6. BAMS Decon/IPC

Question 1

Decon Sciences

1. What is the definition of cleaning
2. What are the 4 elements of cleaning
3. How should instruments be transported to and from an LDU

Answer 1

1. Removal of contamination from an item to the extent necessary for its further processing and intended use
2. Chemicals, temperature, energy, time
3. Rigid, durable, leak-proof container with a tight-fitting lid. Container should be clearly labelled and easy to clean and disinfect

Question 2

Decon Cycle

What is the definition of:

1. Operator
2. User
3. Manager
4. Decontamination
5. Policy
6. Procedure
7. Outcome
8. Work instruction
9. Automatic control test
10. Name 3 key pieces of legislation relevant for decon
11. What are the components of the decon cycle

Answer 2

1. Person with authority to operate decon equipment. They can note instrument readings, replenish detergent solutions and perform simple housekeeping tasks (clean equipment, make ready for use)
2. Person responsible for the day-to-day management of the equipment. Can certify equipment as fit for use, keep all documentation relating to equipment, ensure equipment is subject to periodic testing and maintenance, maintain records and train operators
3. Person ultimately responsible for LDU operation
4. Combination of processes (washing, disinfection, sterilisation) used to make reusable items safe for handling by users and for use on patients
5. An overall statement of intent. It is a set of rules/requirements to be followed to achieve a given outcome/process
6. A guideline of major methods that is used to meet policies as defined by a company/practice
7. A landmark event in pursuit of overall intent
8. Specific steps needed to carry out procedures
9. The first run each day with instruments
10. Health and Safety at Work Act (1974)
    Medical Device Directive 2007/47/EC
    Health and Safety (medical Devices) regulations 1996
11. Cleaning, disinfection, inspection, packaging, sterilisation, transport, storage, use and transport

Question 3

Water

1. What is cold mains water used for
2. What is hot mains water used for
3. What are 4 types of demineralised water and what are they used for
4. What is the purpose of demineralising water
5. Why should rinsing (manual/WD, etc) use demineralised water
6. What are detergents

Answer 3

1. Manual washing, ultrasonic cleaning, WD
2. Manual wash, WD
3. Reverse osmosis (WD, sterilisers), distilled (sterilisers), deionised (sterilisers), sterile (sterilisers)
4. Remove unwanted ingredients which would be harmful to the device or provide a rough surface for micro-organisms to cling on to, making them difficult to further clean - remove suspended particles and minerals which could create a rough surface on instruments for micro-organisms to cling/adhere to
5. To prevent mineral deposits turning to limescale on the surface
6. Wetting agents with a hydrophobic end that sticks to soiling and a hydrophilic end that surrounds soiling molecules and interacts with water, allowing the soiling to be easily washed away

Question 4

Manual and Ultrasonic Cleaning

1. What PPE should be used for manual cleaning
2. What temperature should manual washing be performed at
3. How is corrosion avoided
4. Name 2 methods of manual cleaning, what the technique involves and what they are used for
5. What is the function of an ultrasonic cleaner
6. When and why should ultrasonic cleaners be degassed

Answer 4

1. Full-face visor, marigold-type gloves, plastic disposable gown (not apron), hair net
2. Below 35C (30-35C)
3. Avoiding wire brushes, disposing of instruments with rust spots, incorporating corrosion resistance layer on instruments
4. Immersion - scrub under water to minimus aerosol risk. Non-lumened devices, mirrors, probles
   Non-immersion - wipe using detergent solution and clean using a non-linting cloth
5. Pre-treatment to WD. Remove gross contamination/contamination that is difficult to remove
6. After filling (before use). To remove air/oxygen from the water, as oxygen inhibits cavitation and forms bubbles, leading to less effective cleaning. Degassing removes any gases, ensuring bubbles are only produced from ultrasonic activity and the bubbles produced are of the same intensity

Question 5

Washer Disinfectors

1. What is the definition of disinfection
2. What is the most common contact time for disinfection in healthcare
3. Describe the 5 stages in a standard washer disinfector cycle
4. List 3 WD housekeeping tasks

Answer 5

1. Destruction of pathogenic and other kinds of micro-organisms by physical or chemical means
2. 90-95C for 12s
3. Flush - items flushed with water <45C to remove gross contamination
   Wash - detergent and water solution remove any remaining soil
   Rinse - removal of any remaining cleaning agent
   Disinfect - thermal disinfection at holding time using RO water
   Dry - circulating 90C heat to remove remaining moisture and prepare items for packaging/sterilisation
4. Check filter for blockages, clean door and seal, check door and seal for signs of damage, check detergent level, test spray arms (ensure freely rotating)

Question 6

Sterilisation

1. What is the definition of sterilisation
2. What is the definition between a sterilised and sterile instrument
3. Why is steam sterilisation perferred
4. What are the standard measurements for appropriate sterilisation
5. What are 3 types of bench top sterilisers and what are 2 used for
6. What are the daily and weekly tests for 2 types of sterilisers
7. List 3 steriliser housekeeping tasks

Answer 6

1. Process of making a medical device free from live, reproductive micro-organisms. Probability of viable micro-organisms present following sterilisation should be <1/1x10^6
2. Sterilised - instrument that has been sterilised but is unwrapped and there is no attempt made to maintain sterility
   Sterile - wrapped instrument processed using a vacuum steriliser
3. Exposes the device to steam at specific temperatures for a specified holding time to kill micro-organisms. Rapid heating, rapid destruction of micro-organisms (inc bacterial spores), no toxic residues, low cost, easily controlled and monitored
4. 134-137C, 2-2.3bar pressure, min 3 mins, direct contact with all surfaces essential
5. N-type - non-vacuum. Passive air removal - natural/gravitational displacement. For non-wrapped solid items
   B-type - active air removal (vacuum). For wrapped and lumped instruments (maintains sterility)
6. Type B daily - Helix/Bowie-Dick test
   Type N daily - steam penetration test
   Type B weekly - vacuum leak test and air detector function test
   Type N weekly - protein test strip
7. Wipe door seal and chamber, check 3 door safety devices, draining and refilling daily

Question 7

SICPS and chain of infection

1. List the 10 SICPs
2. List the 6 components of the chain of infection
3. What are the WHO 5 moments for hand hygiene

Answer 7

1. 1. Patient placement
2. Hand hygiene
3. Respiratory and cough hygiene
4. PPE
5. Safe management of care equipment
6. Safe management of care environment
7. Safe management of linen
8. Safe management of blood and body fluid spillages
9. Safe disposal of waste (including sharps)
10. Prevention and exposure management (including sharps)
11. Infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host
12. Before touching a patient, before clean/aseptic procedures, after body fluid exposure/risk, after touching patient surroundings, after touching a patient

Question 8

Blood spillages

1. How would you manage a blood spillage
2. What 2 cleaning agents can be used and what concentration
3. How long should the cleaning agent be left for

Answer 8

1. Saturate area with paper towels and use them to mop up (dispose of in clinical waste)
Apply cleaning agent
Clean area
Mop with detergent
Dry

2. Sodium hypochlorite or sodium dichloroisocyanurate. 10,000ppmCl-
3. 3-5mins

Question 9

Sharps injury

1. Give 3 examples of an exposure/sharps injury
2. What is a significant exposure
3. What is an exposure prone procedure
4. Give 3 ways that you can prevent sharps injuries and BBV acquisition
5. How do you manage a sharps injury
6. What are the risks of acquiring HBV, HCV and HIV from infected individuals and what is the treatment for each

Answer 9

1. A needle or sharp object contaminated with blood/bodily fluids that pierce/break the skin; splashing of blood/bodily fluids onto broken skin; contamination of eyes, nose or mouth with blood/bodily fluids; human bite that breaks skin
2. Where needles/sharp objects that are contaminated with blood/bodily fluids from a source patient who is infected with a BBV pierce the skin
3. An invasive procedure where there is a risk that injury to the worker may result in exposure of the patient’s open tissues to the blood of the worker
4. Appropriate HH, appropriate PPE, safe disposal of waste (including sharps), following other SICPs, safety devices, minimal manual manipulation of sharp instruments and devices
5. Stop what you are doing
   Apply pressure and allow to bleed
   Wash area under warm running water (don’t scrub)
   Assess type of injury
   Risk of source blood
   Establish contact with tutor and occupational health (baseline bloods, PEP if appropriate, bloods 12 weeks after exposure)
6. HBV – 0.3% risk (no PEP required for successful vaccine responders)
   HCV – 0.03% risk (no PEP)
   HIV – 0.003% risk (begin ART ASAP)

Question 10

Waste management

1. What are the 4 principles of waste management
2. Name the 4 streams of waste and give an example of what would go in each
3. Give 3 key features of amalgam containers
4. What is a waste consignment note and how long should it be kept for
5. Name 3 pieces of legislature relevant to this topic

Answer 10

1. Segregation, storage, disposal, documentation
2. Black – domestic waste
   Yellow – clinical waste
   Orange – special clinical waste (identifiable body parts)
   Red – special waste (amalgam)
3. White containers with a red lid. They are rigid and the lid contains a mercury vapour suppressant and they are leak/spill proof. They should be clearly labelled and changed regularly
4. Waste consignment/transfer note provides a description of the waste, nature of origin, quantity of waste and transport mode and destination. It should be kept for a minimum of 3 years
5. Health and Safety at Work Act (1974), COSHH (2002) and the Environmental Protection Act (1990)