Chapter 7 Flashcards

Question

What are protozoa?

Answer 1

Unicellular eukaryotes responsible for causing diseases such as malaria and chronic sleeping sickness. Include amoebas, flagellates, ciliates, coccidia, and microsporidia. Transmitted through the fecal-oral route.

Answer 2

Protozoa that is responsible for amebic dysentery. Usually in pt's undergoing a colonoscopy/sigmoidoscopy. Endoscope and other instrumentation should be thoroughly decontaminated.

Answer 3

A unicellular protozoa that will grow if vaginal/urethral acid levels are off and cause trichomoniasis which is usually and STD.

Answer 4

eukaryotic organisms that are either unicellular yeasts or multicellular molds and mushrooms. reproduce both sexually and asexually. Majority are opportunistic pathogens that cause infection when host is immunocompromised. Common in HIV/AID's patients.

Answer 5

Fungal infection caused by common bread mold. Increase in cases follows organ transplants. One type is the extremely destructive rhinocerebral zygomycosis which causes damage to cranial bones and tissues of the face.

Answer 6

-structural design of body: skin and mucous membranes -circulatory and chemical response: immune and inflammatory response -immunity: active/passive antibody reaction

Answer 7

The minimum infection prevention measures that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where healthcare is delivered.”

Answer 8

Proper hand hygiene Use of appropriate personal protective equipment (PPEs)—gloves, masks, gowns, etc. Respiratory hygiene and cough etiquette. Safe injection procedures. Safe handling of potentially contaminated items and surfaces in patient care areas.

Answer 9

Direct Contact: Light handle drops into open wound; hypodermic needle-stick injury from two-handed recapping Indirect Contact: Bioburden on gloves contaminates equipment that is handled by non-gloved person who rubs eyes Droplet (0.5mm): Infection spread through the air by droplets spread by sneezing, coughing, or talking Airborne (0.5mm): Infection spread through the air by sneeze droplets

Answer 10

exogenous: preop personnel, the environment, and contaminated instrumentation endogenous: patient's microflora

Answer 11

Personnel: Don proper OR attire and errors should be noted, communicated, and corrected immediately Environment: OR's should be designed with clean zone, filtered/controlled air systems, and soil resistant building materials. Patient: preoperative antibiotic prophylaxis should be performed. plain or antibacterial drapes may be used. procedures may be postponed until prior infections have cleared.

Answer 12

inanimate objects that may contain infectious microorganisms including walls, floors, cabinets, furniture, and equipment.

Answer 13

-age: peds and geriatric pts -obesity: diminished blood flow, larger wound, difficult adipose -general health -carriers of S. aureus and MRSA -remote infection -preop hospitalization -preexisting illness and treatment. -malnutrition -tobacco usage -diabete -malignancy

Answer 14

-preop hair removal: shaving can leave nicks allowing bacteria to colonize -type of procedure: clean contaminated (class II), contaminated (class III), dirty (class IV), and cases that compromise blood flow carry higher risk of infection. -duration: longer=higher risk of infection

Answer 15

The absence of pathogenic microorganisms or disease

Answer 16

Principles applied through use of aseptic (clean) techniques to prevent pathogenic microbial contamination of the surgical environment

Answer 17

Substance that kills bacteria

Answer 18

The number of microbes or amount of organic debris on an object at any given time; gross contamination on surgical instruments or supplies

Answer 19

Sterility determined by how a package is handled and stored rather than time elapsed; a package is considered sterile until opened or the integrity of packaging material is violated

Answer 20

Agent that destroys fungal organisms

Answer 21

A resistant form of bacteria that can form a protective shell and remain dormant to survive in adverse conditions then reproduce when conditions become favorable again

Answer 22

Agent that destroys all bacteria in the spore stage

Answer 23

Having been rendered free of all living microorganisms, including spores on inanimate surfaces.

Answer 24

Contamination of a sterile field or package that occurs from the passage of fluid through a microbial barrier

Answer 25

Mechanically cleaned and chemically disinfected but not sterile; in surgical scrub procedure, the removal of transient microbes and reduction of indigenous skin microflora to an irreducible level

Answer 26

To render items safe to handle by high-level disinfection

Answer 27

To render items safe to handle by proper sterilization methods; however, unwrapped so not appropriate for use within the sterile field

Answer 28

Microbes that have been deposited onto the skin surface and are easily removed with routine hand washing

Answer 29

Living carrier that transmits disease; may show no signs of disease itself

Answer 30

Agent that destroys viruses

Answer 31

process by which most, but not all, the microorganisms located on inanimate (non-living) surfaces are destroyed. Decontamination is a category of disinfection

Answer 32

process by which most (but not all) microorganisms located on animate (living) surfaces, such as the skin, are destroyed.

Answer 33

name used to describe the solutions that are used by the sterile surgical team members to perform the surgical scrub and the prep solutions used on the patient for preoperative skin preparation of the surgical site.

Answer 34

Created by the CDC and FDA: The system rates the degree of risk to patients for infection based on how and where the items will be used

Answer 35

Items used for invasive procedures or vascular access and carry a high potential for causing SSIs include: surgical instruments, devices that enter the vascular or urinary systems (needles, catheters), implantable items (wires, screws, joint replacements, mesh, sutures), and any monitors or probes that enter deep tissue layers or cavities. These items must be sterilized.

Answer 36

Items that come into contact with mucous membranes or nonintact skin; however, they carry a lesser risk of infection due to the properties of resistance of intact mucosal linings to many commonly encountered bacterial spores. Examples include: laryngoscopes, anesthesia and respiratory equipment, and some endoscopes. High-level disinfection should be used for items in this category, but sterilization may also be preferred following decontamination.

Answer 37

tems that come into contact with a patient’s intact skin and clean environmental equipment items pose the least risk of infection. Examples include blood pressure cuffs, pulse oximeters, OR transport stretchers, and other furniture. These items require either intermediate-level or low-level disinfection.

Answer 38

The physical removal of blood, body fluids, and/or gross debris (bioburden) from an inanimate object.

Answer 39

High-level disinfection: Kills all microorganisms except spores and prions (CJD). Intermediate-level disinfection: Kills most microorganisms, including bacteria, most viruses and fungi, M. tuberculosis and HBV; ineffective against spores. Low-level disinfection: Kills some fungi and viruses, and most bacteria, but is not effective against spores and M. tuberculosis.

Answer 40

Concentration level of the disinfectant solution. (higher concentration = higher effectiveness but could be too corrosive for some materials) Bioburden. (exposure to blood, fluids, tissues, etc. decrease efficiency so materials should be cleaned first) Contact time. Physical factors of the solution, including temperature of the solution, water hardness, pH level, and exposure time. (solution should come in contact with all surfaces)

Answer 41

-high-level disinfectant/sterilant -for devices that can withstand full immersion -shelf life is 14 days without surfactant and 28 days with; concentration should be tested before each use. -prior to immersion, items should be rinsed and cleaned -after immersion items should rinsed with sterile water -20 mins in room temp for disinfection, 10 hrs for sterilization Action: Alkylation of cell protein Advantages -dual purpose (both sterilize and disinfect) -noncorrosive -effective against positive and negative gram Disadvantages -noxious -unstable (shelf life) -items have to be dried and cleaned beforehand Safety -store in well ventilated room -wear PPE -use respirator/mask

Answer 42

-effective disinfectant for floor, surfaces, and equipment -fast acting and effective Action: disrupts cellular metabolism Advantages -Bactericidal, virucidal, tuberculocidal: it is effective against HIV, HBV, and other viruses. -Fast-acting solution. Disadvantages -Corrosive -loses effectiveness in organic soil -noxious odor Safety -wear PPE -don't mix w formaldehyde -don't mix w ammonia

Answer 43

-Glutaraldehyde (Cidex) -Sodium hypochlorite (bleach)

Answer 44

Phenol (Carbolic Acid) Quaternary Ammonia Compounds Alcohol

Answer 45

-disinfects large areas such as floors and countertops Action: denatures enzymes and causes lysis Advantages -economical -effective in removing feces Disadvantages -irritating to skin (isopropyl alcohol neutralizes) -noxious odor -irritate resp tract -for noncritical items Safety -wear PPE -use respirator -store in well ventilated room

Answer 46

-SSI -pneumonia -GI infection -UTI -bloodstream infections

Answer 47

Prokaryotes that divide by binary fission which are classified based on specific characteristics observed in a lab. Identified by relationship of the microbe to other microbes/humans.

Answer 48

-forgetfulness and memory problems -confusion and disorientation -behavior and personality changes -problems w vision and processing -hallucinations or delusions -ataxia -balance problems -dystonia -seizures -paralysis -wasting

Answer 49

by examining the brain tissue

Answer 50

Attacks the brain. Creates a chain reaction in proteins in the neurons.

Answer 51

Vigilant with aseptic and sterile techniques to prevent the perioperative transmission of pathogenic microbes, thereby preventing SSI's

Answer 52

Safety is important when utilizing. -have access to MSDS -use approprate PPE -well ventilated and temperature controlled storage areas -follow manufacturer's reccomendatioins -do not mix disinfection solutions together -dispose of expired solutions according to policy

Answer 53

Physically removing blood, body fluids and gross debris (bioburden) from an inanimate object. Termed doing dishes

Answer 54

Humans are more mobile and viruses adapt to become more resistant. Misuse of drugs can make viruses can do this as well.

Answer 55

Agents that destroy all microoganisms including spores but not prions. Could use steam, chemical agents, high velocity electron bombardment, and UV/Gamma radiation.

Answer 56

-physical factors of the solution (vary in ability to kill microbes) -selection based on item classification -manufacturer recommendations (pH, water hardness, temp) -exposure time: high- 20/30 mins; intermediate/low- 10/15 mins

Answer 57

Bactericidal, fungicidal, and pseudomonacidal. Not sporicidal, virucidal, or tuberculocidal. Some facilities consider low quality. Action: cause leakage of the protoplasm in microbes. Advantages: Low cost, easy to mix w water, odorless and noncorrosive Disadvantages: kill limited number of classes of microbes. easily reversed when solution contacts organic debris, tap water, or detergents. Gauze or fabrics absorb the disinfectant ingredient Safety: wear PPE, store in well ventilated area w controlled temp

Answer 58

a dilution of 60–70% alcohol concentration are tuberculocidal, bactericidal, virucidal, and fungicidal; they are not sporicidal. useful in cleaning and disinfecting small noncritical surfaces. solutions may be as effective or more effective than other compounds for use in skin disinfection for surgical scrub and patient skin prep. Action: Causes protein denaturation, lysis, and metabolic interruption of cells Advantages: nontoxic to skin, reduces bacteria on skin, good range of effectiveness against microbes including HIV Disadvantages: slight odor, highly corrosive, highly flammable Safety: wear PPE, avoid use in ESU and lasers, prevent pooling, store in well ventilated area

Answer 59

-Washable floor and walls -Easily cleaned furniture -Effective decontamination and sanitation techniques -spills/contaminated items should be handled according to standard precautions -EVS should follow standard precautions and OSHA. -exposure control plan must be avaliable

Answer 60

-should be routine for cleaning and decontamination of OR surfaces, scrub sinks, cabinets, walls, floors, and ceilings -contaminated work surfaces should be decontaminated by circulator when not possible for concurrent cleaning -reusable contaminated linens should be uses as little as possible and in leakproof bag. should not be sorted or rinsed in areas of use. wear PPE when handling -regulated waste should be put into leak-proof that are biohazard with only contaminated items bc it is costly to dispose of

Answer 61

OR furniture, equipment, surfaces, and lights must be “dampdusted” with a disinfectant solution on a lint-free cloth. -begin w the highest surface to the lowest to avoid settling of dust -table should be unlocked and moved to the side to mop floor/clean posts and casters -mattress pads should be removed to clean both sides, surfaces, and hinges of table -clean walls if blood and bodily fluid are present -clean cabinet doors (watch track) -clean outer surfaces of lights.

Answer 62

CST may not always be able to perform these procedures if busy. They come secondary. -Have a basin of sterile water for soaking instruments. Never use NS bc it is corrosive. Wipe instruments w wet sponge -Instruments w a lumen should be flushed periodically. -

Answer 63

-cleaning bioburden from nonsterile surfaces -changing full suction container. wipe outside and put into biohazard bag. put Isolyser inside -contaminated surgical instruments from falling should be retrieved and put into basin w water or disinfectant solution or if needed should be taken to substerile room to be sterilized. -if kick bucket is full, RN/CST can count sponges in 5/10s and place in clear bag for anesthesia. sponges should not be lined up on floor. hanging sponge counting bag systems may also make things easier. -use something such as sponge stick to transfer contaminated items.

Answer 64

Cleaning the OR in between procedures includes removing soiled linens and waste bags, mopping the floor, and cleaning the walls. Referred to as turnover -suction containers should be disconnected and wiped down then disposed of -dispose of sharps and put them in puncture proof container -linen and trash bags should be put into designated area for EVS -place all instruments into case cart/table w plastic cover for transfer to decontamination room. some ORs have rigid containers for contaminated instruments be careful not to transfer bioburden.

Answer 65

a method for transporting surgical equipment to the OR and back to CSPD. -at end of procedure CST loads cart w surgical equipment -cart is transferred to CSPD (could be dumbwaiter or regularly transferred) -CSPD cleans, decontaminates, assemble, wrap, and store instruments and case cart. -CSPD uses DPC to pull carts -Transferred back to OR

Answer 66

A thorough cleaning of the room after the last procedure. -ceilings, floors, and lights are wiped down -all furniture is wiped down -OR table is thoroughly wiped down -all equipment is wiped down -horizontal surfaces are cleaned -equipment is moved to the side and OR floor is thoroughly flooded w disinfectant and wet vacuumed -equipment is moved back. -substerile room, stretcher, scrub sinks, and OR halls (wet vacuumed) are also cleaned Particular attention should be paid to scrub solution dispensers.

Answer 67

Cleaning and disinfection processes are scheduled on a weekly basis. -ceilings and walls are thoroughly cleaned inside and outside including halls. -mounted light fixtures are cleaned -air vents and heating duct grills are vacuumed -inside/outside of supply cabinets are cleaned -sterile supply rooms and storage areas are cleaned -housekeeping supply rooms are cleaned

Answer 68

Cases where there is known infection. -should be the last scheduled case of the day -floor, ceilings, and walls should be cleaned w phenolic detergent -furniture is cleaned w a 70% alcohol solution -rubber/plastic tubing is replaced

Answer 69

-Filtered air is exhausted to the outside of the health care facility. -The minimum air exchange rate is 10 times per hour and negative pressure maintained. -Temperature should be maintained between and with a humidity of 35 percent to 72 percent. -when design CSPD of does not allow the separation of decontamination and clean work areas to prevent cross contamination. Personnel should wear PPE.

Answer 70

First step is cleaning. -presoak contaminated instruments. (use sterile water, proteolytic enzymatic and lipolytic enzymatic solution, and then detergent solutions) -confine instruments in closed containers

Answer 71

Sterile Water: keeps organic debris moist but ineffective in softening or removing dried debris Enzyme solutions: Removes moistened and dried debris w/o mechanical action but efficiency depends on concentration, temp, and contact time. Detergent: Keeps organic debris moist while loosening dried debris but mechanical action is still required to remove soil.

Answer 72

-Place heavy instruments on the bottom of the tray and not on top of other delicate instruments -Instruments w ring handles should be unratcheted and stringed instruments should be facing the same way -Instruments w multiple parts should be dissembled -Enzymatic foam spray may be sprayed over instruments -Transport case cart to decontamination.

Answer 73

physically remove debris that was not removed or softened during the presoak. disinfectant agents are weakened in the presence of organic soil.

Answer 74

Chelation: binding minerals in the solution. prevents deposit on the surface of surgical instruments, which causes spotting. Enzymatic: Catalysts that aid in breaking down organic soil into solution. Emulsification: The action of dispersing two liquids not capable of being mixed. Solubilization: solubility of a substance is increased within a solution.

Answer 75

Enzymatic: aids in chemical reaction of breaking down organic debris. specific to the type of debris to be removed. require dilution and more effective in warm water. Ultrasonic: manufactured specifically for ultrasound cleaners. may have surfactant and chelating agents Manual Detergent: used for hand cleaning or pre soak. high foaming should not be used in mechanical cleaning equipment. instrument must be rinsed thoroughly Washer-decontaminator: liquid solution w thee pH levels. Neutral pH: least corrosive but lease effective. Moderate pH: low-level alkaline, may be combined w surfactant and chelating agents, safe for stainless steel but may be harmful for chromium oxide layer. High pH: Most effective but corrosive, should be used w neutralizer.

Answer 76

-Clean -Disinfect (renders safe to handle) -Inspect (includes lubricate and sort) -Package -Sterilize -Store

Answer 77

First sink- Instruments are washed in lukewarm water, enzymatic cleaner (neurtal pH), detergent, and solution filled water Second sink- Intermediate rinse w distilled water Third sink- Final distilled water rinse to prevent spotting

Answer 78

-Instruments placed into a perforated/wire mesh tray to prevent interference with the cleaning action of the machine. -Heavier instruments placed on the bottom of the tray -Hinged instruments must be left in an open position -Instruments with attachments must be disassembled. -Instruments with concave surfaces should be placed upside down

Answer 79

Machines that eliminate manual cleaning to protect personnel. Includes washer-sterilizer, washer-decontaminator, and ultrasonic cleaner

Answer 80

Pre-rinse: some use enzymatic solutions Cleansing: Detergent solution Final rinse: 180-195 degree water Dry: uses high temp Some have ultrasonic cleaning phase. Allow hands off processing but no sterilizing. Instruments are safe to handle bc considered immediate level disinfection

Answer 81

-can process majority of stainless steel and heat resistant instruments -bioburden should be removed to prevent baking on -stainless steel items should not be put next to other materials bc an electrolytic reaction can occur and fuse them together -uses a free-rinsing, low-sudsing w neutral detergent. high sudsing will leave residue -instruments are deemed safe to handle, high level disinfected, but not ready for use in surgery. -two types. tunnel like chamber w door at each ends and rotating sprayer arms. also have a horizontal/cabinet type which has a door on one end.

Answer 82

-Pre-rinse: A cool/lukewarm water spray rinse removes soil. -Automatic detergent injection -Fill phase: The chamber is filled with water -Wash phase: Water is agitated inside the chamber for soil removal; the machine controls water temperature.(270 degrees) -Post-rinse: Loose soil and detergent film are rinsed off items. -Sterilization phase: Steam sterilization cycle—this is usually a gravity cycle. -Lubrication (milking) -Drying phase

Answer 83

Removes small organic particles from areas of instrumentation that manual and mechanical cleaning cannot get to by use of cavitation. Uses high frequency sound waves converted to vibrations. The energy sets molecules in rapid motion forming microscopic bubbles on surface of instrument. Bubbles enlarge, become unstable and implode- creating a vacuum. Particles are dislodged and float to the surface of the solution

Answer 84

-Instruments are placed into a mesh tray for exposure. (emersed in a warm water, low-sudsing, neutral pH solution -Machine must be de-gassed (running empty cycle) -Fluid must be frequently changed bc of buildup of bioburden. -Lid should be kept closed when running the cleaner bc there are fine particles that can be harmful

Answer 85

Should be flushed until liquid is clear. Hydrogen peroxide is a great irrigation solution but must be rinsed away.

Answer 86

Should NEVER be submerged. 1. leave air hose attached 2. wash cord w lukewarm water, neutral detergent, and a cloth/soft-bristled brush 3. wipe handle w ^ 4. rinse all components w distilled water 5. may need to be oiled

Answer 87

1. Channels, holes, and joints should be thoroughly cleaned 2. soak endoscope in enzymatic solution 3. use hand-held washing gun for washing and compressed air for drying 4. use detergent from manufacturer 5. take care w eye pieces and lenses 6. avoid denting to keep light fibers safe

Answer 88

1. long flexible cleaning brushes are used to clean channels 2. soak in enzymatic solution w ports open. flush w cleaning solution 3. exterior should be cleaned w neutral solution and soft brush/cloth

Answer 89

Lubricated to maintain optimal function. Should be sprayed or immersed. Fully effective after sterilization. Left on during assembly, wrapping, and sterilization.

Answer 90

Used to enclose a device that is to be sterilized and maintains sterility. 1. maintains the sterility of the items until use. 2. permit the package to be opened in a manner that allows for easy removal of the sterile items without contamination 3. allow the sterilizing agent to penetrate and reach all surface areas of the items to be sterilized.

Answer 91

-Efficiency: conform to size/shape, cover contents entirely, flexible and memory free -Ease of opening -Sterilization suitability: allow air to be removed, withstand conditions from autoclave, allow for escape of sterilizing agent, allow contents to dry -Strength: resist tears and punctures, avoid degrading -Barrier efficiency and support impermeability - Seal integrity - Safety -Sterility maintenance

Answer 92

-Made of cotton and cotton blends -Reusable so must be laundered. W repeated laundering fibers may be lost and sheet must be discarded. -must be inspected for holes -can be treated to be moisture resistant -comes in single and double ply (a towel may be placed in between instrument and wrap to assist w moisture absorption) -ranges from 140-288 thread count

Answer 93

Advantages: Economical and reusable. Easily penetrated by sterilant. Disadvantages: May absorb moisture during steam sterilization, least effective at providing bacterial barrier, not recommended for use w EtO, require laundering

Answer 94

-Disposable -Made of various shapes and sizes -Made of plastic synthetic fibers -Laid out flat when stored

Answer 95

Advantages: Excellent barrier, lint free, impervious to moisture, tear resistant Disadvantages: Cost, not as "memory-free"

Answer 96

-Single Use, Disposable -Easy memory but not as flexible -Easily penetrated by steam

Answer 97

Advantages: plentiful supply, inexpensive, porous Disadvantages: Brittle in dry conditions, easily torn, not unifrom in thickness

Answer 98

Used w EtO and Sterrad. Steam can damage the contents.

Answer 99

-Used w steam and EtO. -Most common in hospital. -Plastic must be about 2mm, allow for visualization. -One side of pouch is paper, one is plastic -The side and top edges are heat sealed w an open end for item to be placed. Open end is then heat sealed, taped, or strip of adhesive which is folded over. -Available in precut sizes or in roll which is cut to size -Do not use staples or rubber bands to close -Place items so the end of the item can be grabbed by CST -Correct size is important. Too big can compromise sterility. Too small can tear and be difficult to remove air. -If writing on pack, write on plastic -As much air should be removed as possible -Sharp edges should be protected w tip protectors -Heavy items w multiple parts can be double peel packed -

Answer 100

-Reusable -Provide assurance of package integrity bc can't be torn -Easily opened -Uses a chemical indicator to ensure sterility -Used to return contaminated items -Come in a variety of sizes, designs and are stackable

Answer 101

-Can be safely sterilized w other supplies. Should be placed beneath absorbable items to prevent condensation drips. -Drying time should be increased to allow revaporization of condensation -Use prevac instead of gravity for adequate air removal -Check gaskets -Disposable filters should be replaced after every use

Answer 102

-max size for Muslin wrap is 12x12x20 and item should not exceed 12 lbs -linen packs should be loosely packed -double wrapping is essential (double ply) -should be inspected for holes -chemical indicator tape is labeled -size matters. too big can inhibit penetration. too small can tear at corners and cannot cover. if used to establish field, wrapper must extend 6 inches below. must cover hand if being thrown -Place towel between bottom of tray and wrap to cushion corners -Don't pack set too dense. ANSI and AAMI says don't exceed 25 lbs -Dust covers should be 2-3mm thick and labeled

Answer 103

Inspection, Reassembly, and Preparation

Answer 104

-Inspect for bioburden -Scissors should have no burs or cracks. Blades close smoothly. Sharp enough to cut two 4 × 4 sponges with little effort. -Ratchet must lock properly -Jaws of clamps close evenly -Forceps close evenly with tips evenly lined. -Ratchets on self-retaining retractors remain locked in the open position and release with little effort. -Points on nondisposable trocars should be inspected for burs, cracks, scratches, or bends. -Manufacturer’s instructions must be followed for proper inspection of powered instruments. May need to be lubricated. Power hose should be checked for cracks and cuts. The power hose should be coiled loosely to prevent kinking and damage.

Answer 105

Some instruments might need to be reassembled. Some should not to make sure steam reaches all surfaces (Balfour, poole suction tip, staplers).

Answer 106

-Sterilant comes into contact with all surface areas. -Positioned in a protective manner -Evenly distributed

Answer 107

-Instruments placed in a mesh-bottom w towel lining the bottom to allow penetration of sterilant -Instruments should be evenly distributed w like size, shape, and function, grouped together -Special trays for micro-instruments -Small residual of distilled water should be left in lumens -Concave instruments placed on their sides -Loose instruments should not tightly group or piled -Large, loose instruments should be placed so there is minimal movement w heavier ones on bottom and towels can be used to separate layers -Absorbent towel should be placed between basins and items in basin. No sponges and woven materials in basin. OR handles be placed down. Basin should be placed w fold down. Should be no more than 7 lbs. -Trays should contain all instruments for a procedure. Also be autoclaved flat.

Answer 108

Envelope- small trays and individualized items Square (Parallel)- large packs and instrument trays

Answer 109

-Content -Inventory control -Rotation of stock -Quality assurance

Answer 110

-Name of tray or package contents -Date of sterilization -Identification of the sterilizer used (usually by number designation) -Cycle or load number -Initials of the employee who prepared and processed the package -Department to which the package belongs

Answer 111

Permanent marker, labeling gun, bar code scanning labels

Answer 112

Julian date. It's the number of calendar days but no year

Answer 113

Steam, Chemical Agents, High-electricity bombardment, UV/Gamma radiation

Answer 114

Thermal (steam, dry heat): Most metal surgical instruments, powered instruments, micro-instruments Gas (EtO, Gas plasma): Powered instruments, Delicate instruments, Fiberoptic instruments, Lensed instruments, Plastic, Rubber, Porous and MOISTURE and HEAT sensitive items Chemical (Cidex, Steris): Lensed instruments, fiberoptic instruments/cables, heat-sensitive instruments

Answer 115

Advantages: more effective in transferring thermal energy, protective outer layer of microorganisms is softened allowing denaturation, most economical, safest, quick, nontoxic, easy to maintain quality control, readily available Disadvantages: Human error, heat and moisture sensitive items cannot be sterilized w steam

Answer 116

-Temperature -Moisture -Air -Pressure -Contact -Time

Answer 117

The minimum time for sterilization will depend on temperature and cycle type. (gravity displacement and dynamic air removal). Some microbes are harder to kill than others

Answer 118

Wrapped set: 250deg- 30mins; 270deg- 15 mins; drying time-15-30 min Unwrapped set (no lumens): 270deg-3mins; drying time- 0-1 mins Unwrapped set (lumens): 270deg- 10mins; drying time: 0-1mins

Answer 119

-Strainer is obstructed. Make sure it is lint fee -Containers are placed incorrectly. Should be positioned to allow escape of steam and circulation. Items are packed and wrapped loosely.

Answer 120

Wrapped set: 270 for 4 mins; dry 20-30 mins Unwrapped set (no lumens): 270 for 3 mins Unwrapped set (lumens): 4 minutes

Answer 121

Should be at a good temp to kill spores.

Answer 122

Raises the temperature of steam to force it into packaging

Answer 123

-Should be 97-100% humidity -Acts as a catalyst to temperature to coagulate and denature proteins as it allows for a lower temperature (6 hours dry = 12 minutes wet) -Cold metal on moist heat can create condensation -97% heat w 3% water. Less than 3 is too dry and won't penetrate. More than 3 is too wet and packs will be soaked which causes strike through contamination

Answer 124

Should be completely removed. Air doesn't mix w steam so it sinks to the bottom of autoclave and should be removed via gravity displacement or prevac.

Answer 125

-Ranges from large to small -Metal Jacket:

Answer 126

Relies on gravity to remove air from chamber. Steam enters at top so air sinks and is drained. Slower than a prevac sterilizer. Pack loosely so air doesn't get trapped. Cycle- Conditioning: steam enters chamber, air is displaced, temp and pressure are reached Exposure: Temp is maintained for required time Exhaust: Steam valve closes, drain opens, steam is removed, filtered air is let in and pressure becomes normal Drying: Heated, fresh air vaporize and packs are dried.

Answer 127

Uses a vacuum pump to remove air making cycle faster. Cycle- Air removal (prevacuum): Vacuum pump removes 90% of air Conditioning: Steam injected into chamber. Second air removal phase: Vacuum removes remaining air (99% is gone atp) Exposure: Steam enters chamber and temp is held Exhaust: Outlet opens and steam is drained Drying: pump turns on and produces 90% vacuum to remove moisture. Filtered air and normal pressure is returned.

Answer 128

Another version or dynamic air removal cycle but has 4-5 vacuum phases. Steam enters in between each of the vacuum phases to aid in removing air and preconditions load by penetrating packages. Eliminates the need for a Bowie Dick Test.

Answer 129

1. Increases speed of operation 2. More efficient at removing air 3. Not as dependent on the positioning of load 4. Condensate is produced during preconditioning phases, reducing cycle time

Answer 130

Test which checks for air removal in prevac autoclaves. -performed at first run of day and after repairs -placed on front bottom shelf over drain -test is charted -commercial test is called DART and stands for daily air removal test -does not test for sterilization -look for a uniform change in color.

Answer 131

Sterilizing dropped items. -Most common method CST's use. -Avoid as much as possible especially implantable items. -Decontaminate item first and place in perforated tray

Answer 132

-Chamber walls are hot and can burn -Make sure door is closed tightly before starting -Only open door when exhaust valve says pressure is 0 -Stand behind door to avoid steam -Don't touch item until cool. Towels can be used as hot pads

Answer 133

Monitored for quality assurance, ensurance of sterility, and proper operation of sterilizer. Methods are mechanical, chemical, biological, and administrative.

Answer 134

Autoclaves have gauges and recorders to monitor progress of sterilizer. Traces over a 24hr period. Prints record and is charted which can be used legally. Print should be verified and initialed it verifies sterilizer worked properly.

Answer 135

Used internally and externally to ensure that items have been exposed to proper temperature, humidity, and sterilant. Detects sterilization errors which can be caused from machine malfunction, incorrect assembly or wrapping, and incorrect loading.

Answer 136

Class 1: Process indicators—indication of exposure to the sterilizing agent. Class 2: Indicators for use in specific tests—assessment of a specific function of the steam sterilizer (e.g., Bowie-Dick test). Class 3: Single-variable indicators—determine if a single parameter is being met, such as temperature. Class 4: Multivariable indicators—designed to react to two or more of the parameters Class 5: Integrating indicators—designed to react to all sterilization parameters. Most accurate indicators. Can be used to release loads that do not include implants. An example is a challenge test pack. Class 6: Emulating indicators—designed to react to all sterilization parameters of a specific sterilization cycle.

Answer 137

-Paper impregnated w dye that changes in presence in temperature and sterilant -Autoclave tape has diagonal lines that are creme or green and turn black -Internal steam indicators are placed in the hardest part for sterilant to reach. Read when package is opened. -Rigid containers may have dots that become black -Peel packs may have a dot or edge -Chemical indicates exposure

Answer 138

Device that contains certain microorganism which is killed when exposed to sterilant. Microbe is in spore stage. Guarantees that items are sterile and conditions have been met.

Answer 139

Geobacillus stearothermophilus. Highly resistant to steam but harmless to humans.

Answer 140

-Comes in packs which can be commercially or house made according to AAMI standards but is difficult. -Placed in hardest part for sterilant to reach which is bottom front over drain chamber. -At end of cycle, the vial is crushed. If yellow it means it failed. If red it means it passed.

Answer 141

-Incubated for 24hrs. -Incubated at 131-140 degrees. -A control/test vial is used to validate the results -Frequency of testing ranges from weekly to daily (busy facility) -Always monitor for implantable items

Answer 142

-Wet packs should be considered contaminated bc of wicking. Moisture from packs results from too many instruments in tray, sets are assembled w/o towels, woven packs are wrapped too tight, trays are improperly loaded. -Sterilizer (esp pipes) should be examined yearly -Filters w brown or orange spots indicate steam is not pure

Answer 143

Used to process materials like plastic, rubber, and MRI safe plastic. -Kills all microorganisms + spores -Noncorrosive -Gas comes in cylinders which withdraws air from chamber and replaces it w EtO -Temp increases permeability of cells but not as high as steam (85 to 145) -Humidity should be kept between 30 and 80% -Instruments should be free of lubricant bc EtO cannot permeate and if mixes w water becomes ethylene glycol which is toxic.

Answer 144

-Very expensive -Toxic (can lead to skin/respiratory irritation, headaches, nausea, cancer, reproductive issues, and chromosomal alterations) -Flammable (contains chlorofluorocarbons to reduce but bad for ozone) -Long sterilization process since packages have to be aerated which lead to long turnover -BI is basilis atropheas (should be ran w every load)

Answer 145

Sterilization machine w separate vented chamber. There are vacuum pumps to remove air and humidifiers to maintain humidity. Favorable setup is sterilizer and aerator but if not available aerate in chamber for 8hrs at 140 or 12hrs at 120

Answer 146

Advantages: can be used to sterilize materials sensitive to heat and moisture, less corrosive, less damaging Disadvantages: Aeration times are lengthy, personnel hazards, and damaging to certain materials

Answer 147

Uses gas at lower temp to sterilize heat and moisture. Electrical current is passed through hydrogen peroxide gas creating a cloud of plasma which penetrates materials and creates free radicals inactivating microbial life. -Bi is Bacillus atrophaeus. CI is tape that turns pink. -Cannot be used for lumens bc diffuser has not been approved by FDA -Can be used on nonwoven materials and tyvek (no paper) -Chambers should be loaded w adequate space. Multiple cartridges are loaded into sterilizer. Cycle ranges from 28-38 mins and does not require aeration. -Paper is printed demonstrating cycle parameters

Answer 148

For instruments that are heat sensitive but moisture stable. Include Glutaraldehyde and Peracetic acid (Steris)

Answer 149

Uses peracetic acid. It is a strong sterilant and should be carefully handled. -Cycle takes 23 mins at 122 degrees -Sterilizes flexible and rigid scopes -BI is Geobacillus Stearothermophilus or there are chemical strips that measure concentration but are not at valid -expensive -for immediate use only bc sterilized w cassete

Answer 150

1–2 minutes: Water enters the processor through a three-step treatment process. 2–4 minutes: Treated water mixes with a peracetic acid germicide, creating a solution to process the items. 4–10 minutes: Six-minute exposure phase destroys all microbial life on items. 10–12 minutes: Solution rinses safely down the drain. 12–18 minutes: Two rinse phases remove chemical residue. 18–23 minutes: Automated filter integrity test confirms that the filter operated successfully. 23rd minute: Validated items are ready for immediate use.

Answer 151

-Commercially used -Uses irradiation to produce chemical and thermal energy which disrupts DNA and kills microbes/spores -Use radioactive gamma rays or beta particles. -Package integrity is used to monitor sterilization.

Answer 152

Alternative method of sterilization which oxidizes bacteria. -Destructive to plastics and metal and corrosive to some metals. Cannot be used on long cannulated instruments -Generator converts oxygen to ozone and it penetrates cell membranes causing them to explode -Machine uses vacuum pump to increase penetration -Cycle is 60 minutes w no aeration needed

Answer 153

-Uses hydrogen peroxide in gas form to sterilize -Cannot be used on paper wraps, nylon, rubber, and some metals. -Has not been cleared by FDA for use in facilities

Answer 154

Documentation is key. All mechanical printouts and preventative maintenance, items, patient, team member, and results of indicator must be charted. Used in court of law, to track infection, and inspection by the Joint Commission.

Answer 155

Contamination is event related instead of time related. Package will remain sterile unless torn, wet, etc. It is more economical. Depends on quality of wrap, storage, transport, and handling.

Answer 156

CST must have a understanding of asepsis and sterile technique and adhere to and permit no compromises in the entire perioperative period. Involves constant inspection, monitoring and regulation of the patient, sterile field, environment, personnel and equipment. The CST anticipates the needs of the patient, the surgical team, and gives unselfish, vigilant care.

Chapter 7 Flashcards

Preventing Perioperative Disease Transmission