Midterm Week 4 (Instrument Processing) Flashcards
Autoclave =
A steam sterilizer (uses moist heat in the form of saturated steam under pressure)
Bioburden =
A population of viable microorganism on a product
Tests to see if the Autoclave work (2)
1) Biological Indicators
2) Bowie-Dick Test
Biological Indicators =
= A sterilization monitor consisting of a known population of resistant spores that is used to test the sterilizer’s ability to kill microorganisms
Bowie-Dick Test =
= An air removal test designed to test the ability of the autoclave to remove air and gases from the chamber and of steam to penetrate into a specific pack
Chemical Indicator =
= Device used to monitor one or more process parameters in the sterilization cycle. The device response with a chemical or physical change (usually a color change). They are usually supplied as a paper strip, tape, label that changes color when parameters are met
Disinfectant =
= An antimicrobial agent used to destroy microorganisms on inanimate surfaces
Disinfection =
= Process that destroys pathogenic microorganisms through the use of liquid chemical germicide. Does not kill high number of spores
Note: Does not provide same margin of safety asctd with sterilization.
Flash Sterilization =
= (immediate use sterilization) - steam sterilization process for sterilizing items that are needed immediately ex) emergency: when inst. Falls and central sterile doesn’t have any
Spore =
= An inactive or dormant, but viable state of microorganism that is diff to kill. Sterilization methods are monitored by their ability to kill a known pop of highly resistant spores
Sterile =
= Free of all viable organisms, including spores
Sterilization =
= A process that kills all living microorganisms, including spores
Biofilm =
= A collection of microscopic organisms that exist in a polysacchride matrix that adheres to a surface and prevents antimicrobial agents from reaching the cells
Contaminated =
= Refers to items that are not sterile → soiled or potentially soiled, that were open for surgery, whether or not actually used
Decontamination =
= Process that renders a contaminated item safe for handling, accomplished manually or with an automated system
Washer-Decontaminator =
= Automated processing units used to decontaminate instruments; includes washing and rinsing and maybe ultrasonic cleaning
Washer Sterilizer =
= An automated processing unit used to decontaminate AND sterilize instruments; includes washing, rinsing, and sterilization. Instruments processed in this manner are not ready for patient use and must go through final sterilization process
Nursing Diagnosis rt surgical instrumentation
High risk for infection secondary to contact with contaminated instruments and injury from instrumentation failure
Nursing Responsibilities for surgical instrumentation
- knowledge of principles of cleaning, inspecting, packaging and storage of sterile supplies
Desired pt outcome rt surgical instrumentation
- Freedom of Infection rt postop wound infection/SSI
Central Sterile processing is considered what type of area? what should be worn?
Semi restricted = hair cover, proper OR attire
Spaulding Classifications of Items (3)
1) Critical
2) Semicritical
3) Non-Critical
1) Critical =
Critical items (4)
= Must be sterile, items that come in contact with sterile tissue or the vascular system
- Surgical instruments, Orthopedic implants, Sutures, Cardiac Caths
2) Semicritical =
Semicritical items (3)
= High-level disinfection* but may be sterile: Items that contact unbroken mucous membranes but do not penetrate them
- Thermometers, Cytoscopes, Dental Dams
3) Non-Critical =
Non-Critical items (3)
= Low-level disinfection: contact skin
- Crutches, BP cuffs, Stethoscopes
What is Spaulding Classification used for?
To determine whether an item must be sterilized or whether disinfection is sufficient
Methods of Sterilization are chosen based on what?
Choice of method depends on compatibility of item to be sterilized with sterilization process, configuration of item, required equipment, cost, availability, safety factors, packaging of item and length of time of sterilization process. Each method has advantages & disadvantages
Types of Sterilization (2)
1) Thermal Sterilization
(Autoclave - Gravity Displacement/Prevacuum Sterilizer)
2) Chemical Sterilzation
(EO/Low Temp Hydrogen Peroxide Gas Plasma)
Autoclave
- Is e____, s____, and e____
- Used for the ____ of _____
- For sterilization to be achieved, what must happen?
- economical, safe, effective
- majority of instruments
- steam must penetrate every fiber of packaging and contact every surface of the item, and intended parameters be met
What are the parameters of the autoclave? (4)
1) Moisture/Humidity
2) Temperature
3) Time
4) Pressure
What is autoclave made up of?
Rectangular metal chamber and a shell
What is the term for the space in between the chamber and the shell?
Jacket
What happens when the autoclave is activated?
Steam and heat fill the jacket and maintained at constant pressure, keeping autoclave in heated ready state
Autoclave Advantages
Steam is:
- A____, F___, E____, and E____ safe
- ______ with most in house _____ materials
- leaves no ____ residue
- Suitable for a ____ range of instruments
- Available, Fast, Economical, Environmentally
- Compatible, packaging
- Toxic
- Wide
Autoclave Disadvantages
- Variety of instruments cannot withstand?
- Prone to?
- _____ of sterilization cycle must be _____
- moist heat above 250 F (like endoscope, but most stainless steel can)
- operating error
- Timing, adjusted
Two Types of Steam Sterilizers (Autoclaves)
1) Gravity Displacement
2) Prevacuum Sterilizer
Gravity Displacement =
= Air in chamber is displaced by gravity. As steam enters from a port located near the top and rear of the chamber, it is deflected upward. Air is heavier than steam and by force of gravity, the air is forced to the bottom while steam rides on top of air
Prevacuum Sterilizer (Dynamic Air Removal) =
= Vacuum pump evacuates air from chamber before injection of steam
Gravity Displacement Disadvantages (2)
Length of time
Dependence on gravity to remove air
Prevacuum Sterilizer Advantages
- ______ _____ of objects inside chamber will have ____ impact upon air removal
- Entire load will heat r_____ and more u____
- Autoclave may be used to _____ capacity
- Incorrect placement, less
- rapidly, uniformly
- maximum
Prevacuum Sterilizer Disadvantage (1)
- In event of a leak, air pocket can form and inhibit sterilization
IUSS (Immediate Use Steam Sterilization) =
- when no ____ available
- IUSS should not be used for?
= “sterilization of items intended for immediate use and cannot be stored for later use” (quick way to sterilize an unwrapped item)
- replacement
- routine sterilization or whole sets of instruments
Chemical Sterilization (2)
1) Ethylene Oxide Gas (EO)
2) Low Temperature Hydrogen Peroxide Gas Plasma
Ethylene Oxide Gas (EO) =
= a toxic gas used to sterilize items that cannot tolerate temperature and moister of steam sterilization. Achieves sterilization by interfering with protein metabolism and reproduction of cell
What is EO Gas used for? (4)
- flexible and rigid endoscopes
- plastic goods
- instruments with electrical components
- delicate instruments that will dull after repeated steam sterilization
What are the parameters for EO Gas sterilization? (4)
- Temperature
- Humidity
- Exposure Time
- Gas Concentration
EO Gas Advantages (4)
- Effective against all types of microorganisms
- Does not require high heat
- Noncorrosive
- Effectively penetrates large bundles and permeates all porous items
EO Gas Disadvantages (5)
- Toxic (Carcinogen)
- Lengthy time
- Highly flammable
- Strict local, state, and federal regulations
- More expensive
Low Temperature Hydrogen Peroxide Gas Plasma =
= radio frequency or electrical energy & hydrogen peroxide vapor within vacuum effectively kills microorganisms
Low Temperature Hydrogen Peroxide Gas Plasma Advantages (5)
- Safe alternative to EO (not toxic)
- Short time
- Hydrogen peroxide is compatibile with most metal and plastics
- Simple to operate
- No plumbing or drains
Low Temperature Hydrogen Peroxide Gas Plasma Disadvantages (1)
- Not compatible with powders, liquids, linen, gauze and paper
Before it can be assumed that a sterilizer is working properly and that an article can be considered sterile, certain parameters must be met (4)
Time
Humidity
Pressure
Temperature
Indicators are used to monitor these parameters, indicators provide opportunity for a variety of personnel to check the process (3)
Mechanical (Physical) Indicators
Chemical Indicators
Biological Indicators
Physical Monitors =
= Graphs, Temperature, Pressure Recorders, Digital printouts and gauges that record activity during sterilization
Biological Indicators =
- __-__ indicators placed _____
- ______ after sterilization for ___ hours
- growth reading =
= Strips, Ampoules, Capsules that contain highly resistant spores
- 1-2, inside
- Incubation, 24
= sterilization conditions not met → requires sterilizer to be taken out of service
Which indicator is the most accurate method of ensuring efficacy of the sterilizer?
Biological Monitors
How often should steam sterilizers be tested with the Biological Monitor?
Daily
Chemical Indicators =
= Tapes, Strips, Labels impregnated with dye or chemical that develops visual or physical change when certain conditions are achieved
The Bowie-Dick Test is what type of indicator?
Chemical indicator - to test efficacy of air removal and steam penetration in pre-vacuum sterilizers
Where should chemical indicators be placed?
Inside and outside of all packages (possible to have an outside indicator pass and inside indicator fail)
Do chemical indicators establish sterility?
NO, they are tools to determine whether conditions of sterilization have been met
What does tape with black marks mean?
Tape with Black marks = has been processed/sterilized, may bring into OR, inside will be another tape indicator
Examples of Disinfectants (5)
- Alcohol, Chlorine, Formaldehyde, Glutaraldehyde, Hydrogen peroxide
Glutaraldehyde = high lvl disinfectant that is also capable of sterilization but bc of lengthy immersion period required to sterilize, rarely used
Levels of Disinfection (3)
1) Low Level Disinfection
2) Intermediate Level Disinfection
3) High Level Disinfection
Low Level Disinfection (3)
Vegetative bacteria, lipid viruses, some fungi
Intermediate Level Disinfection (4)
Vegetative bacteria, Viruses, Fungi, + Myobacteria
BUT NOT SPORES
High Level Disinfection (5)
Vegetative Bacteria, Virus, Fungi, Myobacteria
+ SOME SPORES
Intraoperative Cleaning =
= First and most important step in instrument decontamination is cleaning
- Contaminated instruments should be washes asap to prevent blood & debris from drying in crevices or on instrument surfaces
Should instruments be washed during procedure? using what?
Should be periodically wiped and or rinsed with wet lap sponge or immersed in sterile water NOT saline, lumens should be flushed
Postoperative Cleaning =
= start cleaning process ASAP → transported to dedicated decontamination area in leak-proof container
What should be done before instruments are cleaned? (4)
- Disassembled, Blade & drill bits removed from handles
- Sharps should be segregated from general instruments
- Box locks and other joints opened
- Heavy instruments placed on bottom
1) What if theres no automated washer?
2) Describe manual cleaning?
3) What should personnel wear during mechanical cleaning?
4) After mechanically cleaned, where do the instruments go?
1) May be manually cleaned
2) Mechanical cleaning in an automated system is preferable bc the process has been validated and is consistent
3) PPE
4) Placed in trays with wire open mesh bottom → then placed in washer sterilizer or washer-decontaminator where mechanical cleaning occurs
Ultrasonic Cleaning =
= dislodges and removes tenacious debris → using high intensity sound waves that generate tiny bubbles that expand until they collapse or implode and dislodge the debris
Ultrasonic Cleaning
- Some instruments such as flexible _______ & ______ instruments need special attention and include a complex multistep process
- Instruments with movable parts should be ->
- Instruments are inspected for ->
- endoscopes, robotic
- lubricated with an antimicrobial, water soluble lubricant
- cleanliness, integrity, alignment, sharpness of edges, and function
Packaging Materials are intended to do what? and should be compatible with?
To maintain sterility of items, should be compatible with sterilization process and device manufacture directions
Types of Packaging Systems (4)
Woven Fabrics
Non-Woven Fabrics
Plastic/Paper, Plastic/Tyvek pouches
Rigid Container Systems
Woven Fabrics =
Reusable?
Cotton and polyester-blend fabrics are used to wrap material after cleaning and before sterilization
- Reusable
What types of sterilization are woven fabrics compatible with and not with? (2), (1)
Steam and EO, not Hydrogen Peroxide
Nonwoven Fabrics
= Single use, disposable wrapper
What types of sterilization are non-woven fabrics compatible with and not with?
Steam and EO, not Hydrogen Peroxide
Plastic/Paper, Plastic/Tvek Pouches
Advantages (3)
Disadvantages (1)
= Used to wrap items in preparation for sterilization
- Inexpensive, permit visualization of contents, lint free
- Little resistance to puncture
Rigid Container Systems =
Advantages (1)
Disadvantages (2)
= Rectangular receptacles made from aluminum, stainless steel, heat resistant plastic, or combination. Lid and base held together by a latch or lock and key
- Durable and protects instruments from damage
- Weight (heavy) and potential for residual condensation
Must be washed, inspected and maintained prior to filling
What type of packaging is best?
Rigid Container
Shelf Life
1) Where should sterilized items be stored?
2) Where should sterile items vs clean items be stored?
1) Sterilized items should be stored in a well ventilated, limited access area with controlled temperature and humidity
2) Separately and not under sinks or other areas where may get wet
How long is an instruments shelf life?
- NO EXPIRATION DATE ON STERILITY, shelf life is event related, not time related
- A package is sterile until an event happens to render that package unsterile
