Chapter 7 pt 3 Flashcards
4 types of sterilization
steam
chemical agents
high electricity bombardment
UV/ gamma radiation
what kind of sterilization is autoclave
steam sterilization
most common
how does autoclave work
uses pressurize moisture + heat
all microbes + spors
most dependable + inexpensive
what items can not be used with autoclave
items not heat, moisture, or temperate sensitive
6 autoclave critical factors ( to make it sterile)
time
contact
temperature
pressure
moisture
air
critical factors with autoclave: time
some microbes are harder to kill
how long do you autoclave instruments
wrapped instrument: 15 at 270
unwrapped no lumen: 3 mins at 270
unwrapped with lumen: 10 mins 270
how long does a wrapped and unwrapped inst take to dry
wrapped: 15 mins
unwrapped: 1 min
critical factors with autoclave: contact
remove bioburden from all surfaces
ensure drain is lint free/ preventing air from leaving
- make sure not wrapped too tightly
- proper placement
critical factors with autoclave: temperature + pressure
increasing pressure= increasing temp
pressure
- * raises temperature of steam*
critical factors with autoclave: moisture
catalyst to temperature
allows for lower temperature
steam 97-100% humidity
condensation against metal
97% steam w/ 3% water
critical factors with autoclave: air
must be completely removed
doesn’t mix with steam
removed via gravity/ prevac
3 basic components of autoclave
metal jacket - preheat if using outside steam
three pipes
- steam
- drain
- filter air ( dry time)
electromechanical switches (old)
- microprocessor system (new)
gravity displacement sterilizer
passively remove air from chamber
steam pushes air out the bottom
packing too tight- trap air
- more time than prevac autoclave
gravity displacement autoclave cycles
condition cycle- air is displaced
exposure cycle- temp maintained
exhaust cycle- steam removed
dry cycle- air revaporizes + removes moisture from packs
dynamic air removal autoclave
prevac
uses vacuum pump to remove air
prevac autoclave cycle
prevacuum - 90% of air
conditioning - steam injected
2nd prevacuum 90% of air again
exposure - steam enters + temp maintained
exhaust - steam leaves
dry - 90% vacuum removes moisture
advantages of dynamic air removal autoclave
more efficient at removing air
increases speed of operation
lower cycle time
what do you have to perform for dynamic air removal autoclave
bowie dick test
checks air entrapment
used first run of the day + after fix
placed horizontal over the drain
vacuum system not sterilization test
commercial name for bowie dick test
DART: daily air removal test
what is the steam flush pressure pulse cycle
part of dynamic air removal autoclav
four to five phases instead of two
eliminates need for bowie dick test
aids in removing air
immediate use steam sterilization
aka flash sterilization
most common sterilization method by STSR
sterilizes unwrapped items
only use it if you have to (ex inst falls)
never use on implantable items
sterilization monitoring
for quality assurance
monitor sterility or items
methods of monitoring
mechanical
chemical
biological
administrative ( documentation)
mechanical monitoring
measuring time, temp, and pressure over 24 hrs
prints out stats per day
used for permanent records
most important part of mechanical monitoring
verifies sterilizer worked properly ( all parameters were met)
chemical monitoring
aka indicators, integrators
placed inside and outside packages to verify items were exposed to sterilizing conditions
does not authenticate sterility
what does chemical monitoring indicate
machine malfunctions
incorrect assembly/ wrapping
incorrect loading
chemical monitoring classes
class 1: process- external exposed
class 2: specific test - bowie dick test
class 3: single variable - temp, pressure, steam
class 4: multi variable - two or more parameters
class 5: integrating - react to all parameters
- most accurate
emulating: all parameters of specific cycle
what do chemical monitors indicate
chemical indicators indicate exposure
types of chemical monitoring
tape
internal steam indicators
rigid containers indicato dots
peel pack with an edge or dot
how long does biological indicator monitoring take
20 min
what is the difficult steam resistant spore called that BI tests kill
geobacillus stearothermophilus
which is the only guaranteed sterility test
biological indicator (BI) test
which spore is non harmful to humans
geobacillus stearothermophilus
how long + hot do you incubate BI test once its crushed
24 hours
131-140 degrees
how frequent do you test BI
ranges from every load to weekly
whenever implantable item
what do the colors mean in a BI Test
red= negative
yellow= positive (unsterile)
what is done at the end of the BI monitoring cycle
vial is crushed and intubated
troubleshooting
wet packs
-contaminated via strikethrough or wicking action (inside or outside)
troubleshooting: wet outside of pack causes
condensation dripping from shelves
dripping
troubleshooting: wet inside of pack causes
too many instruments in tray
packed too tight
without absorbent towels
improper loading
steam purity
contaminated filters
brown/ orange spots
ethylene oxide (ETO)
main chemical used for gas sterilization
kills all microorganisms + spores
characteristics of ETO
non corrosive
passes through woven materials
how do you move the ETO machine
if you MUST move it, pull it instead of pushing it so fumes don’t go in your face
disadvantages of ETO machine
expensive
toxic
- must be aerated for 8 hours
flammable
hydrogen peroxide gas plasma
aka sterrad
uses gas at low temperature, for heat and moisture resistant items
- scope and camera
indicators of hydrogen peroxide gas plasma (sterrad)
biological indicators is bacillus atrophaeus
tape turns dark blue to pink
what can sterrad not be used for
narrow lumens
- scopes light cords
what packaging is used for sterrad
tyvek
- allows bacteria to move out but get trapped back in
sterrad processing pros
allows space around items
doesn’t require aeration, drying, or cooling time
how long is the sterrad cycle time
28-38 minutes
what are liquid chemical sterilization for
heat sensitive but moisture stable
glutaraldehyde (cidex) rules
must be dry prior to immersion or it all be diluted
must be tested each day for concentration level
what does sterrad do
uses peracitic acid- strong sterilant
used for flexible and rigid scopes
how long and hot is steris go for
23 minutes at 122 degrees
disadvantages of steris
expensive
no shelf life, needs immediate use
ionizing radiation
produce thermal/ chemical energy disrupting DNA
gamma rays or beta particles
100% commercially used, hospitals don’t do it
- implants
alternative sterilization methods
ozone gas
- oxidized bacteria
not cleared by FDA
- vaporized hydrogen peroxide
- chlorine dioxide gas
administrative centers of sterilization process
document everything!!!
what are the things you document with indicator
items
patient
team member
result of indicator
what is the purpose of documenting
inspection ( joint commission )
infection control
court of law
what does event related sterility do
replaces expiration dates in facilities where you sterilize the item
outside sterilized items shipped in will have expiration date on them
event related sterility trumps expiration date (hole in glove despite not expired, still unsterile)
event related sterility summarized
unless package is compromised, its sterile
AST standards of practice 1
have all necessary supplies to prepare sterile field for surgery beforehand
AST standards of practice II
everything should be positioned prior to opening sterile items
AST standards of practice III
sterile technique must be strictly adhered by team (open with surgical conscience)
AST standards of practice IV
traffic in and out of OR should be monitored and controlled when you begin opening sterile items
AST standard of practice V
sterile supplies should be opened as close to time of surgery as possible
AST standard of practice VI
limit your movements ( touch once move around little)
AST standard of practice for bowel technique 1
bowel instruments should be isolated for anything else ( cross contamination + SSI)
AST standard of practice for sterility of underside of mayo 1
only sterile members touch it, not CN
AST standard of practice for surgical drapes 1
only sterile drapes used
AST standard of practice for drapes II
hole in drape = contaminated
AST standard of practice for drapes III
drapes should be fluid resistant
AST standard of practice for surgical drapes IV
lint free
AST standard of practice for surgical drapes XII
reusable woven fabric drapes should have same barrier of non woven disposable drapes
reccomeneded standards for gowning and gloving 1
all sterile members need to have a gown in sterile field
recommended standards for gowning and gloving II
compromise of integrity of microbial barrier = contaminated
recommended standards for gowning and gloving IX
everyone put on gloves before going into field, prevents SSI
recommended standards of practice for gowning and gloving XI
double gloving
what is typically not done but should be
separate sterile surface should b used for gowning and gloving to avoid contamination of back table
