Infection Prevention and Control of Environment, Instrumentation, and Supplies Flashcards
define microbiology
the science of microscopic organisms and diseases they cause
what do cleaning practices follow?
microbiology
What are 2 key strategies to reduce the patient’s risk for infection?
- providing a clean environment
- processing surgical instrumentation properly
Who is ultimately responsible for providing a clean environment in which the operative or invasive procedure will take place?
the RN
What are traffic zones?
they support the movement of patients, personnel, equipment, and supplies by designating the apparel appropriate for each zone in the periop environment
which 2 areas should be clearly marked with signage?
semi-restricted and restricted areas
What are the 3 zones in the perioperative environment?
- unrestricted
- semi-restricted
- restricted
In the unrestricted area, there are no restraints on what?
attire
what are permitted in the unrestricted area?
street clothes
What may be included in unrestricted areas?
- locker rooms
- lounge areas
- preoperative and postoperative areas with access to procedural rooms
What is the only thing that may be restricted in unrestricted areas?
public access
What does the semi-restricted area contain?
the peripheral support areas, including storage for equipment and supplies
What are also within the semi-restricted zone?
hallways with access to the restricted areas and to the preoperative and postoperative areas
individuals in the semi-restricted area should wear what?
hospital-issued surgical attire and cover all head and facial hair
the semi-restricted area is restricted to what?
authorized personnel
what is included in the restricted area?
the operating rooms and other rooms where invasive procedures are performed
the restricted area should only be accessible from where?
semi-restricted area
what is required in the restricted area?
specific attire, including a surgical face mask
who is allowed in the restricted area?
only authorized personnel are allowed in this area to support patient care
environmental controls related to what?
maintaining established parameters for humidity, temperature, ventilation, and appropriate cleaning practices
What are monitored within the perioperative department suite to provide an optimal environment for conducting operative and invasive procedures?
suite, humidity, temperature, ventilation, and air exchanges
OR doors should remain closed to do what?
to maintain acceptable HVAC ranges
What kind of air pressure do decontamination and cleaning areas require?
negative air pressure to prevent disbursement of microorganisms into the surrounding environment
Why is environmental cleaning performed?
to decrease the incidence of SSIs by reducing the number of pathogens that can be transferred from inanimate objects to the patient
the surgical suite can be cleaned by who?
personnel with varied experience and training
unlicensed assistive personnel who clean perioperative patient care areas need the same training on what?
the same training on personal protective equipment, bloodborne pathogens, and standard and transmission-based precautions as other surgical team members
HVAC parameters for the OR
1. total air exchanges
2. total outdoor air exchanges
3. temperature
4. relative humidity
5. pressure
- 20
- 4
- 68-75 degrees(20-24 degrees)
- 20-60%
- positive
HVAC parameters for the GI suite
1. total air exchanges
2. total outdoor air exchanges
3. temperature
4. relative humidity
5. pressure
- 6
- 2
- 68-75 degrees (20-24 degrees)
- 20-60%
- no recommendation
HVAC parameters for the procedure room
1. total air exchanges
2. total outdoor air exchanges
3. temperature
4. relative humidity
5. pressure
- 15
- 3
- 68-73 degrees (20-23 degrees)
- 20-60%
- positive
HVAC parameters for the decontamination area
1. total air exchanges
2. total outdoor air exchanges
3. temperature
4. relative humidity
5. pressure
- 6
- 2
- N/A
- N/A
- negative
HVAC parameters for the sterile processing clean room
1. total air exchanges
2. total outdoor air exchanges
3. temperature
4. relative humidity
5. pressure
- 4
- 2
- 68-73 degrees (20-23 degrees)
- max 60%
- positive
HVAC parameters for the sterile storage area
1. total air exchanges
2. total outdoor air exchanges
3. temperature
4. relative humidity
5. pressure
- 4
- 2
- max 75 degrees
- max 60%
- positive
Wearing the correct PPE is important for what 2 things?
- infection control measure
- caustic cleaning chemicals
what 3 things should cleaning agents and disinfectants be?
- hospital grade
- registered with the US environmental protection agency
- specific for targeted organisms
What is not intended for cleaning in the OR?
alcohol, high-level disinfectants, and liquid sterilants
Why are alcohol, high-level disinfectants, and liquid sterilants not allowed?
may damage the finish of metal furniture and equipment
How should disinfectants be applied?
- with a low-linting cloth
- clean, reusable mop head
- single-use mop
soiled cleaning materials are considered what? and should never be what?
contaminated; and should never be returned to the cleaning solution container or used for multiple patients
in order for disinfectants to reach their maximum effectiveness what must be provided?
adequate time, expressed as dwell time
What negates the efficacy of the cleaning process?
attempts to cut down on room turnover time by decreasing dwell time or beginning to clean the room before the patient is transferred to PACU
what are multidrug-resistant organisms?
microorganisms, mostly bacteria, that are resistant to one or more classes of antimicrobial drug
What is every perioperative team member’s responsibility regardless of the type of health care facility or setting when it comes to cleaning?
preventing MDRO transmission by adhering to strict cleaning, disinfection, and sterilization practices
What do extremely virulent pathogens require?
they require specialized environmental cleaning procedures
What are examples of extremely virulent pathogens?
- clostridium difficile
- prions
- some multidrug resistant organisms
What is the best strategy for effectively removing the pathogen from environmental surfaces?
using the appropriate hospital-grade EPA-approved disinfectant and following the manufacturer’s instructions for use
what should be done first, unless the disinfectant is approved for cleaning?
the surface should be cleaned first to remove organic matter and debris
Why do spills pose a safety risk?
because personnel may slip and fall on wet surfaces or be exposed to caustic substances or noxious fumes
What do spills containing biohazardous substances serve as?
reservoirs for disease transmission when clothing or shoes spoiled by the spill are worn outside the OR
What are considered biohazardous substances
blood or body fluids
How should biohazardous spills or other potentially infectious substances be removed?
with an absorbent cloth followed by cleaning and disinfecting the affected area
How should OTHER spills be managed?
based on recommendations described on the SDS for the substance involved
What should always be worn when handling a spill?
PPE (gloves, masks, eye protection, other impervious clothing as necessary
Room turnovers involve what?
standardized practices that performed at the conclusion of each operative or invasive procedure
What instruments, trash, and soiled linen placed in?
fluid-impervious containers and transported to the appropriate processing area
Before the first procedure of the day, inspect what?
the OR for cleanliness
What should also be done before the first procedure of the day besides inspection?
damp dust all horizontal surfaces using a lint-free cloth
what is the survival time for clostridium difficile?
> 5 months
What is the cleaning agent for clostridium dificile?
beach, hydrogen peroxide
What is the survival time for methicillin-resistant staphyloccoccus aureaus
7 days-7months
What is the cleaning agent for MRSA?
EPA-registered disinfectants effective against staphylococcus aureaus will kill MRSA
What is the survival time of Mycobacterium tuberculosis?
hours to days (airborne) to 6 months (in dust if protected from sunlight)
What is the cleaning agent for mycobacterium tuberculosis?
UV light, EPA registered disinfectant. Transmission through contact is very rare. N-95 PPE is not necessary if the room has been ventilated for 28 minutes at 15 air exchanges/hour
What is the survival time of vancomycin-resistant enterococcus (VRE)
5 days-4 months
What is the cleaning agent for vancomycin-resistant enterococcus?
EPA-registered disinfectant
Can suction container contents be poured down a drain?
yes unless contraindicated by local environmental regulatory agencies
How does room cleaning work?
move from cleaner areas towards more contaminated areas
high-touch surfaces (control panels, workstations, door handles, telephones, light switches) require what?
extra attention during routine cleaning
Why do the use of computers in the OR pose a challenge?
because they may harm keyboards
single-use items should never be used for what?
for multiple patients
Ceilings and walls should be what?
cleaned as necessary after each procedure
Even with the most thorough cleaning practices, the floor of the Or should always be considered what?
contaminated
Terminal cleaning occurs when?
after the last procedure of the day
what is the purpose of terminal cleaning?
to provide a thorough, final disinfection of perioperative areas
What 3 things should be done when doing a terminal clean?
- the entire floor, including under the OR bed and any other equipment, should either be wet vacuumed or mopped.
- clean all exposed surfaces, including wheels and casters.
- Remove, inspect, and clean mattress pads
What should be done with cracked mattresses or positioning pads?
they should be discarded because they harbor moisture and bacteria
What should hospitals do regarding cleaning in unused semi-restricted or restricted areas?
develop and follow their own policies
Disposal of waste should follow what?
local, state, and federal guidelines
Where is information regarding what PPE should be worn when handling certain hazardous materials?
SDS
How does OSHA’s bloodborne pathogens standards define regulated waste?
any item that, when compressed, would release blood or other potentially infectious material (OPIM) in any form (i.e. liquid, semi-liquid, solid)
Where must personnel place materials contaminated with blood or other body fluids?
in closable, leakproof containers or bags that are color coded, labeled, or tagged for easy identification as biohazardous waste
Where should hazardous materials be stored?
in a secured area
What do hazardous materials need to be labeled with?
name, use, and warnings
hazardous materials or solutions must be transported from the point of use to the disposal area in what? With a what?
sealed, leakproof, nonbreakable container. With a label that can identify the waste contents
extra care must be taken with what kind of agents? why?
cytotoxic agents; they may leave a residue on instruments and subsequently require specific cleaning of these instruments
Staff working in decontam should be notified about what? why?
of instruments contaminated with cytotoxic agents so that they can have the appropriate PPE
All personnel coming in contact with what should double glove?
chemotherapeutic agents
occupational doses of radiation should be what?
as low as is reasonably achievable (ALARA)
what is the per-year maximum radition exposure limit for radiation workers?
5,000 millirem (mrem) per year (a chest x-ray is 4 mrem)
Personnel should adhere to what kind of precautions when processing instruments used for handling radiation seeds?
standard precautions
Personnel should use what to handle radioactive specimens?
forceps
Where should radioactive specimens be placed?
in a container to protect personnel from exposure
What are 5 ways to dispose of radioactive waste?
- bodily wastes with low levels of radioactivity: disperse in the local swere system after flushing twice (dilute and disperse)
- bodily wastes with high levels of radioactivity: hold in an appropriate container marked radioactive for a specified amount of time to decrease the radiation to a safe level, then disperse in the local sewer system (delay and decay)
- items with high levels of radioactivity: place in an appropriate container marked “radioactive” and then bury (concentrate and contain)
- incineration
- small items (syringes, vials, cotton swabs, tissue) with less than 1.35 microcuries: place in routine garbage
Who is an excellent resource when determining the appropriate disposl method for radioactive materials?
facility’s nuclear medicine officer or radiation safety officer
Many of the agents used for high-level disinfection pose what?
special handling risks to staff, especially with eye and skin injuries
What are 3 examples of hazardous chemicals?
- hydrogen peroxide
- ortho-phthaladehyde
- glutaraldehyde
What should never be disposed of in septic systems?
high level disinfectants
hazardous chemicals may be disposed of, along with copious amounts of water, in the facility sewer system UNLESS…
there are local disposal restrictions
What do regulatory agencies require for perioperative cleaning practices and the competency of those performing these tasks?
documentation
What can keeping a record of the persons performing the cleaning, the area, and any special considerations assist with?
- audits
- identifying opportunities for performance improvement
- tracking possible sources of infection outbreaks
Who advocates for hand hygienece as the most important step in preventing the transmission of microorganisms?
World Health Organization and Centers for Disease Control and Prevention
Does AORN go based of WHO and CDC for hand hygiene?
yes
What are the 2 primary methods of hand hygiene?
- washing with soap and water
- using surgical alcohol based hand rubs
When should all health care personnel perform hand hygiene?
- upon arrival at and before leaving the health care facility
- before and after having contact with a patient
- before donning and after removing gloves
- before and after eating
- before and after going to the rest room
- any time the hands are contaminated
What are additional measures to decrease the liklihood of bacteria being transmitted from the caregiver’s hands to the patient?
- fingernails should be well groomed and no longer than 2 mm
- chipped nail polish should be removed
- artificial nails or any nail enhancements should not be worn
- rings and arm jewelry should not be worn in the perioperative area
- health care providers should have intact skin when providing direct patient care
The prion associated with CJD is incredibly difficult to what?
eradicate by current disinfection and sterilization methods
Are their any current EPA-approvided disinfectant available to inactivate CJD?
no
What kind of PPE should personnel use when handling equipment or instruments suspected of CJD contamination?
standard and contact precautions
What are 4 precautions to minimize the risk for transmission of infectious agents?
- washing hands frequently and correctly
- using PPE appropriate for the anticipated type of exposure
- implementing methods to safely handle sharps, and
- implementing procedures to clean the patient environment and equipment
What is the only way to prevent the transfer of C. diff?
handwashing with soap and water
What are not as effective for killing C. diff spores?
surgical hand rubs
What do these 4 precautions apply to?
1. washing hands frequently and correctly
2. using PPE appropriate for the anticipated type of exposure
3. implementing methods to safely handle sharps, and
4. implementing procedures to clean the patient environment and equipment
- blood
- bodily fluids (except for sweat)
- mucous membranes
- nonintact skin
does blood have to be visible for standard precautions to be implemented?
no
what is the goal of PPE?
to protect the health care worker, the environment, and the patient
Does PPE take the place of handwashing?
no
What are contact precautions used for?
used for pathogens that are spread through either direct or indirect patient contact
direct transmission follows what?
the passage of infectious organisms between 2 people
indirect transmission occurs when?
after contact with contaminated surfaces (OR beds, instruments, equipment)
What decreases the risk of indirect transmission of pathogens?
single-use patient care items and thorough cleaning and disinfecting of nondisposable equipment
When are airborne precautions implemented?
for pathogrens that are small (5 micrometers or less) and that can stay suspended in the air
How are airborne pathogens spread?
through sneezing, coughing, and talking
where should patients suspected of or diagnosed with an airborne disease be placed?
in a negative-pressure room to prevent air circulation of the pathogen to other areas of the hospital
pathogens greater than 5 micrometers in size require what?
droplet precautions
How do droplet precautions and airborne precautions differ?
although also spread through sneezing, coughing, and talking, the larger droplet microbes tend to settle on surfaces within 3 feet of the patient patient source
What can be considered additional protection from exposure with droplet precautions?
distance
The elements of respiratory hygiene/cough etiquette are meant to be incorporated into what?
standard precaution protocols
What do the elements of respiratory hygiene/cough etiquette include?
- covering the mouth and nose with a sleeve or tissue rather than with a hand when coughing or sneezing
- educating health care staff, patients, and visitors
- posting signs with instructions to patients, families, and visitors in a language that is appropriate to the population being served
- providing source control measures (tissues, masks, disposal)
- performing hand hygiene after contact with respiratory secretions
- ensuring a separation of at least 3 feet (ideally) between persons exhibiting signs and symptoms of a respiratory infection and others in the room
What 5 diseases have a contact route of transmission?
- HIV infection
- Hep B infection
- Hep C infection
- Staph aureus infection
- C. diff infection
What is the required PPE for handling these 5:
1. HIV infection
2. Hep B infection
3. Hep C infection
4. Staph aureus infection
5. C. diff infection
- gown and gloves
- mask and eye protection if there is risk of contact with the eyes or mucous membranes
What 5 diseases have a droplet route of transmission?
- meningitis
- pneumonia
- mumps
- rubella
- pertussis
What is the required PPE for handling these 5:
1. meningitis
2. pneumonia
3. mumps
4. rubella
5. pertussis
- surgical mask
- gloves, gown, eye protection if there is risk of spray to the yes or mucous membranes
What 3 diseases have a airborne route of transmission?
- mycobacterium tuberculosis
- varicella
- rubeola
What is the required PPE for handling these 3:
1. mycobacterium tuberculosis
2. varicella
3. rubeola
- NIOSH N-95 fit-tested respirator
- gloves, gown, and eye protection if there is risk of spray to the eyes or mucous membranes
Instruments and devices sold in the US should have what kind of clearance for use in surgery?
US food and drug administration clearance
What should instruments and devices sold in the US come with?
written manufacturer-validated cleaning and decontamination guidelines
What should be considered with the purchase of new instruments or equipment?
the cleaning, decontamination, and sterilization capacities of the facility
Who designed a classification system in 1939 for determining which method of sterilization or high-level disinfection to use?
Dr Earle Spaulding
the choice of sterilization methods is based on what 3 things?
- composition of the instrument
- intended use of the instrument
- inherent risk of infection posed by the instrument when coming into contact with the body
What is a critical device according to spaulding classification?
instruments that are inserted directly into the bloodstream or other sterile tissues
What are 3 examples of critical devcies?
- surgical instruments
- endoscopes used in sterile cavities (laparascopes, arthroscopes)
- endoscopic biopsy forceps
Should critical devices be sterilized?
yes
If a critical device is not sterile what is there a risk of?
risk for transmission of infectious organisms
semi-critical devices are what?
Devices that encounter intact mucous membranes or non-intact skin and that do not enter areas of the body normally considered sterile
How should semi-critical devices be treated?
should be cleaned and then processed at minimum with high level disinfection
heat-stable instruments should be what when possible?
sterilized
semi-critical instruments that cannot tolerate high levels of heat may be sterilized via what?
a low-temperature method (hydrogen peroxide, ozone, or ethylene oxide
What are examples of semi-critical devices?
bronchoscopes, laryngeal blades, and GI endoscopes
what are non-critical devices?
those that contact intact skin or those that may have become contaminated with blood or other body fluids through indirect contact
Non-critical devices should be what? (as far as cleaning)
be thoroughly cleaned before intermediate-level disinfection with an FDA-approved disinfectant effective against HEP B
What are examples of non-crticial devices?
- blood pressure cuffs
- ECG electrode leads
- stethoscopes
Equipment found in the OR (monitors, ESU’s, suction devices) may not be in direct contact with the patient but may still be considered what?
contaminated with blood or other body fluids
Equipment found in the OR should be what?
appropriately cleaned and disinfected between paitnets
What are 2 caveats to the spaulding classification system today?
- the same instrument may encounter multiple levels of processing. For example, a sterile biopsy forceps passes through the lumen of an endoscope that has been high-level disinfected, or the handle of a laryngoscope may be processed differently (low disinfection) thantion the blade that contacts intact mucous membranes (high-level disinfection or sterilization)
- The increasing number of highly virulent and/or drug resistant organisms (C. diff) encourages the use of sterilization to best ensure eradication of pathogens; however, some instruments (notably endoscopes) are heat sensitive and cannot withstand steam sterilization
What is the role of the scrub tech in POC cleaning during the procedure?
- should keep instruments as free of debris as possible to prevent corrosion, rusting, and pitting
- should flush lumens with sterile water that is kept in a sterile basin in a ring stand located away from the field
What does flushing lumens by a scrub tech do?
removes debris and increases the risk of the formation of biofilmw
What is biofilm?
cells that collect on instruments and protect microorganisms from disinfectants
True or false; all instruments that have been on the sterile field during the procedure do not need to be cleaned whether or not they have been used
false; they do need to be
What 3 things should the scrub person do at the end of the procedure?
- seperate instruments with multiple parts and open all instruments that have clamps to allow thorough cleaning
- should place delicate instruments (fiberoptic cords, rigid endoscopes, microsurgical instruments) in a separate area to protect them
- should also separate sharp instruments (scissors, towel clips) that could injure sterile-processing personnel
Where should disposable sharps be placed?
sharps container
Where should liquids go that are used to decontaminate instruments?
discarded or should be placed in leakproof containers with lids
What should be used to keep instruments moist at the point of care?
a manufacturer-approved instrument cleaner
What prevents fluids and organic matter from drying on the instrument?
keeping soiled instruments moist and/or soaking them in an enzymatic solution
what can saline do to instruments?
cause pitting of the instruments
what can be used to cover instruments at the end of the procedure?
towels soaked in water
To decrease exposure of personnel to potentially infectious microorganisms during transport from OR to decontam, all instruments opened onto the sfield should be placed in what?
in leakproof, rigid, puncture-resistant containers with lids and labeled with a biohazard sign
Containers, reusable case cart covers, and instrument case carts should be what?
cleaned and disinfected properly for use
prep for cleaning decontam should occur when?
ASAP after the conclusion of the surgical procedure
What is the purpose of cleaning (2 things)?
- to remove bioburden (microbial load) to make an instrument safe for handling by sterile processing personnel
- to prepare the instrument for disinfection or sterilization
The decontamination area should have what 6 things?
- automated and manual equipment to clean all types of instruments in use
- adaptors and accessories to connect to cleaning equipment
- a filtered, medical grade air supply (compressed air)
- a treated water source for rinsing instruments
- an eyewash station
- a dedicated sink for handwashing
What is PPE for personnel in the decontam area?
- head covering
- an impervious gown with sleeves
- gloves extending over the cuff of the gown
- a mask and eye protection or eye shield
- shoe covers or boots
What should happen after PPE removal?
hand hygiene
Personnel should follow the manufacturer’s written cleaning product instructions for use related to what 4 things?
- water quality, hardness, temperature, and PH
- the correct concentration and dilution of the product
- adequate contact time
- proper storage, shelf life, and use life of the product
The cleaning products used in the decontam area have the following properties?
- nonabrasive, low foaming, easy to remove during rinsing, and biodegradable
- effective for removing soil
- nontoxic in the correct dilution
- tested for concentration levels
- cost-effective
- extended shelf life
What items are needed in the decontam area for cleaning instruments?
- brushes (disposable or cleaned at least daily)
- enzymatic and non-enzymatic cleaners
- soft, low-linting cloths
- testing equipment
- 70% to 90% isopropyl alcohol
- a thermometer
- measuring devices
cleaning and decontamination processes may be what 2 things?
- mechanical (preferred)
- manual
Mechanical washer/disinfectors combine what things?
cleaning, rinsing, disinfecting, lubrication, and drying cycles
What are the benefits of using a mechanical washer/disinfector?
- decreased exposure and handling of contaminated items by sterile processing staff
- the ability to standardize cycles and detergent concentrations
true or false; all instruments are appropriate for mechanical washer/disinfector?
no; i.e. powered instruments, microscurgical or other delicate instruments, instruments that cannot be immersed
What are ultrasonic cleaners ideal for?
to remove debis from hard-to-reach areas and for items too delicate to go through a washer-sterilizer
What should personnel do with instruments before placing them in an ultrasonic cleaner?
remove gross debris
instruments with similar metals should be placed where?
in the ultrasonic cleaner
what can mixing metals do?
result in electroplating, which could cause etching or pitting of the instruments
any alteration in the finish of an instrument encourages what?
microorganisms to affix to the surface
After removal from the ultrasonic cleaner, instruments should be what?
thoroughly rinsed with treated water
manual cleaning is reserved for what?
instruments that cannot tolerate mechanical cleaning and for facilities lacking automated cleaning euipment
Some instruments that are especially difficult ot clean may be what?
manually and mechnically cleaned per the manufacturer’s IFU
What does an initial rinse in cold water for manual cleaning help prevent?
helps to prevent blood coagulation and faciliates the removal of gross debris
What should be used to ensure that the cleaning detergent reaches all surfaces with manual cleaning?
a brush the length of the lumen
What does holding the instrument vertically and immersing it in the cleaning solution help to prevent?
the formation of air pockets in the lumen, which can impede the cleaning process
After cleaning, all instruments should be examined for what?
residual debris
What can be used to check hard-to-clean areas, channels, and lumens?
lighted magnification or a borescope
what should be removed from lumens? using what?
moisture; compressed air
If recommended by the manufacturer’s IFU, rinsing instruments in alcohol can promote what?
- drying
- inhibit microbial growth
- prevent biofilm formation
documentation can be used to track what 2 things?
- the quality of the instrument cleaning process
- identify areas for improvement
What 3 things requipred special cleaning and sterilization processe?
- opthalmic instruments
- flexible endoscopes
- instruments exposed to prions
intraocular ophthalmic instruments that have been improperly processed
toxic anterior segment syndrome
What is toxic anterior segment syndrome?
a sterile postoperative inflammation limited to the anterior segment of the eye
What are the causes of toxic anterior segment syndrome?
- inadequately flushing phacoemulsification and irrigation/aspiration handpieces
- using enzymatic cleaners
- using an incorrect detergent concentration
- using contaminated ultrasonic fluids
- adding antibiotics to balanced salt solutions
- using epinephrine with preservatives
- using powdered gloves
- reusing single-use products
- failing to maintain instruments correctly
What is special care of ophthalmic instruments in addition to following the IFU for the appropriate cleaning agents?
includes additional rinsing and inspection under magnification to verify that viscoelastic material and other debris has been removed.
What should you do with ultrasonic cleaners before cleaning ophthalmic instruments?
should be emptied and cleaned prior to cleaning
true or false; should a load be solely dedicated to ophthalmic instruments
true
What are prions?
causative agents for Cruetzfeldt-Jakob disease
Why are prions difficult?
they pose a special challenge for cleaning and sterilizing instruments
What happens if instruments are contaminated with prions?
must be handled with special precautions because, to date, there is no FDA-approved agent for inactivating prions
What kind of instruments are preferred for Creutzfeldt-Jakob disease?
single use instruments
What kind of reusable instruments are preferred for high risk Creutzfeldt-Jakob disease patients?
only reusable instruments that are easy to clean and can tolerate an extended steam sterilization cycle
What should you do with instruments that cannot be immersed or cannot withstand high-temperature steam sterilization?
should be discarded
What has a high attraction to prions?
stainless steel
what happens when the instruments are allowed to dry with prions?
it is difficult to remove the prions
Instruments used in a Creutzfeldt-Jakob case should be what?
kept moist with a wet towel or submersed in water until they can be cleaned and decontaminated
What kind of cleaning method has been found to be most effective in inactivating prions?
a combination of alkaline and enzymatic cleaning agents and steam sterilization
after instruments used in a Creutzfeldt-Jakob disease case are decontaminated, they should undergo one of what 3 methods for sterilization?
- prevacuum sterilization at 273 degrees fahrenheit (134 degrees celsius) for 18 minutes
- gravity displacement sterilization at 270 degrees fahrenheit (132 degrees celsius) for 60 minutes
- immersion in 1 N sodium hydroxide (ie, 1 N NaOH in a solution of 40 grams in 1 L of water) for 60 minutes, then removed, rinsed with water, and sterilized using one of the cycles described above
What kind of sterilization should not be used on instruments exposed to high risk tissue?
immediate use steam sterilization
What kind of instruments have been implicated in serious and life-threatening infections?
flexible endoscopes
Because biofilm can sometimes be virtually impossible to remove, what is especially important?
to begin cleaning at the point of use, followed by leak testing, thorough cleaning, and high-level disinfection or sterilization
What may help ensure that debris is removed?
using a magnifying glass
If it is compatible with the manufacturer’s instructions, what should personnel flush channels with?
alcohol
Before placement in storage, what should the channels of the duodenoscope and elevator mechanism be dried with?
forced air before placement in storage
Because improper cleaning has been implicated in patient injury, all personnel responsible for processing flexible endoscopes must receive what?
initial and ongoing education
Is it the responsibility of the nurse to also have education and competency verification for endoscope processing?
yes
Enhanced methods for processing flexible duodenoscopes may include implementing HLD followed by what 5 things?
- endoscope quarantine until the duodenoscope is culture-negative
- a liquid chemical sterilant processing system
- a second round of HLD
- ethylene oxide sterilization
- FDA-cleared, low temp sterilization
Where should count sheets not be placed and why?
should not be placed inside trayes. The sheet may inhibit the sterilization process, and printer ink may transfer to the instruments
What are the 10 things that should be included in documentation of instrument cleaning and disinfection?
- date and time of cleaning and disinfection
- identification of instruments
- method and verification of cleaning
- audit results
- identifier of mechanical instrument washer efficacy results
- lot numbers of cleaning agents
- testing results for insulated instruments
- disposal of defective equipment
- maintenance of cleaning equipment
