Chapter 7 pt 2 Flashcards
disinfection, decontamination, sterilization
disinfection
microorganisms on inanimate surfaces are destroyed
reduces 99% of pathogens in room
not including spores
antisepsis
most but not all microorganism on animate surfaces are destroyed
surgical scrub, surgical site
antiseptic
surgically clean animate surfaces
cannot fully kill everything
sterilization
destruct all microorganisms + spores on inanimate surfaces
anything used on wound needs to be sterile, even if they don’t come in direct contact (basin)
CDC/ FDA system does what (classification of pt care items)
rates degree of risk for infection
- how item will be used
- where items will be used
classification of patient care items
indicates appropriate method of disinfection/ sterilization to be used
- critical (sterilisation)
- semi- critical (high level disinfect)
- non- critical (low level disinfect)
critical items
invasive/ vascular access
high potential for SSI
- monitors/ probes/ vascular or urinary/ implantable
STERILIZED!!!
semi critical items
mucous membrane or non intact skin within mucous
- natural orifices
lesser risk of infection
- laryngoscopes, endoscopes, resp eq
at minimum, high level disinfectant
non critical items
pt intact skin or clean equipment
least risk for SSI
- bp cuff
low level disinfectant
disinfection principles
safety when utilizing disinfecting agents
- never mix solutions
- use PPE when handling
- ventilated storage areas
- throw out expired solutions
- use for intended purpose
what do cleaning agents do
physically removing blood, body fluids bioburden
disinfecting agents
destroy pathogenic microorganisms by direct exposure to agents
3 levels of disinfection
high level - all microorganisms (not spores + prions)
intermediate level - most microorganisms + TB
low level - kills some virus, most bacteria
- ineffective against spores prions and TB
sterilizing agents
destroy all microorganism (spores but not prions)
- steam (most common) + chemical agents
disinfectant efficiency factors
concentration level of disinfectant
- high concentration increases level of disinfect
bioburden
contact time - contact with all surfaces, disassemble multiple part items
disinfection efficiency factors
selection based on item + classification
- critical, semi, non
manufactures recommendations - temp+ PH
exposure time
- 20- 30 minutes (high)
- 10- 15 minutes ( intermediate)
disinfectant compounds
high level:
- cidex aka glutaraldehyde
- household bleach aka sodium hypochlorite
intermediate or low level disinfectant compounds
phenol (carbonic acid)
alcohol
environmental decontamination
design is conductive to minimizing microbial counts
- washable floors and walls
- easily cleaned furniture
- prevent cross contamination
decontamination of the operating suite pre op
prior to first procedure
clean all surfaces especially horizontal ones
damp dusting:
- begin with the highest surface you can reach
remove mattress pads
clean fluids from floor
clean cabinet doors
decontamination of the operating suite inter op
basin with sterile water available
instruments not easily cleaned kept in basin
instruments with lumen periodically flushed
wet lap on mayo to wash instruments in between use
never use saline!!
turnover steps
clean
damp dusting
soak instruments no saline
mop
wash hands
clean up case cart
routine schedule for OR surfaces to clean
scrub sink, cabinets, floors, walls, ceiling
concurrent cleaning
by circulator
ASAP after cases
reusable linen
handle as little as possible
leakproof biohazard bags
not rinsed or sorted on OR
wear appropriate PPE
decontamination practices prior to first procedure
damp dust
disinfectant solution
horizontal surface, highest
remove pads on OR table
move OR table to mop under floor
cabinet doors
decontamination practices intraop
soak clean instruments no saline
periodically flush lumen
what to do for sharps in turnover
STSR responsibility
puncture proof sharps container
- no overflow
endoscopic to open case
order in which things are opened is CRITICAL for flow of surgery
things you HAVE to have in case cart
blade
bovie
suction tip
lap songe
phrase for instruments needed in every case
start, control, and stop the bleeding
who recommends that the OR be cleaned between procedures
CDC
weekly cleaning routine
literally everything
what do do with a dirty case (infection/ disease)
last case of day
clean with phenolic detergent
cleaned with 70% alcohol
rubber/ plastic tubing replaced
instrument cleaning cycle
operating room (in use)
decontamination
assembly + sterilize
sterile storage
repeat
decomtam room
filtered exhaust to outside
negative pressure
seperate from clean room
how much humidity + temp in decontamination
64-70 degrees
35- 72%
how many air exchanges in decontamination
10 time/ hr
cleaning instruments
soak
proteolytic- gets blood
decontamination room purpose
remove physical debris
what kind of water does decontamination room use
neutral pH to not damage
cleaning solutions used in decontamination room
-chelation - prevents spots
-enzymatic - break down tissue
-emulsification - disperse 2 liquids that can’t mix
-solubilization - increases dissolvablty
characteristics of 1st sink for manual cleaning
lukewarm, pH neutral, enzymatic cleaner
use soft brush
ratchets + box locks
change solution frequently
process of manual cleaning
clean with sink, 2nd sink used to rinse, dried for spots
mechanical cleaning
eliminates manual cleaning process
3 types of equipment
prepare instruments
3 types of cleaning equipments
washer - sterilizer
washer - decontaminator
ultrasonic cleaner
washer disinfector phases
hands off processing
1 pre rinse
2 cleaning: detergent solution
3 final ringe: 185 degrees
4 dry: using high temp
washer sterilizer
requires manual cleaning
- bakes on bioburden
requires proper arrangement
neutral pH
instruments safe to handle
washer sterilizer phases
prerinse
injects detergent
fill total emergence
wash- agitation
post rinse
steam sterilization - 270 degrees
milking
drying
ultra sonic cleaner
removes small particles in hard to get places
used last usually
how the ultra sonic cleaner works
high sound waves convert to bubbles,
bubbles get too big, unstable, implode- pulls particles off instrument to surface of solution
special care instruments
follow manufacture instruction
flush lumen with hydrogen peroxide
cleaning power instruments
do not submerge
h20 only, never alcohol
- causes drying/ cracking
lukewarm water
oiling may be necessary
- run 30- 60 seconds
cleaning rigid endoscopes
soaked in enzymatic solution
stored dry
avoid denting
definition of sterility
absence of all living microbes, including spores
no grey area
tissues are sterile
what are instruments checked for
function and integrity, prepared f or sterilization
where do you check function of instruments
CSPD
FDA + cosmetic act requirements for instrument packing and wrapping
packing material maintain sterility until use
opened easily, prevent contamination
sterilizing agent must be able to each all surfaces of the item
4 option of packing materials
woven
non woven
pouch packing (peel pack)
rigid instrument container
what are woven textiles made up
cotton, or cotton blend
reusable
woven textile ply
single ply (wrap x2), or double ply (x1)
towel may be placed in between instruments and wraps to assist with moisture absorption
thread count range
140- 288 tc
higher thread count, lower bacteria penetration
non wovan wrap characteristics
single use
made of plastic synthetic fibers
stored laid out flat
paper wrap characteristics
single use
extreme memory, not flexible
easily penetrated by steam
what is tyvek- plastic packaging used for
EtO and sterrad
- steam will melt material and damage contents
what is the most common type of pouch packaging
paper- plastic
at least 2mm- not flimsy
what is paper plastic packing used with
steam and EtO
why is correct size important for paper plastic packs
too big- compromise sterility
too small- can tear, difficult to remove air
what is the order to put when double pouch packing paper plastic
paper to paper, plastic to plastic
what do we use to protect the tips with paper plastic pouching
commercial tip protector or foam sleeves ( no latex)
when do you label paper plastic pouching
prior to sterilization on plastic only
where on basket do you put paper plastic pouching
placed on edge in perforated basket
all in the same direction
rigid instrument container characteristics
reusable: metal or plastic
stackable + easily storable
locking lids - chemical indicator
assure sterility, can’t be torn
what is used to return contaminated items to CSPD
rigid instrument containers
sterilization recommendations for rigid inst pans
placed on shelves (in autoclave) beneath absorbable items
in what conditions are woven fabrics stored
68-73 degrees
30-60% humidity
2 hours to rehydrate
what is AAMI max muslin wrap
12x12x20
- not exceed 12 lbs
how are linens packed in general packing
linens packed loose
-allows steam to penetrate
double wrap
- single ply x2
what is the max weight for instrument pans and who sets it
25 lbs
AAMI and ANSI
how large does the instrument set have to be
large enough to have 6” below on 4 sides of table or stand
how thick are instrument pan dust covers
2-3 mm thick
- clearly marked if sterile
steps of preparation of instrument sets and basin sets
inspect
reassemble
preparation
inspection process of scissors/ trocars
look for cracks or scratches
inspection process of ratchets
ensure they don’t spring
inspection process for clamps
make sure they stay locked
jaws align
what do we need to ensure for preparation when reassembling
sterilant contacts all surfaces
item will be protected until use
items weight is evenly distributed in packaging
preparation regulations of large loose instrument
minimal movement
heavier on bottom
may use a towel to separate layers
preparation regulations of basins
nested with towel between**
no more than 7lbs
fold is down during sterilization***
preparation regulation for light handles
down for drainage
preparation regulation for trays
contain all instruments for procedure
autoclaved flat to allow steam/air removed via perforations
two kinds of folds for preparation
envelope
- small trays+ individual items
square fold (parallel folding)
- large trays
what does a Label provide
content
quality assurance
inventory control
rotation of stock
what do you label before sterilizing
everything
labeling options
permanent marker
label gun
bad code scanning labels
Julian date
of calendar days
no year needed due to event related sterility
ex: 1- 365
