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BDS3 Instrument decontamination > Instrument decontamination > Flashcards

Instrument decontamination Flashcards

1
Q

What is the definition of Critical Device under the Spaulding classification?

A
  • A device that penetrates soft tissues, makes
    contact with bone and enters or contacts the
    bloodstream or normally sterile tissue
  • Device must be cleaned and then sterilised
  • e.g. Surgical biopsy instruments, forceps
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2
Q

What is a Semi-critical Device definition under Spaulding Classification?

A
  • Device that comes into contact with non-intact skin or mucous membrane, but does not penetrate soft tissue or make contact with the bloodstream, bone or normally sterile tissue
  • The device must be cleaned and subject
    to high-level disinfection. Steam sterilisation preferred
  • e.g. dental mirrors, anaesthetic syringes
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3
Q

What is a Non-critical Device definition under Spaulding Classification?

A
  • Device that only comes into contact with
    the skin and intact mucous membrane
  • Cleaning followed by low level disinfection
  • e.g. Chair light handle
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4
Q

What are the stages of life cycle for processing instruments?

A
  • Acquisition
  • Cleaning
  • Disinfection
  • Inspection
  • Packaging
  • Sterilisation
  • Transport
  • Storage
  • Use
  • Transport
    and repeat process from cleaning
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5
Q

What occurs during the cleaning stage?

A
  • Removes all of the biological matter from the surface of instruments following use
  • Recommended method is automated Washer-Disinfector
  • Secondary method is Ultrasonic bath
  • Manual cleaning should only be carried out if only option
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6
Q

Why must all instruments be cleaned at first stage?

A

1) Functionality of instrumentation
2) To minimise the spread of contamination
3) To prevent failed procedures (biopsy)
4) To achieve steam contact
5) It is a legal requirement

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7
Q

What occurs during sterilisation stage?

A
  • After all visible contamination has been removed
  • Instruments should then be processed through a ‘steam sterilizer’
  • Use vacuum and non-vacuum machines
  • Vacuum being the best process (Type –
    B) and non-vacuum (Type – N)
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8
Q

What is an operator defined as according to Scottish Health Technical Memorandum (SHTM)?

A
  • Defined as a person, designated by management, with authority to operate a WD
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9
Q

What correct PPE must be donned before performing manual cleaning?

A
  • Apron
  • Face shield
  • Rubber gloves and heavy duty gloves on hands
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10
Q

In regard to manual cleaning how must a sink have specific requirements?

A
  • Must be a dedicated sink for purpose of manually washing
  • Cannot be a hand washing sink or used for any other purpose
  • Another sink required for rinsing instruments following cleaning
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11
Q

What are the specific requirements of water for manual cleaning?

A
  • Standard potable water or tap water can be used
  • Water must be between 30-35 degrees C
  • Temp excess of 35degree C can cause proteins to coagulate, making them more difficult to remove
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12
Q

What are the specific requirement of chemical detergents in manual cleaning?

A
  • Chemical detergents used
  • Should be formulated specifically for manual cleaning, generally an enzymatic or pH neutral detergent
  • Manufactures instructions should always be followed for dosing levels of each chemical
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13
Q

Why must instruments be cleaned below water with long handled soft bristled brush?

A
  • Metallic brush should never be used as could damage instrumentation
  • Instruments must be in contact with water and detergent solution
  • Minimises splashing as this contaminates surroundings
  • Scrubbing above surface has potential to produce aerosols
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14
Q

When should manual cleaning be carried out?

A
  • It is specifically recommended by the manufacturer’s instructions for processing
  • If there is no other alternative i.e. all automated equipment is out of service
  • The automated process of the Ultrasonic or WD has failed to remove the contamination
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15
Q

What is an Ultrasonic bath?

A
  • Secondary or back up method to washer-disinfector
  • Uses soundwaves at very high frequencies to produce bubbles that implode
  • Bubbles have scouring effect against hard surface of instruments
  • Has potential to damage instruments so always verify MI
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16
Q

What is the automated cleaning cycle of Ultrasonic cleaner?

A
  • The operating temperature is set between 20 – 30 degrees Celsius
  • The machine can be filled with tap water to
    the required volume which is marked on the chamber
  • Chemical must be added to the water in the chamber based upon the MI
  • The cycle must be ran for a specified period
    of time, established at validation
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17
Q

What is a degas cycle in Ultrasonic Cleaning?

A
  • Degas cycle must be ran before equipment can be used
  • Chamber must be filled with water and detergent before any production cycle
  • Standard production cycle ran with chamber empty
  • Reason is there are air/gas bubbles inside water normally
  • During ultrasonic process any bubbles made will collapse into the air bubbles
  • Effects efficacy of equipment and prevent proper cleaning of instrument
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18
Q

What occurs after manual or ultrasonic cleaning?

A
  • Must be rinsed in separate rinsing sink
  • After processed through washer-disinfector
  • Must be thermally disinfected again
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19
Q

Reasons for Manual and Ultrasonic cleaning?

A
  • Manually scrubbing with a brush exerts a greater force than the Washer-Disinfector is capable of producing
  • Some pieces of equipment must only be
    Manually washed, in-line with manufacturers
    Recommendations
  • Ultrasonic baths have a ferocious process that
    is very good at removing contamination
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20
Q

Reasons against Manual and Ultrasonic cleaning?

A
  • A member of staff is required to be present for the entire process
  • There is a risk of aerosol production
  • There is a risk of contaminating the surrounding
    environment
  • There is the potential for inconsistency in the process due to human error
  • There is a high risk of sharps injuries for members of staff carrying out the process
  • Ultrasonics have a ferocious process which has the potential to damage some equipment
  • There are no automatic water changes in an Ultrasonic bath
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21
Q

What is an AWD’s?

A
  • Automatic Washer-Disinfectors
  • Machine automatically cycle through stages to produce clean instrumentation free from contamination, thermally disinfected and dry
  • Load carrier where instruments are positioned’
  • Chamber where process takes place
  • Control panel to operate it
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22
Q

Ultrasonic vs Washer-Disinfector

A
  • The Ultrasonic has a powerful process and
    can remove hard-to-reach contamination
  • It is an automated process, but it only has
    one stage and does not disinfect or dry
  • The contamination is removed from the
    surface of the instrument, but it remains
    present in the chamber
  • It has the potential to damage certain
    instruments and still requires manual stages
    such as rinsing
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23
Q

What are the stages in an AWD?

A

Flush/Prewash – this stage saturates the contamination and removes gross contamination
Main wash – this stage is supplemented by detergent to more effectively remove biological matter
Rinse – this stage removes any remaining residue, biological or chemical before disinfection
Thermal Disinfection – this stage actively kills microorganisms with the use of heated water
Drying – this stage uses hot air to remove any remaining moisture from the surface of the instruments

Fresh water used at each stage, fills SUMP and circulated throughout chamber

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24
Q

Why is the flush/prewash, main wash and rinse stage important?

A
  • Only chance to remove proteins or prion (vCJD)
  • Cannot be deactivated through disinfection or sterilisation
  • High temp make them adhere to surface of instruments
  • Can survive high temps for longer periods of time than standard sterilisation process
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25
Q

What temperatures must each stage of WD be carried out?

A

Flush/Prewash – less than <35 degrees
Main wash – temperature dependent on chemical used for process
Rinse – less than <65 degrees
Thermal disinfection – must be between 90 – 95 degrees for minimum of 1 minute
Drying – has no specified temperature but generally 100 degrees (hot air)

26
Q

Why is the use of WD the first step in decontamination process?

A
  • Consistency as machine process is virtually same every time
  • Traceability as automated processes produce a printable record of each cycle
27
Q

What are the daily checks of the WD?

A
  1. Check that the Sprays arms spin freely without obstruction
  2. Check the spray jets (on the spray arms) are not blocked
  3. Make sure there is no debris (tape or labels for instance) on the strainer/filter, and that there are no parts of instruments or any other potential blockage’s.
  4. Check the condition of the door seal and wipe and clean if necessary
  5. Verify there is a suitable amount of chemical in the reservoir
  6. Record the disinfection temperature of the first cycle every day (commonly referred to as an ACT)
28
Q

What are the loading requirements of a WD?

A
  • The available load carrier/basket furniture must be used
  • Clip trays must be used and positioned correctly
  • No overlapping or shadowing of equipment
  • Hinged instruments must be opened at the hinge
  • All assemblies should be disassembled beforehand
    Specific loading requirements must be followed to ensure instrumentation is fully cleaned and disinfected
29
Q

What is an Illuminated magnifier used for?

A
  • After WD process if finished, instrumentation must be inspected for damage or to see if contamination still present using an illuminated magnifier
30
Q

Why do we use Steam for sterilisation?

A
  • Steam carries a massive amount of energy
  • It is a non-toxic component in the sterilisation process
  • For certain applications it can be recondensed and used again
  • The main ingredient is water which is readily available
  • There is no waste product except water
31
Q

What water is used for sterilisation process?

A
  • Purified water (RO, De-ionised, Distilled, Sterile)
  • Organics, minerals and micro-organisms removed or filtered before hand
32
Q

Why do we use steam instead of water for sterilisation process?

A
  • Volume of steam compared to water is in excess of thousand times greater
  • Creates huge amount of pressure within small confined spaces
  • Can flood chamber with steam from small amount of water
  • High P helps with permeability of steam
33
Q

What types of Sterilisers are available?

A

Type-N - Basic process of sterilisers, aka Gravity Displacement Steriliser or autoclave

Type-B - Most robust processing cycle, aka Vacuum Capable or Porous load steriliser

Type-S - Specialised piece of equipment used for specific purpose e.g. sterilising dental handpieces (least common)

34
Q

How does Type-N steriliser work?

A
  • This machine heats water in the chamber
    As it turns to steam it passively forces the air from the chamber
  • This process isn’t entirely efficient and can leave
    pockets of air within the chamber
  • This is not favourable for a high quality sterilisation
    process
  • You cannot process wrapped instruments or channelled or lumened instruments either
35
Q

Why are pockets of air not a good thing when created during Type-N steriliser?

A
  • Air does not behave the same way as steam
  • It can not be heated, or maintain temperature
    the same way that steam can.
  • It is always a lower temperature than the steam
    surrounding it.
  • If it is in contact with air it is not contacting steam.
  • This means anything that the air is in contact with
    might not achieve its sterilisation temp for min required time
36
Q

What only can you process in Type-N Steriliser?

A
  • Rigid steel/solid instrumentation with no pockets channels or lumens
37
Q

How does Type-B Steriliser work?

A
  • The first step on this machine is to remove all STEAM of the air from the chamber
  • After that it fills the chamber with steam. * Because the air has been removed first, a vacuum has been created.
  • This allows the steam to rush into the chamber
    meaning it effectively contacts all surfaces
  • It has the capability to penetrate wrappings of
    instruments and sterilise the instruments inside
38
Q

What instruments can you process in Type-B steriliser?

A
  • Wrapped, channelled and lumened instruments
  • Porous items such as cotton wool swabs
39
Q

How does Type-S Steriliser work?

A
  • This piece of equipment also washes and lubricates hand pieces that are being processed as well as sterilising them.
  • It has a vacuum cycle but does not process wrapped instruments
40
Q

What daily tests should be carried out on Sterilisers?

A
  • Checking door seals are intact and free from debris and clean if necessary.
  • Verify the chamber is free from damage, debris,
    contamination or instruments from previous cycles. - Verify the condition of the load carrier
  • Fill and drain the feedwater reservoir each day
  • Drain the used water reservoir each day
41
Q

What tests must be carried out on a weekly basis for Type-B sterilisers?

A
  • An ‘Air Leakage Test’ must be ran
  • An ‘Air Detector Function Test’ (ADFT) must be ran
  • Both these tests are machine cycle
42
Q

What must the container for transportation be?

A
  • Right sided
  • Tight fitting lid
  • Leak proof
  • Colour coded or clearly marked
43
Q

How can blood or biological matter affect instruments during transportation?

A
  • Start to dry in and stubbornly adhere to surface of instrument
  • Instruments can be bagged and sprayed in packets for transportation
  • Best course of action is having shortest time between use and processing
44
Q

What is the Sinner circle?

A
  • Developed in 1950’s by Herbert Sinner
  • 4 key elements required for successful cleaning process
  • Energy/ Chemicals/ Temperature/ Time
  • If you decrease of increase any quarter it will impact efficacy of process
45
Q

What is conductivity of water?

A
  • Aka Total Dissolved Solids
  • Water travels from source to point of use and collects things such as
  • Minerals (calcium, potassium)
  • Silicates ( Sand, glass, rock)
  • Organics (vegetation, colloidal particle)
  • Metals (iron, zinc, tin, mercury)
    Measure in micro-siemans us
46
Q

How is distilled water made?

A
  • Produced by boiling and recondensing standard tap water
47
Q

How is De-ionised water made?

A
  • Produced by passing water through ion exchange that picks up things like sodium, calcium and potassium
48
Q

How is sterile water made?

A
  • Water already been filtered by the previous methods and then sterilised
49
Q

What is reverse osmosis?

A
  • Semi permeable membrane filter used to remove particulate and bacteria from water
50
Q

What is the conductivity of pure water?

A
  • 4.3us
  • Pure water has nearly all particulate filtered out and has very low levels of bacterial and fungal presence
51
Q

When is high and low alkaline detergent used?

A
  • For enclosed process
  • Not designed to be in contact with skin
52
Q

When is Enzymatic detergent used?

A
  • Breaks down protein into smaller particles
  • Used in Ultrasonic and Manual washing
53
Q

When is pH neutral detergent used?

A
  • Less harmful to operators skin
  • Manual washing but can be used in WD as well
54
Q

How do detergents work?

A
  • Has hydrophilic end which attracts water
  • Has hydrophobic end which repels water
  • Contamination drawn to hydrophobic end and flushed away as hydrophilic end attaches to water molecules
55
Q

What are the table of factors?

A

Word doc

56
Q

Why do we need sterile instruments?

A
  • Reduces probability of infection transmission.
  • International standard for surgical instruments.
  • Legislative and professional standards.
  • Maintaining high quality of care for patients
57
Q

What is a medically sterile definition?

A
  • The theoretical probability of there being a viable micro-organism present on/in the device shall be equal to or less than 1 x10-6.
58
Q

How can we record when things have been sterilised?

A
  • Steriliser test record
  • If it wasn’t documents it didn’t happen
59
Q

What can be spread via infected dental instruments?

A
  • HIV
  • Hep B and C
  • Herpes
  • vCJD (variant Creutzfeldt-Jakob Disease)
60
Q

Why should we worry about vCJD?

A
  • Prions more difficult to inactivate on surgical devices
  • Infectivity can survive steam sterilisation at 134℃ for 18mins
  • Cases are low but asymptomatic carriage is relatively high and is approx 1 in 2000 for UK

BDS3 Instrument decontamination (2 decks)

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