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CNOR > CNOR Infection Prevention and Control of Environment, Instrumentation, and Supplies pt 2 > Flashcards

CNOR Infection Prevention and Control of Environment, Instrumentation, and Supplies pt 2 Flashcards

1
Q

Packaging materials should be compatible with what?

A

different types of sterilization methdos

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2
Q

What 3 things disqualify a package from being used?

A
  1. broken seals
  2. evidence of loss of package integrity (the condition of a sterilized package)
  3. evidence of moisture penetration
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3
Q

What 2 things should be inspected on an instrument prior to being packaged?

A
  1. cleanliness
  2. function
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4
Q

instruments should be what prior to packaging?

A

dry

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5
Q

Instruments with multiple parts should be what?

A

disassembled if possible

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6
Q

instruments with locks should be what?

A

processed in the open position

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7
Q

What should not be placed in sterilization containers unless required by the manufacturer’s IFU?

A

towels

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8
Q

What is used to prevent microbial migration?

A

sequential wrapping with 3 single wraps or a single wrap with 2 layers

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9
Q

What should be followed when placing one pouch inside another?

A

IFU

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10
Q

If recommended by the manufacturer, pouches should be placed how?

A

paper side to paper side

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11
Q

To allow sterilant contact and drying during sterilization, pouches should be what?

A

properly spaced and positioned on edge

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12
Q

package labels should be what? so that what?

A

should be secured so that they do not become dislodged during processing, storage, and movement to the point of use

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13
Q

peel pouches should not be placed where?

A

in instrument sets

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14
Q

What is the weight limit for instrument pans and their contents?

A

a 25 lb weight limit

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15
Q

Why is their a weight limit for instrument pans?

A

allows for adequate drying of contents and decreases the risk of injury to the staff handling the sets

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16
Q

Before placing the contents of a rigid container, OR personnel should check what 3 things?

A
  1. check the filters for defects and determine whether the valve is functional
  2. ensure that no moisture is present
  3. determine whether the indicator has turned
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17
Q

What should OR personnel check wrapped containers for?

A

check for perforations and moisture and whether the indicator has turned

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18
Q

Where should personnel label a peel pack?

A

on the plastic side

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19
Q

What can writing on the paper side of a peel pack do?

A

may cause the ink to leach through and compromise the integrity of the package

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20
Q

discovery of a wet pack involves what?

A

a multidisciplinary approach to determine and correct the problem

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21
Q

Who will be involved if a wet pack is discovered?

A
  1. infection preventionist
  2. perioperative and sterile processing staff and managers
  3. facility manager
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22
Q

What are the subsequent events if a wet pack is discovered?

A
  1. load in question should be quarantined according to lot number
  2. surgeons should be notified
  3. the sterilizer should be repaired if needed
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23
Q

Documentation on the package label should include what 5 things?

A
  1. the sterilizer identifier
  2. the cycle or load number
  3. the date of sterilization
  4. a description of the contents
  5. assembler identification information
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24
Q

New, repaired, refurbished, or loaned instruments need to be what before use?

A

cleaned, decontaminated, inspected, and sterilized

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25
Q

What does single use mean?

A

that personnel must use that item only one time

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26
Q

single-use istruments that are reprocessed must meet what?

A

FDA guidelines for reprocessing, which includes policies, procedures, competencies, and education

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27
Q

Items that are not clean cannot be what?

A

sterilized

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28
Q

What can be used to sterilize heat- and moisture-stable items?

A

saturated steam under pressure

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29
Q

what is the critical step in steam sterilization?

A

the removal of air from the chamber

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30
Q

How can the removal of air from the chamber be achieved?

A

via gravity displacement or through a dynamic air removal process (prevacuum)

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31
Q

What are the 4 parameters of steam sterilization?

A
  1. pressure
  2. temperature
  3. time
  4. moisture
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32
Q

what are the first 3 parameter that are captured as part of the sterilizer monitoring log or record?

A

pressure, temperature, time

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33
Q

What are examples of items that can be sterilized with saturated steam?

A

stainless steel instruments, glass, and towels

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34
Q

What may you also use saturated steam with but may require longer exposure or drying times?

A

some powered instruments, specialty orthopedic instruments and devices, and neurosurgery

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35
Q

Both terminal sterilization and immediate-use steam sterilization follow what?

A

the manufacturer’s written guidelines for required cycles for different devices and load configurations

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36
Q

immediate-use steam sterilization follows the same what?

A

process as that for saturated steam under pressure without the dry cycle

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37
Q

Why should IUSS not be used frequently?

A

increased risk of infection secondary to inconsistent cleaning practices in the OR and the transfer of the item from the sterilizer to the point of use

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38
Q

IUSS should only be used when?

A

in specific situations when there is not enough time for a full cycle

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39
Q

What should definitely not be sterilized through IUSS?

A

implants; except in the case of a defined emergency in which no other option is available

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40
Q

If an implant is processed via IUSS, what needs to be run with the load?

A

a biological indicator and a type V integrating chemical indicator

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41
Q

Records for IUSS should include what?

A
  1. the item sterilized
  2. the patient’s name
  3. the sterilizer number
  4. the cycle paramaters - temperature, duration of cycle
  5. monitoring results
  6. the date and time the cycle was run
  7. the name of the cycle operator
  8. the reason for IUSS
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42
Q

what provides a monitoring system for quality assurance with IUSS?

A

routine follow up audits

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43
Q

what is ethylene oxide sterilization?

A

a low temperature sterilization method used for moisture- and heat-sensitive devices (fiberoptic cords, lensed instruments, flexible endoscopes)

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44
Q

EO is very effective but what 4 features make it less than ideal choice?

A
  1. EO is a known carcinogen
  2. the extensive time required for aeration (up to 8 hours) makes EO an impractical choice for many operating rooms
  3. EO is explosive and flammable
  4. Sterilizer installation must meet National Institute for Occupational Safety and Health (NIOSH) and EPA standards for exhaust of flumes
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45
Q

items must be what before placement in the chamber for EO?

A

must be dry

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46
Q

what is imperative in EO and why?

A

correct loading of the baskets or cart is imperative to allow for EO circulation and penetration.

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47
Q

EO-sterilized items must be what to prevent burns to staff or patients?

A

must be aerated at the endy of the cycle

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48
Q

Peronnel must wear what with EO?

A

must wear EO monitoring badges during exposure

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49
Q

low-temperature hydrogen peroxide methods (vapor, gas plasma combination, ozone combination) can be used when?

A

to sterilize items that cannot tolerate high temperatures and humidity (i.e. some plastics, electical devices, and corrosion-susceptible metal alloys

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50
Q

Why is low-temperature hydrogen peroxide desirable?

A

packages do not require aeration

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51
Q

What are the risks that accompany low-temperature hydrogen peroxide methods?

A

it may cause burns, upper airway irritation, and, in cases of severe exposure, permanent lung damage

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52
Q

what cannot be used in low-temperature hydrogen peroxide methods?

A

liquid and cellulose-based paper

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53
Q

instruments should be evaluated for what with low-temperature hydrogen peroxide methods?

A

for acceptable lumen diameter and length

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54
Q

what needs to be specially designed and designated for low-temperature hydrogen peroxide sterilization?

A

trays, mats, and containers AND cleared by the FDA

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55
Q

What can ozone sterilization be used for?

A

to sterilize moisture- and heat-sensitive items according to the manufactuerers’ IFU

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56
Q

What has the FDA approved the use of ozone sterilization for?

A

for use with metal and plastic surgical instruments

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57
Q

what does ozone sterilized use?

A

uses only oxygen and water in the sterilizer chamber

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58
Q

personnel should first determine what before using ozone sterilization?

A

lumen diameter and length

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59
Q

What cannot be used with ozone sterilization?

A

cellulose-based paper

60
Q

What can be used with ozone sterilization?

A

FDA approved rigid containers and nonwoven packages

61
Q

When is dry heat sterilization used?

A

for materials that are impenetrable to moist heat and can withstand high temperatures

62
Q

What are examples of items that can tolerate high, dry heat?

A

dental instruments, oils, and heat-stable powders

63
Q

What usually cannot withstand the high temperatures associated with dry heat sterilization?

A

most types of type

64
Q

what kind of containers should be used for dry heat? and why?

A

small containers to allow for the lowest possible package density

65
Q

What should personnel use to prevent burns with dry heat?

A

proper PPE - insulated gloves, handles

66
Q

At the end of the cycle, personnel should what with dry heat sterilization?

A

should not touch the sterilizer chamber or items in the chamber. allow things to cool before handling

67
Q

What is paracetic acid liquid sterilization?

A

a low-temperature sterilant that should not be used for devices that are heat sensitve, can be immersed, are approved for this process, and cannot be sterilized using steam sterilization methods

68
Q

In FDA-cleared formulated prodcuts, paracetic acid liquid is effective even when what is present?

A

organic matter

69
Q

What is really important for paracetic acid liquid with use?

A

since the processed item is wet and the container is not sealed, the item should be transported to the point of use to be used immediately, not stored for later use

70
Q

Paracetic has what kind of implications for staff?

A

health implications, include skin and eye irritation, burns, and toxic effects to internal organs

71
Q

glutaraldehyde and ortho-phthalaldehyde are used as what?

A

high-level disinfectants or chemical sterilants

72
Q

To use chemical sterilants, the device must be able to be what?

A

be immersed in the disinfectant bath

73
Q

What is the advantage of glutaraldehyde?

A

it has a noncorrosive action on endoscopic equipment, thermometers, rubber, anesthesia equipment, respiratory equipment, and plastic

74
Q

What are health concerns associated with glutaraldehyde?

A

include respiraotry irritation from the vapor and contact dermatitis

75
Q

where should the glutaraldehyde bath be located?

A

in a well-ventilated area that has 7 to 15 air exchanges per hour to prevent toxic fume buildup

76
Q

what should be checked prior to each glutaraldehyde load?

A

concentration and temperature of the solution

77
Q

If a glutaraldehyde solution is not within acceptable parameters what should eb done?

A

the solution must be discarded

78
Q

what should the container being processed with glutaraldehyde and ortho-phthalaldehyde have?

A

a tight fitting lid

79
Q

In order to avoid diluting the glutaraldehyde and ortho-phthalaldehyde solutions, items must be what?

A

dry

80
Q

thorough cleaning of the instrument prior to placement in the bath is important why?

A

HLDs may fix blood and organic material to the surface of the instrument

81
Q

At the end of a cycle with glutaraldehyde and ortho-phthalaldehyde, instruments must be what?

A

thoroughly rinsed and lumens flushed at the end of the cycle

82
Q

what does working with glutaraldehyde, hydrogen peroxide, and ortho-phthalaldehyde require?

A

that perioperative nurses wear protective attire, which may include chemical-resistant gloves, protective eyewear, and an impervious gown or apron

83
Q

the process of sterilization requires what?

A

properly functioning devices

84
Q

what does monitoring of both packages and sterilizers provide?

A

provides verification that the recommended parameters for sterilization have been met

85
Q

What 3 things should be used to monitor the sterilization process?

A

physical, chemical, and biological indicators

86
Q

What are physical monitors that are reviewed by staff at the end of each cycle to ensure that paramaters for meeting sterility have been met?

A
  • temperature, time, pressure, humidity, sterilant concentration
87
Q

Where are physical monitors results recorded?

A

in logs, digital readings, printouts, graphs, or gauges

88
Q

What should documentation of sterilization process incorprated into?

A

the facility’s quality assurance plan

89
Q

If physical parameters are not met, or if the sterilizer has been moved, cleaned, or repaired, what must happen?

A

a biological indicator must be negative for 3 consecutive cycles (empty chamber) before the sterilizer is returned to service

90
Q

what are chemical indicators used for?

A

to immediately verify that the package has been exposed to the sterilization process

91
Q

chemical indicators do not establish what?

A

sterility of the content

92
Q

biological indicators are used to monitor what?

A

sterilizer efficacy

93
Q

when should biological testing for steam sterilizers be performed?

A

at least weekly, although most facilities choose to test their sterilizers daily to allow for earlier discovery of equipment malfunction or errors

94
Q

all loads containing implants should contain what?

A

a BI and be quarantined until the BI results are known

95
Q

Storing sterilized items in a controlled environment helps to ensure what?

A

the integrity of the product and decreases the risk for contamination through dust, moisture, heat, or excessive handling of the packaging

96
Q

Shelf life is related to what rather than what?

A

related to event (amount of handling, exposure to humidity) rather than to the length of the time the package sits on the shelf or the date it was sterilized

97
Q

What 3 environmental conditions help assure sterility of stored packages?

A
  1. the temperature does not exceed 75 degrees fahrenheit
  2. there are 4 total air exhanges per hour
  3. the relative humidity is between 20% and 60% and no higher than 70%
98
Q

personnel should place chemical indicators where in the package?

A

in the package area that offers the most challenge for air removal and sterilant contact

99
Q

Storage areas for sterilized instruments and supplies and shelves, racks, bins, and containers must be what? and kept?

A

in compliance with fire codes and kept clean and dry

100
Q

sterile supplies must be how many inches above the floor?

A

8-10 inches above the floor

101
Q

sterile supplies must be how many inches from the outside walls?

A

2 inches

102
Q

sterile supples must be how many inches from the ceiling or sprinkler heads to support adequate air circulation and cleaning?

A

18 inches

103
Q

sterile supplies must never be stored where?

A

under sinks or other areas where moisture or vermin can compromise the integrity of the packaging

104
Q

sterile items stored outside a designed sterile storage room should be kept where?

A

in closed cabinets or carts

105
Q

sterile storage rooms may contain either?

A

closed or open shelves or racks

106
Q

the bottom of an open shelving unit must be what?

A

solid

107
Q

Flexible endoscopes should be stored how?

A

vertically in a drying cabinet or closed cabinet with high-efficiency particulate air (HEPA) filtered air that provides positive pressure to promote drying and discourage bacterial growth

108
Q

Is there a standard for maximum storage time of flexible endoscopes?

A

no

109
Q

A multidisciplinary team should establish what for endoscopes?

A

a policy for the length of time an endoscope may be stored before reprocessing is required

110
Q

What is the description of a chemical indicator CLASS I?

A

process. place externally (i.e. tape)

111
Q

What is the purpose of a chemical indicator CLASS I?

A

immediately verifies exposure to the sterilization process

112
Q

What is the description of a chemical indicator CLASS II?

A

speciality (i.e. bowie-dick air removal test sheet/pack)

113
Q

What is the purpose of a chemical indicator CLASS II?

A

tests for the precence of air in the sterilizer chamber of a prevacuum steam sterilizer

114
Q

What is the description of a chemical indicator CLASS III?

A

single parameter (i.e. time or pressure)

115
Q

What is the purpose of a chemical indicator CLASS III?

A

reacts to 1 critical process parameter

116
Q

What is the description of a chemical indicator CLASS IV?

A

multi-paramter (time, temperature, and pressure)

117
Q

What is the purpose of a chemical indicator CLASS IV?

A

reacts to 2 or more critical process parameters

118
Q

What is the description of a chemical indicator CLASS 5?

A

integrating. place internally. multilayered trays may require an indicator on each layer

119
Q

What is the purpose of a chemical indicator CLASS 5?

A

reacts to all critical process parameters. used for all implantable devices

120
Q

What is the description of a chemical indicator CLASS 6?

A

emulating. place internally.

121
Q

What is the purpose of a chemical indicator CLASS 6?

A

reacts to all the critical parameters of a specialized sterilization cycle

122
Q

A health care facility plan for receiving and using loaned instrumentation includes what?

A

tracking and maintaining quality controls

123
Q

A health care facility plan for receiving and using loaned instrumentation must describe what?

A

appropriate decontamination and sterilization processes for the loaned items

124
Q

A health care facility plan for receiving and using loaned instrumentation should most importantly include what 3 thingS?

A
  1. details about how to acquire instruments and implants
  2. written manufacturer’s instructions for cleaning, assembly, and sterilization
  3. requirements to limit instrument set weight to no more than 25 pounds
125
Q

requests for loaned instrument use should include what?

A

quantities and the time of use, return, and restocking to prevent the need for IUSS

126
Q

Sterile processing manager should maintain what for loaned instruments?

A

should maintain the documentation of loaned transactions in a central location and give a copy to the industry representative

127
Q

What must be removed before loaned items are transported to the sterile processing area?

A

external shipping containers

128
Q

sterile processing personnel should inspect what upon receipt? and then do what?

A

should inspect rigid instrument containers upon receipt and then clean and decontaminate the containers

129
Q

sterile processing personnel should inventory what?

A

inventory the instruments and implants and then clean, decontaminate, and sterilize the loaned instruments before sending them to the point of use

130
Q

true or false; presterilized loaned instruments do not need to be reprocessed

A

false; they do to ensure sterility and prevent cross-contamination from another facility or during transport to the receiving facility

131
Q

At the completion of the procedure, sterile processing personnel should what what before returning loaned instruments to an industry representative?

A

clean, decontaminate, inventory, and inspect the instruments

132
Q

What helps ensure that instruments have been returned in good repair and are safe to handle?

A

documentation

133
Q

steam sterilizer (include IUSS) has what biological indicator?

A

geobacillus stearothermophilus

134
Q

What is the timing of testing for steam sterilizers and biological indicators?

A

at least weekly, preferably daily

135
Q

steam sterilizer, dynamic air displacement has what biological indicator?

A

bowie dick

136
Q

What is the timing of testing for steam sterilizer, dynamic air displacement and biological indicators?

A

empty the chamber at the beginning of each day the sterilizer is used

137
Q

EO has what biological indicator?

A

bacillus atrophaeus

138
Q

What is the timing of testing for EO and biological indicators?

A

every load

139
Q

low-temp hydrogen plasma has what biological indicator?

A

geobacillus stearothermophilus

140
Q

What is the timing of testing for low-temp hydrogen plasma and biological indicators?

A

at least daily

141
Q

ozone has what biological indicator?

A

geobacillus stearothermophilus

142
Q

What is the timing of testing for ozone and biological indicators?

A

at least daily

143
Q

dry heat has what biological indicator?

A

bacillus atrophaeus

144
Q

What is the timing of testing for dry heat and biological indicators?

A

at least daily

145
Q

paracetic acid has what biological indicator?

A

no fda-cleared biologic indicator is available currently

146
Q
A

CNOR (12 decks)

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