LDU Practical Flashcards
What are the stages of the decontamination cycle
- Acquisition
- Cleaning
- Disinfection
- Inspection
- Packaging
- Sterilisation
- Transport
- Storage
- Use
- Transportation (Dirty)
What is acquisition?
-Practices should have a documented policy for the purchase of re-useable medical devices (including surgical instruments).
-This ensures the equipment purchased is:
–> fit for intended purpose
–> compatible with existing equipment
–> easy to clean
–> can be decontaminated within the practice
What are the 3 types of cleaning?
Choice of methods:
- Manual
- Ultrasonic
- Automatic washer disinfector
What method of cleaning is preferred and why?
Automated cleaning is preferred to manual cleaning due to:
–> the reproducibility and control of the process.
–> it is more readily validated
What is cleaning?
-Physically removes contamination from the medical device
What may cleaning involve?
a disinfection element such as in the use of a washer-disinfector.
What does the type of cleaning depend on?
the equipment being cleaned and the type of contamination being removed
What is disinfection?
reduce the number of viable microorganisms and may not necessarily inactivate certain viruses and bacterial spores
Methods of disinfection + what does it depend on?
- depends upon the nature of the surgical instrument being cleaned but is usually achieved by an automated washing process (thermal) or by chemical means.
- Chemical disinfection only where no practical alternative exists.
When is disinfection required
- Disinfection is required for contaminated equipment prior to handling and inspection, before packaging and sterilization.
What is inspection and when does it take place
Following cleaning.
All instruments should be carefully examined for organic material and/or damage under magnification
Who is inspection/maintenance or testing carried out by?
trained persons in accordance with the manufacturer’s instructions and/or practice policy
Where practicable inspection + functional testing of surgical instruments should be carried out by a person not responsible for cleaning the item.
Those persons carrying out these tasks have a responsibility for ensuring that the items are fit for reuse.
Must record all tests performed
What is packaging
For products to be packaged, the materials used must be compliant with the relevant European Standards (BS EN 868).
Methodology used for packaging within the practice should be documented.
When are items sterilised
following cleaning and disinfection
What must be considered for sterilisation
- the sterilisation process used (e.g steam sterilisation)
- type of cycle (e.g. Vacuum Type B or Non Vacuum Type N);
- any relevant cycle parameters (e.g. 134-137°C for a minimum holding time of 3 minutes).
What will vacuum benchtop sterilisers sterilise?
only reliably sterilize wrapped and hollow devices e.g. cannulated items like dental handpieces.
What is transport?
All sterile or sterilized devices must be transported in clean dry conditions in a manner that provides segregation from sources of water and contamination, and provides mechanical protection to prevent damage to devices and flexible packaging (sterile).
What is storage
-environmental conditions of storage areas must ensure integrity of all materials and products, i.e. clean, dry, well ventilated and secure.
- storage areas should be protective to prevent contamination or deterioration of the product.
- items w/ damaged packaging should not be used.
-stock rotation should be used for storage, i.e. FIFO (First in, First out).
-labelling of equipment should following approved methods (see BS EN 868 series)
-NO PEN OR PENCILS = will puncture the sterile packaging
What is use?
Single use sharps devices must be disposed of at chair side into an appropriate waste disposal stream.
What is transportation (Dirty)
Used devices must be transported in a clean solid walled, rigid, durable leak proof container with a tight-fitting lid to protect the instruments from damage.
If dirty instruments are transported through public access areas= must be appropriately labelled, colour coded.
What is disposal?
Consider appropriate waste stream
Manual washing
-only be carried out in facilities,
-using procedures when manufacturer’s instructions state, which:
* Ensure the safety of the operator;
* Provide an effective cleaning method;
* Minimise the possibility of cross-contamination of devices being cleaned;
* Minimise the possibility of contamination of devices with residual process chemicals;
* Do not damage the devices being cleaned;
These should be documented in a manual wash procedure. Record details of items processed
Ultrasonic cleaner
preferred “back up” cleaning method if AWD is unavailable
Specification should include:
* Control of process time and temperature
* Lid interlock
* Choice of detergent according to manufacturer’s instructions
* Dispenser for known volumes of detergent according to manufacturer’s instructions.
* Choice of load carrier(s) appropriate to nature of devices to be processed.
* Handpieces processed in accordance with the devices manufacturer’s instructions
* Chamber drain tap to allow chamber to be emptied
Operation of ultrasonic
Operation: Documented procedure should specify the following;
* Correct loading procedure
* Correct choice of operating cycle time
* Operating temperature
* Correct choice of detergent
* Draining of ultrasonic bath at 4 hourly intervals or sooner if grossly contaminated
* Record details of items processed
operating principles of automated washer disinfectors
AWD: Specification
* Independent monitoring and recording of process temperature
* Pass through design preferred
* Detergent in accordance with manufacturer’s instructions
* Choice of load carrier(s) appropriate to nature of devices to be processed.
* Cycle in progress and failed cycle interlocks
* Low-level detergent alarm/interlock
AWD Operation
Documented procedure: this should include;
- Loading procedure,
- Choice of operating cycle,
- Choice of detergent
- Trained staff
- Record details of items processed
5 stages of AWD
- Flush: removing gross contamination from the items in the load with water at a temperature not exceeding 35°C.
- Wash: removing any remaining soil by washing with water, water and detergent, or water and enzymic cleaner. Several sub-stages may be used consecutively to provide a combination of treatments; physical removal of the soil by the action of water jets.
- Rinse: removing any residual detergent or enzymic cleaner. This stage may be combined with the thermal disinfection stage which follows;
- Disinfection: raising the temperature of the load to the preset temperature (using hot water) and maintaining the temperature for the required disinfection holding time.
- Drying: purging the load and chamber with heated air to remove residual moisture.
