Asepsis in Cath Lab

Question 1

Absence of germs such as bacteria, viruses, and other microorganisms

Answer 1

Asepsis

Question 2

Standard healthcare practice that helps prevent the transfer of germs to or from patients, staff and surrounding environment

Answer 2

Aseptic Technique

Question 3

Sterile attire, hand hygiene and non touch technique to achieve a safe level of asepsis for technical and short procedures

Answer 3

Aseptic Fields

Question 4

When does the Cath Lab need to meet OR standards of surgical asepsis

Answer 4

Planting permanent devices such as pacemakers, defibrillators, or artificial valves. Complex EP procedures as well

Question 5

What is the range of infection rates in the Cardiac cath lab and EP procedures

Answer 5

0.1% to 0.6%

Question 6

What is HAI

Answer 6

Healthcare Associated Infection

Question 7

When should PPE be worn by all healthcare workers in the Cath Lab

Answer 7

Direct patient contact

Question 8

What should all lab personnel entering the hybrid or procedure room wear?

Answer 8

Scrub attire and head coverings

Question 9

What are Sterile Surfaces

Answer 9

Free of all living organisms including bacterial spores and viruses

Question 10

Visitors entering the cath lab should don either

Answer 10

Clean surgical attire or single use jumpsuit (bunny suit)

Question 11

When should OSHA specified respiratory protection be worn?

Answer 11

Person with known or suspected active tuberculosis disease

Question 12

What should be adhered to follow hand hygiene

Answer 12

Fingernails short 1/4 inch, use hand lotion that is compatible with gloves, exclude healthcare providers from environment if they have cuts, abrasions, dermatitis, or fresh tattoos

Question 13

When should cath lab personnel wash their hands

Answer 13

Coming in and leaving duty, before and after each contact with patient or environment, after donning and removing gloves, before and after eating/restroom, any time there has been contact with blood or other materials, after hands are visibly soiled.

Question 14

What is the purpose of surgical scrubbing

Answer 14

Remove debris and transient microorganisms from nails, hands, and forearms.

Question 15

What are the five planes for cleansing hands

Answer 15

two sides, back, front, and fingertips

Question 16

Where should hands be held during scrubbing

Answer 16

above the elbows

Question 17

When using a alcohol based surgical hand antiseptic, what are the following steps:

Answer 17

-Remove jewelry
-Don a surgical mask
-Prewash hands and forearms if soiled
-clean under fingernails with a nail pick under water
-Rinse hands and forearms under running water
-Dry hands and forearms thoroughly with disposable paper towels
-Dispense recommended amount of antisepsis product and apply it to hands and forearms
-Repeat application as directed
-Rub thoroughly until completely dry.

Question 18

When using a traditional scrub-with-water product, the following steps are:

Answer 18

-Remove jewelry
-Don a surgical mask
-Prewash hands and forearms with soap and water if visibly soiled
-Clean under fingernails with a nail pick under water
-Dispense recommended antimicrobial product
-Apply to wet forearms and hands using a soft sponge
-Keeping hands elevated, scrub all skin surfaces with a sponge for 3-5 minutes
-Avoid splashing surgical attire
-Discard sponges in container
-Keeping hands elevated, rinse hands and forearms from fingertips to elbows under water
-In OR, dry thoroughly with a sterile surgical towel before donning gown and gloves
-Keeping hands elevated, dry hands with a sterile towel if required

Question 19

When does the surgical gown be considered a sterile field

Answer 19

chest down to the level of the surgical field

Question 20

Gowning Procedure:

Answer 20

1: Hold a folded sterile gown by the collar away from the body
2: Allow the gown to drop open, ensuring that no part of it touches the floor or any other object
3: Slide both arms into the sleeves, always keeping them above the waist. Flex the elbows to get the arms through the sleeves
4:Staff members will grasp the collar of the gown and fasten the tabs at the back of the neck
5: The gown can be tied at the waist after gloving

Question 21

When performing closed assisted gloving, the steps are:

Answer 21

1: Arms are pushed only so far into the sleeve of the sterile gown that the hands are still covered by the cuff
2: The nondominant hand is used to pull the sterile glove onto the dominant hand
3: The gloved hand then applies the remaining glove to the other hand
4: Gloves are adjusted once both hands are covered

Question 22

Open assisted method of applying gloves are:

Answer 22

1: Sterile gown is donned, with hands emerging from the cuffs
2: Using the non-dominant hand pick up the glove for the dominant hand at the cuff, using just the fingertips
3: Slide this hand into the glove until a snug fit over the thumb joint and knuckles is achieved.
4: Slide the gloved fingertips into the folded cuff of the remaining glove. Slide the ungloved hand into the glove until a snug fit is achieved
5: Unfold the cuffs of both gloves down over the gown cuffs and up the sleeves as far as they will go

Question 23

When should you wear two surgial gloves on each hand?

Answer 23

Whenever there is a risk of exposure to blood, body fluids, and other infectious materials during the operation

Question 24

What is considered the sterile field

Answer 24

Area surrounding the site of incision or perforation into tissue that has been prepared for a surgical or invasive procedure. Anything that is covered with sterile drapes and drape accessories as well.

Question 25

When should sterile fields be prepared

Answer 25

As near as possible to the start time of the surgical or other invasive procedure.

Question 26

How far away should non scrubbed personnel be from the sterile field

Answer 26

12 inches away and not pass in between two sterile fields

Question 27

What should you do with a sterile item that touches an unsterile area?

Answer 27

Discard ad replace the item. Do not wipe the item with disinfectant.

Question 28

What should you check before introducing an item to the sterile field?

Answer 28

-Check for an expiration date
-Check the packaging to ensure there has not ben a breach
-Check chemical sterilization indicator on package

Question 29

How do you open a sterile item?

Answer 29

Open a wrapper flap that is farthest away from the body
Open each side flap
Open the near flap

Question 30

How do you cover a sterile field?

Answer 30

Use two sterile cuffed drapes to cover the sterile field. First drape should be placed horizontally over the table with the cuff at the halfway point. Place a 2nd drape on the other side to cover the 1st cuff To remove, place your hand in the 1st cuff drape and remove and repeat with the 2nd cuff.

Question 31

What should you do to prepare puncture site?

Answer 31

Assess the skin of presence of moles, warts, and rashes. Hair should be left at the surgical site unless removed by doctors orders

Question 32

Where should hair removal take place

Answer 32

Away from the sterile field and in another room. Use a electric powered clipper with a disposable head

Question 33

What is the CDC guidelines to preparing the skin

Answer 33

1: Prepare clean skin with an antiseptic before peripheral venous catheter insertion
2: Prepare clean skin with a 0.5% or greater chlorhexidine preperation with alcohol before central venous catheter and arterial catheter insertion and during dresing changes.
3: Antiseptics should be allowed to dry.

Question 34

What is the proper preparation for central and arterial catheter insertion

Answer 34

0.5% or greater chlorhexidine with alcohol

Question 35

If there is a contraindication to chlorhexidine, what do you use as an alternative?

Answer 35

Tincture of iodine and iodophor. 70% alcohol can also be used

Question 36

What are the three designated areas in a cath lab suite

Answer 36

Unrestricted areas, Semi Restricted areas, and Restricted areas

Question 37

What is in the unrestricted areas:

Answer 37

entrances for patients, personnel and deliveries.
Waiting and registration areas.
Break rooms
locker rooms
PACU units

Question 38

What is in Semi-Restricted Rooms:

Answer 38

-Equipment storage and supply areas
-Sterilization Areas
-Corridors between unrestricted and restricted areas
-HVAC required areas with personnel wearing surgical attire

Question 39

What is in Restricted Areas:

Answer 39

-Pressure positive rooms with doors closed at all times.
-Invasive procedure rooms
-Sterile items storage

Question 40

What is the HVAC parameters of the ICVL environment:

Answer 40

-Humidity at 30-60%
-Rooms kept cool at 68-73 degrees F
-Ventilation at a rate of 20-25 room air exchanges per hour
-Filter system

Question 41

Before the first procedure of the day:

Answer 41

-Inspect records and assess the cath lab to ensure terminal cleaning was completed the previous evening
-Wipe all horizontal surfaces with a disinfectant to remove any dust that accumulated overnight
-If no confirmation of terminal cleaning, do a full terminal clean

Question 42

Cleaning between cases:

Answer 42

-Removal of all equipment and linens soiled with body fluids
-Spills cleaned off the floor
-Procedure table cleaned with disinfectant
-All equipment spot cleansed if soiled with body fluids
-Any patient contacted equipment cleaned between patients
-Refillable soap dispensers disassembled and cleaned before refilling

Question 43

Terminal cleaning or final cleaning of the day:

Answer 43

-Cleaning entire floor with disinfectant
-Washing all surfaces to remove contaminants and dust
-All soiled equipment removed
-Terminal cleaning in procedure rooms, scrub areas, and utility rooms.
-Any material left in the room should be clean and free from any contamination
-All biohazardous material should be removed to the dirty utility area.
-Every surface and furniture wiped down
-Replacement of multiuse transducers

Question 44

Where are gowns considered sterile

Answer 44

From the axilla (armpit) to the level of sterile field and sleeves from 2 inches above the elbow to the cuff