Infection Control Flashcards
Ambient
- the immediate surroundings of something.
Antiseptic
- relating to or denoting substances that prevent the growth of disease-causing microorganisms
Autoclave
– steam sterilizer
Bactericidal
- a substance which kills bacteria
Delaminate
- to change the vital functions
Denaturation
– to change the vital functions forces and activities of an organ
Disinfectant
– agent that kills microorganism except spores
Germicide
- agent that destroys harmful microorganisms (germs)
Ionizing radiation
– method of sterilization using radiation as cobalt 60
Lumen
– space within a tube
Saturated steam
– steam that contains the maximum amount of water vapor
Bioburden
- the number of bacteria living on a surface that has not been sterilized.
Sporicidal
– agent capable of killing spore forming organisms
Terminal decontamination
– process of rendering all articles free of pathogens at the end of an operative procedure
Terminal Cleaning
done after the last OR case
. Wipe down of ceilings, floors including OR lights
. OR tables
. OR furniture
. Sub sterile room, scrub area, hallway
Ultrasonic cleaner
– cleaning machine used in the process that uses ultrasound to agitate a fluid container and its contents
Antisepsis
– the process of inhibiting the growth of microorganisms; used on animate objects
Per acetic acid
- organic compound can be used as a bleaching agent (Steris)
Plasma sterilization
–used for moisture-and heat sensitive devices, such as cameras, scopes and light cords(Sterrad)
Shelf life
- the length of time for which an item remains usable, fit for consumption, or saleable
Sterilants
– an agent used to destroy microorganisms in an inanimate object
Sterilizer
– equipment or chamber used to attain physical or chemical sterilization
Differences between;
Sterilization & Antisepsis
Sterilization. - The process destroying all microorganisms including spore bearing ones (used on inanimate objects)
Disinfection. - The process of destroying all microorganisms except spore bearing ones (used on inanimate objects)
Antisepsis. - The process of inhibiting the growth of microorganisms (used on animate objects)
Frequent methods of sterilization
a) Steam under pressure (Autoclave)
b) Ethylene oxide (EO)
c) Activated glutaraldehyde (Cidex)
d) Plasma (Sterrad)
e) Gravity displacement
f) Pre-vacuum
g) Per acetic acid (Steris)
h) Ionizing radiation
i) Ozone gas
j) Chlorine gas
k) Vapor phase hydrogen peroxide (VPHP)
Factors that affect the steam sterilization process
- Temperature
- Time
- Humidity
- Concentration of the sterilizing agent
- Penetrating ability of the sterilizing agent
Principles of steam sterilization
I. Microorganisms are destroyed through a process of denaturalization and coagulation within the cell
II. Steam is the preferred method because it is the least expensive, most efficient and safest for processing heat and moisture stable instruments.
III. Water is heated and converted to steam
IV. Water is submitted in the chamber to increasing pressure witch increases the temperature
V. In the gravity displacement sterilizer, the steam drives the air out of the bottom of the chamber. Steam permeates to all areas of the instrument and sterilizes it
Glutaraldehyde (CIDEX)
(High Level Disinfectant )
- Liquid Disinfectant / sterilants
- Kills microbes by attacking cell protein
- Used on instruments that can withstand complete immersion and heat sensitive instruments
- 20 min – disinfection/ 10 hrs – sterilization
- Items must be thoroughly washed/dried/rinsed
- Cold sterilizer
Sodium Hypochlorite (household bleach)
- Used for surfaces, floors and equipments
- Not used in instruments (highly corrosive)
- Harmful to the skin
Phenol (Carbolic Acid)
(Intermediate Level Disinfectant)
- Destroys bacteria through denaturation and coagulation of proteins
- Used as a general cleaning agent (floors, countertops, toilets)
- Economical
- Limited use on non critical items
- Extremely irritating to the skin and mucous membranes
Quaternary Ammonium Compounds
(Intermediate Level Disinfectant)
- Quats
- Benzalkonium chloride
- Used on general cleaning
- Bactericidal, fungicidal, pseudo monacidal but ineffective to TB
Alcohol
(Intermediate Level Disinfectant)
- 60% to 70% Isopropyl or ethyl alcohol
- Most useful for non critical surfaces
- Used for skin disinfection and skin prep
- Corrosive to stainless
- Highly flammable
Dirty Cases
. OR closed for 48hrs
. Floor should be cleaned with phenolic agent
. Equipments should be wiped with 70% alcohol
Cleaning
1st step in the decontamination process
. STSR is responsible for presoaking used instruments
. Initial arrangement of instruments
- Placement of heavy instruments at the bottom
- Locking instruments are kept open
- Curved instruments are placed with the curved in the same direction and from large to small (Kelly, Crile, Mosquito)
- Multiple parts are disassembled
. Instruments are placed on the case cart
Pre Soaking Solutions
- Sterile Water
. Keeps organic debris moist but ineffective in softening or removing dried debris - Enzyme
. Removes debris - Detergent
. Loosens dried debris
Manual Cleaning
- Physically remove debris
- Steps in manual cleaning
. Instruments are immersed in enzymatic cleaner(lukewarm)
. Friction will loosen organic material
. Back and forth motion should be used
. Instrument and brush should be submerged
. Instruments with lumen should be cleaned with a stylet
. Instruments are rinsed with distilled water and dried
Common chemical cleaners &
3 types of equipment for cleaning and decontamination
- Enzymatic
- Manual detergent
- Washer Decontaminator
. Items are considered clean and exposed to intermediate level of decontamination - Washer Sterilizer(found in decontamination room)
. Sterilization is incorporated - Ultrasonic Cleaner
.Not considered as a disinfecting machine but for cleaning instruments
. Uses cavitation
. the formation of an empty space within a solid object or body. (bubbles)
INSTRUMENT PREPARATION AND WRAPPING
. Association for the Advancement of Medical Instrumentation (AAMI)
- Instrument sets should not exceed 20 lbs.
. Instruments must be checked for function and integrity
. Packaging
- Wrapping or enclosure of reusable materials
- Packaging materials 3 performance standards:
.Maintain sterility
.Allow easy opening and removal of sterile items
.Allows sterilizing agent to penetrate and reach all surface areas of all items to be sterilized
Sterilization suitability
- Must allow air to be completely removed
- Must withstand conditions of sterilization
- Material must allow the escape of sterilizing agent
- Allow drying
- Must allow gas and moisture to escape (EO sterilization)
- Rigid containers are placed on bottom shelf
- Peel packs are placed on the edge
- Basins are on its side
If instruments are stiff, then lubrication with immersion in white milky solution is necessary (milking)
Instrument Lubricant contains an all-natural corrosion inhibitor and lubricant specially formulated to lubricate and protect surgical instruments, hinges, box locks and general equipment during autoclaving.
Steam Sterilization (AUTOCLAVE)
- Located in SPD
- Uses moist heat under pressure
- Increased pressure, increases temperature
- More effective
- Economical
- Safest
- not all instruments can be steamed
- Time - 15 to 30 mins
- Contact – steam must contact all surfaces
- Temperature (250 - 270F)
- Pressure (15-17psi for gravity sterilizers and 27-30 psi for pre vacuum)
- Moisture – acts as a catalyst
- Coagulates of cell proteins
- Air - Free from air: as it decreases the temperature and the penetration
Autoclave Cycle Buttons:
. Condition
. Exposure phase
. Exhaust
. Drying phase
Gravity Displacement Sterilizer
- Relies on gravity to displace air
- Uses steam
- Slower than pre vacuum sterilizer
- 250F / 30 min.
Pre vacuum Sterilizer
- Vacuum system removes air reducing total time
- Bowie Dick test (for air entrapment)
Flash sterilization (in sub sterile room)
- Sterilizing metal instruments with; wooden handles, plastic parts, rubber tubing, non porous and unwrapped instruments that have been dropped during the procedure
- Items are placed in an instrument tray
- Temp:
. 270F
. 3 to 10 mins
Monitoring of Sterilization process
- Mechanical
. Recorders
. Gauges - Chemical
. Autoclave tape change from white to black - Biological
. Only test that guarantees sterility
. Use on first load every day
. Contains Bacillus stearothermophilius; incubated 24 hours before reading @ 131-140F (50-55C)
Ethylene Oxide [EO] (in SPD)
. Gas sterilization used to sterilize heat or moisture sensitive instruments (does not melt items)
. Does not corrode, passes through woven materials
. Residual amount of distilled water should be left in instruments with lumen before sterilizing
. Effective against all microbes and spores
. Spores are hydrated with moisture
. Expensive; highly flammable
. Linked to cancer and reproductive problems
. Lengthy cycle process (16 hrs to 21 days)
. Greatest health exposure risk
Per acetic Acid
. STERIS Machine
. For endoscopes
. Expensive
. 30 mins.
. Found in the sub sterile room
Ionizing Radiation
- Commercially used
- Uses cobalt 60 (radioactive isotope)
- Death of microbes and spores by disrupting their DNA
Plasma sterilization (STERRAD)
- Safer than ETO
- Hydrogen peroxide plasma gas
- Used for heat sensitive materials
3 levels of disinfection:
. Decontamination
. Disinfection
. Sterilization
Decontamination
Physical removal of blood, body fluids, and gross contaminant debris on an object (Bioburden)
Disinfection
Destruction of pathogenic microorganism or their toxin or vectors by direct exposure to chemical or physical agents
Sterilization
Destruction of all microorganisms by:
. Steam
. Chemical agents
. Electron bombardment
. Ultraviolet radiation
Critical Items
Instruments used inside the body
(Surgical instrument; implants/prosthesis; needles)
Semi critical items
Instruments used for mucous membranes (Respiratory, GI, GU)
(Scopes)
Noncritical items
Used for items that contact the intact skin
(OR furniture, BP cuff)
High level disinfection (Level 1)
Kills most microorganism
Used for critical items: used inside the body (Surgical instrument; implants/prosthesis; needles)
Intermediate disinfection (Level 2)
Kills most microorganisms, bacteria, viruses and fungi, MTB (mycobacterium tuberculosis), HBV (Hepatitis b) not spores and prions
Used for Semi critical items: mucous membranes (Respiratory, GI, GU) (Scopes)
Low level Disinfection (Level 3)
Most bacteria, some fungi and viruses, not effective against MTB
Used for Noncritical items: items that contact the intact skin (OR furniture, BP cuff)
Intraoperative decontamination roles/duties:
STSR - should have basin with sterile water available
Circulator
. cleans spills,
. change suction canisters,
. cleans specimen container
. Cleans/sterilizes contaminated instruments
Decontamination between procedures
OR be cleaned between procedures “turnover”
. Involves wiping the OR bed with disinfecting solution
. Cleaning areas with obvious blood splashes
. STSR responsible for disposing sharps
. Used instruments are cleaned, placed in case cart
Instruments requiring special care
. Instruments with lumens
. Power instruments
. Endoscopes
Sterility
. Absence of all microbes including spores
. An item is either sterile or not
Woven Textiles (Packing Material)
. Cotton or mixed
. Economical - Reusable
. Easily penetrated by sterilants
. May absorb moisture
. Least effective in providing bacterial barrier
Woven textiles with barrier properties (packing material)
. Cotton or mixed
. Chemically treated to make them moisture resistant
Woven Material
Advantages:
. Economical
. Reusable
. Easily penetrated by sterilants
Disadvantages:
. Absorbs moisture
. Least effective at providing bacterial barrier
. Not recommended for ETO sterilization
. Has to be laundered after use
Types of Packaging Materials
. Muslin
- Made of cotton
- Double ply is preferred
- 140 TC
. Thread count
- Number of threads per square inch
- The higher the tc, the more resistant to contamination
Nonwoven materials:
. Disposables
. Plastic fibers
. Excellent barrier properties
. Impervious to moisture
. Costly – single use
. Not as memory free
Paper
. Single use
. Does not have flexibility
. Easily penetrated by steam
. Easily torn or punctured
Advantages:
. Plentiful supply
. Cheap
. Porous
Disadvantages:
. Brittle in dry conditions
. Easily torn, punctured or ruptured
. Not uniform in thickness
Pouch packaging: Peel packs
. Paper plastic
-Steam & ETO
.Tyvek plastic
-ETO & Sterrad
. Bottom end of peel packs are open for placement if instruments – sealed with heat or tape (do not use staples)
. If labeling a peel pack, use a felt tip marker on the plastic side
General Principles of Packaging
. Fabrics should be stored 62-72F and 35-70% humidity
. Muslin wraps not more than 12x12inches and not more than 12lbs
. Double wrapping is essential for proper barrier
. If the wrapper is going to be used in establishing a sterile field it should be large enough
. The instruments should be densely packed
Inspection
. Concave Instruments should be placed on its side. Basins are separated by a pervious material (towel)
. Instruments with different metal components should be separated by a towel
. Instruments with lumens should be dried completely
Labeling
. Package content
. Shelf life
. Date of sterilization
. ID of sterilizer
. Cycle number
. Initials
. Department
