LDU Practical

Question 1

What are the stages of the decontamination cycle

Answer 1

1. Acquisition
2. Cleaning
3. Disinfection
4. Inspection
5. Packaging
6. Sterilisation
7. Transport
8. Storage
9. Use
10. Transportation (Dirty)

Question 2

What is acquisition?

Answer 2

-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

Question 3

What are the 3 types of cleaning?

Answer 3

Choice of methods:
- Manual
- Ultrasonic
- Automatic washer disinfector

Question 4

What method of cleaning is preferred and why?

Answer 4

Automated cleaning is preferred to manual cleaning due to:
–> the reproducibility and control of the process.
–> it is more readily validated

Question 5

What is cleaning?

Answer 5

-Physically removes contamination from the medical device

Question 6

What may cleaning involve?

Answer 6

a disinfection element such as in the use of a washer-disinfector.

Question 7

What does the type of cleaning depend on?

Answer 7

the equipment being cleaned and the type of contamination being removed

Question 8

What is disinfection?

Answer 8

reduce the number of viable microorganisms and may not necessarily inactivate certain viruses and bacterial spores

Question 9

Methods of disinfection + what does it depend on?

Answer 9

• 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.

Question 10

When is disinfection required

Answer 10

• Disinfection is required for contaminated equipment prior to handling and inspection, before packaging and sterilization.

Question 11

What is inspection and when does it take place

Answer 11

Following cleaning.
All instruments should be carefully examined for organic material and/or damage under magnification

Question 12

Who is inspection/maintenance or testing carried out by?

Answer 12

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

Question 13

What is packaging

Answer 13

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.

Question 14

When are items sterilised

Answer 14

following cleaning and disinfection

Question 15

What must be considered for sterilisation

Answer 15

• 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).

Question 16

What will vacuum benchtop sterilisers sterilise?

Answer 16

only reliably sterilize wrapped and hollow devices e.g. cannulated items like dental handpieces.

Question 17

What is transport?

Answer 17

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).

Question 18

What is storage

Answer 18

-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

Question 19

What is use?

Answer 19

Single use sharps devices must be disposed of at chair side into an appropriate waste disposal stream.

Question 20

What is transportation (Dirty)

Answer 20

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.

Question 21

What is disposal?

Answer 21

Consider appropriate waste stream

Question 22

Manual washing

Answer 22

-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

Question 23

Ultrasonic cleaner

Answer 23

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

Question 24

operating principles of automated washer disinfectors

Answer 24

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

Question 25

5 stages of AWD

Answer 25

1. Flush: removing gross contamination from the items in the load with water at a temperature not exceeding 35°C.
2. 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.
3. Rinse: removing any residual detergent or enzymic cleaner. This stage may be combined with the thermal disinfection stage which follows;
4. Disinfection: raising the temperature of the load to the preset temperature (using hot water) and maintaining the temperature for the required disinfection holding time.
5. Drying: purging the load and chamber with heated air to remove residual moisture.