on how to process

FDA

chemical and biological indicators must be cleared by

FDA

chemical and biological indicators must be cleared by which agency?

FDA

pre/post market medical device requirements, "medwatch", device classification and recall

FDA

a proper full gallon chemical agent disposal will most likely need to be communicated with

FDA and or EPA

IFU

FDA requires these specific instructions on how to clean and sterilize products

surgical N-95 mask

FDA- cleared as surgical mask, NIOSH certified as respirator; have all the qualities of N-95 along with evaluation for fluid resistance, flammability and biocompatibility

rotating stock to ensure that the oldest supplies are used first

FIFO (First In First Out)

to ensure the end of a scope lens is not foggy/smudged; recommended testing item

FRD (NOT alcohol-micro cat like scratches)

NFPA Red Diamond

Flammability

Foreign Body

Fracture

FTSG

Full Thickness Skin Graft

HLD; used on critical and semi-critical, immersible devices; most common formulation is Cidex; should NEVER be used as an environmental disinfectant (not a cleaning agent; possible requirement for employees to be routinely monitored for exposure levels; this HLD has ceiling threshold of .05ppm

Glutaraldehyde

disease caused in the course of being treated in a hospital

HAI/Nosocomial infection

Nosocomial Infection

HAI; disease caused in the course of being treated in a hospital

Confidentiality

HIPAA (Health insurance portability and accountability act)

low level disinfection is level needed for destruction of

HIV

kills most microorganisms but not necessarily spores

HLD

mycobacteria (method of destruction)

HLD

Ortho-phthaldehyde (OPA)

HLD; contains .55% ortho-phthaldehyde; one formulation known as Cidex OPA; items must be thoroughly cleaned, rinsed and dry; residual soil will show a blue stain on improperly cleaned instrument; patients skin can be discolored by chemical residue if not thoroughly rinsed 3 separate times

third of five major steps for flexible endoscopes

HLD; if HCF authorizes this method

HWR

HardWare Removal

HCF

HealthCare Facility

responsible for 90,000 deaths per year in the US according to CDC

Healthcare Acquired Infections; HAIs

Handheld instruments (7 basic categories)

Hemostats (clamps), scissors, needle holders, forceps (tissue/dressing), retractors (handheld/self retaining), laparoscopic instruments, miscellaneous instruments

a liver biopsy would be performed to test for....

Hepatitis C

ortho-phthaldehyde is a (disinfectant)

High Level Disinfectant

HLD

High Level Disinfection

semi-critical items require

High Level Disinfection

the process that kills most microorganisms but not necessarily spores

High Level Disinfection

when processing a never before seen instrument follow mfg

IFUs

passivation layer can damaged by ...

Improper handling of instruments (dumping on table, scratching surface (metal brushes), wrong cleaning agents, chemicals (saline, bleach, hard water, flash sterilization); Stains (electrolysis, high alkaline deteregent, iodine, solutions (NACL), caked on blood)

requisitions filled and delivered as they are received

In Demand distribution system

(Right OR Left) IHR

Inguinal Hernia Repair

INS

Insertion

NFPA Yellow Diamond

Instability

Intra-Medullary (femur/humerus)

IOC

IntraOperative Cholangiogram

I & D

Irrigation & Debridement

provides standards and evaluations for HCF, conducts onsite inspections, "Tracer Methodology"

Joint Commission

medical grade kraft paper can not be used with

LTGP

cotton gauze sponges should not be processed in

LTGP sterilizers

no implants in

LTGP/LTHP only autoclave

Lap Appy

Laparoscopic Appendectomy

LAVH

Laparoscopic Assisted Vaginal Hysterectomy

Lap Chole

Laparoscopic Cholecystectomy

LROU

Lateral Rectus both eyes

when a new medical device is purchased and received in spd tech must have

MFG IFU before processing

ALL contaminated items arriving to decon from OR, wards etc

MUST be containerized with lid during transport

Personal Protective Equipment (PPE)

MUST be worn to protect from blood and bodily fluid

MROU

Medial Rectus both eyes

A combining vowel (o) is dropped or added to aid in pronunciation of a

Medical term

MIS

Minimally Invasive Surgery

minimum concentration of a liquid chemical sterilant/HLD that achieves the claimed microbicidal activity

Minimum Effective Concentration (MEC)

Portals of Entry

Mucous membranes (respiratory, GI, Genitourinary, conjunctiva); Skin (broken, hair follicles, sweat glands); Parenteral Tissue (injections, bites, cuts and wounds)

Salmonella, M.tuberculosis, E.coli, streptococcus

Multi-Drug Resistant Organisms

a soap dispenser (wall-mounted or portable) should __________ be on or around the same sink used for decontaminating instruments; includes alcohol based waterless solutions

NEVER

a thermometer is _______ classified as a critical medical device

NOT

basin/bowls should _________ be inside instrument sets

NOT

NFPA

National Fire Protection Association

Cell structure

Nucleus>Cell Wall>Cell Membrane>Cytoplasm>Cilla and Flagella

bloodborne pathogen exposure regulated by

OSHA

eyewash stations must be available for emergency use

OSHA

exposure control plan

OSHA designed to protect employees against exposure to bloodborne pathogens

Responsible for regulating EO gas

OSHA, EPA

are involved with regulation and control of EtO when used as a sterilant (not CDC)

OSHA,EPA and FDA

Ergonomics

OSHA; fitting the job to the worker, prevent injuries before they occur

Standard Precautions (FKA Universal Precautions)

OSHA; handling infectious material as if they were infectious

hemi-

One half

Open Heart

ORIF

Open Reduction Internal Fixation

limits developed by OSHA to indicate the maximum airborne concentration of a contaminant

Permissable Exposure Limit (PEL)

PMR

Posterial Medial Release

PLIF

Posterior Lumbar Interbody Fusion

removing disc tissue pressing on lower spine, inserting piece of bone between vertebra and fusing area with plates and screws

Posterior Lumber Interbody Fusion (PLIF) (skeletal)

P>A>S>S (operation of fire extinguisher)

Pull the pin; Aim the nozzle; Squeeze the handle; Sweep the stream over base of fire

PASS (use of fire extinguisher)

Pull. Aim, Squeeze, Sweep (base)

Pulmonary Artery

used for cleaning inanimate environmental surfaces and floors

Quaternary Ammonium Compounds (QUATs)

Environmental Protection Agency (EPA)

Registers and regulates environmental disinfectants, controls emissions into the air and water, regulates the manufacture and sale of EO gas

RACE

Remove/Rescue, Alarm, Confine/Contain, Extinguish

R>A>C>E (fire safety)

Remove/Rescue; Alarm; Contain/Confine; Extinguish

main function is to supply oxygen to the body and remove carbon dioxide from the body; *the area where homeostasis (regulation) of pH occurs in the body

Respiratory system

REV

Revision

RCA

Root Cause Analysis

a repair to the muscles and ligaments of the shoulder joint

Rotator Cuff Repair

repair to muscles and ligaments of the shoulder joint

Rotator Cuff Repair (muscular)

OSHA Hazard Communication Standard

SDS must be available for each chemical in the dept

manufacturers instructions for processing

SPD tech must have this information before processing a new medical device

Surgical Site Infections (SSI)

SPS must do their part in their duty to prevent

STSG

Split Thickness Skin Graft

SAD

SubAcromial Decompression

SSI

Surgical Site Infections

Evironmental Controls

Temp, Humidity and Air exchange requirements

TMJ

Temporal Mandibular Joint

TAL

Tendon Achilles Lengethening

TOSI; for mechanical washers

Test Object Surgical Instruments; amber color wipes clean

Making an opening into thoracic cavity to give surgeons access to lung and heart

Thoracotomy

TDC

Thyroglossal Duct Cyst

T & A

Tonsillectomy & Adenoidectomy

TAH

Total Abdominal Hysterectomy

THA

Total Hip Arthroplasty

TSA

Total Shoulder Arthroplasty

TASS

Toxic Anterior Segment Syndrome; patient could go blind, have severe infection, need to have special antibiotics/surgery

TEE

TransEsophageal Echocardiogram

TUR

TransUrethral Resection

TURP

TransUrethral Resection of Prostate

TSE

Transmissible Spongiform Encephalopathies

resistance barriers

UNBROKEN skin and mucous membranes

UDT

UnDescended Testicle

UPJ

UreteroPyloric Junction

UPPP

UvuloPalatoPlasty

typical order of LTGP process

Vacuum, Injection, Diffusion, Plasma and Vent

VRE

Vancomycin Resistant Enterococcus

VDO

Varus Derontational Osteotomy

furthers international cooperation in improving health conditions

WHO

Decontamination Area

Where soiled items are received and cleaned. *All levels for the same tray should be labeled w/a tag to identify the level number and set to which it belongs.

classify bacteria by color change (red/pink, purple/blue)

Ziel-Nelson and Gram Stain

all loads containing implantable devices should be monitored with

a biological indicator

to avoid TASS spd tech in decon should use

a fresh bath in manual bath and ultrasonic and eye instrument cycle in automated washer

is required for rinsing when a high alkaline detergent is used in a mechanical washer

a neutralizing acid

Immediate Use Steam Sterilization (IUSS/Flash) may be used when

a one of a kind, emergently needed instrument underwent contamination

susceptible host

a person or animal that lacks the ability to resist infection by infectious agent

steam gun

a powered nozzle on a long stick(wand); used to clean wheels on patient care equipment, clean case carts, stretchers, etc.; to avoid steam burns wear appropriate PPE (rubber boots and heat resistant gloves)

Regulation

a principle, rule, or law designed to control or govern behavior.

-esis

a process

simultaneous wrapping means to wrap an instrument set with

a single non-woven wrapper, double ply, bonded at the edges

fiberoptic light cables should be cleaned with

a soft cloth and detergent

surfactants

a surface acting agent that lowers the surface tension of a liquid so it can penetrate deeper and prevent debris from being re-deposited (suspension)

may be placed in the bottom of a tray to aid in the drying of wrapped instrument sets

a towel

lapar/o-

abdomen

peritoneum

abdominal lining covering internal organs

an instrument tray for a laparotomy procedure must include an

abdominal retractor

gram positive organisms (rods/bacilli)

ability to slow down metabolism and become dormant when environment threatened; form (endo)spores

-ago, -esis, -ia, -iasis, -osis

abnormal condition, disease

-sclerosis

abnormal hardening

-stenosis

abnormal narrowing

prion

abnormal protein

supra-

above

hyper-

above, excessive

supra-

above, upper, excessive

towels/liners in bottom of/under tray ....

absorb moisture to prevent condensation, facilitate drying; protects instruments; prevents tears in wrapper

items to be separated inside instrument sets; be placed in ________________ non packaging material (surgical towels, autoclavable bags, medical grade kraft paper, pouch rolls); chemical indicators/integrator inside

absorbent

not all materials are __________________ for all types of sterilization

acceptable

teeth

accessories of mechanical chewing

powered equipment should be lubricated

according to mfg instructions

acetabul/o-

acetabulum (hip socket)

best used for removing mineral rust deposits from metal instruments; average soak time 15-30 mins

acid

acceptable means of marking instruments

acid based etching; heat fused nylon (color coding/dipping); laser etching; marking tape

a solution with a pH of 3

acidic

pH is a measure of

acidity/alkalinity

trans-

across

trans-

across, through

Ethical Actions

actions that conform to accepted and professional standards of conduct.

sterile storage should be located

adjacent to sterilization area

EtO requires

aeration after processing

aerobic bacteria

aerobes; require free oxygen to grow

bacteria that requires oxygen to grow

aerobic

mycobacterium

aerobic, non-spore forming, non-moving, rod-shaped organisms; usually found in soil

sometimes __________ sterilization, mfg'd sterile items can be placed in plastic bag labeled w/ tray name THEN attached outside sterilized tray (cooled if autoclaved) THEN tray and plastic bag placed inside dust cover

after

PCE should be cleaned and disinfected

after every use

post-

after, behind

anti-

against

liners (soaker sheets) are placed flat on the bottom of mesh tray to

aid in drying of wrapped sets

vertically soaking and cleaning lumened instruments prevents

air bubbles from forming

negative pressure

air exhausted directly to the outside

bowie dick test id used to detect

air leaks or insufficient air removal

bowie dick dart is used to verify

air removal mechanism is functioning properly in steam sterilizer

drains in pre-vacuum and gravity displacement sterilizers are placed at the bottom front of the sterilizers because..

air tends to concentrate at the bottom of the chamber

no ________ for sterrad incubator, visually read

alarm

________________ is not recommended for testing/cleaning of scope lens due to causing micro cat like scratches on lens surface

alcohol

a solution with a pH of 13

alkaline

pH of 9 or more

alkaline

multi-step process in a mechanical washer; to reduce the potential for instrument corrosion

alkaline wash, acid rinse, regular rinse

EtO gas kills microorganisms by

alkylation

the process by which Ethylene Oxide destroys microorganisms

alkylation

acrylic nails are not permitted in prep and packaging because they can....

allow fungus to grow beneath them

sigmoidoscope

allows for visual inspection of lower part of large intestine

gastroscope

allows for visual inspection of upper digestive tract

engraving should not be used to mark surgical instruments because

allows microbes to harbor

par-, para-

alongside, near, beyond

intermittent suction

also known as wagenstein or gomco, uses intermittent suction to gently suction out the stomach

Minimum Effective Concentration (MEC) test

also referred to as minimum recommended concentration; req'd before each use of solution; is the minimum concentration of a liquid chemical sterilant/HLD that achieves the claimed microbicidal activity; commercial test strip; date of expiration must be on container

can be used as a simple test to check functioning of ultrasonic cleaner

aluminum foil

test for ultrasonic place __________ __________ in unit; if working correctly there will be small pinholes from cavitation and numerous creases in foil

aluminum foil

HLD may be neutralized with

ammonia

proper neutralizing agent for HLD spill

ammonia

basin sets should be prepared for sterilization with

an absorbent material between each basin

a diagnostic may be required to run in an AER with PA prior to

an actual load being run

wicking material

an approved absorbent material that allows for air removal, steam penetration and facilitates drying; non woven

a confidential medical evaluation must be performed when

an employee is exposed to blood/body fluid

Standard

an established norm determined by opinion, authority, research and/or theory.

tetanus and botulism classified as

anaerobic bacteria

refers to the form and organization of body parts

anatomy

bowls, kidney basins, medicine cups and the like should be placed

angled to the upside down position to facilitate drainage and avoid condensation

host

animal, plant or human that supports the growth of microorganisms

tarsals

ankle; metatarsals and phalanges form ankle and foot

used topically to prevent or inhibit growth of microorganisms on living tissue

antiseptics

ano-

anus

patient care equipment or devices

any medical equipment designed by the mfg to be reused for multiple patients

when using sequential wrapping method

apply one wrapper followed by a second one

when using the sequential wrapping method...

apply one wrapper followed by a second one

used when disinfecting patient care equipment or possibly environmental surfaces

approved clorox bleach wipes

when selecting size for peel pouches...

approximately 1" of space between item and edge; do not use paper clips, staples, pins, rubberbands

Powered Surgical Instruments (PSI)

are NOT to be cleaned using a mechanical cleaning process(ultrasonic, washer); manual ONLY

brachi/o-

arm

axill/o-

armpit

circum-

around

peri-

around

carries blood away from the heart

arteries

Coronary Artery Bypass may be performed on a patient with ..

arteriosclerosis

coronary artery bypass surgery may be performed on patients with....

arteriosclerosis

arteri/o-, arter/o-

artery

under standard precautions, all blood and other potentially infectious material are handled

as if they were infectious

for testing of rigid sterilization containers, the BI should be placed

as recommended by MFG of container

large intestine

ascending colon; transverse colon; descending colon; sigmoid colon; rectum; forms, stores and expels feces through anus

absence of microorganisms that cause disease

asepsis

double peel packs are mainly used for ___________ presentation in OR

aseptic

a technician in decon notices that maintenance worker did not remove barrier attire when leaving the area to get tools, the technician shoulppd

ask the maintenance person to remove barrier attire when leaving the area

eyebrow, facial muscles, eyelids, eyelashes, conjunctiva and tear ducts

associated structures of eye

microorganisms can wick into package that is still moist

at the end of a steam cycle

separated by mitral (bicuspid) and tricuspid valves

atria and ventricles

atri/o-

atrium

append-

attach

employees should be trained in the appropriate

attire to wear when performing specific tasks

300 series stainless steel

austenictic

paper-plastic peel pack and/or paper-plastic tip protector are not allowed inside

autoclave rigid container set or soft textile wrap

thermal disinfection can be accomplished with the use of _______________ _________________, washer decontaminators, washer disinfectors

automated washers

powered surgical equipment should not be cleaned using

automated washing/ mechanical process

major divisions of nervous system

autonomic/involuntary nervous system; voluntary nervous system

Emergency eyewash stations

available within 10 seconds/30 meters of chemicals; hands-free; test regularly and document, 0 4 gallons of water.

damage to medical/surgical supplies stored in the receiving area can be avoided by

avoiding temperature and humidity extremes

ab-

away from

dis-

away from

ex-

away from, out

sternum found in (skeleton)

axial

rod shaped bacteria

bacilli

used to test for: dry heat sterilization and EtO

bacillus atrophaeus

binary fission

bacterial reproductive process that takes place when a mother cell divides into two daughter cells

cover garment in prep area because of

bacterial shedding from arms

jackets in prep and packaging prevent

bacterial shedding from bare arms

dys-

bad

water with EtO

bad combination, deleterious to patient, no water should remain in lumens of endoscope, channels or any area prior to processing

tendon

band of tissue connecting muscle to muscle

ligament

band of tissue that connects bones

an integral part of tracking system

bar-coding of instrument sets

powered surgical instruments (PSI)

battery powered, electrical and air power (pneumatic)

to prevent needlestick injuries

be aware of visible surroundings; needles and other conatminated sharps should never be recapped, purposely bent or broken by hand

pre-

before

always wash hands (when?)

before and after going on duty, before and after meals, after using bathroom, after sneezing/coughing into hands, after handling soiled items(garbage), before and after gloving, etc

cleaning/sterilization instructions requested from MFG

before the item is purchased

rigid sterilization containers must be biologically tested

before they are purchased

ante-

before, forward

fore-

before, in front of

retro-

behind, backward, back of

initial water in manual bath should not be too hot (temp)

below 140 F

infra-

below, beneath

hypo-

below, deficient

pron/o-, pronat/o-

bent forward

inter-

between

temperature on ultrasonic water

between 100-140 degrees F

ultra-

beyond, excess

chol/e-

bile

liver produces

bile

bacterial reproductive process; cell divides

binary fission

blood, tissue and/or body fluids on surgical instruments

bioburden

number of microorganisms on contaminated item

bioburden

disposable sharps removed and properly disposed of in

biohazard labeled rigid container

soiled items held in user dept for pick up must be stored in designated area and labeled with

biohazard sinage

Regulated Medical Waste (RMW)

biohazardous waste or infectious medical waste (contaminated by blood, body fluids or other potentially infectious material); requires special handling and treatment prior to disposal

monitoring method, verifies that conditions within the load were adequate to kill bacterial spores

biological

vial containing spore test cycles/loads within a sterilizer

biological indicator

department that checks surgical electrical equipment/ personal use prior to use

biomedical engineering department

microgrind, supercut, supersharp blades

black rings/handles **NOT to be confused w/ ebonized

cyst/o-

bladder, cyst, sac of fluid

sodium hypochlorite

bleach

-rrhage, -rrhagia

bleeding, abnormal excessive fluid discharge

vesic-

blister

connective tissue fluid; moves throughout the circulatory system; erythrocytes (red)/ leukocytes (white)

blood

hem/o-, hemat/o-

blood

vascul/o-

blood vessel, little vessel

bioburden

blood, tissue and or body fluids on surgical instruments; number of microorganisms on a contaminated item

contaminated surgical instruments should be transported to decon immediately to prevent...

blood/body fluids/other contaminates from drying; extended drying will damage instruments over time

(OSHA) hospital's exposure plan helps protect employees against exposure to

bloodborne pathogens

Under OSHA, a hospital's exposure control plan is designed to help protect employees against exposure to these

bloodborne pathogens

steam BI for gravity displacement

blue

titanium

blue

will be obvious on an improperly cleaned instrument that has been disinfected in ortho-phthaldehyde

blue stain

in non table top steam sterilizers steam is generating in

boiler

steam itself is generated in the

boiler of the autoclave

oste/o-, os-, ost-

bone

stapes

bone in inner ear

red blood cells develop

bone marrow

metatarsals

bones in the feet

metacarpals

bones in the hands

femur, patella, tibia, tibula (appendicular)

bones of lower limb

humerus, radius, ulna (appendicular)

bones of upper limb

carpals

bones of wrist

ambi-

both

paper liner/towels may retain moisture; do NOT use _________ mat and liner

both

both eyes

when sorting, heavy instruments on __________, light instruments on _______. (same for prep and assembly)

bottom, top

rigid sterilization containers are complex containers w/ these parts...

bottom; inner basket; top; a gasket aligned inside top (w/no gap); latches (to secure closed); filters (vary by size; single use); valves (reusable/filterless)

chemical indicative pack, no spore, tested on 2nd cycle of autoclave to determine air removal

bowie dick dart

in qualification testing of steam sterilizers, to establish a baseline for the sterilizers performance, a BI PCD should be performed before

bowie dick test

weakest part of instrument, most likely to find cracks and most difficult to clean

box lock

ONE of the largest organs in the body; controls all movement; monitors and maintains all body systems

brain

cerebro-

brain

main control unit of central nervous system

brain

central nervous system

brain and spinal cord

CJD prion exposure can effect

brain and spinal cord, instruments can not be run in IUSS/flash/low temp *prevac steam autoclave only

Nucleus

brain of cell; where DNA is found

microbiology

branch of biology; deals with microorganisms and their effects on other living organisms

etiology

branch of science; studies the cause of and origins of disease/abnormal conditions

catabol/o-

break down

proteolytic

breakdown of blood soil

proteolytic enzyme

breaks down blood soils

mamm/o-

breast

mast-

breast

sternum

breast bone

pneum/o-, pneumon/o-

breath

spiro-

breathe

Short bones

bridges (metacarpals)

titanium instrumentation identified via

bright blue color

NOT a requirement for bacteria to survive

bright light

urethra

brings urine from bladder to outside the body

example of flexible endoscope

bronchoscope

instruments used for respiratory system

bronchoscopes; tracheostomy sets

proper gloves for HLD

butyl

Decon gloves

butyl; double gloving does NOT compensate

hospital non disposable scrubs must be laundered

by the facility

calcane/o-

calcaneus (heel bone)

you are taking a used IV pump from a nursing unit to be reprocessed the nurse tells you not to take it because there is an emergency admission and the patient will need it (ethically correct action)

call your department to have a clean pump brought up to the unit right away

small sets

can be on non perforated trays; tilt on edge in sterilizer to prevent puddle/ condensation (kidney basins, bowls etc)

instrument demagnetization

can be prevented by keeping dissimilar metals separated

jewelry not recommended in spd

can get caught in moving equipment

loose fitting clothing and jewelry should not be worn in SPD because it....

can get caught in moving equipment

carcin/o-

cancerous, cancer

resistant to heat and chemicals

capsule

breathing process removes

carbon dioxide

the breathing process removes __________ gases from body cells

carbon dioxide

longitudinal serrations

carmalt

stainless steel instruments are not approved to be ran in

cart washing machine

chondr/o-, chondr/i-

cartilage

usually used to manage instruments and supplies for individual surgical procedures; generally prepared for one special surgical case, not used for general supply replenishment

case cart system

compounds that contain a positive electrical charge

cationic

Creutzfeldt-Jakob Disease (CJD)

caused by prions; not a virus

pitting

caused by saline, potassium, chloride, blood or other compounds; detergent residue or high pH; metals with dissimilar composition processed together; electrolysis

mechanical process by which ultrasonic cleaner works

cavitation

process used by ultrasonic cleaner

cavitation

alveoli-

cavity

used to remove cement

cebatome

basic fundamental unit of life

cell

cyt/o-, -cyte

cell

nucleus

cell's brain

smallest unit possessing the basic characteristics of life

cells

should not be processed in LTGP

cellulose based sponges (or any of the like; non cellulose based only)

nervous system composed of two major parts

central nervous system (brain an spinal cord); peripheral nervous system (nerves that connect brain and spinal cord to other parts of body)

largest part of the brain

cerebrum

largest part of the brain, controls mental activities and movement

cerebrum

part of brain responsible for consciousness

cerebrum

3 parts of brain

cerebrum, cerebellum, brain stem

steam is exhausted from the sterilizer through the

chamber drain line

if PPE gets soaked with blood or other infectious material....

change immediately!

during inspection of syrgical instruments, all handheld surgical instruments must be

checked for cleanliness and proper function

bowie dick test is considered (monitoring process)

chemical monitoring process

passivation

chemical process; final stage of surgical grade instrument; provides corrosion resistant layer "finish" by forming thin transparent CHROMIUM OXIDE film; steam sterilization and regular use of water soluble based lubricant (milk) reinforces protective coating

MSDS provide health and safety hazard and risk information on..

chemicals

Material Safety Data Sheets provide health and safety hazard and risk information on what?

chemicals

sequestering/ chelating agent

chemicals that hold, remove or inactivate hard water minerals

pect-

chest

thora/o, thorac/o-

chest

thoraco-

chest

Chain of command

chief operating officer, VP nursing, sterile processing manager, SPD lead tech, SPD processing tech, SPD inventory tech, SPD case cart tech

should NEVER be used to remove gross soil on instruments

chlorine

should never be used to remove gross soil on instruments

chlorine

removing gallbladder

cholecystectomy (digestive)

layer on a surgical instrument created by passivation

chromium oxide

finished processed layer; intended to make instrument corrosion resistant

chromium oxide layer

autoclave tape is considered (indicator class)

class 1

indicators tapes, indicator dots on tamper locks and load cards (with CI on its edge) are examples of

class 1 externally visible chemical indicators

bowie dick dart test, have a categorized parameter of its own and are classified under

class 2

integrating indicators ("integrators") are classified under

class 5 steam parameters

chemical indicators/integrators for instrument sets should be at least class 4+, usually __________ ____; placed inside __________ package to be sterilized

class 5; every

emulating indicator

class 6

Fire extinguisher for ordinary combustibles

class A

ordinary combustibles

class A

flammable liquids

class B

electrical equipment

class C

combustible metals

class D

transport containers

clean and disinfect between use

all devices processed by LTGP must be

clean and dry

staff member brings several contaminated trays to spd on a cart and request replacement trays be put on same cart. Tech should....

clean and dry the cart and send it to distribution for trays

a staff member brings several contaminated trays to SPD on a cart and request that replacement trays be put on the same cart. The technician should....

clean and dry the transport cart and send it to distribution for trays

items being unloaded from the steam sterilizer should be handled with

clean hands

first step when instrument needs to be sterilized for immediate use

clean instrument according to mfg instructions

all items with lumens

clean manually with snake brush of appropriate size and length; makes direct contact with all walls of lumen; inspection is critical; brush from small end to larger end, make sure not blocked; reverse flushing

people flow in spd

clean to dirty

containers are to be disassembled and ______________ after each use; manually, mechanical washer/cart washer

cleaned

powered equipment should be

cleaned as specified by manufacturer

supplies contaminated with blood and body fluids that require sterilization should be

cleaned, dried and passed on to the processing area for assembly, packaging and sterilization

new/ repaired instruments must be ____________/_____________ prior to use

cleaned/decon'd

the first and most important step in the decon process is_____________, followed by thorough rinsing.

cleaning

acceptable method of deceon of an item used on a patient

cleaning w/ detergent solution then using an appropriate disinfection agent

inspecting in prep/pkg look for

cleanliness, functionality, completeness

thromb/o-

clot

coagul/o-, coagulat/o-

coagulation (clotting)

water in initial manual bath that is too hot (above 140 F) can cause

coagulation and inactivate enzymatic detergent

high heat in manual bath may cause

coagulation of blood still on instrument/device

3 main shape classifications of bacteria

cocci (round), bacillus (rods), spirillum (spirals)

cry/o-

cold

bluish-gray stains

cold sterilization solution being used outside MFG guidelines

bluish gray stains

cold sterilization solution being used outside manufacturers guidelines

Quality Assurance (QA)

collection of data and identification of issues

col/o-

colon

colo-

colon

most effective means of reducing spread of C.diff

combination of hand hygiene and contact isolation

Class D Fire Extinguisher

combustible metals

jaws

come in contact with patient; some with serrations, some carmalt

co-

come together

deionized water

commonly used as a final rinse; the process by which ions with an electrical charge are removed from water

all low/intermediate level disinfectants are NOT

compatible for any given equipment/environmental surfaces

opened but unused instrument sets should be

completely reprocessed

organs

complex structures with specialized functions within the body

the most cost efficient and cost effective method for inventory control in SPD ordering and data generation

computerized inventory control system

parameters of gas sterilization in 100% EtO sterilizer are

concentration, exposure time, humidity and temp

parameters for ozone sterilization

concentration, temp, time

primary reason items are allowed to cool on a sterilizer cart before being placed in storage

condensation and contamination may result if items are moved to cooler areas when they are still warm

4 phases steam sterilizer (prevac)

condition, sterilization, exhaust, drying

gradual heating of packs

conditioning phase

gradual heating of packs occurs during

conditioning phase of steam sterilization cycle

phases within LTHP cycle

conditioning, sterilization, aeration

dry heat uses a heat process called

conduction

autonomic/involuntary nervous system

conducts impulses to smooth muscle, cardiac muscle and glands; controls heart rate and breathing

spinal cord

conducts nerve impulses; center for spinal reflexes; provides two way communication between brain and body

HIPAA deals with

confidentiality

humerus, radius, ulna

connect at elbow joint

femur, tibia, fibula

connect at knee joint

loaner instruments must be

considered contaminated and must be completely reprocessed; Never take another's 'word' for it that they are clean; manufacturer's IFU should be followed; do not guess

red tagged instruments(before being sent for repair) and opened but not used items

considered contaminated; need to be completely reprocessed/ decontaminated

Hepatitis A

considered food related disease

pelvis

consist of sacrum, coccyx and hip bones

a loaner instrument has been contaminated during a procedure and the OR wants to sterilize it in IUSS (first step)

consult MFG written instructions for approved sterilization methods and parameters

the effectiveness of any chemical disinfection process depends on...

contact time, concentration of solution and temperature of the solution

floor trays

contain instruments/supplies for entire procedure

enzyme based detergents

contain organic substances that assist in the breakdown of protein soils and blood

cholera is transmitted by

contaminated food and water

state of being soiled or infected by contact with infectious organisms or other material

contamination

state of being soiled/infected by contact with infectious organisms

contamination

in sterile storage, temp is 70 F and humidity is 69% (what should be done)

continue with routine activities

-stalsis

contraction, constriction

a BI used as a comparison to test and not intended to have a bacterial spore killed, due to not being ran

control and should result positive

-stasis, -static

control, maintenance of a constant level

describes general environmental conditions of SPD sterile storage

controlled temp and humidity, limited traffic

Traffic Control

controlling access to SPD

steam sterilization uses a heat process called

convection

allow heat/steam to _______ before taking instruments from autowasher

cool

in regards to plastic maintenance dust covers, item within should be

cooled to prevent condensation

kerat-

cornea

___________ protectors can be used in place of towels to prevent tears

corner

all packages must be labeled completely and _____________ prior to sterilization; avoid mistakes; name, destination, initials of preparer; using non toxic ______________ marker

correctly; permanent

cortic/o-

cortex, outer region

non toxic permanent pen/marker should be used to write on data cards, ___________ sheets, and tray list

count

in one layer trays there need to be ____ chemical indicators; 1 in center/pack bottom, 2 caddy corner and 1 on _______ ________

count sheet

multipart instruments; if to remain disassembled all parts must be present and listed on ___________ ___________

count sheet

permanent, no toxic ink should be used on

count sheets and external sterilization tape

transport containers should prevent spillage

covered/enclosed (case) carts, bins with lids, sterilization containers with solid bottom, impermeable bags

laparoscopic instruments (*include robotic instruments)

cracked insulation can cause electrical shock/burns

making an opening into skull to access brain

craniotomy (skeletal)

would be considered high risk for special prion processing

craniotomy set

instruments used for the nervous system

craniotomy sets; cervical fusion discs; laminectomy sets

skull

cranium and facial bones

-ostomy

create an opening

instruments that enter sterile tissue; implants; surgical instruments

critical; sterilization

in sets selected protrude susceptible instruments should be in...

cuffed towels (if HCF allows), kraft type popcorn bags or foam

in sets all instruments should _________ in the same direction

curve

lateral sides of pouches should not be ________ to fit inside inner pouch

cut

paper tray liners may be ______ to fit bottom of tray

cut

a textile (soft) wraps edges can not be

cut to accommodate a smaller instrument set

-otomy

cutting into

part of cell where food molecules aer received, processed and used

cytoplasm

part of cell where food molecules received, processed and used

cytoplasm

clean horizontal work surfaces and floors....

daily

floor and work surfaces should be cleaned

daily

temp and humidity in decon should be monitored

daily

the drain line basket in a steam sterilizer is cleaned

daily

transportation carts cleaned

daily

floors mopped...

daily, not swept

black dots noted in a fiberoptic cable during inspection indicate

damage to glass rod

black dots in fiberoptic cable shaft indicate...

damage to the glass rod; renders useless, unserviceable

Morals

deal with or relate to principles of right and wrong behavior.

necr/o-, -necrosis

death

lumens should be checked for cleanliness and blockages when arriving from _____________ to prep

decon

major physical areas of SPD

decon, assembly and sterile processing, sterile storage and distribution

sequence for work flow where devices are processed

decon, assembly, packaging, sterilization, sterile storage

soiled items are received and cleaned

decontamination

the use of physical/chemical means to remove, inactivate or destroy blood borne pathogens on the surface of an item

decontamination

doffing must be done within_________ _________

decontamination room

correct sequence for the traffic workflow areas in which medical devices are processed

decontamination>assembly>packaging>sterilization>sterile storage

dermis

deeper than epidermis; *contains nerves and blood supply

hypodermis (subcutaneous)

deepest layer of skin

Immunity

defensive response of the body to antigens; Acquired (active vs passive)

process by which spd tech fills a clean/new ultrasonic bath (may not have an instrument set during this initial run)

degassing

instruments; manually cleaned/decontaminated by hand, wiped down with soft lint free cloth and it's enzymatic detergent bath is low suds/foam action

delicate instruments (camera, light cord, flexible endoscope etc)

requires the using department be responsible for maintaining inventory levels; labor intensive

demand distribution system

gather information

dendrites

every healthcare facility has an organizational structure or chart that outlines...

departmental authority relationships

organizational structure chart that outlines...

departmental authority relationships

used to harvest skin grafts and reshape skin surfaces

dermatome

nerves and blood supply (layer of skin)

dermis

assist in the removal of calcium, magnesium and certain other cations in hard water

descaler

laparoscopic instruments

design presents special challenges to cleaning process; must be disassembled for cleaning; check outer sheath for cracks

rigid sterilization containers

designed to hold medical devices for sterilization, storage, transportation and aseptic presentation of contents (ANSI/AAMI ST 77)

self retaining retractors are usually

designed with spring (mechanical design) that keeps them open to retract

why electrical etching/engraving is never used on instruments

destroy passivation layer and allow microbes to harbor

prior to disinfection PCE should be cleaned with

detergent

water hardness can impact the effectiveness of ____________which may cause staining and possible rust to instruments.

detergent

color result of chemical placard must be complete uniformity to be considered a "go", if not notify supervisor

determination of bowie dick dart

Root Cause Analysis (RCA)

determines underlying cause of adverse events; used after incident to uncover primary cause

process by which ions with electrical charge are removed from water; commonly used as final rinse

dionized water

principal route of nosocomial infections

direct contact

principle route of nosocomial infection

direct contact

devices with lumens/cannulations may be flushed w/ treated water prior to sterilization; ONLY if you are to place in steam sterilizer ___________________ ________________; not recommended to utilize/keep water that lumen instrument may have inside from automated washer

directly after

before multipart instrument is manually cleaned

disassembled according to IFU then soaked in water with enzymatic detergent

before any item with multiple parts is cleaned it must be ______________

disassembled as directed by the manufacturer

disposable sharps should be removed and ____________ in the appropriate containers at ________; watch for those that slip past and report it!

discarded; POU

when floor trays are opened and not used all disposable items must be ________________ and instruments completely _________________

discarded; reprocessed

failure to wear PPE in decon can result in

disciplinary action

-pathy

disease

patho-

disease

pathogenic

disease producing

pathogen

disease producing microorganisms

equipment w/ electrical cord that is cracked, frayed or broken should be

disinfected and sent out for repair

3rd sink in three sink method

distilled/ de-ionized water as final rinse to aid in preventing staining

National Institute for Occupational Safety and Health (NIOSH)

division of CDC; oversees airborne control/respiration masks

If a device is labeled as belonging to one area of SPD

do NOT borrow from one area of SPD to another

anaerobic

do NOT require oxygen to grow

Examples of recommended practices

documents developed by IAHCSMM, SGNA, AORN

peracetic acid

does not end in "hyde" but still HLD; not recommended in cancer patients

how to avoid biofilms

don't allow instruments to soak (in enzymatic detergent) for a prolonged time frame; 5-10 mins unless specified longer via instruments IFU; Never store instruments wet, dry after cleaning

Irregular bones

don't fit any specific category (pelvis)

to avoid wet load

door cracked 2-4" open for 20-30 mins before removing

only paper-plastic peel packs (no tyvek) may be utilized to

double peel pack an instrument

coldest location inside the steam sterilizer chamber

drain line

if a item needs to be corrected/removed from sterilization load record

draw a line through item followed by your initials

petrolatum gauze dressings would be sterilized in

dry heat

what sterilization method would be appropriate for petrolatum gauze dressings?

dry heat

BI Spore Bacillus Atrophaeus is used for

dry heat and EtO

information not required to be recorded on a HLD record

dry time

selected sterilization time is not a factor affecting

dry time in a steam sterilizer

item configuration must promote_____________

drying

towel/ instrument liner/ mat on bottom of mesh tray aid in __________ of wrapped instrument sets

drying

aeration

dryong phase

more than 90% of C. Diff HAIs occur

during or after antimicrobial therapy

chemical indicator/integrator should be placed within

each package to demonstrate whether conditions were adequate to achieve sterilization

work stations to be cleaned ..

each shift

inspection of handheld instruments; check for

each time they are handled, assembly/prep/packaging; cleanliness, function (sharpness, working order), alignment, tension of ratchet, cracks (box lock), burrs/nicks, loose screws/broken welds, loss of plating (sometimes, s/n, catalogue #, nomenclature)

myringo-

ear

organ of hearing

ear

oto-

ear

tympanic membrane located in

ear

micro drill

ear surgery; drives small wires through bone

"pakistan"

easily missed disposable instrument; almost all instruments with this name are disposable; Exceptions: army-navy, some dental, and a few others)

used for laser procedure

ebonized instruments

ordering the optimum quantity based on historical data

economical order quanity

must be sterilized on _______; paper to plastic- plastic to paper

edge

Alcohols

effective antiseptics AND sanitizers; kill variety of bacteria, mycobacteria and fungi; set/wet/contact time 5 mins; NOT effective against spores and some hydrophilic viruses; evaporates quickly and flammable; may damage latex, rubber and plastics; solvent; instruments with lenses should NOT be soaked in this (scratches in lens surface)

cubit/o-

elbow, forearm

powered instruments

electric, air(pneumatic), battery; dermatone, cebatome, micro drill

Class C Fire Extinguisher

electrical equipment

NOT authorized on stainless steel instruments

electrical etching/engraving

LTGP sterilizers require a special

electrical outlet for installation

a laparoscopic instrument with cracked/nicked insulation can cause

electrical shock/burns

kidneys

eliminates wastes and helps maintain water and chemical balance

lot control numbers are used to

enable recall following sterilization failure

all contaminated items arriving must be

enclosed with lid during transport to decon

ductless glands; secretes hormones

endocrine system

used to view internal organs through very small openings

endoscopic instruments

Department Of Transportation (DOT)

enforces laws relating to transportation of medical wastes

an exhaust hood over the EtO gas sterilizer is an example of

engineering control

instruments must never be

engraved

-megaly

enlargement

chemical indicator tape

ensure tape is of ample length; not too long, not too short; place stamps on tape not wrap itself; do NOT use pins, staples, paper clips

uterus

environment for implantation of egg and development of fetus

substance that acts as a catalyst in living organisms, regulating the rate at which life's chemical reactions proceed, *without being altered in the process; reduce the activation energy needed to start these reactions.

enzyme

contain organic substances that assist in the breakdown of protein soils and blood

enzyme based detergents

prior to transport to decon

enzyme spray/ moisture maintenance; damped to soaked wet towel apllied over or wrapped around the instruments/devices; sterile water; NO SALINE

test used to decipher rust vs stain

eraser test

when testing a scissor for sharpness it is important to make several cuts (mid way up to tip) with

esmark, commercial booklet of red/yellow rubber band sheath or possibly facial tissue

flexible tube, moves food to stomach via peristalsis

esophagus

brain stem

essential functions controlled

standard

established norm based on theory

standard

established norm determined by opinion, authority research and theory

OSHA

establishes PEL for chemicals

SGNA

establishes standards for processing flexible endoscopes

AAMI

establishes sterilization standards based on opinion, research and theory

practice of doing the right thing

ethics

distribute instruments ____________ in the tray

evenly

a stamp dating system where items are considered sterile unless the integrity of the package is compromised

event related date

sterilier #, load # and date sterilized

event related sticker

multi level sets should have a chemical indicator in _________ _________

every level

integrity of sterile package should be inspected

every time it is handled

unless mfg states otherwise, stainless steel instruments are to be lubricated

every time it receives full circle of treatment (usually accomplished in automated washer cycle)

all materials are not designed to be acceptable for

every type of sterilization

multi-color (rainbow) stains

excessive heat, hot spot in autoclave

multi-color (rainbow) stains

excessive heat; hotspot in autoclave

-ectomy

excision, surgical removal of

relaxed, after being maintained

exhaust phase

must be checked before releasing an item to fill a sterile supply order

expiration date, whether the package is damaged, and verification of chemical indicator

Dry heat

exposure time 2 hours @320 F

proper cleaning chemical disposal will more than likely need to be communicated with FDA/EPA

exposure to cleaning chemicals, disinfectants and other chemicals in raw sewage

the time for which the steam sterilizers chamber is maintained (can't drop) within the specified range for temperature, sterilant concentration, pressure and humidity

exposure/sterilization phase

prions (method of destruction)

extended sterilization

sensory organs

extensions of the nervous system that allow perception of environment

purpose of evenly distributing large sets of instruments

extra condensation will make the set more difficult to dry

spores can survive

extreme heat, lack of water and exposure to many toxic chemicals and radiation

flexible endoscopes

extremely difficult to clean because of the numerous small channels (lumens) and size (some more than 6 feet long); most are semi-critical (possible low temp sterilization); only those trained for, should reprocess

ophthal-

eye

residue on _______ instruments can cause TASS

eye

using a lighted magnifying lamp to visualize defects limits...

eye fatigue

chemical indicators/integrators are necessary to be placed in each level of multi-layer tray for the operator/users

eye-view when opened

blephar/o-

eyelid

blepharo-

eyelid

sense of sight

eyes refract and focus incoming light waves onto photoreceptors in back of eye

not a necessary requirement of a requisition

facility phone number

Unethical Professional Conduct

failure to conform to moral standards or policies.

salping-

fallopian tube

tachy-

fast, rapid

adip/o-

fat

lipid/o-, lip/o-

fat, lipid

vagina, fallopian tubes, uterus, mammary glands

female reproductive organs

gynec/o-

female, woman

femor/o-

femur (thigh bone)

Lower limb bones

femur, tibia, fibula, patella, tarsals

pyrogens

fever producing substances once circulated in the blood

eyeball

fibrous and vascular tunics, retina; sclera; cornea;iris; pupil; retina

respiratory system function

filters, warms and humidifies air breathed in

ileum

final portion of small intestine

(3 sink method) 3rd sink

final rinse- distilled/deionized water (to aid in preventing stains)

-dactyl

finger

digit

finger or toe

in the final steps of hand washing fingers should be rinsed with

fingertips up

manual and/or automated mechanical cleaning

first step in decon process

Ergonomics (OSHA)

fitting job to worker, prevent injuries before they occur

-pexy

fixation

thread like tails, help bacteria move through liquids

flagella

NFPA Red Diamond

flammability

Class B Fire Extinguisher

flammable and combustible liquids

not classified as a 'terminal sterilization'

flash/IUSS

do not stack rigid containers during sterilization (unless directed by mfg) should be ________ on cart

flat

4 basic types of bone

flat, irregular, short, long

approved to be cleaned by AER

flexible endoscopes

Practice Cleaning

floor;mopped daily, horizontal areas (prep, storage, etc); weekly, air circulated vents; monthly, light fixtures; bi-annually

-rrhea

flow

-dema

fluid

_________ corners of count sheet, do not staple

fold

frenu-

fold

in double peel packs inside pack should never be ______________ over

folded

in regards to measure the ratio of detergent vs water (manual bath batch and ultra sonic) ALWAYS

follow manufacturer guidelines; type of water; too little= won't have full effect that instruments deserve; too much= can oversaturate instruments, cause damage and inactivation

inanimate object involved in spread of infection

fomite

nails, tissues and money are examples of

fomites

pod/o-

foot

Critical

for sterile areas, must be sterilized

Loaner Area

for the receipt and return of instruments borrowed for specialty procedures.

if used instruments in the basin are not clearly visible ______________ should be used to pick them up

forceps

carpals, metacarpals, phalanges

form wrist and hand

quadr/i-, quadr/o-

four

Skeletal system

framework for body; protects internal organs

measuring scissors

from screw point to tip of blades

front/o-

front

enzymatic detergents; spray/foam/gel

fully concentrated

Physiology

functions of body parts

Cell

fundamental unit of life; smallest and most numerous structure of body; performs all processes needed for life

-stomosis, -stomy

furnish with a mouth or outlet, new opening

-desis

fuse, bind, tie together, surgical fixation

chole-

gall bladder

cholecyst/o-

gallbladder

water that has been contaminated by feces of humans and animals MOST notably responsible for

gastrointestinal disease

eye instruments; if processed in mechanical (automated) washer, do not clean with .....

general surgery instruments; preferred use of gentle cycle; thoroughly rinse and inspect cannulas multiple times; final rinse should be sterile, distilled or deionized water

rigid endoscopes

generally cleaned manually and separately to prevent cross contamination; 1x use on detergent bath with soft cloth or impregnated sponge (goes for flexible scopes, cameras and the like); auto washer and ultrasonic will damage

(some) AMW cycles

gentle; quick; instrument; orthopedic; utensil (glass items)

used to test for: regular steam sterilization(autoclave), sterrad, V-pro & ozone

geobacillus stearothermophilus

2 common biological spores

geobacillus stearothermophilus and bacillus atrophaeus

aden-

gland

pituitary, pineal, thyroid, parathyroids, adrenal, pancreas, thymus

glands of endocrine system

PPE ALWAYS donned LAST

gloves

gluc/o-

glucose (sugar)

should not be used as environmental disinfectant

glutaraldehydes

contra-

going against, opposite

tungsten carbide

gold handle

tungsten carbide identifier

gold handles

an effective case cart system requires

good communication

escherichia coli (E.coli)

gram negative organism; frequent cause of infections of the bloodstream, urinary tract, GI tract

pseudomonas

gram negative organism; responsible for infections in lower respiratory tract, burns, urinary tract, ear and eye

salmonella

gram negative organism; sources include eggs, poultry and dairy

microorganism, has the ability to slow metabolism and become dormant

gram positive bacillus

staphylococci

gram positive cocci; common cause of nosocomial infections; MRSA

staphylococcus aureus

gram positive coccus

Clostridium Difficile (C. Diff)

gram positive, spore forming, anaerobic bacillus; spread occurs from person to person or contamination of patient care environment; affects GI-colon; difficult to eradicate, spores can be highly resistant to disinfectants; can survive on dry surfaces for many weeks or months

can be used to sterilize liquids

gravity sterilization

before instruments are processed in ultrasonic

gross soil should be removed

before instruments processed in ultrasonic

gross soil should be removed manually

it is important to control humidity in sterile storage to prevent

growth of microorganisms

sepsis

growth of pathogenic bacteria in living tissue

ginge-

gums

sense of taste

gustatory

PPE Donning order

hair covering, shoe covers (*hand hygiene), gown, mask, goggles/faceshield, gloves

Bouffant or Cap

hair covering; changed daily; if non-disposable, facility must launder

semi-

half

include chlorine and iodine based compounds; low to medium level disinfectant; can have a set time of approx. 5 mins; corrosive to metal, rubber and some plastics

halogens

sodium hypochlorite (bleach) is one division of (disinfectants)

halogens

which group of disinfectants does sodium hypochlorite belong to?

halogens

CDC

hand hygiene, isolation procedures, environmental infection control and disinfection and sterilization

classification of surgical instruments

handheld, powered, endoscopic, laparoscopic

alcohol based hand antiseptics are acceptable only if

hands are not visibly soiled

an emergency eyewash station must allow for

hands free operation

silicates

hard, glassy mineral substance; occurs in a variety of forms; all natural water supplies contain some dissolved 'silica'

NOT all microorganisms are

harmful to human body

dermatome

harvest skin grafts and reshape skin surfaces

tap water

has been treated and acceptable for drinking; filtered/softened

distilled water

has been treated to remove ions, making it free of minerals

this is a high patient census and there is no PCA pumps available for distribution (action)

have staff check units more frequently

cephal/o, -ceps

head

cranium

head

NFPA Blue Diamond

health hazard

aud-, audi/o-, audit/o-

hearing

4 chambered organ pumps blood through body

heart

cardi/o-, card/o-

heart

function of autonomic nervous system

heart rate

therm/o-

heat

super heating

heat added to dry steam in the absence of water

cauter/o-, caut/o-

heat, burn

K-Pad

heating pad using hot water to provide heat, there are a variety of pad sizes

in sets ___________ instruments on bottom

heavier

_____________ individual items of large metal mass should be wrapped in _______________ material to absorb moisture/enhance drying

heavy; absorbent

calcaneous

heel bone

hand held retractors must be

held open manually

gram stain; Ziehl-Neilson stain

helps identify different types of bacteria via color change

grasp, hold/occlude tissue

hemostat (kelly, crile); dressing (smooth) forceps; tissue forceps (typically w/teeth); bone holding forceps

healthcare workers are most likely to be infected by

hepatitis B

liver biopsy would be performed to check for

hepatitis C

anodized aluminum may be affected by the use of

high alkaline detergents

peracetic acid, glutes or OPA

high level disinfectants

brown/orange stains

high pH surface deposits, improper soaps and detergents, baked on blood, soaked in saline

washer- decon/disinfector unit in a cycle of decon may contain

higher (alkaline) pH level detergent (9-11)

regarding steam sterilization , higher temps require

higher pressure

surgical (OR) grade

highest grade of steel and quality; reusable

tenac/i-

holding fast, sticky

ratchet

holds instrument closed; difficult to clean

People Flow

how people move through the department or processing area. *Clean to Dirty

Work Flow

how the work progresses through the department or processing area. *Dirty to Clean

principal living reservoir of human disease

human body

humer/o-

humerus (upper arm bone)

Upper limb bones

humerus, radius, ulna, carpals, metacarpals and phalanges

processed flexible endoscopes should be ...

hung vertically with no coils in the scope in a well ventilated, dust free cabinet for 12-14 days (depending) after that must be reprocessed

visual means of monitoring the humidity in sterile storage area

hygrometer

in neck between lower jaw and larynx; doesn't articulate w/another bone (axial)

hyoid bone

used to regulate body temp

hypo/hyper thermia machines

patient cooling machine

hypo/hyper thers mia machine

corrugated cardboard boxes

ideal for logistically transporting medical supplies/equipment; Bugs love to hide/live on areas in between

change manual bath batch

if seen as too visibly soiled (even after 1st set decon'd); after a "numbered" time use (MAX AVG 8 hours); and selected instrument sets (1x use of small bowl for camera, scope, light cord etc. *if HCF doesn't have commercial sponge)

you receive a text message while you are assembling instruments set (best action)

ignore until on break

ili/o-

ilium (pelvic bone)

incident reports should be filed

immediately

ability of the body to specifically counteract antigens

immunity

white blood cells provide

immunity

valve type rigid containers could _____________ aeration, not usually recommended for EtO/low gas plasma sterilization cycles

impede

decon PPE, not absorbing, leak/water proof

impervious

mechanical process by which an automated washer works

impingement

MUST be sterilized WITH accompanying biological indicator....

implants

dark brown/black stains

improper detergents, dried blood

most likely to damage passivation layer

improper handling

if an IV, feeding pump or the like is to be transported through the hospital to spd it is to be

in a covered cart or a closed plastic bag

if a requisition is not made, no supplies are issued

in a demand requisition system

for manual lubrication, surgical instruments should be placed

in a lubricant solution then room air dried

EtO PCD (biological test pack) placed

in geometric center of load

fomite

inanimate (non living) object involved with the spread of an infection

aside from paper product soaked in blood, paper should NOT be disposed of in biohazard container due to

incineration process

apparatus for maintaining favorable growth for BI

incubator

if disinfectant dries on the surface before specified exposure time has elapsed, the process becomes __________________

ineffective

seps/o-

infection

-itis

inflammation

oral cavity

ingest food, mix w/ saliva and swallow

breathing

inhalation and expiration; exchange of air between atmosphere and alveoli of lungs

bacteriostatic disinfectants

inhibit the growth of microorganisms (w/out destroying them) during processing and when dry, leave behind a protective film on the processed item; reactivated when in contact w/ moisture; could cause tissue damage if reactivated by body fluids; rinsing may be recommended for these disinfectants

cochlea is part of

inner ear

tympan-

inner ear

retina

inner most layer of eyeball

may not be folded to accomodate fitting in outside pack

inner peel pack

tungsten carbide

inserts/tips; strong metal; gold handles

SPD tech can play a role in fire prevention by

inspecting insulation on reusable laparoscopic instruments

spd tech can play a role in fire prevention by

inspecting insulation on reusable laparoscopic instruments

NFPA Yellow Diamond

instability

may be run for 1st (actual) load containing a PCD (autoclave steam sterilizer) cycle

instrument container (sets)

poor water quality can contribute to

instrument corrosion, staining, spotting, increased microbial levels

permanent, non toxic ink should be used to write on

instrument count sheets and tray lists

-tome

instrument for cutting

-scope

instrument for visual examination

hinged instruments that "stick";milk; already incorporated to a washer/decon cycle; one type stays on one side of SPD other stays on it's side; 30 second to 1 minute average set time; autoclavable; do NOT wash after for prep assembly design

instrument lubrication product

main HCF won't allow _____________ in cart washer

instruments

instrument magnetization happens when...

instruments are exposed to motorized devices (magnetic pad/ needle counters)

sternal saws, open heart instruments, coronary dilators

instruments used for circulatory system

thyroidectomy set

instruments used for endocrine system

myringotomy set(ear); cataract set(eye); corneal transplant set(eye)

instruments used for sensory organs

total hip and knee sets; osteotomes; screw sets

instruments used for skeletal system

cystoscopes; ureteroscopes

instruments used in viewing urinary system

Sharps

instruments/devices with points/blades

-graph

instrumnet used to record

class 5 indicator

integrating indicator

fungi (method of destruction)

intermediate level disinfection

nonlipid, small viruses (method of destruction)

intermediate level disinfection

phenolics

intermediate to low environmental disinfectant; carbolic-acid based; effective against vegetative bacteria, fungi, and TB; bacteriostatic and leave a residue

entero-

intestine

infection

invasion of body tissue by microorganisms which multiply and produce a reaction

disadvantage of exchange cart system

inventory is duplicated

can represent 40% of HCF operating budget

inventory of medical surgical supplies

a rough indication of the effectiveness of the inventory system, evaluated by inventory turnover, percent of back orders and availability of critical items

inventory performance

smooth muscle

involuntary movement; slower to contract and relax; common throughout body systems (e.g. digestive tract)

low to intermediate disinfectants

iodine (generally used as skin antiseptic); should not be used to disinfect medical devices that will be used in patients

EPA, FDA, OSHA and state DOH

issue regulations

most unique feature of an integrating chemical indicator

it's ability to perform in parallel to a biological indicator

part of the steam sterilizer that produces heat inside the chamber to prevent condensation from forming on the chamber walls

jacket

the two pressure gauges on a steam sterilizer measure the pressure in the ..

jacket and the chamber

arthr/o-

joint

articul/o-

joint

where two bones meet/articulate

joint

dating system; records date as the number of days that have elapsed since January 1st; commonly used for items deemed as expiration sensitive

julian (time related) date

Joints

junctions between bones; articulation

designed to reduce storeroom inventory

just in time

stockless distribution systems aka

just in time distribution systems

instrument damage/protection

keep in designated location on tray during transport; do not stack unless in rigid container; protect delicate items w/ fine, sharp tips; heavy instruments on bottom of tray; separate rigid/flexible endoscopes from instruments

Defense mechanisms

keep us healthy

hemostats (clamps)

kelly, crile; used primarily to clamp arteries, may be used to dissect tissue

nephro-

kidney

pyelo-

kidney

reno-

kidney

organs of the urinary system

kidneys, ureters, urinary bladder, urethra

bacterialcidal disinfectant

kill microorganisms but do not leave a film on device surface

-cidal

killing

-cide

killing

patella

knee bone

patella

knee cap

miscellaneous instruments

knife handles, towel clips, sponge forceps

all levels of the same tray should be

labeled to identify the level number and set to which it belongs

biohazard sinage

labeled with biohazard label; alert personnel that they contain potentially biohazardous material

missing items in set must be __________ on outside of set and reported to ___________ for approval to still use set

labeled; supervisor

smooth muscles

lack striations

instruments used for digestive system

laparoscopes, sigmoidoscope, colonoscope, laparotomy set

instruments used for the reproductive system

laparotomy sets; vaginal delivery sets; vasectomy set

too many _______ items can cause extra condensation, make drying difficult or cause item to rip through

large

tibia

large bone in lower leg

humerus

large bone in upper arm

femur

large bone in upper leg

colon

large intestine

sigmoid

large intestines

macro-

large, abnormal in size or length, long

radius

larger bone in lower arm

fundo-

largest part of organ

when double paper plastic pouching is permitted the inner pouch must

lay flat inside the outer pouch

epidermis; dermis; hypodermis

layers of integument

should not be worn as PPE when manually decontaminatiing flexible fiber optic endoscope

lead apron

OSHA requires that containers for potentially infectious materials be

leak proof

prior to manual cleaning of flexible endoscope (first step)

leak test

prior to manually cleaning a flexible endoscope it MUST be ______________________

leak tested

not a method for checking the visual clarity of a rigid endoscope

leak testing

lev/o-, levat/o-

left

left eye

adductors

leg muscles

when lifting heavy items which muscles should bear the most weight?

legs

when lifting heavy objects which muscles should bear the weight?

legs

shelf life

length of time a disinfectant can be properly stored, after which it must be discarded

use life

length of time or number of times used after which the efficiency of a disinfectant is diminished

phac/o-, phak/o-

lens

advantages of LTHP vs LTGP

less number of lumen restriction, more number of cycles ran via cylindrical cartridges, more options of running various temp sensitive items

Clean/Sterile Storage Humidity Requirement

less than 70%

the technician is asked to remove an arthroscopy sat from the aerator four hours prior to completion of aeration time. The supervisor is not available, what should the technician do?

let the set complete and borrow a set from another hospital

the technician is asked to remove an arthroscopy set from the aerator four hours prior to the completion of aeration time, the supervisor is not available, what does the tech do?

let the set complete the aeration cycle and borrow a set from another hospital

you note a co-worker has hair hanging out of their surgical cap while assembling sets (action)

let them know the hair is visible

Cellular>Tissue>Organ>System

levels of organization of body

bio-

life

plastic paper peel pouches used to package single, ________ weight items

light

psychrophiles

like cold temperature; 59-68 degrees F

thermophiles

like warm temperature; 122-158 degrees F

each time the ultrasonic is drained it should be cleaned and disinfected with a ________ ________ ___________ soaked in ________% alcohol; to be effective the alcohol should remain wet for _____ minutes

lint free cloth; 70%; 10 mins

automated mechanical washer detergents are usually in _____________ form and low suds/foam producers

liquid

hepat/o-

liver

organ that produces bile

liver

produces bile

liver

vectors

living things responsible for causing disease (insects/rodents)

improper ____________ of washers is a major contributor to cleaning failures

area for receipt and return of instruments borrowed for specialty procedures

loaner area

hyoid bone

located in neck; supports tongue and swallowing; only bone NOT articulated w/another

lumb/o-

loin

carmalt

longitudinal; lengthwise from tip

-lysis

loosen

instrument lubrication product "milk"

loosens instrument box locks, screw locks, scissor blades and any other metal on metal moving part

should be placed on each package sterilized and on the sterilization load record

lot control numbers

use appropriate temperature when sealing autoclave vs ______ temp; usually 100 degree difference; check quality of seal; no lumps/gaps/folds (allows microbes to harbor)

low

according to spaulding classification, a non critical device requires

low level disinfection

in regards to OSHA and PPE, gloves are still necessary when dealing with

low level disinfection

level of disinfection needed for destruction of HIV

low level disinfection

lipid, medium sized viruses (HIV) (method of destruction)

low level disinfection

vegetative bacteria (method of destruction)

low level disinfection

Quaternary Ammonium Compounds (QUATs) AKA a 'wetting agent'

low level environmental disinfectants; effective against gram-positive bacteria but ineffective against some gram-negative microorganisms, lipid viruses and spores; are bactericidal; used for inanimate environmental surfaces (*floors, walls and furniture); should be mixed with distilled water

dark brown/black stains

low pH(less than 6) acid stain; may be caused by improper detergents, dried blood

cavitation

low pressure bubbles in a cleaning solution burst inward(implode) to dislodge soil from instruments

when it comes to enzymatic detergent..

low suds/foam

cotton gauze cannot be used in which sterilization process?

low temp gas plasma

double peel packs are not allowed for ______ ______ ppks; steam _______________ only

low temp; autoclave

considering majority of PCE only touches a patients skin, approach of cleaning

low to intermediate level disinfection

Environmental Disinfectants

low to intermediate; usually used on nonliving surfaces/ inanimate objects (devices/surfaces); NEVER use on surgical instruments

ventricles

lower chambers; force blood out of heart into arteries

floor grade

lower grade of steel and quality; mirror/shiny finish

mandible

lower jaw bone

infer/o-

lower of body

pylorus

lower opening of stomach

the reorder point

lowest amount of stock

chemical agent that loosens metal on metal moving parts

lubrication/ "milk"

optional feature of ultrasonic; not all HCF will have this; ideal for laparoscopic instruments

lumen cleaner

LTHP (VPro Maxx) involves

lumen cycle (55min), non lumen cycle (28min), flexible cycle (35min)

inspection and verification of adequate cleaning is difficult with instruments that have

lumens

inspection and verification of adequate cleaning is difficult with instruments with...

lumens

pulm/o-, pulmon/o-

lung

pleuro-

lungs

supin/o-

lying on the back

HLD gloves must be

made of thick utility/butyl rubber; 12-18 mil in thickness

Martensitic stainless steel (400 series)

magnetic, CAN be heat hardened, harder; scissors, forceps, osteotomes, chisels

digestion and absorption

main functions of digestive system (GI tract)

cerebellum

maintains balance

instrument loss

major financial burden for facility; AORN recommends ALL surgical instruments be counted after each case for inventory control

HCF Environments

major source of a variety of pathogens

if the OR request instruments for an emergency ruptured aortic aneurysm, the technician should send....

major vascular instruments

if the operating room request instruments for an emergency ruptured aortic aneurysm, the tech should send

major vascular instruments

How to know if High Level Disinfectant...

majority end in "hyde"; one exception peracetic acid

cardiac muscle

makes up heart; contracts automatically; involuntary and rhythmical

craniotomy

making an opening into the skull to access the brain

Myringotomy

making incision into tympanic membrane (eardrum) to permit fluid to drain and placing small tubes in membrane to permit continuous drainage

testes, seminal vesicles, prostate gland, bulbourethral glands

male reproductive organs

seminal vesicles and bulbourethral glands part of

male reproductive system

Compliance w/a regulation is

mandatory/required by law

forceps

manipulate and grasp tissue, sponges and dressings; must align during testing or is unservicable

first step in decontamination

manual and or automated , mechanical cleaning

typical operational order of average stainless steel instruments

manual clean>rinse>(ultra)sonic>rinse>automated washer(have incorporated rinsing and drying)>to prep

when sorting items in decon psi require

manual cleaning

typical operational order of stainless steel instruments in decon process

manual cleaning, (rinse), ultrasonic (rinse), washer/decon, (rinse)

first step in decon

manual cleaning; three sink method

poly-

many, much

no ________/_______ on soft textile wrap itself!

marking/ writing

myel-

marrow

400 series stainless steel

martensitic

3 basic principles of packaging

material must allow sterilant to reach contents, material must provide good barrier to keep out microorganisms, package must be able to be opened aseptically (w/out contamination)

basic principals of packaging

materials must allow sterilant to reach the contents, must be able to be opened aseptically (without contamination), must be a barrier for microorganisms

limited use instruments

max number of uses per mfg

with respect to rigid sterilization container testing; defines the sterilizers ability to sterilize under actual use conditions

maximum load testing

failure to remove all air from a package to be steam sterilized

may result in poor steam penetration

detergents can have single enzyme or complex

means more to enzymatic detergent bath

disease not spread by droplets

measles

pH level

measure of acidity or alkalinity

angstrom=

measure visible light

2nd step in decon; after manual cleaning and rinse

mechanical application of a thermal or chemical disinfection process

cleaning verification effectiveness products would be used on

mechanical washers

cleaning verification effectiveness products would be used on _______________

mechanical washers

textile wrappers made of...

medical grade/approved wicking material

all healthcare professionals must be properly trained in the handling of

medical waste

fascio-

membrane

protect membrane between bones and soft tissue of central nervous system

meninges

often pathogenic to humans because they grow best at body temp

mesophiles

steam load with mixed fabric and metal

metal below fabric

when a steam sterilizer load contains a mixture of fabric and metal items, where should the items be placed?

metal items below fabric items

compatible packaging; dry heat

metal, glass, aluminum foil

stacking of rigid containers in a steam sterilizer is permitted when

mfg provides technical data showing that it is acceptable

used in ear surgery and for driving very small wires through bone

micro drill

HCF medical waste

microbiology lab waste, pathology and anatomy waste, blood/body fluid specimens, blood products and sharp items

bacteria measured in

microns

microorganisms measured in

microns

minute living things too small to be seen with the naked eye

microorganisms

some but not all _______________ are harmful to your body

microorganisms

microbiology deals with

microorganisms and their effect on other living organisms

spores

microorganisms capable of forming thick (shell-like) wall around themselves to survive in adverse conditions

bacteria, viruses, fungi, protozoa and microscopic algae

microorganisms include

bloodborne pathogens

microorganisms that can be present in human blood and body fluids; are capable of producing disease in humans

chemical indicator goes in ___________ of basin set

middle

mes-, meso-

middle

smallest bones in body found in

middle ear

clamps used for hemostasis are also designed to

minimize damage to tissue

proper stock rotation is most effective to

minimize frequent reprocessing of sterile supplies

stock rotation and frequent evaluation of stock levels will

minimize the need for reprocessing and prevent outdates

adding chemicals to the boiler feed water

minimizes contaminates

flush and brush lumened instrument in decon

minimum 3xs or until completely clean

temperature and humidity in the decon area should be

monitored daily

a non cellulose filter (rigid container) can not be used

more than once

envelope fold

most common; used on small/medium items

Hepatitis B

most effective method of infection control is to be vaccinated before exposure; HCF must offer vaccination at no cost to employee

if it ends in "ase"

most likely an enzyme

water that has been contaminated by human feces and animals

most notably responsible for GI disease

carry messages from brain to organs and muscles

motor nerves

digestive process begins in

mouth

stomato-

mouth

-kinesis

movement

tongue

moves food around; assist w/swallowing

Semi-Critical

mucous membranes, high level disinfected

when loading mechanical washer, do not process ___________-_________ trays assembled! remove each level and treat as an individual tray

multi-level

after ultrasonic cleaning check _____________ instruments to make sure vibrations did not loosen screws

multi-part

disassemble instruments with ___________ parts (if indicated by mfg); containerize small parts

multiple

wet load

multiple packages in the same load found with excess moisture

my/o-

muscle

fibrill/o-

muscle fiber, nerve fiber

inferior oblique

muscle in eye

myocardium

muscle tissue of the heart

quadriceps

muscles found in legs

if proper ergonomics is not occuring

musculoskeletal disorder can occur

sterilization maintenance covers AKA dust covers

must be 2-3mm thick; specifically designed to keep dust, moisture and other contaminants out of sterile packages; NOT a sterile cover; self sealing/heat sealed; use correct size, remove air before sealing, wash hands prior to packaging, use gloves

transporting contaminated items

must be appropriately handled, confined and contained after use and during transport to decon; separation/segregation of clean and contaminated during transport

Everything entering Decon

must be cleaned before leaving

Any item that fully enters decon room....

must be cleaned by SPS techs prior to leaving

main disadvantage of using rigid sterilization container systems

must be disassembled, processed, reassembled and checked before each use

when the jaws of stainless steel needle holder (non tungsten carbide) become worn

must be discarded

policies and procedures for correct handling of sterile supplies

must be made available to distribution personnel

confidential medical evaluation

must be performed any time employee is exposed to blood or other body fluids

ideal packaging characteristics

must be tamper evident, be the right size, protect instrument from physical damage, be durable and resist tearing/puncturing, allow for aseptic presentation

if a wrapper is used as a sterile field

must extend 6" over the edge of the table

BI test vs control

must have same lot number

cause of tuberculosis

mycobacteria

responsible for leprosy

mycobacterium leprae

cause of tuberculosis

mycobacterium tuberculosis

count sheet/ tray list include...

name of instruments, type, size, quantity, mfg, catalog number; outside tray in mini dust cover (AORN; each facility decides)

-atresia

narrowing

proxim/o-

near

detergents used in ultrasonic should be low suds foam and have a ______ _______ pH

near nuetral

cervix

neck of spine or uterus

cervic/o-

neck, cervix (neck of uterus)

instruments received from surgery red tagged (broken)

need to be cleaned before going for repair

aspirate (inject/infuse)

needles, trocars, cannulas

refers to air exhausted directly outside

negative pressure

the ventilation system should be designed to maintain

negative pressure; air coming into decon, not bad decon air flowing out (to prep or other areas); directly exhausted to the outside

removal of kidney

nephrectomy (urinary)

neuro-

nerve

autonomic system

nerves communicate w/visceral organs

peripheral nervous system

nerves connecting brain and spinal cord to the other outside parts of the body

AMW, first the alkaline wash, then a _________________ acid rinse, then a regular (_____________ water) rinse, dry then off to prep

neutralizing; treated

instrument lubrication (typically decon side)

never use oil based; do not wipe off, allow to dry; unless otherwise stated by mfg lubricate instrument every time it's used; Application: manual/mechanical (washer/disinfector)

routine biological testing of steam sterilizers should be performed

no less than weekly

due to incineration

no paper in biohazard containers, unless saturated (soaked/dripping) with blood; same for gloves, booties and other PPE

for removing stubborn soils and stains; can be difficult to remove; must be thoroughly washed with detergent and thoroughly rinsed

non abrasive cleaning agents

items to be sterilized in low temp gas plasma must be packaged in

non cellulose based material; tyvek

compatible packaging; ozone

non cellulosic wrap(paper), certain containers

majority of patient care equipment classified under (spaulding)

non critical level

Austentic stainless steel (300 series)

non magnetic, can NOT be heat hardened, more corrosion resistant than 400 series; bowls, basins, malleable retractors

Physical Environmental Controls

non porous wood doors, shelves, etc

for marking sterilization tape use

non toxic permanent marker (sharpie)

acceptable for steam sterilization

non woven wraps

come in contact with intact skin; reusable medical equip; patient care equip

noncritical; low to intermediate level disinfection

Unrestricted Areas

normal traffic areas; hospital corridors, most offices, locker rooms, and general public areas (cafeteria, waiting rooms); street clothes may be worn in unrestricted areas

lacri-

nose

naso-

nose

rhin/o-

nose

rhino-

nose

upper respiratory system

nose, nasal cavity, pharynx, sinuses and larynx

a patient contracts an infection from an improperly sterilized surgical instrument... example of?

nosocomial infection

can not be prevented by increasing length of patients stay

nosocomial infection

patient contracts an infection from improperly sterilized surgical instrument (example of)

nosocomial infection

non-

not

turbidity

not clear/transparent because of stirred up sediment/solids; when stirred= clouded/obscured

square fold

not common; used on larger containers

brown/orange stains

not rust; result of high pH surface deposits; may be caused by improper soaps/detergents, baked on blood, soaking in saline

overall weight for rigid containers

not to exceed 25 pounds

if spill of HLD were to occur

notify chain of command and refer to (M)SDS

functional center of cell governs activity and heredity

nucleus

the functional center of a cell that governs activity and heredity

nucleus

DNA found in

nucleus (brain) of cell

effectiveness of disinfection

number and location of microorganisms (bioburden); resistance of microorganisms to disinfectant; concentration and potency of the disinfectant

function of gastrointestinal system is to provide

nutrients

OSHA has a great effect on the SPD by it's regulation of..

occupational exposure, airborne contaminants, bloodborne pathogens and workplace hazards

whether utilizing low temp, steam or EtO tape, it is recommended to apply what is necessary to be written

off to the side (tape on table), never while on wrapping material

mesophiles

often pathogenic to humans because they grow best at body temperature; 68-113 degrees F

________ will not allow penetration to the surface of instrument; hydrophobic

oil

detergents can not have/be ____ _____

oil based

Class K Fire Extinguisher

oils/fats in cooking appliances

sense of smell

olfactory

paper-plastic peel pouches should be placed

on edge (paper-plastic-paper-plastic)

ppk items in steam

on edge, paper to plastic

VRE can survive

on hard surfaces 5-7 days, on hands for hours

supplies should never be stored

on the floor

for steam sterilization, basin sets should be positioned

on their side

in a mixed load of (wrapped) textile sets and rigid metal sets, textile packs should be placed

on top rack

if a biological test is performed daily, how often is it necessary to incubate a control biological indicator?

once a day and if a new lot number is used

to prevent cross contamination, many MFG will only allow a cord device, flexible scope, rigid scope, camera, light cord or the like to be used (cleaning)

once in manual bath/batch of diluted deteregent and once via a pre-impregnated sponge (w/detergent) to include one time use of disposable snake brush

uni-

one

2 or more rigid pans on sterilizer racks going to be run need to be placed flat...

one above the other in a respected separate rack

viruses

one of a group of minute infectious agents that grow ONLY in living tissues/cells; require living host to multiply; not composed of cells

non woven wrapping materials ...

one time use; slightly shrink during steam; excellent barrier against microorganisms; available in multiple sizes and thickness; prone to damage(heavy trays/improper handling); **cannot be cut to accomodate size

simultaneous wrap

one time wrap; double bonded

loaner instrument sets can be placed inside rigid sterilization containers

only with mfg instructions

all instrument joints should be fully ___________ during manual cleaning, sonic and w/d

open

in sets all instruments in _______ position

open

open hinged instruments must stay__________ through decontamination process

open

urethra

opening from the bladder to the meatus

PPE is NOT __________ and ___________ fit.

optional, MUST

main gastrointestinal tract organs responsible for digestion

oral cavity, pharynx, esophagus, stomach, small intestine, large intestine

items on stringer recommended to follow.....

order on count sheet

Class A Fire Extinguisher

ordinary combustibles

used to remove severe stains on stainless steel instruments

organic acid detergent

microbe

organisms of microscopic/submicroscopic size; generally include viruses, rickettsiae, bacteria, algae, yeasts and molds

complex structures with specialized functions within the body

organs

system level

organs which together perform complex functions for the body

medicine cups should not be placed in basin set unless they can be ________________ to ensure drainage of condensate (concave facing down)

oriented

blue stain would be obvious on improperly cleaned instrument that has been disinfected with

ortho-phthaldehyde

PSI saw attachments

oscillating (side to side), sagittal (back and forth), reciprocating (push and pull)

during _____________ the solution outside the cell passes through the cell wall into the cell; if disinfectant is too weak or too strong, this process will not occur

osmosis

CBSPD

other than IAHCSMM, certification for sterile processing

epidermis

outer layer of skin

implant labels are provided for placement on ___________ of set

outside

ecto-

outside, outer, on

female reproductive organs

ovaries

oophor-

ovary

source of sterilization mechanism for both hydrogen peroxide sterilants (sterrad/VPro) to include ozone

oxidation

3 main aspects; ozone (O3)

oxygen, water and electricity

a solution is considered nuetral

pH 7

a cleaning solution is considered alkaline

pH 9

name of stainless steel instruments to look out for due to possibly being disposable

pakistan

when placing paper plastic pouches in a sterilizer, pouches should be positioned

paper facing plastic

non infectious medical waste

paper towels, nonwoven wraps not contaminated with dripping blood or other potentially infectious materials, urine; considerable trash; do not require special colored bags

requires the use of a pre determined inventory list

par level inventory distribution system

the computerized locked supply system is a variation of

par level system

fixed inventory level aka

par-level inventory

serrations

paralell grooves

an infection caused by a needle stick enters through

parenteral tissue

removing salivary gland because of a tumor formation

parotidectomy (digestive)

humerus (skeleton)

part of appendicular skeleton

duodenum

part of small intestine

mixing recommendations usually referred to in____________

parts

ppm

parts per million

biggest difference in instrument manufacturing process

passivation

final stage in mfg a 'finishing' of surgical grade instrument

passivation

surgical grade instruments, if properly cared for, will last longer than floor grade instruments bc they have a ...

passivation layer

disease producing microorganisms

pathogen

few microorganisms are__________

pathogenic (disease producing)

PCA pump

patient controlled anesthesia. used to allow patient to administer pain medication as needed

scapula, clavicle; connects bones of the arms, aids in arm movement (appendicular)

pectoral girdle

connects bones of the legs to the axial skeleton; sacrum and coccyx (tail bone) (appendicular)

pelvic girdle

human reservoirs

people harbor organism and transmit directly or indirectly

may possibly be used in AER

peracetic acid

device being sterilized in LTGP can only be touching

perforated sterilizing rack

validation

performed by MFG

employees should be trained in appropriate attire to be worn when_________

performing specific tasks

somatic system

peripheral nerves communicate w/ skin and skeletal muscles

Semi-Restricted Areas

peripheral support areas to OR, hallways to OR, SPD clean assembly and sterile storage; surgical scrub attire and hair covers required

when marking use non toxic ___________ pen, does not run

permanent

an ongoing inventory management system

perpetual inventory system

tracks all incoming and issued supplies to determine, on an ongoing basis the quantity of supplies in storage

perpetual inventory system

-ac, -al, -ar, -ary, -ic, -ical, -ine, -ior, -ory, -eal, -ary, -ous, -tic

pertaining to

-emia

pertaining to blood, blood condition

-scopic

pertaining to visual examination

refers to the function of specific body parts

physiology

master gland, helps control activities of endocrine glands

pituitary gland

master gland; located in brain; coordinates all activities of endocrine system

pituitary gland

not part of reproductive system

pituitary gland

a broken glass suction bottle is returned to decon. what do you do?

place it in appropriate rigid container

broken glass returned to decon..

placed in appropriate rigid container

large sets

placed in perforated/ mesh baskets; can be placed flat in sterilizer

when sorting, heavy instruments and delicate instruments (e.g. microsurgical) should be

placed in separate trays

sterile trays that may be subjected to storage challenges should be

placed in sterility maintenance cover

when sterilizing two large basins with smaller bowls in the same set, the chemical indicator should be

placed in the top and bottom of basins

steam sterilizer load with linen packs only, packs should be

placed on their edges

when a steam sterilizer is loaded with linen packs only, the packs should be

placed on their edges

NOT part of the final preparation of PCE

placement of disassembled parts into a plastic bag

fungi

plant-like; can cause serious illness/death in immunocrompromised people

do not place paper _________ pouches inside instrument trays (rigid/textile soft wrapped); ppk

plastic

soft _________ or __________ brushes preferred/recommended

plastic/nylon

write on ___________ side of peel pouch (if HCF allows, possibly sterilization tape/ auto print labels); write on indicator tape NEVER on _______________ material

plastic; packaging

AMW detergent of neutral pH (7) is used for

plastics, aluminum and anodized aluminum containers

ear

plays role in equilibrium and balance; consist of the smallest bones of the body

prep of decon soiled items is initially performed at

point of use

rigid sterilization container filters, some paper, some ______________; neither to be reused

polyethylene

compatible packaging; low temp gas plasma

polyolefin wrap, tyvek(non-cellulose), *specific rigid containers

robotic instruments

popular brand, davinci; requires special cleaning protocols; have flush ports (to flush ports and faucet); manual cleaning involves multiple steps (scrubbing(several intricate moving parts), flushing, priming/u.sonic cleaning, rinsing, drying, (possible) lubricating; a prolonged manual soak and ultrasonic set time may be (and usually is) required

unacceptable in any zone of SPD/OR, related perioperative setting

porous wood furniture related material

sterile storage ventilation system must be under

positive pressure

black stains

possible exposure to ammonia

devices known/suspected to be contaminated with prions

posterior eye tissue, brain tissue and spinal cord tissue are considered to be high risk; when sent to CS/SPD for reprocessing, they should be identified by means of a form, tag or other label placed inside/outside the container or basket of instruments, followed by an extended heat sterilization; powered equipment or equipment requiring low temp sterilization SHOULD NOT be used in procedures involving high risk tissues as such

avoid soaking lumened instruments for lengthy periods

potential formation of biofilms

potential hydrogen

when sorting items in decon; require manual cleaning

powered equipment

ethics

practice of doing the right thing

_____ & _______ filtered water helps to eliminate pyrogens, foreign body reactions or medical complications in patients and prevents spotting as the instruments dry

pre & post

water purification usually involves

pre and post filtration

(3 sink method) 1st sink

pre soak/washing- tap water and detergent

a bowie dick test should be performed on which type of sterilizer

pre vacuum steam

if grossly soiled items cannot be cleaned immediately

precleanse spray then keep moist with a soaked towel

first step of decon; should be at operator's Point Of Use

precleanse; enzyme spray

(3 sink method) 2nd sink

preliminary rinse- tap water

cleaned items are inspected, assembled and packaged

prep/assembly (pkging)

depress/o-

press down

necessary to attain the high temp needed in a steam sterilizer

pressure

necessary to attain the high temperature needed in a steam sterilizer

pressure

bowie dick should be performed in

prevacuum steam sterilizer

tip protectors

prevent damage of delicate items, stops protruding and keeps tips open; can be made of silicone, rubber, paper-plastic, foam

warm up jackets are recommended to be worn in prep and packaging for the purpose of....

preventing bacterial shedding from bare arms

bronchus

primary branch of trachea

direct contact

principal route of nosocomial infection

regulation

principle, rule or law; control or govern behavior

Professional Ethics

principles of conduct governing an individual or group.

morals

principles of right and wrong behavior

abnormal/ misfolded protein

prion

cause of CJD

prions

spongiform encephalopathy is caused by

prions

MFG IFUs must be obtained

prior to a medical device being cleaned and processed

cannulate/drain

probes, catheters, drains; cannulas

steps for performing a task

procedure

-tomy

process of cutting

mammary glands

produce milk for nourishment of child after birth

salivary glands

produce saliva to cleanse teeth and dissolve food chemicals; mucous used to lubricate pharynx

reason for mfg to possibly assign expiration date to a sterile medical device

product degradation

reason for a mfg to assign an expiration date to a sterile medical device

product degredation

count sheets (inventory) ...

promote accountability

ANSI

proposes standards from members such as AAMI; enhancing the global competitiveness and quality of life

containerized packaging systems are most commonly used to

protect surgical instrument sets during steam sterilization

Flat bones

protective shells (ribs)

bony encasement

protects central nervous system

OSHA

protects workers from occupationally caused illness and injuries

Occupational Safety Health Administration (OSHA)

protects workers; OSHA standards are required by law; sets occupational exposure limits for all chemicals in the workplace under mSDS (material safety data sheet); "right to know"; Emergency eyewash stations

breaks down blood soils

proteolytic enzyme

shank

provide closing force

main role of spd

provide dependable reliable services to enhance quality of patient care

function of gastrointestinal system

provide the body with nutrients

power nozzles; vegetable sprayer

provide water and/or detergent to flush lumen devices

hypo/hyperthermia machine

provides heat or cooling to warn up or cool a patients body temp

SPD Responsibilities

providing dependable, reliable services to enhance the quality of patient care. Instruments sets, patient care equipment, and other medical devices must be processed and distributed in an accurate and timely manner so that patient care is not adversely affected.

when veins vs. arteries are reversed in the concept of blood flow

pulmonary; bluish color of vein indicate blood needs oxygen

supply item usually requested, battery operated and used to flush and suction wound site of I&D

pulse lavage

emerson pump

pump to provide suction to the chest

IV pump

pump used to control the delivery of intravenous fluids and medication, can be macro or micro

feeding pump

pump used to deliver tube feedings to a patient

circulatory system

pumps blood (tissue) throughout the entire body and removes waste products

heart

pumps more than 10 gallons of blood a minute through arteries and veins; has 4 chambers

-centesis

puncture, to remove fluid

not an element of distribution system

purchasing

gram positive stain

purple/blue

pyo-

pus

fever producing substances, cause complications in patients especially if water is not pre and post filtered

pyrogens

dead microorganisms on soil or organic debris left on surgical instruments after sterilization can form...

pyrogens, foreign body reactions or medical complications in patients

muscles found in legs

quadriceps

collection of data and identification of issues

quality assurance program

Long bones

raise and lower (humerus and femur)

needles/sharps in decon should never be

recapped

pharynx

receives food and transports to esophagus

stomach

receives food from esophagus; mixes with gastric juices; moves chyme to duodenum

vagina

receives penis and is birth canal

Function of CS/SPD

receives, cleans, decontaminates, assembles, inspects, disinfects, sterilizes reusable medical and surgical devices

first to accept responsibility for all supplies in the facility

receiving area

floor trays should be prepared using ...

recipe cards; outside pack; id's contents

important for spd tech to learn anatomy and physiology in order to

recognize where instruments are used

it is important for SPD tech to learn anatomy and physiology in order to

recognize where instruments are used

tympanoplasty

reconstructing the ear drum so sound waves can be sent to the middle and inner ear

-gram

recording

procto-

rectum

grow and develop in bone marrow

red and white blood cells

gram negative stain

red/pink

when cleaning an IV pump it is important to use a germicide on the pump surface in order to...

reduce bioburden present on the equipment

surface wetting agent

reduces/lowers surface tension; breaks up and disperses solid/liquid soils from item being clean; suspends soil and clumps so they can wash away easily

OSHA Standard 29 CFR 1910.1030

regarding bloodborne pathogens

Non-restricted hallways, offices, cafeteria etc

regular street attire

Food and Drug Administration (FDA)

regulates all medical devices. MedWatch (recalls); approves reprocessing of single use devices; require IFU (instructions for use)

EPA

regulates disinfectants, clean air & water act, mfg and sale of EO

principal, rule or law used to control/govern behavior

regulation

rule designed to govern behavior

regulation

cationic

relating to compounds that contain a positive electrical charge; exhibits germicidal properties

anionic

relating to compounds that have a negative electrical charge; form a large group of synthetic detergents

sterile items that are protected from the environment have been proven to

remain sterile indefinitely

descaler

removal of calcium, magnesium and certain other metal cations in hard water (= to CLR)

nephrectomy

removal of kidney

ureters

removal of urine from kidneys to bladder

cebatome

removes cement

parotidectomy

removing a salivary gland because of a tumor formation

orchiectomy

removing a testicle

Coronary Artery Bypass Graft

removing a vein from the lower limb to bypass a blocked coronary artery of the heart

recommended performance check for automated washer

removing and cleaning drain basket daily; verifying spray arms are moving

cleaning and decontamination are important because

removing as many microorganisms as possible before the sterilization process enhances the probability of bacterial kill

Bilateral SalpingoOopherectomy

removing both fallopian tubes and ovaries

tonsillectomy

removing lymph tissue in the pharynx (throat)

Cholecystectomy

removing of gallbladder

Carpal Tunnel Repair

removing tissue displaced bone in wrist area to release pressure on median nerve

foginess without successful remedy w/ anti-fog..

renders useless, unserviceable

in a hurry to leave for an appointment you forget to punch out (action)

report this to your supervisor the next day

If blood splash exposure(esp to orifice) or needle/sharp stick occur

report to HCF direct chain of command immediately; immediately "milk" with warm soapy water prior to heading to ER: employee confidential medical evaluation is to follow

if bowie dick test fails the first time

report to supervisor for further instruction

when/if wet pack is noted when steam sterilizer is unloaded

reprocess the items

genitalia

reproductive organs

compliance with OSHA

required by law

medical device reporting regulation

requires HCF to report deaths or serious injuries from medical devices

right to know standard

requires employers to have SDS for chemicals

N95 mask

respirator filtering mask with thicker design to protect above average surgical mask; must fit-test (HCF respiratory therapy dept); may help protect against H1N1, SARS, tuberculosis and ebola; Not recommended for children or people with facial hair

the majority of HLD are ___________ ___________, use in well ventilated areas; use exhaust hoods vented to the outside

respiratory irritants

pulmonary capillaries are found in the

respiratory system

plastic sterilization bags are generally used to package

respiratory therapy equipment

plastic sterilization bags are generally used to package...

respiratory therapy items

one of the most common portals of exit in transmission of disease

respiratory tract

pathogens that cause tuberculosis, whooping cough, pnuemonia, measles, mumps and smallpox are discharged through

respiratory tract

skeletal muscle

responds to stimulation by contracting and relaxing; voluntary; striated; *attached to bone by a tendon

infection control is the _____________ of everyone who works in healthcare

responsibility

penrose drain

retract spermatic cord during IHR

when preparing instruments from a dissection set for processing in a washer/decontaminator the instruments should be positioned with the ....

retractors on the bottom of basket and hand held instruments on the top

if instrument in prep has missed bioburden on it....

return ENTIRE set

while delivering sterile supplies to multiple nursing units, the tech is asked to take an opened/used tray to decon, best procedure?

return for the used tray after completing all deliveries using the appropriate collection cart

woven wrapping materials...

reusable (100% cotton/blend); muslin; launder between uses and de-lint; out date at 30 days; QA process (track # of uses, poor barrier properties)

de-

reversal of, without

the diffusion (flowing) of water through a semi permeable membrane to eliminate impurities

reverse osmosis

bluish-black stains

reverse plating may occur; when two different types of metals are ultrasonically processed together(e.g. stainless steel and chrome processed together)

cost/o-

rib

separated by septum

right and left chambers

right eye

disposable sharps must be disposed in

rigid biohazard container

AER is not for

rigid scopes

if using paper plastic peel pouches these do not go inside ____________/ ________ __________ instrument sets

rigid/soft wrapped

____________ after ultrasonic cleaning prior to placing in automated washer

rinse

prior to placing an instrument set from one mechanical unit to another.......

rinse

one method of preventing biofilm formation in lumens is to

rinse the lumens with distilled water and dry them well

a tray of instruments has been brought to decon in a saline solution (action)

rinse with water then clean in usual manner

unless otherwise directed, an item high level disinfected in glutaraldehyde must be

rinsed a minimum of two times

just as cleaning is the most important step in the decontamination process, _________________ is the most important step in the cleaning process; removes loosened soils and debris

rinsing

due to several intricate moving parts the amount of time that's authorized to go in ultrasonic is extended past the normal avg set time, rather it's between 15-30 mins in duration

robotic instruments

bacillus

rod shaped bacilli

ppk available in ________ to alllow for cutting to desired length

rolls

palate

roof of mouth

cocci

round/spherical shaped cocci

glutaraldehyde requires

routine employee monitoring for exposure levels

need to be separated from instruments in it's pan prior to being ran in an automated washer

rubber mats

-rrhexis

rupture

-cyst

sac

AMW detergent of alkaline (9-11)

safe for stainless steel instruments; needed for mechanical washers for removing heavy organic soil followed by neutralizing (acid) rinse along with water at a higher temp to maximize the effectiveness of the final detergent action

CS/SPD has responsibility for ensuring surgical instruments are ...

safe, clean, sterile and in proper working order

instruments should NEVER be soaked in; salt from this liquid will cause damage

saline

hom/o-

same, similar

Finishes of handheld instruments

satin (reflects light); shiny; black (ebonized) bland, absorbs light for laser procedures

Pectoral girdle

scapula and clavicle connect bones of arms and aids movemnet

cut/incise (sharps)

scissors (curved; designed to cut flesh); knives/scalpels; chisels; osteotomes

abrad/o-, abras/o-

scrape off

raph/o-

seam, suture

-crine

secrete

seminal vesicles

secrete fluid as a medium for sperm

bulbourethral glands

secrete substance to coat lining of urethra, neutralize pH of urine and lubricate penis in preparation for coitus

pancreas

secretes pancreatic juice for digestion; regulates blood sugar

prostate gland

secretions assist sperm mobility

retract tissue/organs

self retaining (designed w/ spring to keep open); handheld (skin hooks, bone hooks)

some peel pouches _________-__________, some _________ _________

self-sealing; heat sealed

come in contact with intact mucous membranes; non invasive endoscopes; endotracheal tubes

semi-critical; HLD; sterilization although desirable is not absolutely necessary

proper action in prep/assembly if an instrument within a set still has noticeable gross contamination

send back entire set for complete disinfection reprocessing

if a reusable sterile basin set that is not in a plastic protective covering is dropped on the floor

send it to be reprocessed

voluntary nervous system

sensation; mental function; skeletal muscle contractions

alg/e, algi/o, alg/o-, algesi/o-

sensitivity to pain

carry information to the brain

sensory nerve

unexpected occurrence involving death/serious injury; may specifically include loss of limb/function

sentinel event

hand washing facilities must be ______ from sinks used to decontaminate instruments

separate

before any instrument pans with multiple layers enter either sonic or washer decon/disinfector

separate to allow each layer to receive cleansing it deserves

AMW, keep layers of instruments (sets/pans) ___________________!

separated

before transport to decon reusable sharps and instruments actively used in procedure should be

separated/segregated from other instruments

the growth of pathogenic bacteria in living tissue

sepsis

two types of wrapping methods

sequential and simultaneous

SCD

sequential compression device. used to provide alternating compression to the lower extremities to help prevent the formation of blood clots. also known as DVT deep vein thrombosis machine

wrapping methods

sequential wrap; simultaneous wrap; square fold; envelope fold

AAMI

sets standards for CS/SPD; major resource for healthcare guidelines

gonads

sex glands

-plasty

shape

acu/o-

sharp, severe, sudden

Handled only if wearing PPE; all injuries that occur MUST be reported immediately

sharps

all decon rooms need to be accommodated.....

sharps bag and rigid container

are considered to be the most contaminated PPE, donned and doffed first

shoe covers

first item to be placed on when donning PPE

shoe covers

order of applying PPE

shoe covers>hand hygiene>gown>mask>face shield/goggles>gloves

advantages of LTGP sterilizing unit

short sterilization times, no warm up, no DART, no dry time, no necessary aeration

any injury to employee no matter how slight

should be documented in an incident report

medical waste requiring storage

should be kept in labeled, leak proof, puncture resistant containers under conditions that minimize or prevent foul odors; May be handled by janitorial

Training

should be standardized

glutaraldehydes

should never be used as an environmental disinfectant; require routine employee monitoring for exposure levels

scapula

shoulder blade

clavicle

shoulder bone in front

____________ mats as liners (small/delicate items) keep in place

silicone

remove ______________ mats prior to loading mechanical washer

silicone

protozoa

single celled (animal-like) microorganisms

protozoa

single celled organisms

fungi include

single celled yeast

fungi include

single celled yeasts

Hand washing

single most effective way to prevent infection; 15 second minimum

disposable instruments

single use; do NOT reprocess

chain of infection

six steps; causative agent, reservoir of the agent, portal of exit, mode of transmission, portal of entry, susceptible host

types of muscle tissue

skeletal (striated, voluntary), smooth (involuntary, digestion associated), cardiac (heart, involuntary)

function of the voluntary nervous system

skeletal muscle contractions

function of voluntary nervous system

skeletal muscle contractions

cutane/o-

skin

derma-

skin

largest organ OF the body

skin

largest organ of body

skin

Non-Critical

skin or contact indirectly, low-intermediate disinfection

floor trays usually consist of..

skin prep, anesthesia, instruments, drapes and towels, gauze and cotton balls

Integumentary system

skin, hair, glands and nails

comprised of the cranium and facial bones (axial)

skull

covers brain

skull

crani/o-

skull

cranio-

skull

axial skeleton

skull, hyoid, vertebral column and thoracic cage

Axial skeleton

skull>hyoid bone>vertebral column>thoracic cage

sterility assurance level (SAL)

slight probability of a viable microorganism being present on a product unit after sterilization

brady-

slow

micr/o-, micro-

small

ulna

small bone in lower arm

fibula

small bone in lower leg

ileo-

small intestine

disadvantages of LTGP sterilization units (with 24 hr BI)

small units, lumen and legth restrictions, long bio read outs once in incubator

-ula

small, little

cochlea

snail like structure in middle ear

Portals of Exit

sneezing, coughing (Respiratory); feces, saliva (GI tract); secretions from penis and vagina, urine (Genitourinary tract)

equipment to be processed and distributed in a timely manner

so that patient care is not adversely affected

orthopedic instrumentation

soak in a lipolytic or multi enzyme solution; U.sonic cleaning usually recommended (many MFG recom. extended cycle); connect flexible reamers to sonic irrigators if directed by MFG- always follow their instructions; Kerrison ronguers- especially problematic (kerrisons that cannot be opened for cleaning should be routinely cleaned by instrument repair service)

distal end of a rigid endoscope should be cleaned with a

soft bristled brush

clostridium botulinum is harbored in

soil

major non living reservoirs of infectious disease

soil and water

bottom shelf within sterile storage

solid

wash ___________ pans separately; do not place over instruments

solid

Sterile storage racks MUST be

solid bottom, 2" from wall, 18" from ceiling or sprinkler (deflector plate), 8-10" from floor to prevent dirt/dust/splashing when cleaning

manufacturer verified device for testing ultrasonic

sonocheck

commercial products to verify cleaning process outcomes for either ultrasonic/automated washer

sonocheck (u.s.), aluminum foil (u.s.), TOSI (u.s. and a.w.)

verify effectiveness of ultrasonic cleaners

sonocheck or related commercial test strips (to include aluminum foil method)

reservoirs of infection

source of disease causing organisms must be present

NFPA White Diamond

special hazard information

muscles

specialized cells responsible for contractions in the body

PPE

specialized clothing, protect against hazard

exchange cart is not considered a

specialty cart

testes

sperm cells and male sex hormones formed

shape of streptococcus

spherical

shape of cocci can be

spherical/round

soaking is not recommended from POU to transport because of the potential for ____________

spillage

sprilillum

spiral and corkscrew

shape of spirochete

spiral like

spirochetes

spiral-like shape; found in water, sewage, soil and decaying organic matter; reason water in SPS decontamination needs to be looked at being treated (filtered, softened, distilled, sterile, etc.)

spleno-

spleen

a microorganism that is resting and has a hard, shell like outer covering

spore

in order to test the effectiveness of some sterilization cycles ______________ are within a biological indicator vial

spores

microorganisms; form a thick shell to survive adverse conditions

spores

used to test effectiveness of sterilization cycles

spores

prior to disposal in rigid sharps container

spores deemed not to be used may be recommended to be 'killed" via it's processing method (sharps container because containerized with glass inside plastic)

SMS

spunbound meltblown spunbound

two folding techniques of a soft wrapped item

square (larger items) and envelope (small to medium items)

manufacturing material of choice

stainless steel; shiny/mirror finish, matte/satin finish

personnel who collect/process PCE should observe

standard precautions

training should be

standardized

major cause of healthcare acquired infections

staph aureus

Examples of gram positive bacteria

staphlococcus, enterococcus and streptococcus

Homeostasis

state of equilibrium; conditions within cells must remain stable

Recommended Practices

statements of sound principles of practice based on scientific data and opinions of experts.

recommended practices

statements of sound principles of practice based on scientific data and the opinion of experts

BI Spore Geobacillus Stearothermosphilus is used for

steam (autoclave), LTGP

for autoclave sterilization to occur

steam must make contact with all surfaces

most cost efficient sterilization method

steam under pressure

to kill the remaining microorganisms on metal surgical instruments within SPD, the most cost effective sterilization method is generally considered to be....

steam under pressure

geobacillus stearothermophilus used for

steam, sterrad, VPro and ozone

procedures

steps for performing a task are defined

for a soft wrap that is too small...

sterilant can reach but susceptibility for contamination on slightly exposed areas

for a soft wrap that is too big...

sterilant penetration can be prevented/inhibited along with air removal

Restricted Areas

sterile procedures are performed; surgical scrub attire, hair covering and mask required

absence of all microbial life including spores

sterility

______________________ will not compensate for poor cleaning

sterilization

absence of ALL microbial life (including spores) is accomplished via

sterilization

bacterial spores (method of destruction)

sterilization

process by which all forms of microbial life including spores are destroyed

sterilization

verify correct container for _________________ process selected (sterrad different)

sterilization

lot control numbers should be placed on each package sterilized and on the...

sterilization load record

holding/maintained phase of steam

sterilization phase

all devices should be able to be ____________ in the same cycle

sterilized

used in open heart surgery

sternal saw

Thoracic cage

sternum and 12 pairs of ribs; protect organs of chest and upper abdomen

a small cut is noted in the cord of an IV pump (action)

still clean, disinfect, tag and send to biomedical engineering and immediately out of circulation

gastr/o-

stomach

-lith

stone

litho-

stone

best method of action if you receive blood/body splash to mouth/eyes, needlestick or cut in your dept

stop what you're doing immediately cleanse w/warm soapy water, report in same facility's ER/ED and notify your chain of command

all play a role in how bones support other body systems

storage of minerals, growth of blood cells and protection of internal organs

urinary bladder

storage sac for urine

septoplasty

straightening or removing cartilage and/or bone in the nose when the nasal septum is deformed, injured or fractured

appendix

structure in lower intestines

Anatomy

structure, form and organization of body parts

oral suction

suction machine used to suction out upper respiratory tract, uses continuous suction

autoclave loads require

sufficient dry time and proper loading prior to set's steps of storage/distribution

steam at a temp which exceeds that of a saturated steam (in the absence of water) at the same pressure; also referred as 'dry steam'

super heat

epidermis

superficial protective layer

when heat is added to steam without increasing moisture content

superheated steam

when heat is added to steam without increasing moisture content, the steam is called...

superheated steam

scissors with black handles referred to as

supersharps

hyoid bone

supports the body and functions in swallowing

ultrasonic should contain ______________ to bind with the soils and hold them in suspension after they are removed from the instruments

surfactants

_____________ instruments represent a large portion of the HCF budget

surgical

containerized packaging systems are most commonly used to protect

surgical instrument sets

PPE in decon

surgical scrub attire; to be laundered by facility; bonney suit; dedicated shoes

Decontamination area attire

surgical scrubs and OSHA required PPE

Clean assembly and sterile storage attire

surgical scrubs and hair covering

Operating room

surgical scrubs, hair covering and masks

-rrhaphy

surgical suturing

-cele

swelling

-edema

swelling

coccyx

tail bone

multipart instrument

take apart during decon! ; follow manufacturer guidelines

latches/locks applied as a final closure on the ends of rigid containers are known as

tamper-evident seals

water that has been treated and is acceptable for drinking

tap water

1st sink in 3 sink method

tap water and detergent (pre-soak/washing)

2nd sink in three sink method

tap water( for preliminary rinsing)

lacrim/o-

tear, tear duct, lacrimal duct

-dontia

teeth

Accessory digestive organs

teeth, tongue, salivary glands, liver, pancreas

accessory digestive organs

teeth, tongue, salivary glands, liver, pancreas

a coworker is observed taking dressing supplies for use at home (first action)

tell him/her that this is not the right thing to do

critical parameters for heat sealing paper-plastic pouches

temp, pressure and dwell time

when sealing peel pouches, use correct _______________ to seal

temperature

connects muscle to bone

tendon

teno-

tendon

achilles

tendon at base of leg at heel

hamstring

tendon in leg

drains in pre vacuum and gravity displacement sterilizers are placed at the bottom front because the air

tends to concentrate at the bottom of the chamber

FRD test

test to see if fog is smudge/ permanent

orchio-

testes

must be placed on their sides in the steam sterilizer in order to facilitate air removal and steam penetration

textile packs

packaging means...

textile wrappers, plastic paper pouches (ppk), rigid sterilization containers

compatible packaging; ethylene oxide (EtO)

textile, nonwovens, polyolefin wraps, paper plastic pouches/rolls, tyvek (all plastic pouches), polyethylene, most rigid containers

compatible packaging; steam

textile, nonwovens, polyolefin wraps, paper-plastic pouches/rolls, rigid sterilization containers

AAMI recommends that rigid sterilization containers be biologically tested before purchase and annually to verify

that the sterilizer is able to sterilize the contents

immunity

the ability of the body to specifically counteract antigens

asepsis

the absence of pathogenic microorganisms that cause disease

reverse osmosis

the diffusion (flowing) of water through a semi-permeable membrane to eliminate impurities that it contains

Ethics

the discipline dealing with what is good and bad and with moral duty and obligation.

if too many microorganisms remain after the cleaning process when high level disinfecting a device

the disinfection process might not be effective

does not depend on cost of chemical

the effectiveness of any chemical disinfection process

when a positive BI demonstrates a sterilization process failure and the failure is the result of an operator error

the error should be corrected and the load reprocessed

most important factor in preventing bacteria from contaminating sterile packages

the handling of packages

principal living reservoir of human disease

the human body

a gauge on the main steam line, usually located at the back of the sterilizer tells you the steam pressure as it is entering

the jacket

if hydrogen peroxide is mixed with even a drop of water in LTGP

the load can abort

mode of transmission

the method of transfer of an infectious agent from the reservoir to a susceptible host

causative agent

the microorganism that causes an infectious disease

American Medical Association (AMA)

the most important organization related to healthcare ethics.

economical order quantity

the optimum amount of a supply to order

portal of exit

the path by which an infectious agent leaves the reservoir

portal of entry

the path used by an infectious agent to enter a susceptible host

reservoir of the agent

the place where an infectious agent (microorganism) can survive

the two gauges on a steam sterilizer measure

the pressure in the jacket and the chamber

condensation

the process by which a gas or vapor changes to liquid; leads to microbe build up, which leads to patient infection

AAMI's definition of cleaning

the removal of contamination from an item to the extent necessary for further processing or for it's intended use

cleaning

the removal of contamination from an item to the extent necessary for further processing or for the intended use (AAMI ST79)

AAMI's definition of cleaning

the removal of contamination from an item to the extent necessary for further processing or it's intended use

a batch of detergent diluted with recommended type and amount of water will have ______ _______ effect on the 5th instrument set being decon'd as the 1st

the same

Degassing ultrasonic

the solution in the ultrasonic after filling with water and the amount of detergent recommended should be run on an empty cycle each time water is changed

impingement

the spray force action of pressurized water in an automatic washer against instruments being processed to physically remove bioburden

sterility maintenance cover should be placed on sterile items when

the sterile items cool to room temp

thermal disinfection

the use of heat to kill all organisms except spores

decontamination

the use of physical or chemical means to remove, inactivate or destroy bloodborne pathogens on the surface of an item (OSHA)

automatic washers clean via

thermal disinfection (use of heat to kill) and spray force action (impingement)

NOT classified as critical medical device

thermometer

outside shipping cartons should not be brought into SPD because

they are often biologically contaminated

shipping cartons are not acceptable in sterile storage because

they can harbor bacteria

surgical grade instruments, if properly cared for, usually last longer than floor grade instruments because

they have a passivation layer

the MAIN disadvantage of using rigid steriliztion container system

they must be disassembled, processed, reassembled and checked before each use

all contaminated items must be handled as if...

they represent the worst case scenario

biofilms

thick masses of cells and and extracellular material; adhere ti the surface of any object that comes in contact with non sterile water (including distilled/dionized water); form a protective slimy film making cleaning, disinfection and sterilization difficult if not impossible

sternum, 12 pairs of ribs; protects chest and upper abdomen

thoracic cage

making opening into thoracic cavity to give access to lungs and heart

thoracotomy (respiratory)

effective sterilization begins with

thorough cleaning

fourth of five major steps for flexible endoscopes

thorough rinse (3x or 30 secs) to remove all HLD via treated water

flagella

thread like tails; help bacteria move through liquids

pharynx

throat

tracheo-

throat

thyro-

thyroid

if a non-perforated tray is used for the sterilization of instrument sets, it must be

tilted in the sterilizer rack

parameters for LTGP (VPro)

time, temp and hydrogen peroxide concentration

parameters for LTGP sterilization

time, temp, hydrogen gas plasma

3 parameters of steam autoclave sterilizer

time, temp, pressure

hyoid

tiny bone in neck

measuring hinged instruments

tip of finger rings to end of jaws

measuring retractors

tip of handle to tip of blade, length and width of retractor blade (several measurements needed)

eye instruments should not be placed on top of each other in tray and ________ should not protrude through basket

tips

cut with dissecting scissors

tissue

retractors hold back

tissue/organs

sterilization

to accomplish the absence of all microbial life (including spores)

purpose of insulation on laparoscopic instrumentation

to avoid unwanted electrical shock/burns when cauterizing

-clast

to break

-tripsy

to crush

excis/o-

to cut out

purpose of tungsten carbide insert on a needle holder

to hold suture needle better

purpose of packaging....

to maintain sterility until opened for use

overall role of SPD

to provide dependable service to enhance patient care

syn-

together, with, union, association

gloss-

tongue

sterilant penetration can be inhibited by using a wrapper that is

too large

follow mfg guidelines for enzymatic detergent

too much/too little can render ineffective

odon-

tooth

proximal

top of limb; opposite distal

alcohol is used as

topical antiseptic or a sanitizer (shelves, bins etc)

lacer/o-, lacerat/o-

torn, mangled

most efficient distribution system

total exchange cart

ad-

toward

medial

toward center of body; opposite lateral

distal

toward end of limb

superficial

toward surface of skin; opposite deep

inferior

toward the feet

superior

toward the head

lower respiratory system

trachea, bronchial tree, lungs

place sterile items in a plastic bag/tote bin when

transporting by hand

fallopian tubes

transports egg to uterus

esophagus

transports food to stomach by peristalsis

esophagus

transports food to the stomach

when a rep brings an outside vendor set it should be

treated as contaminated and sent through entire process

when handling surgical instruments, final rinse in cleaning should be done using

treated water

when handling surgical instruments, the final rinse should be performed using______________

treated water

delt/o-

triangle

ureter

tube connecting bladder and kidneys

esophagus

tube from throat to stomach

-oma

tumor

metal-bristled brush can be used to clean

tungsten carbide jaws of needle holders

not clear because of stirred up sediment

turbid(ity)

"ban the fan"

turbulent air flow, re-circulate dust and microorganisms, interferes with maintaining air pressures

bi-

two

di-

two

bluish-black stains

two different types of metals ultrasonically pressed together

ear consist of

tympanic cavity and membrane; malleus, incus, and stapes; eustachian tube connects middle ear to throat; cochlea (organ of corti)

type of organism to be killed helps determine....

type of disinfectant that should be used

manual cleaning detergents

typically of neutral pH; available in liquid, solid, powder; follow the manufacturer instructions and measure accurately

acceptable packaging material for low temp gas plasma

tyvek

ebonized instruments(due to texture flaking) and plastic trays(absorb sound waves) are not recommended for use in ____________ ; hinged instruments must be in open position; not recommended to clean in 'strung' position

ultrasonic

plastic rigid set containers are not recommended for the _______________ cleaner

ultrasonic

gross soil should be removed prior to placing instruments in _____________ ______________

ultrasonic cleaner

due to the aerosol of microbes CS/SPD personnel are to ALWAYS brush/clean devices

under the surface of the water

to prevent aerosols, submersible instruments should be brushed

under the surface of the water

sub-

under, less, below

sentinel event

unexpected occurrence involving death/serious physical or psychological injury within hospital

bacteria are

unicellular

instruments of ______________ metals should not be placed together in the same tray for processing (e.g. stainless steel should not be placed with aluminum, copper, or brass instruments

unlike

an-, ana-

up, apart, backward

epi-

upon, above

atria

upper chambers; receive blood back from veins

maxilla

upper jaw bone

connect kidneys to urinary bladder

ureters

regulates pH and volume of body fluids; controls red blood cell production and blood pressure; removes salts and nitrogenous waste from body; helps to maintain normal concentration of water and electrolytes

urinary system

categories of instruments are categorize according to _________

use

opthamology instruments; to avoid TASS

use fresh new batch of enzymatic detergent in both bath and sonic (if manuf. states sonic is even ok to use for these instruments); followed by thorough rinsing via deionized/treated water!

sequential compression device (SCD)

used for circulation support for prevention of clots

iodophors

used for skin antisepsis; should never be used for cleaning instruments

laparoscopic instruments

used minimally invasive surgery; selected ways to test serviceability

High Level Disinfectants

used on devices that will come into contact with patients; kills most organisms but not necessarily spores

needle holders

used primarily to hold suture needles; testing: 2-0 nylon (ethilon) tug

cart washer

used to clean and sanitize metal surgical case carts, supply carts and with a special loading rack, any sterilization container; provides wash (with detergent of MFG choice), rinse and dry cycles (some- acid rinse with MFG choice); used also to clean rigid containers and filter covers; just the separate containers itself

scissors

used to cut/dissect tissue, cut dressing/suture; testing: esmark/facial tissue (several cuts in test material)

finger rings

used to grasp instrument and control jaw action; can be open/closed, round/oval

retractors

used to hold back tissue and organs

colonoscope

used to visualize the entire large intestine

bronchoscopes

used to visualize the tracheobronchial tree

cystoscope

used to visualize urethra and bladder

MRSA

usually transmitted by healthcare workers due to poor/infrequent handwashing, or w/ pateients who have been on antibiotic therapy for a long time; Methicillin Resistant Staph Aureus

Antiseptics

usually used topically to prevent, arrest or inhibit the growth of microorganisms on living tissue

if glass device is authorized to be ran in automatic mechanical washer (cycle)

utensil cycle

hyster/o-

uterus

colp/o

vagina

MFG performs

validation

the manufacturer performs ________ for a product, the facility end user performs _______.

validation; verification

system level of organization

various numbers and kinds of organs which together perform complex functions for the body

living things responsible for causing disease

vectors

lyme disease is transmitted by

vectors

lyme disease transmitted by

vectors

phleb/o-

vein

ven/o-

vein

veno-

vein

would not be included in the routine inspection of an instrument

vendor identification number

end user performs

verification

cover spinal cord

vertebrae

vertebral column

vertebrae separated by discs; lumbar, thoracic and cervical spine

26 ring shaped bones (cervical, thoracic, lumbar) (axial)

vertebral column

instruments with lumens should be soaked

vertically

any instruments that arrive with lumens should be soaked _________ NOT ___________

vertically; horizontally; flush and brush 3x or until clean

angio-

vessel

vaso-

vessel

-oscopy

viewing

influenza caused by

virus

prions

virus-like; cause variety of neurodegenerative diseases of humans and animals; have affinity for eye, brain and spinal cord tissues; *VERY difficult to kill by usual sterilization methods (considering HCF's willingness to reprocess- extended exposure time in steam)

minute infectious agents, grow only in living tissues/cells, require living host to multiply

viruses

organisms of microscopic/ submicroscopic size include

viruses, rickettsiae, bacteria, algae, yeasts and molds (microbe)

a manual cleaning bath can be used for a max of 8 hours unless

visibly soiled or for opthalmology instruments

plastic paper peel pouches are used to _______________ contents; ppk'd in prep for user's "________________ ________ ________"

visualize; "position of use"

laryng/o-

voice box

larynx

voice box

Association of peri-Operative Registered Nurses (AORN)

voluntary; develops nationally recognized standards, recommended practices and guidelines for peri-operative setting

Society of Gastroenterology Nurses and Associates (SGNA)

voluntary; established standards for effective processing of flexible endoscopes

The Joint Commission (TJC) formally (Joint Commission on Accreditation of Healthcare Organizations (JCAHO))

voluntary; establishes accrediting standards and conducts onsite inspections; annual competency testing

World Health Order (WHO)

voluntary; furthers international cooperation in improving health conditions

Association for Professionals in Infection Control (APIC)

voluntary; international organization dedicated to prvention and control of infections

Center for Disease Control and prevention (CDC)

voluntary; promotes health by preventing and controlling disease; publishes recommendations and guidelines; hand hygiene (15 second minimum); NO artificial nails; classifies medical devices according to Spaulding

American National Standards Institute (ANSI)

voluntary; proposes standards to include enhancing the global competitiveness and quality of life

Association for the Advancement of Medical Instrumentation (AAMI)

voluntary; sets standards for CS/SPD

clean as scheduled and document..

walls, vents, ceiling fixtures, cabinets, shelving

requirements for bacteria to survive

warmth, food, and water

if a technicians skin is exposed to liquid ethylene oxide (first)

wash the exposed area with large amounts of soap and water

lumened items must be _________ and _________ by hand and thoroughly rinsed with treated water (deionized/distilled)

washed and flushed

recommended lubricants for use on surgical instruments

water based

unless sink turns off automatically after hand washing

water should be turned on via disposable towel and turned off using a different disposable towel

(enzymatic) detergent

water soluble cleansing agent composed of "surface wetting agent"

light and dark spots

water spots from allowing instruments to air dry

hydr/o-, hydra-

water, fluid

spirochetes are found in

water, sewage, soil and decaying organic matter

Cells require

water; food; oxygen; heat; pressure; Do NOT require cold

impervious

waterproof/water resistant; ideal against chemicals and bloodborne pathogens in decon

box lock

weakest part; most likely to find cracks; most difficult to clean

ALL personnel entering decon MUST_______ ________

wear PPE

anyone entering the prep area must

wear proper attire

floors in prep should be

wet mopped daily

SPD should be, due to possibility of dust kick up when sweeping

wet-mopped daily

policies

what a department must do

laparoscopic instruments should be reassembled for sterilization

when recommended by mfg

sterile packs are most vulnerable to contamination

when the package is still hot

Preparation and Packaging Area

where cleaned items are inspected, assembled, and packaged.

Sterile Stores

where items for patient care from outside manufacturers are stored. Sometimes referred to as Medical Supply Distribution, Central Supply, or similar designation.

Patient Care Equipment Clean-Up Area

where patient care equipment is cleaned and disinfected.

Dispatch

where sterile and clean items are dispensed.

Sterile Storage Area

where sterile items are stored until needed.

Case Cart Area

where sterile supplies (trays and/or sterile items from outside manufacturers) are kept and picked for surgical cases.

Sterilization Area

where terminal sterilization is performed.

ability of disinfectant to perform correctly depends on

whether it remains wet (in contact) for the required amount of time

the ability of a disinfectant to perform depends on ...

whether it remains wet for the stated amount of time

the ability of a disinfectant to perform most efficiently depends on

whether it remains wet for the stated amount of time

not required documentation in high level disinfection records

whether item was completely dry

HLD recording

whether item was completely dry (or not); not necessary to be recorded; it's on YOU

responsible for providing immunity

white blood cells

broncho-

wind pipe

trachea

wind pipe

can cause microabrasions which allow microbes to harbor; not recommended; can damage instruments; Exception; tungsten carbide

wire brushes

when cleaning, brush ________ serrations NOT against!

with

aesthet/o-

with feeling

when preparing instruments from a dissection tray for processing in a washer/decon, instruments should be positioned

with retractors on the bottom and handheld instruments on the top

sym-

with, together, joined together

endo-, end-

within, inner

intra-

within, inside

an-

without

warm up jackets

worn to prevent hair and bacterial shedding from bare arms

simultaneous wrapping means

wrap an instrument set with a single, non-woven wrapper, double ply, bonded at edges

Sterile Processing CBSPD Test

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