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principles of surgery > Sterilization and Disinfection > Flashcards

Sterilization and Disinfection Flashcards

1
Q

What is Disinfection?

A

• Reduction or destruction of most pathogenic microorganisms on inanimate (nonliving) objects

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2
Q

What is a Disinfectant?

A

• Chemical agents that reduce microbial load on inanimate objects

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3
Q

What is Sterilization?

A

• Elimination of all microbes on an inanimate object

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4
Q

What is an antiseptic?

A

Antiseptic
• Chemical agents that reduce microbial load or inhibit growth of microbes on living/animate
objects

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5
Q

What is Sterility?

A

Sterility
• Absence of all forms of microbial life only inanimate objects

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6
Q

What are environments that have low level contamination?

A

Low level
• Reception desks
• Offices
• Walls
• Doors

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7
Q

What are environments that have high level contamination?

A

High level contamination
• Kennels/housing
• Exam tables
• Operating tables/floors

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8
Q

What items need critical level disinfection?

A

Equipment, implants entering body sterile tissue, cavity, or blood stream, surgical instrument

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9
Q

What items need semi-critical level of disinfection?

A

Equipment that comes in contact with skin
or mucous membranes without penetrating body or cavity
- Colonoscopes, flexible endoscopes, endotracheal tubes, anesthetic equipment, vaginoscope

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10
Q

What items need non critical disinfection?

A

Equipment that comes in contact with intact skin or mucous membranes but not directly associated with surgery
Laryngoscope, stethoscope, ultrasound probe, blood pressure cuffs, ECG leads, pulse oximeters, exam tables

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11
Q

Which of the following items should be sterilized?
A.) Colonoscopes/ Endoscopes
B.) Surgical instruments
C.) Endotracheal tubes
D.) EKG leads

A

B surgical instruments

(they will be entering the body.)

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12
Q

Which of the following items requires semi critical disinfectant?

a. ) Ultrasound Probes
b. ) Surgical Implants
c. ) Endoscopes
d. ) Catheters

A

c.) endoscopes

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13
Q

Which of the following items requires non critical disinfectant?

a. ) Laryngoscope
b. ) Suture material
c. ) Vaginoscope
d. ) Urinary catheters

A

a.) laryngoscope
Should be disinfected but do not require reduce microorganisms but since sterility specific handling between is not maintained during procedure patients* Should be terminally cleaned sterility isn’t required. Te r m i n a l when done for the day

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14
Q

Does Isopropyl Alcohol disinfect bacteria? Virus? Fungi? Spores?

A

yes, yes, yes, no

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15
Q

Does povidone- iodine disinfect bacteria? Virus? Fungi? Spores?

A

yes (quickly), yes, yes, yes

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16
Q

Does chlorhexidine gluconate disinfect bacteria? Virus? Fungi? Spores?

A

yes (quickly), poorly, poorly, no

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17
Q

Does alcohol based solutions disinfect bacteria? Virus? Fungi? Spores?

A

yes , sometimes, sometimes, sometimes

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18
Q

How does alcohol help surgeons prior to surgery?

A

Helpful in removing excess lipids on the skin prior to
surgery

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19
Q

Is alcohol used as a cold sterile agent?

A

no

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20
Q

Is alcohol bacteriostatic or bacterocidal?

A

Activity
• Bactericidal (bacteriostatic at lower
concentrations)
• Kills many fungi and viruses

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21
Q

Which antiseptic is the most effective?

A

Povidone-iodine (PVI)

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22
Q

Which antiseptic is the least effective?

A

Chlorhexidine Gluconate

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23
Q

What is Povidone- iodine? Does it leave a residue?

A

Activity
• Bactericidal • Fungicidal • Effective against viruses • Sporocidal (15 min contact time)

• Minimal residue
• Effectiveness decreased in presence of organic
material

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24
Q

What is the concentration of iodine for wound management?

A

0.1 to 1% solution

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25
Q

What is the concentration of iodine for surgical prep?

A

10% scrub/solution

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26
Q

What is the activity of chlorhexidine gluconate?

A
  • Activity
  • Bactericidal (rapid; GM + > GM-) • Minimal activity against viruses and fungi • Not sporicidal
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27
Q

Does chlorhexidine leave a residue? Why? Is it easily inactivated?

A
  • Residual activity due to keratin binding
  • Not inactivated by organic debris, alcohol, or soaps
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28
Q

What is the concentration of chlorhexidine for wound management?

A

• For wound management: 0.05% solution

29
Q

What is the concentration of chlorhexidine for surgical prep?

A

For surgical prep: 4% scrub/solution

30
Q

What is the activity of alcohol based solutions?

A

Activity
• Has superior antimicrobial activity than PVI, CHG,
or IPA alone

31
Q

Which disinfectant/ antiseptic is best for spores?

A

Povidone- iodine

32
Q

Which disinfectant/ antiseptic is best for bacteria?

A

alcohol based solutions

33
Q

Which disinfectant/ antiseptics are best for viruses?

A 
Isopropyl Alcohol (IPA) 
and Povidone-iodine (PVI)
34
Q

What are the types of sterilization available?

A
  • Steam Sterilization
  • Chemical (Gas) Sterilization
  • Ethylene oxide
  • Plasma sterilization (hydrogen peroxide gas)
  • Gas plasma
  • Peracetic acid sterilization
  • Ionizing radiation (gamma)
  • Cold chemical sterilization
35
Q

What kind of gas is used in chemical gas sterilization?

A

Ethylene oxide

36
Q

What kind of gas is used in plasma sterilization?

A

hydrogen peroxide gas

37
Q

How does steam sterilization work? Is it common?

A

Saturated steam destroys microorganisms by
coagulation and cellular protein denaturation
• Cylindrical machine
• Very common

38
Q

What are the benefits of steam sterilization?

A
  • cheap
  • non toxic/ safe/ simple
  • effective
  • Can be used for wrapped and unwrapped items
  • Quick turnaround
39
Q

What are the cons of steam sterilization?

A
  • not suitable for heat sensitive items
  • potential for injury if used incorrectly/ not maintained
  • Requires care and maintenance.
40
Q

What is a gravity displacement sterilizer?

A

Gravity displacement sterilizer:
• Works on principle that air is heavier than steam • Pressurized steam goes from outer to inner chamber • Microbial death is dependent on
• Exposure time (minimum 10-30 mins based on what is being
sterilized) • Temperature (250° F- 275° F) • Pressure 15-18 PSI
• Dependable, simple design, affordable

41
Q

What is a prevaccum sterilizer?

A

• Allows sterilization in harder to reach spaces through a vaccum mechanism • Porous items with hard to reach spaces • 3 to 4 minutes at 270°F to 275°F

42
Q

What is a flash sterilizer?

A

• Flash sterilizer:
• Should only be used in emergencies when
no alternative is available • Uses gravity displacement sterilizer
• Metal tray • Metal nonporous items (items without
lumen)
• 3 minutes at 270° F to 275° F
• Metal items with lumen and porous items
(rubber, plastic, autoclavable power tools)
• 10 minutes at 270° F to 275° F

43
Q

What are reasons for failure of a steam sterilizer?

A

• Inappropriate packing or loading • Poor steam quality • Vacuum failure • Inadequate temperature

44
Q

What is a gas sterilizer? What are pros and cons for it?

A

Ethylene Oxide (EtO)
• Flammable gas
• Gas diffusion
• Lengthy time cycle
• Aeration
• Toxic
• Efficacy dependent on:
• [Gas]
• Temperature
• Humidity
• Exposure time

Pros: Sterilizes heat / moisture sensitive equipment.
Cons: Expensive, lengthy cycles, hazardous.

45
Q

What is plasma sterilization? What is the pros and cons for it?

A

• Hydrogen Peroxide (H2O2)
• Low temp sterilization
• “Rapid”
• No drying needed
• Uses UV photons and radicals
• Kills microorganisms by oxidation
Pros: Sterilizes heat/ moisture sensitive items (# 1 option), quick turn around, no harmful emissions.
Cons: Gas cannot penetrate linen, gauze/ wood products/ some plastics. Requires specific synthetic packaging. Sterilization chamber is relatively smaller than an ETO sterilizer.

46
Q

What is Ionizing Radiation? What is the pros and cons for it?

A

(Gamma)
• Low temperature sterilization process
• Useful for heat sensitive
equipment
• Only commercial use since it’s so
expensive
• Uses cobalt 60 gamma rays

Pros: High penetrating power, rapidity of action, low temperature, flexibility.
Cons: Expensive, dangerous, can cause breakdown of packing material or product.

47
Q

What is Peracetic acid sterilization? What are the pros and cons for it?

A

Low temperature liquid immersion
sterilization • Good for heat sensitive items • For immediate use of items
• No long term storage

Pros: Sterilizes heat intolerant items , Rapid sterilization cycle, Low temperature, Safe

Cons: Only applicable for immersible instruments, Can be expensive, No sterile storage

48
Q

What is cold sterilization?

A

Liquid chemicals sterilize instruments
• Noncorrosive • Effect depends on contact (immersion) time
• Disinfection = 10mins
• Sterilization = 10hrs

49
Q

What are the chemicals that can be used for cold sterilization?

A
  • Chemicals can include
  • Glutaraldehyde 2%
  • Ortho-phthalaldehyde (OPA) (Cidex OPA)
  • Hydrogen peroxide 7.5% (Sporox II)
50
Q

How should you handle instruments from cold sterile after they have been sterilzed?

A

• Instruments should be rinsedwith sterile water
and dried with sterile towels

51
Q

What items should you sterilize with steam sterilization?

A

Heat-tolerant and moisture ~tolerant items (ex. surgical instruments, surgical gowns, towels)

52
Q

What items should you sterilize with ethylene oxide (EtO)?

A

Heat-intolerant and moisture ~intolerant items (ex. plastics, endoscope, power cables, camera)

53
Q

What items should you sterilize with gas plasma (H2O2)?

A

Heat-intolerant items (ex. most plastics; adaptor required for items with lumen)

54
Q

What items should you sterilize with ionizing radiation?

A

Most single-use, prepackaged items (ex. suture material, punch biopsy, disposable surgical gown)

55
Q

What items should you sterilize with paracetic acid?

A

Variety of medical and surgical instruments (ex. flexible endoscopes; special connector required for lumened endoscopes) *Only immersible instruments*

56
Q

What items should you sterilize with cold chemical sterilization?

A 
Items containing metal, rubber or plastic and/or 
lensed instruments (endoscopes, cystoscopes, bronchoscopes, arthroscopes)
57
Q

What are the components needed to be wrapped in surgical packs? How should they be wrapped?

A

Components needed for surgery in one
sterile pack
• Gown + towel • Instruments + gauze • Miscellaneous items
• Wrapping material depends on method
of sterilization

58
Q

When are paper bags used for surgical equipment, and what are the pros and cons of this kind of wrap?

A
  • Paper bags
  • Small light, non- sharp items
  • Cotton balls • Gauze

Pros: Cheap, easily obtained
Cons: easily perforated when wet, items cant be visualized, heavy items can break through

59
Q

What linen materials are used for wrapping materials?

A
  • Linen material
  • Usually cotton blend (muslin or linen) • Synthetic material
60
Q

What are laminated sleaves/ pouches/ packs made of? What are the pros and cons of these packs?

A

• Laminated sleeves/packs/pouches
• Combination of transparent heat stable
plastic film laminated to treated paper

Pros: Cheap/ easily obtained, pre cut, several small items can fit at once, instruments can be identified.
Cons: Easily perforated when wet, heavy items can break through

61
Q

What is the purpose of instrument containers? What are they made of?

A
  • Instrument containers
  • Aluminum and stainless steel
  • Store a wide range of surgical instruments
62
Q

What is the procedure for preparing instruments for surgical pack wrapping?

A
  • Cleaning and sonicating instruments
  • Pre clean rinse
  • Instrument soak
  • Cleaning
  • Manually • Ultrasonic cleaning equipment
  • Post clean rinse
  • Instrument drying
63
Q

What is the procedure for wrapping a surgical pack

A

Varies based on the pack but should:

  • Place and organize instruments
  • Add drape and gauze
  • Add sterile indicator
  • Wrap (2x)
  • Secure with autoclave tape
  • Sign and initial
64
Q

What different sterilization indicators can be used? Why do we use them?

A

• Monitors effectiveness of the sterilization process • Chemical indicators:
• Chemical change occurs in response to heat, pressure and/or
humidity but NOT exposure time

  • Does not confirm sterility
  • Biological indicators:
  • Only means of ensuring sterility following sterilization
  • Sterility is assessed using bacteria maintained in a broth or on a strip
65
Q

What is important to remember about wrapping surgical packs?

A

All surgical items should be wrapped so they can be easily unwrapped without breaking sterile technique

66
Q

What is the purpose of folded towels in packs?

A
  • Used to dry hands
  • Used as drapes
67
Q

What are important tips to remember when making packs?

A
  • Incomplete surgical packs may drive you crazy!
  • What you wrap your pack in is very important!
  • How you wrap a pack can affect whether it can be opened aseptically
  • Use autoclave tape…not masking tape
  • When wrapping pouches, ensure handles face the opening for the vet
  • Multipart instruments should be double wrapped
  • How you place an instrument will affect whether it is sterile
  • Correct sealing of bags is essential
  • Do not reuse single use laminated pouches, bags, and wraps
  • Keep in mind where you label and with what
68
Q
A

principles of surgery (14 decks)

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