Lecture 2 - Preparation of Surgical Packs and Team

Question 1

How often should instruments be cleaned?

Answer 1

ASAP after each use

Question 2

What does cleaning instruments remove?

Answer 2

Organic debris and inorganic salt that can affect sterilization

Question 3

What type of water should be used to clean instruments and why?

Answer 3

Distilled or deionized; avoids excess salt, has neutral pH

Question 4

What type of scrub brush should be used to clean insturments?

Answer 4

soft

Question 5

T/F: Instruments should not be soaked

Answer 5

True

Question 6

What type of cleaner should be used for the instruments?

Answer 6

One specific for instruments

Question 7

What is a part of regular instrument maintenance?

Answer 7

lubrication

Question 8

How should instruments be dried?

Answer 8

With a clean cloth in a timely manner

Question 9

What are the 4 sterilization methods?

Answer 9

1. Steam (autoclave)
2. Hydrogen peroxide gas plasma
3. Ethylene oxide
4. Vaporized hydrogen peroxide

Question 10

What is the most common method of sterilization and why is it used so often?

Answer 10

Steam autoclaving;

Inexpensive, easy to use, non-toxic, penetrates packs

Question 11

What is a disadvantage of ateam autoclaving?

Answer 11

May damage heat labile items such as endoscopes and anesthesia tubes

Question 12

What is the temp of autoclaves?

Answer 12

HOT!!!!!!!!!!!

Question 13

What are the 2 types of steam autoclaving?

Answer 13

Gravity displacement and pre-vacuum

Question 14

What type of steam autoclaving is most common?

Answer 14

gravity displacement

Question 15

Under what principle does gravity displacement autoclaving work?

Answer 15

Air is heavier than steam, is passive

Question 16

Under what principle does pre-vacuum autoclaving work?

Answer 16

Active movement of air out of the chamber

Question 17

What temp/time does the ISU autoclave use?

Answer 17

121 degrees C for 30 min, 15 min dry time

Question 18

What are chemical sterilization indicators?

Answer 18

Impregnated paper strips or tape change color when a certain temperature is met

Question 19

T/F: Chemical sterilization indicators do not reflect duration of exposure and do not indicate sterility

Answer 19

True

Question 20

What are biological sterilization indicators and how often should they be used?

Answer 20

Highly resistant, non-pathogenic, spore-forming on paper or in glass vial placed in autoclave;
Use once weekly to ensure effective sterilization process

Question 21

How do biological sterilization indicators work?

Answer 21

After cycle is completed, indicator is cultured;

Any growth indicates failure of sterilization

Question 22

Who/what is responsible for ensuring efficacy of sterilization in practice?

Answer 22

you

Question 23

What are the contents of our surgical packs?

Answer 23

Instruments
1 blue huck towel
20 4x4s - sponge count
1 paper patient drape
4 green huck towels
2 gowns
2 teri towels per gown
2 wraps

Question 24

What is the purpose of pack preparation?

Answer 24

To allow penetration of sterilization agent and sterile handling of equipment prior to use

Question 25

What are the steps of wrapping an instrument pack?

Answer 25

1. Wrap the pack in a clean huck towel 2. Place a pack wrap on a large clean surface 3. Fold the corner closest to you over the tray, fold in edge 4. Fold the right corner over the pack repeat on left 5. Turn around the pack and fold in the far corner, tucking it under the previous folds 6. Repeat with a second layer, apply chemical indicator tape, date, initial

Question 26

What are the steps to folding/wrapping a gown?

Answer 26

1. Place a clean gown on a clean, flat surface, front facing up 2. Fold the sleeves toward the center of the gown 3. Fold the sides of the gown to the center midline (seams align) 4. Fold the gown in half longitudinally 5. Begin fanfolding the bottom of the gown to neck 6. Fold hand towel in half, fanfold similarly, dog ear 7. Wrap the gown with the towel on top in a double wrap

Question 27

What is the ideal environment for pack storage?

Answer 27

Cool, dry and temp controlled environment

Question 28

What is the shelf life of a pack dependent on?

Answer 28

type of materials used; consult autoclave manufacturer recommendations

Question 29

When should you NOT use a pack?

Answer 29

If the seal is broken or the packaging is damaged

Question 30

What should you have on your feet each time you enter the OR?

Answer 30

Shoe covers

Question 31

Masks have a _____ filter to contain _____.

Answer 31

hydrophilic; respiratory secretions

Question 32

What type of nail polish is associated with increased bacterial load?

Answer 32

Those that are >4 days old

Question 33

What is the purpose of the surgical scrub?

Answer 33

1. Mechanical removal of dirt and oil 2. Reduction of the transient bacterial population 3. Depression of the skin's resident bacteria

Question 34

What are 3 types of surgical scrubs?

Answer 34

1. Chlorhexidine gluconate 2. Povidone-iodine 3. Hexachlorophene

Question 35

What are some types of alcohol-based (brushless/rinseless) surgical scrubs?

Answer 35

1. Triseptin 2. Avagard 3. Sterillium rub 4. Purell waterless surgical scrub 5. Endure 450

Question 36

What is the method to scrubbing?

Answer 36

1. Open brush, place package on sink ledge 2. Clean under nails with pick if necessary 3. Hands above elbows - coat arms with chlorhexidine from fingers to elbows 4. Scrub each side of finger, between fingers, back and front of hand 10-20 times for each location 5. Scrub arms by washing each side (from wrist to elbow), alternating between arms. 6. Rinse both hands and arms by passing thru the water in one direction only (fingertips to elbows) 7. Proceed to OR holding hands above elbows (open door with your back) 8. Dry hands and arms using the sterile towel in your pack with aseptic technique

Question 37

What is the contact time for scrubbing and when does it begin?

Answer 37

4 min; begins when you coat your arms with the scrub solution

Question 38

When should you gown?

Answer 38

After you scrub and before you glove

Question 39

When should you glove?

Answer 39

After gowning and prior to handling sterile items

Question 40

Statistically, how often are there glove perforations during surgery and how many holes?

Answer 40

43% of the time, 2.3 holes avg per sx

Question 41

How can you prevent bacterial contamination from holes in the gloves?

Answer 41

Double glove or change gloves during key times such as handling of implants, closure of an enterotomy or pyometra site