Decontamination, Disinfection, And Sterilization

Question 1

What is decontamination?

Answer 1

Removal of gross debris (bioburden)
Any physical or chemical process to reduce the number of microorganisms on any inanimate object so that it is safe for handling

Question 2

What is the importance of decontamination?

Answer 2

Minimize staff exposure
Preserve longevity of instruments
Allow all surfaces to be sterilized
Prevents cross contamination to other pts
Remove pyrogens
Allows direct contact of sterilizing agent

Question 3

What is disinfection?

Answer 3

Process in which items are freed of contaminating agents and rendered safe for human handling

(Not sterilization, cleaning process that it goes through before the staff can handle and then wrap up to be sterilized)

Question 4

Methods of instrument cleaning and decontamination

Answer 4

Pre rinsing in OR
Manual cleaning in steril dept
Washer-sterilizer/washer-decontaminator
Ultrasonic
Lubrication (milking)

Question 5

Explain how the ultrasonic cleaning works

Answer 5

Use high freq sound waves that can clean using cavitation
Also lubricates instruments
Can be used for finer instruments

Question 6

What is cavitation?

Answer 6

Creation of vacuum tears “bubbles” in the fluid which immediately and violently implode to produce millions of microscopic jets of liquid which gently scrubs items submerged in tank.

Question 7

What is the typical lifespan of an instrument?

Answer 7

10 years

Question 8

What is Spaulding’s classification of pt care items?

Answer 8

Determines what processing level is required based on how/where item is used.

Question 9

What are the three levels of Spaulding’s classification?

Answer 9

Critical items
Semi critical items
Non critical items

Question 10

What are critical items?

Answer 10

Items that enter sterile tissue or vascular system.
Surgical implants or needles.
Require high level disinfection

Question 11

What are semi critical items?

Answer 11

In contact with non-intact skin, mucous membranes, or dirty areas (mouth, nose, rectum).
Breathing circuits, fibre optic endoscopes
Intermediate disinfectant

Question 12

What are non critical items?

Answer 12

Items that come in contact with intact skin.
Furniture, equipment, floors, BP cuff.
Low level disinfectant

Question 13

Explain the high level of disinfection

Answer 13

Kills all viruses, bacteria, and fungi.
May kill spores if contact time/conditions are met.
Not effective against CJD

Question 14

Explain intermediate level of disinfection

Answer 14

Kills most bacteria, viruses and fungi

Ineffective on spores

Question 15

Explain low level of disinfection

Answer 15

Kills most vegetative bacteria, fungi and least resistant viruses

Question 16

Methods of physical disinfection

Answer 16

Boiling water - may not kill spores
Pasteurization - hot water decontam/disinfection with chlorine agents.
Ultravioloet radiation - denature DNA and proteins

Question 17

Chemical methods of disinfection

Answer 17

Alcohol, chlorine compounds, formaldehyde, cidex, iodophors, phenolic compounds, hydrogen peroxide.

Question 18

What is cidex?

Answer 18

2% Gluteraldehyde.

Chemical immersion, must be activated, color change, needs testing, 20-30 min soak, requires rinsing and PPE

Question 19

What are the advantages of single use items?

Answer 19

Sterility guaranteed if package intact
More aesthetically acceptable to pts
Prevent cross contamination
More comfort to pts
Eliminates expensive mechanical cleaning

Question 20

What are the disadvantages of single use items?

Answer 20

Costly if accidentally opened or contaminated.
No deviation from custom packs
A defect in one could be in all
May open high number of packages
Inadequate inventory might not be kept
FIFO first in first out
Environment/landfills

Question 21

What is sterilization?

Answer 21

Process by which all microorganisms are killed, including spores.

Question 22

What is the most resistant living organism?

Answer 22

Bacterial spores.

Question 23

What are the four types of monitors used during sterilization?

Answer 23

Administrative - work practices monitored (reciepts), written policies and procedures are followed.

Mechanical indicators - recording charts and graphs, gauges, thermometers, timers, daily function tests.

Chemical indicators - external tape and internal strips

Biological indicators - to ensure functioning properly and microorganism in tiny container that was processed was killed which means entire load is sterilized.

Question 24

What would a positive reaction from a biological indicator look like?

Answer 24

Cloudy growth
Colony forming units
Color change
Fluorescence

Question 25

What is important to know about instruments going through the cleaning/ sterilizing process?

Answer 25

Clamps need to be ope n, scissors open, instruments that can come apart should, lumen instruments should be horizontal, separate unlike metals, cupped surfaces face down, open hinges and box locks, on absorbent towel, ring handles on stringers, sharp and delicate instruments should not touch other instruments.

Question 26

What is important about the instrument packaging for sterilization?

Answer 26

``` Permits penetration of sterilizing agent Can withstand physical conditions of agent Maintain integrity Impermeable to microorganisms Covers items completely Tear and puncture resistant Allows identification of contents Dry fast Free of toxic ingredients Lint free or low linting Protects content from physical damage Economical ```

Question 27

What are some materials used for wrapping surgical instruments?

Answer 27

``` Woven fabrics Non woven fabrics Peel packs or pouches Wrapped trays Sealants and labelling Wrapped trays Rigid closed containers ```

Question 28

Explain woven fabrics re sterilization

Answer 28

``` Not moisture resistant Need to use double thickness esp for heavy pans Sewn together on edges only Withstand laundry 50-70 times Rehydrate after sterilization Stored at rm temp Inspect for holes before use CAn use patches to seal holes if necessary ```

Question 29

Explain non woven fabrics

Answer 29

``` Cellulose, rayon, and nylon Flexible Available in different weights Excellent barrier against microorganisms and moisture Disposable Lint free ```

Question 30

When are peel packs or pouches used for sterilization?

Answer 30

For odd shaped or single instruements

Question 31

Explain wrapped trays

Answer 31

Allow steam penetration Prevent trapped air in tray Cannot be solid Absorbent towel on bottom of tray prevents snagging of instruments or perforations Double wrapped in woven or non woven material Allowed to cool and dry before use

Question 32

Explain rigid closed containers

Answer 32

Metal or plastic Stainless steel mesh or perforated basket insert Lid affixed with metal snap locks Load identifying labels attached before sterilization Single use air filters in top and bottom Specialized sets are provided by manufacturer

Question 33

What are the methods of sterilization?

Answer 33

Thermal Chemical Radiation

Question 34

What type of sterilent is used in an autoclave?

Answer 34

Steam

Question 35

What are the types of thermal sterilization?

Answer 35

Steam under pressure | Dry heat

Question 36

Minimum time temps for steam sterilization?

Answer 36

4 mins at 270 degrees Fahrenheit | 18 mins at 250 degrees Fahrenheit

Question 37

Advantages of thermal sterilization?

Answer 37

``` Easiest and safest Fastest Least expensive and most easily supplied Automatic controls and recording devices No harmful residue on instruments ```

Question 38

Disadvantages of thermal sterilization?

Answer 38

Prepare instruments Need to be free from grease and oil Instruments that are heat sensitive cannot go through Need direct contact on all areas Timing cycles need to be adjusted based on material of items May cause stains

Question 39

Types of steam sterilizes?

Answer 39

Gravity displacement Prevacuum Flash/high speed pressure

Question 40

What is a flash sterilizer?

Answer 40

Can be gravity or pre vacuum based cycles. | Higher heat for shorter period of time.

Question 41

When would dry heat be used?

Answer 41

For oils, talc, and petroleum products.

Question 42

What types of dry heat are available?

Answer 42

Mechanical convection oven | Gravity convection oven

Question 43

Advantages of dry heat

Answer 43

Penetrates substances that other methods can't | Protects cutting edges of sharp instruments

Question 44

Disadvantages of dry heat

Answer 44

Long exposure period Time and temp will vary depending on substance Overexposure may ruin some items

Question 45

What are the methods of chemical sterilization?

Answer 45

Ethylene oxide gas (ETO) Hydrogen peroxide (sterrad) Per acetic acid (steris)

Question 46

Chemical sterilization- explain ethylene oxide gas

Answer 46

Very harmful Colourless gas Carcinogenic Safe for instruments

Question 47

What are advantages for ETO?

Answer 47

Can be used in items that cannot tolerate heat Completely penetrates all porous areas Automatic controls No film on instruments Non corrosive and will not damage instruments

Question 48

Chemical sterilization - explain sterrad or hydrogen peroxide

Answer 48

``` Gas Low temp Used for het and moisture sensitive items. Good for plastics Not as fast as steam Non corrosive ```

Question 49

Chemical sterilization - peracitic acid or steris

Answer 49

``` Liquid chemical (Machine by theatre 12) Low temp Alternative for instruments with lumens and fibre optics Items must be used immediately within 4 hours Environmentally friendly 30 minutes Non corrosive Not For moisture resistant ```

Question 50

What is radiation sterilization?

Answer 50

``` Uses gamma radiation Low temp Long time, expose for 10-20 hours Penetrates most material Used for heat and moisture sensitive No residual radiation generated. Custom packs are done this way ```