Cleaning, Disinfection, & Sterlization - APIC Text Ch. 31 Flashcards
What are critical devices?
Medical devices that contact sterile tissue i.e., surgical instruments
What are semi critical medical devices?
Medical device that contact mucous membranes i.e., endoscopes
What are noncritical medical devices?
Medical devices that contact only intact skin i.e., stethoscopes
Why is properly cleaning and disinfecting reusable medical devices used in invasive medical procedures important?
The devices or instruments contact the patient’s sterile tissue or mucous membranes. When not properly cleaned and disinfected, there is a major risk due to the introduction of pathogenic microbes, leading to infection.
What is the Spaulding Classification System?
Divides medical equipment into 3 categories based on risk.
What are the 3 categories of the Spaulding Classification System?
Critical, sem critical, and non critical
What is the 4Th risk category for primary principles that guide the disinfection and sterilization process added by the Association for Advancement of Medical Instruments?
Environmental Surfaces
What are the 4 classifications of disinfection and sterilization according to the Advancement of Medical Instruments (AAMI)
Critical, semi-critical, noncritical, and environmental surfaces.
Define cleaning?
The removal of foreign material from objects.
Why is cleaning an important part of reprocessing?
Removal of foreign material is required before disinfection, and sterilization can occur so that the materials do not interfere with the effectiveness of these processes.
Why is the failure to properly clean and, disinfect, or sterilize reusable devices significant?
Not properly disinfecting or sterilizing devices after cleaning may lead to transmission via contaminated medical and surgical devices.
Why is environmental decontamination essential?
It plays a role in decreasing the bioburden and potentially Lowering rates of HAIs.
What are examples of environmental surfaces?
High-touched surfaces - countertops, bed rails, tray tables, door knobs, etc.
include items designated by the Spaulding Classification System as noncritical items.
What items should be sterilized?
Critical
What items require high-level disinfection?
Semi critical
What items require low level disinfection?
Semi critical
Note: Environment surfaces according to the AAMI
What level of microbial inactivation does Sterilization offer?
Destroys all microorganisms, including bacterial spores.
What method of temperatures are required for sterilization?
High temperature
Low temperature
Liquid immersion
What type of processing is available for high temperature sterilization?
Steam and dry heat
Examples of high-temperature sterilization applications in healthcare?
Heat-tolerant critical devices, I.e., surgical instruments.
Semi-critical patient care items.
What type of processing is available for low temperature sterilization?
Ethylene oxide gas
Hydrogen peroxide gas plasma
Ozone
Hydrogen peroxy vapor
Examples of low-temperature sterilization applications in healthcare?
Heat-sensitive critical and semi-critical patient care items
What type of processing is available for liquid immersion sterilization?
Chemical sterilants include
>2% glut (~10 hr)
1.12% glut with 1.93% phenol (12 hr)
7.35% HP with 0.2% PA (3 hr)
8.3% HP with 7.0% PA (5 hr)
7.5% HP (6 hr)
1.0% HP with 8.8% PA (8 hr)
>0.2% PA (12 min @ 50-56*C
Examples of liquid immersion sterilization applications in healthcare?
Heat-sensitive critical and semi-critical patient care items that can be immersed
What level of microbial inactivation does high-level disinfection offer?
Destroys all microorganisms except high numbers of bacterial spores.
What methods are required for high-level disinfection?
Heat automated
Liquid immersion
Examples of heat automated High-Level Disinfection applications in healthcare?
Heat-sensitive semi-critical items
I.e., respiratory therapy equipment
What type of processing is available for heat-automated high-level disinfection?
Pasteurization
What is the temperature range and time for high-level disinfection heat automated pasteurization?
65-77 C for 30 minutes
What type of processing is available for liquid immersion high-level disinfection?
Chemical sterilants or HLDs include
>2% glut
0.55% OPA
1.12% glut with 1.93% phenol
7.35% HP with 0.23% PA
7.5% HP 1.0% with 0.8% PA
650-675 ppm chlorine
2.0% HP
3.4% glut with 26% isopropanol
Examples of liquid immersion high level disinfection applications in healthcare?
Heat-sensitive semi-critical items
I.e., GI endoscopes, bronchoscopes, endocavitary probes
What level of microbial inactivation does intermediate level disinfection offer?
Destroys vegetable bacteria, mycobacteria, most viruses, and most fungi
What microbial are not inactivation during intermediate level disinfection?
Bacterial spores
What is the method for intermediate-level disinfection?
Liquid contact
Examples of liquid immersion intermediate-level disinfection?
EPA registered hospital disinfectant with label claims regarding TB
Note: chlorine based products, phenolics, improved hydrogen peroxide-exposure times at least 1 minute.
Examples of liquid immersion intermediate-level disinfection applications in healthcare?
Noncritical patient care items or surfaces with no visible blood.
I.e., blood pressure cuff, stethoscope, bedside table, counter
What microbes are inactivation during low-level disinfection?
Destroys vegetable bacteria, some fungi, and viruses.
What microbes are not inactivation during low-level disinfection?
Mycobacteria or spores
Low lever disinfection method?
Liquid contact
Examples of low level disinfection liquid contact?
EPA-registered hospital disinfectant with no TB claim or 70-90% alcohol.
Note: chlorine-based products, phenolics, improved hydrogen peroxide exposure times at least 1 minute.
Examples of Low-level disinfection liquid constant healthcare application?
No critical patient care items or surfaces with no blood.
I.e., blood pressure cuffs, stethoscope, bedside tables, handrails
How soon should the cleaning process start for critical and semi critical devices?
As soon as possible after use
What should happen to instruments and devices opened but unused during a procedure?
They are considered contaminated and Reprocessed according to their Manufacturer Instructions For Use.
Why is removing debris and contaminants from devices important?
Prevents blood and tissue from drying on the device
Reduces bioburden
Reduces nutrient material
Reduces possiblity of spillage
Reduces possibility of aerosolizing contaminates
The process becomes more difficult
Disinfection or sterilization process becomes less effective
How should resizable medical devices be transported from point of use to reprocessing?
Transporter should follow Standard Precautions
Transported in a closable, puncture-resistant, leak-proof container
Marked as biohazard
Types of cleaning for reusable medical devices?
Manual cleaning
Mechanical or automatic cleaning
When is manual cleaning of reusable medical devices preferred?
When a mechanical unit is not available
When the device is fragile
When the device is hard to clean
What are the two essential components of manual cleaning?
Friction and fluidics
Define fluidics
Why is fluidics used in manual cleaning?
Fluids under pressure
Removes soil and debris from internal channels after brushing and when the design of the he device does not allow the passage of a brush through a channel.
Methods for properly loading devices into a washer disinfector during the cleaning process?
Open-hinged instrument fully
Avoid stacking instruments
Dissenesemble instruments as much as possible
Follow MFUs
The most common types of mechanical cleaning are?
Ultrasonic cleaners, washer-decontaminators, washer-sterilizers
Describe the process of ultrasonic cleaning.
Removes soil by cavitation and implosion
Acoustic energy waves are propagated in an aqueous solution to disrupt the bonds that hold particulate matter to the surface.
Cons of ultrasonic mechanical cleaning?
• Bacterial contamination - no antibacterial label claims
• Endotoxin contamination of surgical instruments causes inflammatory reactions
Describe the process of washer-sterilizer mechanical cleaning.
The device is a modified steam sterilizer that cleans by filling the chamber with water and detergent through which steam is passed to provide agitation. Instruments are rinsed and subjected to a short stem steeumjzation cycle at 285*F.
Describe the prices of Washer-decontaminators/disnfectors used for mechanical cleaning.
The device acts like a dishwasher. Using a combination of water circulation and detergents to remove soil. Some units have a cycle that subjects the instruments to a head process of 93*C for 10 minutes.
Describe the process of washer-pasteurizer for mechanical cleaning.
The device exposes instruments to hot water for 30 minutes at a temperature of ~70*
Note: typically used for respiratory therapy equipment
What detergent solution pH is the best choice for device cleaning?
Neutral or near-neutral
What is sometimes added to neutral pH solutions to assist in the removal of organic material?
Enzymes - usually proteases
Why are enzymes sometimes added to pH neutral detergents?
Assist in the removal of organic material by attacking proteins that make up a large potion if common soil.
I.e., bold, pus
What can inactivate a proteinaceous enzyme?
Germicides
Are enzymatic cleaners disinfectants?
No
Why must all chemicals be rinsed from devices?
adverse medical reactions
I.e., fever
Name some semi-critical devices that require high level disinfecting:
Respiratory therapy equipment
Anesthesia equipment
Gastrointestinal endoscopes
Bronchoscope
Laryngoscopes
Esophageal manometry probes
Anorectal manometry catheter
Endocavaitary probes - rectal, vaginal probes
Prostate biopsy probes
Infrared coagulation device
Diaphragm fitting rings
Gastrointestinal and respiratory tracts are generally resistant to infections caused by what organisms?
Bacterial Spores
Gastrointestinal and Respiratory tracts are generally susceptible to what organisms?
Bactria, mycobacteria, and viruses
What is the variation of exposure time and temperature for High-level disinfectants?
8 - 45 minutes
20* - 25* C
Why are control measure an important part of the reprocessing process?
To help prevent patient exposures.
The use of a central reprocessing area for all instruments is most likely to result in?
The highest cleaning efficiency of medical devices.
Why does a central reprocessing area have the highest efficacy for cleaning medical devices?
It often has specialized equipment and employees who specialize in cleaning the equipment.
Inadequate sterilization of surgical instruments and tubing may result in what adverse event after cataract surgery?
Toxic Anterior Segment Syndroms
What substances have been implicated as the cause of Toxix Anterior Segment Syndrome in cataract surgery?
Impurities of autoclave steam
Heat stable endotoxins
Irritants in the surface of intraocular surgical instruments
