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
2
Q
What is a critical device?
A
- A device that penetrated soft tissues
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
4
Q
What is a non-critical device?
A
A device that only contacts with skin and intact mucous membranes
5
Q
Example of a critical device?
A
Surgical and biopsy instruments , forceps
6
Q
Example of a semi-critical device?
A
- Dental mirror
- Anesthetic syringe
7
Q
Example of a non critical device?
A
- Chair light handle
8
Q
How do you process forceps (critical)
A
Cleaned then sterilised
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)
10
Q
How do you process a chair light handle?
A
Cleaned followed by low level disinfection
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
12
Q
What is the first step of the instrument processing and what happens in it?
A
- Cleaning
- Removes biological matter from the surface
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
14
Q
What is the main method of cleaning?
A
Washer disinfector
15
Q
What is the secondary method of cleaning?
A
Ultrasonic bath
16
Q
What is the next step after visible contamination has been removed and instrument inspected?
A
- Sterilisation through a steam steriliser
17
Q
Define the operator ?
A
An operator is a person designated by management to operate a washer disinfector
18
Q
What are 3 duties of an operator?
A
- Recording WD readings
- Refill WD detergent
- Simple housekeeping
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
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
21
Q
Describe how should the chemical detergent be for manual washing?
A
- enzymatic or PH neutral
22
Q
What are the two types of manual cleaning?
A
- Immersion
- Non-immersion
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
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
25
Why is it important to scrub the instrument below the surface of the water in immersion manual washing?
* The instrument must be contact with the water and detergent
* Scrubbing above the water will create aerosols
* To minimise splashing
26
When should manual cleaning be carries out replacing the WD and USB ?
* recommended by the manufacturer
* no other alternative
* WD or USB did not remove the contamination
27
Describe how the ultrasonic bath works?
* 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
28
What is the operating temperature for an ultrasonic bath?
20-35 degrees
29
What type of water is used in the ultrasonic bath?
Tap water
30
What should you do before using the USB?
A degas cycle must be ran , this is by running a standard production cycle with the chamber empty (except from the load carrier)
31
Why do we need to degas the USB?
* To remove any air bubbles which will effect the efficacy of the equipment and prevent proper cleaning of instrumentation
32
After manual cleaning and USB and rinsing the instrument in the rinsing sink, what is the next step?
Washer disinfector to be thermally disinfected
33
What is the first Stage in the decontamination cycle?
The use of the washer disinfector
34
What is the advantage of the manually washing over the washer disinfector?
Scrubbing produce more force than the washer disinfector could
35
5 disadvantages of ultrasonic bath and manual cleaning?
* Risk of aerosol production
* Risk of contaminating the surrounding environment
* Risk of human error
* Risk of sharps injuries
* USB may damage instruments
36
Where are instrument positioned in the AWD?
in the load carrier
37
2 advantages of USB
* removes hard to reach contamination
* Automated process
38
What are the 5 stages of the washer disinfector and what happens in each stage?
* 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
39
Why is it important to remove proteins or prions during the prewash and wash and rinse stages of the washer disinfector?
* High temperature make them adhere to instrument surface
* They can survive higher temperatures for longer periods of time
40
Flush/ prewash temperature?
Less than 35
41
Main wash temperature?
Depends on chemical used
42
Rinsing temperature for WD?
Less than 65
43
Temperature and time for thermal disinfection?
90-95 degrees for minimum of 1 minute
44
3 advantages of washer disinfector?
* 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
45
When would you the daily checks of the WD?
Before instruments can be processed through it
46
What are the 6 daily checks of the washer disinfector?
* 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
47
3 loading requirements for instruments in the WD?
* Hinged instruments must be opened
* Instruments should be disassembled
* Equipment should not overlap
48
When should be the instruments inspected?
* After WD process to look for any damage or contamination
* using illuminated magnifier
49
If you inspect an instrument after WD and there is still contamination, what would you do?
* Ultrasonic bath or manually clean the instrument
* Then process again in the washer disinfector
50
5 reasons we use steam for sterilisation?
* 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
51
What 4 types of purified water is used in the sterilisation process?
* Reverse osmosis
* De-ionised
* Distilled
* Sterile
52
What are the 3 types of sterilisers?
* Type N - non vacuum
* Type B - Vacuum capable
* Type S - specialised
53
Explain Type N steriliser?
* 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
What is the disadvantage of Type N?
Air is still present in the chamber meaning anything in contact with air will not be sterilised at the same temperature as steam
55
What is the sterilising temperature , pressure and holding time?
* 134-137 degrees
* 2.05 - 2.35 bar
* 3 minutes holding time
56
Describe how type B steriliser work?
* 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
What type of instruments can be processed into type B steriliser?
* Wrapped , channeled and lumened instruments
* Can also process porous items such as cotton swabs
58
Example of an instrument that can be used in type S steriliser ?
* handpieces or instruments according to manufacturer instructions
59
An instrument has been sterilised using Type N steriliser , is it sterile at the point of use?
* No , instruments are sterile following the processing but need to be wrapped immediately after that which carries a risk of recontamination
60
Describe how should the storage area be for sterilised instruments?
* Dry
* Clean
* Free from aerosol contamination
* Temperature controlled
* Away from direct sunlight
61
What are the daily and weekly checks for sterilisers? (5)
* 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
What daily tests are specific to type B steriliser?
* Steam penetration test using Bowie Dick pack or Helix
63
What weekly tests are specific to type B steriliser?
* Air leakage test
* Air detector function test
64
What is the current guidance for sterilisation?
SHTM 01-01 Part D
65
How should be the transport container ? (4)
* Rigid sided
* Tight fitting lid
* Leak proof
* Colour coded or clearly marked
66
When would an insurance test be carried out for sterilisers ?
Every year
67
How can you ensure that biological matter will not dry and stick to the surface of instruments after use?
* Having the shortest time between using the instrument and processing it
* Instruments sprayed in packets for transport
68
What does the sinner cycle consist of ? and what does it refer to ?
* Energy
* Chemicals
* Time
* Temperature
* the 4 elements required for successful cleaning process
69
Two stages where tap water can be used ?
* Cleaning
* Disinfection
70
Why only purified water can be used for sterilisers ?
Because normal water have minerals , silicates organics and metals and had high conductivity
71
Compare the conductivity of normal water to purified water?
Normal - 56.8 micro-siemens
Purified - 4.3 micro-siemens
72
Describe how water is processed to produce each of the purified water types?
* 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
What are 3 types of detergents?
* high and low alkaline
* Enzymatic detergent that breaks down proteins (used in USB and MW)
* PH neutral ( Used in WD and MW)
74
On which end of the detergent removes contamination?
* Hydrophobic end then it is flushed away as water binds to the hydrophilic end
75
Describe the source of energy in MW , USB , WD
* manual washing - scrubbing brush
* USB - high frequency sound waves causing cavitation
* WD - high pressure water jet ( 1-1.5 Bar)
76
According to the sinner cycle , describe the USB bath?
* energy is the largest part of the process
* 20 mins of less - time
* temperature 20-30
* small sachet of chemical is added
77
Temperature and time for thermal disinfection?
90-95 for 1 minute
78
Sinner cycle for different stages
79
What does the life cycle diagram represent?
The mandatory stages that must be carries out when processing instruments
80
Why is a flowline chart important in the LFU?
It shows how you should manage the path of your instrumentation through the LDU to minimise cross-contamination
81
Define guidance?
* Series of documents called *Scottish health technical memorandum*
* provide information on all testing requirements for decontamination instruments , roles and disgnation
82
What is legislation in Decontamination?
* Goverment publications such as Act and Directives that the decontamination process should be carries out according to these legislation
83
What are standards in decontamination?
It is a series of highly technical document that state how equipment should be operated, produced, tested and verified
84
According to SDCEP , what are the 4 resources required for using a WD?
* Appropriate trained staff for WD operation
* Adequate space and utilities
* Compatible instruments and tray system
* A sufficient quantity of instruments
85
What is the guidance for sterilisation?
SHTM 01-01 Part C
86
What is the guidance for cleaning and disinfection?
SHTM 01-01 Part D
87
What is the guidance for decontamination in LDU?
SHTM 01-05 Part B
88
3 points the SHTM guidance covers?
* Role designations and description
* Process definitions and descriptions
* Links to other guidance
89
Who caries out the daily tests of WD?
User
90
Who caries out weekly tests of WD?
User or CP(D)
91
What are 5 weekly tests for WD?
* Safety checks
* Daily tests
* Water hardness test
* Water conductivity test
* Cleaning efficacy test by residual soil detection
92
What are 5 quarterly tests carried out by CP(D) for WD?
* weekly safety and functional checks
* Daily and weekly tests
* Cleaning efficacy test
* Doors and door interlocks
* Chemical dosage test
* Thermometric test for disinfection
93
Weekly test carried out by a CP(D) for sterlisers?
* Weekly safety checks
* Air leakage tests
* Air detector function test
* Automatic control test
* Bowie dick steam penetration test
94
Quarterly tests carried out by CP(D) for sterlisers?
* Weekly safety checks
* Air leakage test
* ACT
* Air detector function test
* BW test
* Verification of calibration
95
What are two legislations for Decontamination?
* Health and safety at work 1974
* Medical device directive 2017 - quality management
96
When would hand hygiene be carried out in the LDU?
* When entering
* between clean and dirty processes
* When leaving
97
What are the SOP's?
Standard operating procedures which is the way activities is standardised within the LDU to make it reproducible and consistent
98
What is the minimum contact rate in disinfection?
12 seconds
99
Define sterilisation?
Process used to produce a product free from viable organisms
100
What is included in the Automatic control test? for WD
* Date
* Operator
* Cycle start time
* Cycle number
* Wash temp
* Disinfection temp
* Cycle duration
* Detergent added
* If the cycle is complete or not
101
Other than ACT what other registers should you record?
Fault register
102
When should you carry out an automatic control test?
* Weekly basis for all equipment
103
What colour is the clean transport box?
Blue
104
Define a medical device?
* Any instrumentation used for carrying out procedures on humans including any equipment used to process these
105
Briefly describe guidance , legislations and standards?
* 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
What does Part A of SHTM 01-01 cover?
The stages of decontamination with a description of each stage
107
Other than SHTM name 3 other guidances?
* SHPN - scottish health planning note
* ISO - international organisation for standardisation
* MDR - Medical device regulations
108
Name 4 legislations in regards of decontamination?
* 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
What legislation related NHS discuss the ethical considerations regarding the procedure of healthcare goods and the global health inequality?
Labour standards assurance system
110
Why is record keeping important in decon?
* To keep a record of all the process and faults
* For traceability
* To Identify any faults in the instruments
111
Who is a compentent person?
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
What type of test is this graph from?
Quarterly test
113
Why is it important to carry out periodic testing?
* Identify that the readings from the machine are accurate
* Identify any faults in the machine
* Identify any deviation from the required set points
114
What is the preferred method for cleaning according to SDCEP?
WD
115
Who can carry weekly and daily tests?
User
116
Who sign off validation reports and verify that all TESTS has been carried out to the required standard?
Authorised engineer (D)
