Instrument Identification + Sterilisation Methods Flashcards
State the 7 instruments required for a basic suture kit
1 x Scalpel handle
1 x Treves forceps
2 x Mosquito forceps
1 x Mayo scissors
4 x Towel clips
1 x Gillies
2 x Needles
Define the term ‘sterilization of instruments’
The process by which instruments + drapes are rendered aseptic (or sterile) by the destruction or removal of all micro-organisms - including spores
State the 2 different categories of sterilization
+
Give an example of each
- Heat sterilization
Hot-air oven + autoclave - Cold sterilization
Ethylene oxide + radiation
State the 4 different methods of sterilization
- High-pressure steam (autoclaves)
- Dry heat (ovens)
- Chemical sterilants (glutaraldehydes or formaldehyde solutions)
- Physical agents (radiation)
Why is boiling not considered an appropriate means of sterilization?
Because it does not reach a high-enough temperature to destory bacterial spores
CHECK - says different in pp
Name 2 chemical solutions, used for chemical sterilization
- Chlorhexidine
+ - Glutaraldehyde
SHOULD ONLY BE CONSIDERED AS A MEANS OF DISINFECTION
They will kill bacteria = when instruments are soaked within them
In order to effectively kill micro-organisms, should dry heat occur for short or long periods of time?
Long periods of time
What 2 things should be considered when cooling metal instruments from dry-heat sterilization?
- Metal instruments are allowed a longer cooling periods, before use
+ - Long periods of dry-heat can cause damage to surgical instruments
What instruments are hot-air ovens most useful for?
Items damaged by moist-heat, such as:
* Glassware
* Powders
* Oils
* Sharp-cutting instruments
What temperature + length of time is required for sterilizing glassware + non-cutting surgical instruments, in a hot-air oven?
Temp = 180 degrees celcius
Time = 60 mins (1hr)
What temperature + length of time is required for sterilizing powders + oils, in a hot-air oven?
Temp = 160 degrees celcius
Time = 120 mins (2hrs)
What temperature + length of time is required for sterilizing sharp-cutting instruments, in a hot-air oven?
Temp = 150 degrees celcius
Time = 180 mins (3hrs)
What is considered the most common form of equipment, used for sterilzation in the veterinary practice?
The Autoclave
How does an autoclave work?
1.Water is boiled (under pressure)
2.This generates steam
3.This generates heat
4.This penetrates the innermost layer of instrument packs
Remember - moisture increases the permeability to the heat
What time length is required for sterilizing items in the autoclave at a temperature of 150 degrees celsius?
180 minutes
(3 hrs)
What time length is required for sterilizing items in the autoclave at a temperature of 160 degrees celsius?
120 minutes
(2 hrs)
What time length is required for sterilizing items in the autoclave at a temperature of 180 degrees celsius?
60 minutes
(1 hr)
What should you avoid overloading + blocking in the autoclave?
Inlet + outlet
valves
What are the 3 main things all instruments should be free from, before entering the autoclave?
+
Why?
Free from:
1. Grease
2. Protein
3. Organic matter
+
Because the above will prevent effective penetration of steam
Briefly explain the drying cycle
- Steam is exhausted
- Steam is replaced by filtered air
- This dries the instrument packs
What are the 4 main/common items that are sterlised within the autoclave?
- Surgical instruments
- Drapes
- Gowns
- Swabs
What is Ethylene Oxide?
A chemical used for sterilisation
What colour is EO gas or liquid?
Colourless
What temperature is EO considered a gas?
UNDER 10.5 degrees celsius
What temperature is EO considered a liquid?
OVER 10.5 degrees celsius
Is Ethylene Oxide heavier than air?
Yes
What are the 4 hazards which EO causes on a cellular level?
It’s:
1. Carcinogenic
1. Neurotoxic
1. Mutagenic
1. Can cause reproductive issues
Long time exposure = chronic exposure
What 4 pathogens are rendered ineffective, when sterilized with the chemical sterilization method?
- Viruses
- Bacteria
- Spores
- Fungi
What happens when the temperature is increased, when using EO?
+
What happens to the duration of the cycle?
The ability of the EO to penetrate materials increases
+
the duration of cycle shortens
What type of bag + type of seal is requried for EO sterilizing?
A disposable bag
+
velcro seal tie
What type of container does EO come in?
An ampule
Where should an ampule be put
+
when should it be broken?
Ampule should be placed within a bag
+
broken only once within the bag
NEVER remove from bag ONCE BROKEN
What type of chip should be placed within the bag with the ampule?
Humidity chip
What is the minimum % of humidity required to kill the pathogenic micro-organisms, during Ethylene Oxide sterilization?
35%
State the 4 hazardous issues that inhalation of EO can cause.
- Respiratory irritation
- Nausea
- Headache
- Neurological dysfunction
What can skin exposure to Ethylene Oxide cause?
- Burns
- Skin irritation
- Allergic contact dermatitis
- Frost bite
What 3 affects can eye exposure to EO cause?
- Severe irritation
- Cataracts
- Corneal burns
How can exposure occur with EO?
- Direct contact with ampule
- Inadequate ventiliation
- Insufficent ventilation times
How does Ethylene oxide gas sterilse instruments, in regards to pathogenic micro-organisms?
(In basic terms)
- The gas inactivates the DNA + RNA within the cell of the pathogenic micro-organism
- Preventing replication (inhibiting)
What are the 3 main dangers that Ethylene oxide poses to humans?
- Toxic to health
- Irritant to tissues
- Highly inflammable
- Highly explosive
What piece of legislation governs the chemicals used for chemical sterilization?
The Control of Substances Hazardous to Health 2002
(COSSH)
When considering dilution rates + contact times of chemicals, what must you follow?
The dilution rates + contact times are utilised, as dictated by the chemical’s manafactures guidelines
What method of sterilization should be kept in fume cupboard, in a well ventilated room + away from all working areas?
Ethylene Oxide
During an Ethylene Oxide cycle, what room is the minimum temperature required?
20 degrees celsius
State the basic method of using a Ethylene Oxide sterilizer
Loading
1. Place indivdually packed items into the polythene liner bag (PLB)
1. Place scored ampoule containg the EO liquid inside the PLB
1. Seal the bag with a metal twist tie
1. Put PLB into sterilizer unit
1. Snap ampoule from outside of the bag, releasing the gas
1. Quickly close + lock the door of the unit
1. Turn the ventilator on + wait 12 hrs
Unloading
1. After 12 hrs, turn on the pump
- 2 hours after aerating, remove sterilized items
- Store items for further 24hrs in a well ventilated room
- Ready for use!
- linear bags are supplied with the sterilzer
- Bags mut be sealed to keep gas circulating around the contents
- This minimizes the exposure to the gas
- Accidental opening = can be prevented if the door is locked
- Pump = allows contents to aerate, before it’s safe for the ‘operator’ to open
- Ensuring any toxic gas has been removede
- Make sure all EO has dissipated
Name as many items + materials that are suitable for EO sterlization?
- Anaesthetic tubing
- Endotracheal tubes
- Fibreoptic equipment
- Optical instruments
- Plastic items - syringes, catheters
- High-speed drills
- Battery operated drills
These can also be considered - BUT - the length of the cycle restricts their everyday use!
* Surgical instruments
* Gowns
* Drapes
How is sterilization achieved using radiation?
Sterilzation is achieved by the use of gamma radiation
Why is radiation sterilzation not used commonly within the veterinary practice?
Because it can only be carried out under controlled conditions, required by at an industrial level
+
Dangerous + harmful
Name 3 types of items which are suitable to be used for radiation sterilization?
- Needles
- Syringes
- Catheters
State the dilution rate required for G9 Instrument cleaner
1:100
1ml G9 : 100ml water
State the dilution rate required for G9 Instrument disinfectant
1:50
1ml G9 : 50ml water
How long does G9 Instrument cleaners + disinfectants affects last for?
Up to 7 days
What is the contact time for soaking instruments in a G9 Instrument cleaners + disinfectant solution?
15 mins
What can Instrument cleaners + disinfectant be used for?
Manual + ultrasonic use
What specific surgical piece of equipment is ideal for using G9 instrument cleaner?
Fibreoptic endoscopes
What is the function of Instrument cleaner?
To remove proteinaceous + organic material from the suface of instruments + endoscopes
What are the 6 types of organic matter does Instrument cleaner digest and dissolve on surgical instruments?
It’s digests + dissolves:
1. Blood
2. Mucus
3. Fecal matter
4. Vomital matter
5. Organic contaminants
6. Proteinaceous soils
What are the 2 other alternative names for purified water?
- Demineralised water
- Deionised water
State the 4 step process to using instrument cleaner to manually clean surgical instruments
- Add 50ml (1:100) of Instrument cleaner to 5L water
- Rinse surgical instruments in cold water to rinse off visable organic matter off
- Submerge instruments ASAP in the solution
- Soak for a contact time of 15 mins
- Rinse throughly with purified water
According to G9 Instrument cleaner..
State the 3 step process to using instrument cleaner in the Ultrasonic cleaning machine to clean surgical instruments
- Add 50ml (1:100) Instrument cleaner to 5L water, in the ultrasonic cleaning tank
- Rinse surgical Instruments in cold water to remove visable organic matter
- Submerge instruments into the ultrasonic cleaning tank, for a contact time of approx 15 mins
- Remove the instruments from the UCT
- Rinse throughly with purfied water
UCT = Ultrasonic Cleaner Tank
What 4 chemicals does G9 Instrument disinfectant not contain?
- Gluteraidhyde
- Phenols
- Chlorine
- Peracetic Acid
State the 6 types of micro-organisms that the G9 instrument disinfectant is effective against
- Bacteria
- Fungi
- Yeast
- Viruses
- Spores
- Mycobacteria
How do ‘Mycobacteria’ differ from bacteria?
Mycobacteria differ in metabolisim, as well as structurally from other bacteria as they have:
- An outer membrane
- They do not have capsules
- Most do not form endospores
- Thicker cell wall
Their cell wall is hydrophobic, waxy + rich in mycolic acids/mycolates
State 6 structures which can be used to define a Mycobacterium
- Gram-positive
- Catalase positive
- Non-motile
- Non-spore forming
- Rod-shaped
- 0.2–0.6 μm wide and 1.0–10 μm long
State the 6 step process to using instrument disinfectant to manually or ultrasonically disinfect surgical instruments
- Add 100ml (1:50) Instrument disinfectant to 5 litres water into the sterilisation trough
- Rinse surgical instruments with cold water to remove any visable organic matter
- Submerge surgical instruments in the sterilisation troughs for an approx contact time of 15 mins
- Remove the instruments from the trough
- Rinse the surgical instruments in purified water
- Dry + package the disinfected instruments
State 4 areas of the body you should refrain from contacting, with disinfectant
- Skin
- Eyes
- Mouth
- Nose (Inhalation)
What 2 factors should you always be aware of before using disinfectants?
- It is used in a well ventilated area
- Using the appropriate PPE
