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BDS4 > Deconatmination > Flashcards

Deconatmination Flashcards

1
Q

What is the splauding classification?

A

A classification that classify devices into critical , semi-critical and non-critical and describes how to process each

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2
Q

What is a critical device?

A
  • A device that penetrated soft tissues
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3
Q

What is a semi-critical device ?

A

A device that comes into contact with non intact skin or mucous membranes but does not penetrate them

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4
Q

What is a non-critical device?

A

A device that only contacts with skin and intact mucous membranes

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5
Q

Example of a critical device?

A

Surgical and biopsy instruments , forceps

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6
Q

Example of a semi-critical device?

A
  • Dental mirror
  • Anesthetic syringe
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7
Q

Example of a non critical device?

A
  • Chair light handle
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8
Q

How do you process forceps (critical)

A

Cleaned then sterilised

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9
Q

How do you process a dental mirror? (semi critical)

A

The device must be cleaned and high level of disinfection required (steam sterilisation)

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10
Q

How do you process a chair light handle?

A

Cleaned followed by low level disinfection

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11
Q

What are the stages in the life cycle of processing instruments?

A
  • Acquisition
  • Cleaning
  • Disinfection
  • Inspection
  • Disposal
  • Packaging
  • Sterilisation
  • Transport
  • Storage
  • Use
  • Transport
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12
Q

What is the first step of the instrument processing and what happens in it?

A
  • Cleaning
  • Removes biological matter from the surface
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13
Q

What are 5 reasons instruments need to be cleaned?

A
  • Functionality of instrumentation
  • To minimise the spread of contamination
  • To prevent failed procedures
  • To achieve steam contact
  • It is a legal requirement
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14
Q

What is the main method of cleaning?

A

Washer disinfector

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15
Q

What is the secondary method of cleaning?

A

Ultrasonic bath

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16
Q

What is the next step after visible contamination has been removed and instrument inspected?

A
  • Sterilisation through a steam steriliser
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17
Q

Define the operator ?

A

An operator is a person designated by management to operate a washer disinfector

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18
Q

What are 3 duties of an operator?

A
  • Recording WD readings
  • Refill WD detergent
  • Simple housekeeping
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19
Q

What are the 3 PPE that a person carrying out manual cleaning should wear after hand hygiene? and why?

A
  • Apron - protect the person clothing
  • Face shield - protect from splashing the face and eyes
  • Rubber gloves and heavy duty rubber gloves - to protect the hand
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20
Q

Why is it required to have a 30-35 degrees water for manual cleaning in the dedicated instrument cleaning sink?

A

A temperature above 35 will cause the protein to coagulate making them difficult to remove

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21
Q

Describe how should the chemical detergent be for manual washing?

A
  • enzymatic or PH neutral
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22
Q

What are the two types of manual cleaning?

A
  • Immersion
  • Non-immersion
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23
Q

3 recommendation for manual cleaning ?

A
  • 30-35 degrees
  • 5ml of detergent per 1L of water ( or follow manufacturer instructions)
  • Temperature sensitive to avoid damage to efficacy of chemicals
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24
Q

Why a metallic brush should never be used for manual cleaning? what would you use instead?

A
  • It may damage the instrument
  • long handled soft bristle brush
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25
Q

Why is it important to scrub the instrument below the surface of the water in immersion manual washing?

A
  • The instrument must be contact with the water and detergent
  • Scrubbing above the water will create aerosols
  • To minimise splashing
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26
Q

When should manual cleaning be carries out replacing the WD and USB ?

A
  • recommended by the manufacturer
  • no other alternative
  • WD or USB did not remove the contamination
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27
Q

Describe how the ultrasonic bath works?

A
  • Use high frequency sound-waves that create bubbles that expand and collapse due to fluctuation in pressure on the hard surfaces of the instrument to remove contamination
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28
Q

What is the operating temperature for an ultrasonic bath?

A

20-35 degrees

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29
Q

What type of water is used in the ultrasonic bath?

A

Tap water

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30
Q

What should you do before using the USB?

A

A degas cycle must be ran , this is by running a standard production cycle with the chamber empty (except from the load carrier)

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31
Q

Why do we need to degas the USB?

A
  • To remove any air bubbles which will effect the efficacy of the equipment and prevent proper cleaning of instrumentation
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32
Q

After manual cleaning and USB and rinsing the instrument in the rinsing sink, what is the next step?

A

Washer disinfector to be thermally disinfected

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33
Q

What is the first Stage in the decontamination cycle?

A

The use of the washer disinfector

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34
Q

What is the advantage of the manually washing over the washer disinfector?

A

Scrubbing produce more force than the washer disinfector could

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35
Q

5 disadvantages of ultrasonic bath and manual cleaning?

A
  • Risk of aerosol production
  • Risk of contaminating the surrounding environment
  • Risk of human error
  • Risk of sharps injuries
  • USB may damage instruments
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36
Q

Where are instrument positioned in the AWD?

A

in the load carrier

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37
Q

2 advantages of USB

A
  • removes hard to reach contamination
  • Automated process
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38
Q

What are the 5 stages of the washer disinfector and what happens in each stage?

A
  • Pre-wash - removes gross contamination
  • Main wash - remove biological matter using detergent
  • Rinse - removes any residue of biological matter or chemicals
  • Thermal disinfection - kills microorganisms using heated water
  • Drying - removes any remaining moisture from surface of instrument using hot air
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39
Q

Why is it important to remove proteins or prions during the prewash and wash and rinse stages of the washer disinfector?

A
  • High temperature make them adhere to instrument surface
  • They can survive higher temperatures for longer periods of time
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40
Q

Flush/ prewash temperature?

A

Less than 35

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41
Q

Main wash temperature?

A

Depends on chemical used

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42
Q

Rinsing temperature for WD?

A

Less than 65

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43
Q

Temperature and time for thermal disinfection?

A

90-95 degrees for minimum of 1 minute

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44
Q

3 advantages of washer disinfector?

A
  • Can remove all contamination
  • Consistency - the same process every time
  • Automated process so produce printable record for each cycle (traceability)
  • Facilitate thorough inspection as handling of instruments safe for stafff
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45
Q

When would you the daily checks of the WD?

A

Before instruments can be processed through it

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46
Q

What are the 6 daily checks of the washer disinfector?

A
  • Check spray arms spin freely
  • Check that spray jets are not blocked
  • Make sure filter is free of debris
  • Check door seal condition and wipe
  • Check there is suitable amount of chemical in the reservoir
  • Record the disinfection temperature of the first cycle
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47
Q

3 loading requirements for instruments in the WD?

A
  • Hinged instruments must be opened
  • Instruments should be disassembled
  • Equipment should not overlap
48
Q

When should be the instruments inspected?

A
  • After WD process to look for any damage or contamination
  • using illuminated magnifier
49
Q

If you inspect an instrument after WD and there is still contamination, what would you do?

A
  • Ultrasonic bath or manually clean the instrument
  • Then process again in the washer disinfector
50
Q

5 reasons we use steam for sterilisation?

A
  • Carries a massive amount of energy
  • non toxic
  • it can be recondensed and used again
  • water is readily available
  • there is no waste product except water
51
Q
A
51
Q

What 4 types of purified water is used in the sterilisation process?

A
  • Reverse osmosis
  • De-ionised
  • Distilled
  • Sterile
52
Q

What are the 3 types of sterilisers?

A
  • Type N - non vacuum
  • Type B - Vacuum capable
  • Type S - specialised
53
Q

Explain Type N steriliser?

A
  • heats water in the chamber to produce steam which passively removes air from the chamber (this can still leave some air within the chamber)
  • you can only process unwrapped and non lumened instruments in this sterliser
54
Q

What is the disadvantage of Type N?

A

Air is still present in the chamber meaning anything in contact with air will not be sterilised at the same temperature as steam

55
Q

What is the sterilising temperature , pressure and holding time?

A
  • 134-137 degrees
  • 2.05 - 2.35 bar
  • 3 minutes holding time
56
Q

Describe how type B steriliser work?

A
  • All air is removed from the chamber
  • This creates a a negative pressure which allows the steam to rush into the chamber contacting all the instrument surfaces
  • it can penetrate wrapping and sterilise the instruments inside
57
Q

What type of instruments can be processed into type B steriliser?

A
  • Wrapped , channeled and lumened instruments
  • Can also process porous items such as cotton swabs
58
Q

Example of an instrument that can be used in type S steriliser ?

A
  • handpieces or instruments according to manufacturer instructions
59
Q

An instrument has been sterilised using Type N steriliser , is it sterile at the point of use?

A
  • No , instruments are sterile following the processing but need to be wrapped immediately after that which carries a risk of recontamination
60
Q

Describe how should the storage area be for sterilised instruments?

A
  • Dry
  • Clean
  • Free from aerosol contamination
  • Temperature controlled
  • Away from direct sunlight
61
Q

What are the daily and weekly checks for sterilisers? (5)

A
  • Check door seal is intact and free of debris and clean
  • Check chamber is free from damage or instruments
  • Fill and drain the feedwater reservoir
  • Drain used water reservoir
  • Check the condition of the load carrier
62
Q

What daily tests are specific to type B steriliser?

A
  • Steam penetration test using Bowie Dick pack or Helix
63
Q

What weekly tests are specific to type B steriliser?

A
  • Air leakage test
  • Air detector function test
64
Q

What is the current guidance for sterilisation?

A

SHTM 01-01 Part D

65
Q

How should be the transport container ? (4)

A
  • Rigid sided
  • Tight fitting lid
  • Leak proof
  • Colour coded or clearly marked
66
Q

When would an insurance test be carried out for sterilisers ?

A

Every year

67
Q

How can you ensure that biological matter will not dry and stick to the surface of instruments after use?

A
  • Having the shortest time between using the instrument and processing it
  • Instruments sprayed in packets for transport
68
Q

What does the sinner cycle consist of ? and what does it refer to ?

A
  • Energy
  • Chemicals
  • Time
  • Temperature
  • the 4 elements required for successful cleaning process
69
Q

Two stages where tap water can be used ?

A
  • Cleaning
  • Disinfection
70
Q

Why only purified water can be used for sterilisers ?

A

Because normal water have minerals , silicates organics and metals and had high conductivity

71
Q

Compare the conductivity of normal water to purified water?

A

Normal - 56.8 micro-siemens
Purified - 4.3 micro-siemens

72
Q

Describe how water is processed to produce each of the purified water types?

A
  • Distilled - boiling and recondensing water
  • De-ionised - passing water through an ion exchange
  • Reverse osmosis - using a semi permeable membrane
  • Steriles - filtered and sterilised water
73
Q

What are 3 types of detergents?

A
  • high and low alkaline
  • Enzymatic detergent that breaks down proteins (used in USB and MW)
  • PH neutral ( Used in WD and MW)
74
Q

On which end of the detergent removes contamination?

A
  • Hydrophobic end then it is flushed away as water binds to the hydrophilic end
75
Q

Describe the source of energy in MW , USB , WD

A
  • manual washing - scrubbing brush
  • USB - high frequency sound waves causing cavitation
  • WD - high pressure water jet ( 1-1.5 Bar)
76
Q

According to the sinner cycle , describe the USB bath?

A
  • energy is the largest part of the process
  • 20 mins of less - time
  • temperature 20-30
  • small sachet of chemical is added
77
Q

Temperature and time for thermal disinfection?

A

90-95 for 1 minute

78
Q

Sinner cycle for different stages

A
79
Q

What does the life cycle diagram represent?

A

The mandatory stages that must be carries out when processing instruments

80
Q

Why is a flowline chart important in the LFU?

A

It shows how you should manage the path of your instrumentation through the LDU to minimise cross-contamination

81
Q

Define guidance?

A
  • Series of documents called Scottish health technical memorandum
  • provide information on all testing requirements for decontamination instruments , roles and disgnation
82
Q

What is legislation in Decontamination?

A
  • Goverment publications such as Act and Directives that the decontamination process should be carries out according to these legislation
83
Q

What are standards in decontamination?

A

It is a series of highly technical document that state how equipment should be operated, produced, tested and verified

84
Q

According to SDCEP , what are the 4 resources required for using a WD?

A
  • Appropriate trained staff for WD operation
  • Adequate space and utilities
  • Compatible instruments and tray system
  • A sufficient quantity of instruments
85
Q

What is the guidance for sterilisation?

A

SHTM 01-01 Part C

86
Q

What is the guidance for cleaning and disinfection?

A

SHTM 01-01 Part D

87
Q

What is the guidance for decontamination in LDU?

A

SHTM 01-05 Part B

88
Q

3 points the SHTM guidance covers?

A
  • Role designations and description
  • Process definitions and descriptions
  • Links to other guidance
89
Q

Who caries out the daily tests of WD?

A

User

90
Q

Who caries out weekly tests of WD?

A

User or CP(D)

91
Q

What are 5 weekly tests for WD?

A
  • Safety checks
  • Daily tests
  • Water hardness test
  • Water conductivity test
  • Cleaning efficacy test by residual soil detection
92
Q

What are 5 quarterly tests carried out by CP(D) for WD?

A
  • weekly safety and functional checks
  • Daily and weekly tests
  • Cleaning efficacy test
  • Doors and door interlocks
  • Chemical dosage test
  • Thermometric test for disinfection
93
Q

Weekly test carried out by a CP(D) for sterlisers?

A
  • Weekly safety checks
  • Air leakage tests
  • Air detector function test
  • Automatic control test
  • Bowie dick steam penetration test
94
Q

Quarterly tests carried out by CP(D) for sterlisers?

A
  • Weekly safety checks
  • Air leakage test
  • ACT
  • Air detector function test
  • BW test
  • Verification of calibration
95
Q

What are two legislations for Decontamination?

A
  • Health and safety at work 1974
  • Medical device directive 2017 - quality management
96
Q

When would hand hygiene be carried out in the LDU?

A
  • When entering
  • between clean and dirty processes
  • When leaving
97
Q

What are the SOP’s?

A

Standard operating procedures which is the way activities is standardised within the LDU to make it reproducible and consistent

98
Q

What is the minimum contact rate in disinfection?

A

12 seconds

99
Q

Define sterilisation?

A

Process used to produce a product free from viable organisms

100
Q

What is included in the Automatic control test? for WD

A
  • Date
  • Operator
  • Cycle start time
  • Cycle number
  • Wash temp
  • Disinfection temp
  • Cycle duration
  • Detergent added
  • If the cycle is complete or not
101
Q

Other than ACT what other registers should you record?

A

Fault register

102
Q

When should you carry out an automatic control test?

A
  • Weekly basis for all equipment
103
Q

What colour is the clean transport box?

A

Blue

104
Q

Define a medical device?

A
  • Any instrumentation used for carrying out procedures on humans including any equipment used to process these
105
Q

Briefly describe guidance , legislations and standards?

A
  • Guidance - documents used to provide a structure that can be followed in practice
  • Legislation - publications by goverments that provide a legal framework for managing the facilities , equipment and process
  • Standards - documents that provide technical information about all aspect of decontamination process
106
Q

What does Part A of SHTM 01-01 cover?

A

The stages of decontamination with a description of each stage

107
Q

Other than SHTM name 3 other guidances?

A
  • SHPN - scottish health planning note
  • ISO - international organisation for standardisation
  • MDR - Medical device regulations
108
Q

Name 4 legislations in regards of decontamination?

A
  • Control of noise at work regulations 2005
  • Control of substances hazardous to health regulations 2002
  • Electricity at work regulations 1989
  • Personal protective equipment regulations 1999
109
Q

What legislation related NHS discuss the ethical considerations regarding the procedure of healthcare goods and the global health inequality?

A

Labour standards assurance system

110
Q

Why is record keeping important in decon?

A
  • To keep a record of all the process and faults
  • For traceability
  • To Identify any faults in the instruments
111
Q

Who is a compentent person?

A

A person designated by the AP(D) to carry out maintenance validation and periodic testing of the washer-disinfectors ,sterilizers and endoscope washer disinfectors

112
Q

What type of test is this graph from?

A

Quarterly test

113
Q

Why is it important to carry out periodic testing?

A
  • Identify that the readings from the machine are accurate
  • Identify any faults in the machine
  • Identify any deviation from the required set points
114
Q

What is the preferred method for cleaning according to SDCEP?

A

WD

115
Q

Who can carry weekly and daily tests?

A

User

116
Q

Who sign off validation reports and verify that all TESTS has been carried out to the required standard?

A

Authorised engineer (D)

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