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REVISION BDS > decontamination 87 > Flashcards

decontamination 87 Flashcards

1
Q

life cycle of a re-usable surgical instrument

A

acquisition - purchase, loan

cleaning

disinfection

inspection –> disposal - scarp/return to lender

packaging

sterilisation

transport

storage

use

transport

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2
Q

at all stages of life cycle of re-usable surgical instrument consider

A

location

facilities

equipment

management

policies/procedure

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3
Q

facilities consideration in life cycle of surgical instrument

A

segregation of clean from dirty

linear flow

continuous production line in a single room

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4
Q

location consideration in life cycle of surgical instrument

A

is it in the correct location to service the surgeries

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5
Q

equipment consideration in life cycle of surgical instrument

A

does it have the correct equipment to make the instrument safe for the patent

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6
Q

management consideration in life cycle of surgical instrument

A

is the proper managament structure in place with quality managament system fit for purpose

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7
Q

policies and procedures consideration in life cycle of surgical instrument

A

are we aware of current recommendations and is the staff trained to appropriate levels

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8
Q

policy

A

is an overall statement of intent or is a set of rules or requirements to be followed

to achieve a given process/outcome

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9
Q

procedure

A

guidelines of major methods used to meet the policies as defined by teh company or practice

usually defined by WHO or at department level

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10
Q

objective

A

landmark event in pursuit of overall intent usually subject to regular review and amendment

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11
Q

work instruction

A

specific steps needed to carry out the procedure

or basically instructions on how to do it

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12
Q

cleaning

A

use recommended detergents

adhere to manufacturers instructions for dilution rate and temperature

nerve immerse handpieces etc - use non-linting towels and not wire brushes as this creates aerosol spray

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13
Q

disinfection

A

destruction of most pathological organism by PHYSICAL rather than CHEMICAL means

less lethal than sterilisation

still leaves bacterial spores

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14
Q

possible disinfection temps and timings

A

65-70o for 10mins

73-78o for 3mins

80-85o for 1min

90-95o for 12secs (most common in healthcare)

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15
Q

things to remember for manual washing

A
  • PPE - full face visor, gloves, marigold type gloves
  • follow work instructions
  • immersion method (most instruments)
  • non immersion method (lumened or cannulated such as handpieces)
  • detergent - should be neutral enzymatic (we use: endozyme AW plus) 30ml to 8l water
  • water temp 30-35oC
  • no metal brushes (plastic only)
  • rinse/immerse instruments in purified water (not handpieces) after cleaning and then dry
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16
Q

inspection methods

A

visual check

lit magnifier

protein residue

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17
Q

packing

A

vacuum pack the items for sterilisation

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18
Q

Type N sterilisation

A

normal

  • for non wrapped solid products
  • air passively displaced by gravity due to stem production
  • hollow or lumened items should not be used here
  • should be used immediately after sterilisation and not packaged for storage

‘sterilised’ but not sterile!

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19
Q

Type B sterilisation

A

better

  • cycle is intended for the sterilisation of wrapped solid, hollow and porous products
  • have _vacuum pump to actively remove air from the chamber and loa_d
    • a.k.a benchtop vacuum sterilisers
  • once packaged the instruments can be classed as ‘Sterile’
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20
Q

Heath and Saftey at Work Act 1974

A
  • up to date standard operating procedures for sharp injuries
  • all staff shuld know how to prevent and control sharp injuries
  • must ensure all members of staff are familiar with the safety policy
  • legal duty to protect the health of your employees and the general public
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21
Q

PPE at work at 1992

A

all equipment which is intended to be work or held by a person at work and which protects them against one or more risks to their health and safety

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22
Q

Consumer protection act

A

must put appropriate safety info or warnings on products

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23
Q

Medical Device Directive

A

standardised european law to govern how medical devices are used to keep things consistent

24
Q

general practice single room local decontamination unit

A

Separate Hand washing facility with PPE storage

  • Set down area for dirty instruments

Washing sink with detergent for cleaning instruments

  • Set down area for washed instruments

U/S cleaner
Rinsing sink

  • set down area for rinsed instruments

Automated washer/disinfector (that includes drying cycle)
Setting down area with task lighting and magnifier for inspection of all instruments
Dental Handpiece lubricator
Area for wrapping instruments (only if you use a vacuum steriliser)
Steam steriliser

  • An area for setting down and wrapping instruments sterilised in a non-vacuum sterliser
25
Q

4 elements of sinner circle

A

time

temperature

mechanical

chemical

26
Q

RED ZONE in LDU includes

A

transport

acquiring medical device

cleaning

disinfection

27
Q

AMBER ZONE in LDU includes

A

inspection

packaging

28
Q

GREEN ZONE in LDU includes

A

sterilisation

transport

storage

29
Q

acquiring medical device in LDU

A

instruments arrive in box from clinic and are placed in recieving area of the LDU

6 steps of hand hygiene performed and PPE donned

30
Q

cleaning stage in LDU

A
  1. U/S bath turned on and cleaning agent and water added (see manufacturers instructions) may need enzymatic cleaner and deionised water or by reverseosmosis
  2. Open any hinged instruments
  3. Dispose any residual single use items
  4. U/S trays then removed and finished items are placed in a new separate tray to betransported to the washer disinfector area

*NEVER PUT HANDPIECES IN U/S BECAUSE IT WILL DAMAGE TURBINE

31
Q

disinfection stage in LDU

A

Handpieces are loaded onto the washer disinfector recepticles

Load instrument casettes into the washer disinfector too but not on top of each other

Single instruments i.e couplands should be placed in a mesh basket

Stages of disinfection (w/ reverse osmosis water)

  • Flushing - removes gross contamination - 45*C
  • Washing - removes any remaining soil
  • Rinsing - removes any additives from cleaning process
  • Disinfection - temp must reach 90*C for 1 minute
  • Drying - purges load and chamber with heated air to remove excess moisture

PPE removed, and disposed

new PPE donned Hand hygiene carried out and worktop cleaned with wipes

PPE then disposed again

U/S receipt printed and recorded along with one from the Washer Disinfector too and record

  • Date
  • Time
  • Cycle number
  • Temperature
  • Holding time

Don new PPE and carry out hand hygiene

Protein test (1x per week)

  • Vigorously swab an instrument and test in protein reagent for 10 secs, if turns brown to blue then its a failed test

Handpieces lubricated

32
Q

inspection stage in LDU

A

PPE re-donned

check under light and magnifier that the lumened instruments are clear

check for rusting, debris or hinge fracture

33
Q

Packaging stage in LDU

A

placing handle of instrument into packaging pouch first

tip protectors for sharp instruments

seal bag with envelope style sticky backing

cassettes are wrapped in sterilisation wrap sheet paper and are taped with autoclave tape (this paper changes colour when sterilisation occurs)

34
Q

sterilisation in LDU

A

Type B vacuum steam steriliser used (Autoclave)

Tests for autoclave (daily and weekly)

  • RO water pumped in
  • warm up cycle done in the morning before tests carried out
  • vacuum test done on first working day of the week
  • Bowie and Dick test done daily - 134oC for 3.5 mins (for uncondensed gases) - light colour to even dark colour

Validation tests - record and report all failures

Sterilising - 134oC for 3-4 mins

Remove kits while wearing heat resistant gloves

Inspect pouches for wetness, colour indicators have changed and that theres no tears in the pouches

35
Q

transport stage in LDU

A

sterilised instruments moved to storage area

36
Q

storage stage in LDU

A

sterile items should be separate from unsterilse wrapped items

37
Q

use of sterilised instruments

A

open when pt arrives using peelback technique

38
Q

5 reasons for cleaning

A
  1. remove oragnic matter
  2. remove restorative material
  3. restore functionality
  4. aid disinfection and sterilisation
  5. medico-legal requirement
39
Q

manager role

A

responsible for LDU

40
Q

user role

A

day-to-day running of LDU, maintains records, ensures tests and maintenance carried out

41
Q

operator role

A

uses equipment, simple housekeeping and maintenance

42
Q

authorising engineer (decon)

A

free NHS Scotland service, advises on validation, maintenance and testing

43
Q

test person

A

conduct and report on validation and periodic tests, must be qualified with >2yrs experience

44
Q

maintenance person role

A

routine and requested maintenance, qualified

45
Q

competent person role

A

responsible for perssure vessels

46
Q

daily checks for ultrasonic cleaner

A

check paper levels

change water

clean and maintain as necessary

degass solution as if there is residual oxygen then it inhibits cavitation and causes less intense bubbles

change water every 4hrs or if visible soiled

47
Q

weekly checks for ultrasonic cleaner

A

daily tests as above

protein tests (brown to blue if it fails?)

48
Q

quaterly checks for ultrasonic cleaner

A

foil ablation test

49
Q

annual checks for ultrasonic cleaner

A

according to SHTM30

visual display of cycle complete

50
Q

daily checks for automatic washer disinfector

A

wipe door seal

check spray arms

clean filter

automatic control test (ACT) with print out

51
Q

weekly checks for automatic washer disinfector

A

act

cleaning efficacy test (protein test strip)

staple result into log book

protein test

52
Q

quarterly checks for automatic washer disinfector

A

according to SHTM30

visual display of cycle complete

values within normal limits

door cannot be opened till cycle complete

no mechanical or other anomaly

recorded into log book

53
Q

daily checks for sterilisers

A

wipe clean

change water

automatic control test (ACT)

steam penetration test - bowie dick or helix

54
Q

weekly checks for sterilisers

A

ACT

steam penetration test

vacuum leak test

air detector function test

55
Q

vacuum leak test

A

is programmed into steriliser to be able to do this

pulls a deep vacuum and holds it

any loss in pressure indicates a leak so fails

56
Q

air detector function test

A

programmed into steriliser

vacuume is pulled and at the same time air is let into the chamber

thermocouple should detect this due to change in temperature

REVISION BDS (43 decks)

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