UNIT 1 ASEPSIS AND STERILIZATION

Question 1

What is the crucial responsibility of a surgical tech?

Answer 1

Preventing surgical site infection is one of the crucial responsibility of a surgical technologist

Question 2

3 COMPONENTS OF AN INFECTION

Answer 2

Source of causative organism (pathogen)
Mode of transmission
Susceptible host

Question 3

Mode of transmission

Answer 3

Direct contact-human-to-human without intermediate carrier
Indirect contact-human-to-object-to-human
Droplet
Airborne spread such as sneezing

Question 4

Example of an indirect contact

Answer 4

Occurs in surgery, when the instruments are not properly sterilized

Question 5

example of an airborne spread

Answer 5

Not wearing mask properly can spread bacteria from our nasopharynx into the air

Question 6

3 CATEGORIES OF SOURCES OF PATHOGENS IN SURGERY

Answer 6

Personnel
Environment
Patient

Question 7

2 CONTROL MEASURES FOR personnel PATHOGENS

Answer 7

handwashing, surgical scrub

good oral hygiene prevents you from having URI

Question 8

2 CONTROL MEASURES FOR environment PATHOGENS

Answer 8

sterilize instruments
Disinfect surfaces to kill fomites
Keep the OR door closed to maintain the positive pressure air flow; this keeps the cleanest air flowing over the patient and out rather than allowing less-filtered hallway air to flow into the OR

Question 9

2 CONTROL MEASURES FOR patients PATHOGENS

Answer 9

wash skin with an antiseptic

If there is an infection do not operate on patient until resolved (unless it’s urgent or emergent)

Question 10

Control measures to block personnel pathogens include:

Answer 10

Sterile gown and double gloves
Keep hair restrained and covered
Proper use and fit of mask

Question 11

What is the proper way to wear a mask?

Answer 11

The mask need to be tied at crown of head, snug nicely at neck and secured properly against the cheek and chin

Question 12

Susceptible host

Answer 12

Everyone can become a susceptible host for pathogens, unfortunately it is not possible to eliminate the patient or eliminate personnel in the case of blood borne pathogens

Question 13

3 HOST FACTORS THAT INCREASE THE RISK OF SURGICAL SITE INFECTION

Answer 13

Age- geriatric/pediatric patients often have reduced immune response due to failing system or immature system
We need a strong immune response but if malnutrition occurs it causes immune response to decrease making us more susceptible to pathogens.
Hospitalization will exposure the patient to numerous microorganisms as a result it will put additional stress on their immune system
Duration of procedure-The longer the skin is open, the more chances for bacteria to invade the site

Question 14

Key points to remember:

Answer 14

Our knowledge and safe practices help prevent SSI

There are several means to reduce or block the transmission of pathogens.

Question 15

5 KEY POINTS THAT ARE PART OF THE CONCEPT OF THE SURGICAL (STERILE) CONSCIENCE.

Answer 15

Honesty
     No reluctance to admit an error
Moral and ethical integrity
Responsibility
     Hesitation or lack of follow through unacceptable
Consistency
     EVERY situation
     EVERY patient
Recognize and correct errors in asepsis

Question 16

What is the “Golden Rule”?

Answer 16

Treat others as you would have them treat you
Safety and well-being of the patient comes first!
Be aware of other team members and help them!

Question 17

To develop a strong sterile conscience, we must:

Answer 17

Know correct practices and WHY those are correct
Be able to physically carry out the correct practices
And decide to do the correct practices

Question 18

PRINCIPLES OF ASEPSIS

Answer 18

A sterile field is created for each surgical procedure
Sterile team members must be appropriately attired prior to entering the sterile field
Movement in and around the sterile field must not compromise the sterile field.

Question 19

Purpose of OR attire

Answer 19

2 way barrier to protect the patient from us and protect us from the patient
Protect patient from unsterile staff to sterile wound
Protect us from the patient who may carry blood borne pathogens

Question 20

Components of OR attire

Answer 20

Scrub suit, mask, hair cover, shoe covers
PLUS:
Eye protection
Radiation protection PRN

Question 21

Hats – OSHA opinion

Answer 21

to provide protection to the patient from any organisms that may shed from the hair or scalp of surgical staff.
may be necessary to prevent splashes of blood or other potentially infectious material (OPIM) from the surgical site onto the surgeon(s) and/or others in the operating room.
the contaminated surgical caps must be laundered by the employer at no cost to the employee
dures are being followed and because contamination could migrate to the homes of employees

Question 22

3 important facts that support double gloving

Answer 22

Fat degrades latex
Barrier decreases over time
Lattice structure fills with fluid
Protect yourself and the patient!

Question 23

State required aspects of personal hygiene

Answer 23

Daily bath or shower
Shampoo hair properly
All hair must be completely contained in the cap
Short, clean nails (no polish); intact skin
Brush teeth daily, use mouthwash
No cologne or makeup

Question 24

5 guidelines for the proper use of masks.

Answer 24

Fit snuggly over nose, mouth, and to cheeks to prevent leaks
Improper tying prevents snug fit
Masks are either on or off
Handle by strings only when removing
Change mask after each case or when it is wet

Question 25

What is the purpose of the surgical scrub.

Answer 25

Remove as many microbes and skin debris as possible from hands and arms, rendering them surgically clean
It also suppress the growth of resident bacteria that may rise to the skin surface

Question 26

3 methods for a surgical scrub.o

Answer 26

Timed (5 minute, 3 minute)
Counted brush stroke
Alcohol-based waterless/brushless (Wipe on and air dry)
Other agents include:
     Chlorhexidine gluconate (CHG)
     Parachlorometaxylenol (PCMX)
     Iodophors (Betadine)
     Alcohol (“brushless scrub”, Avaguard, etc.)

Question 27

What is the purpose for using a sterile sleeve

Answer 27

To cover a small-well defined area of contamination on the gown sleeve.
It slips over the existing sleeve and covers the contaminated area, saving an entire change of gown and gloves during an operation

Question 28

4 options for replacing contaminated glove/s from best to least optimal technique.

Answer 28

Best: replace gown and gloves
Circulator removes glove; other sterile team member re-gloves you
Circulator removes glove; ST re-gloves using open technique
Least: don glove over contaminated glove

we are double-gloved, so the contaminated outer glove is simply removed and replaced with a new outer glove.

Question 29

4 recommendations for the STSR to follow when preparing instruments for decontamination.

Answer 29

Place heavy items at the bottom of a tray; protect the delicate items
Disassemble instruments with multiple parts
Soak instruments or spray with enzymatic foam

Question 30

3 advantages and 2 disadvantages of the 3 types of packaging used for sterilization.

Answer 30

Nonwoven (synthetic material) wrappers
Advantages-no lint; impervious and tear-resistant
Disadvantages-expensive and single use only
Paper/plastic and Tyvek pouches
Advantages-Inexpensive; plentiful supply; porous
Disadvantages-fragile; turns brittle in dry conditions, tears and punctures easily
Woven
Advantages-reusable and easily penetrated by sterilants
Disadvantages-least effective at providing a barrier, cannot be used with EtO
Rigid instrument containers
Advantages-Perfect solid barrier, no tears possible, easy open
Disadvantage-expensive, but last for many years

Question 31

5 practice guidelines for pouch packaging.

Answer 31

Peel off strip and seal carefully and completely
Place item inside, cut roll, heat-seal ends
Do NOT use staples to close package!•Do NOT use rubber bands, paperclips or tape
Protect sharp edges with permeable tip protectors
Orient item when placing in pouch for easier delivery/grasp
Use correct size pouch for item

Question 32

recommended weight limit for instrument sets and explain the reason for the weight limit.

Answer 32

Instrument sets should not exceed 25 pounds

Because the density of contents affects the ability of the sterilizing agent to contact all parts

Question 33

5 tips for preparing and loading items for sterilization.

Answer 33

Use special trays for micro-instruments
Place instruments in a mesh-bottom tray with a towel lining the bottom
Heavy items on bottom or side of tray to prevent damage to more delicate items
Tilt reusable light handles to prevent condensation
Instrument trays placed flat on sterilizer cart

Question 34

5 practice guidelines for immediate-use (flash) sterilization.

Answer 34

Immediate-use sterilization is defined as an urgent process for sterilizing unwrapped items
Don’t misuse to compensate for lack of inventory
Should not be used for implantable items
270° F; no drying time needed because there are no wrappers
Composition of item determines exposure time
Reserved for items needed immediately
Items must be decontaminated and disassembled first

Question 35

3 major types of monitoring for the sterilization process

Answer 35

Mechanical
Chemical
Biological

Question 36

Example of mechanical monitoring

Answer 36

Older type of monitors include chart recorders, thermometers, pressure gauges
Modern monitors provides digital printout provides a record of those parameters

Question 37

Example of chemical monitoring

Answer 37

External 
     Autoclave tape 
     Dots on paper side of peel packs
     Locking devices (plastic tags) with dots for canisters
Internal
Paper strips (aka. “OK” strips)

Question 38

Example of biological monitoring

Answer 38

Uses a known number and type of microbe
Only type that assures kill conditions were met
If one shows growth, all items from that load must be pulled from shelves
Steam sterilization uses: Geobacillus stearothermophilus
Hydrogen peroxide gas plasma sterilization uses: Bacillus atropheous
EtO sterilization uses: Bacillus atropheous

Question 39

Principles of sterile technique

Answer 39

If in doubt about the sterility of an item, consider it non sterile and do not use.
The integrity of sterile packages must be checked before opening
Sterile packages found in storage areas commonly used for storage of non sterile items must not be used.
Hands should not be allowed to fall table level
The back of the sterile gown is considered non sterile
A separate sterile surface should be used for owning and glowing to avoid contamination of the back table.
Only sterile items and sterilely attired individuals may contact sterile areas.
Non-sterile items and individuals may only contact non sterile areas.