Wrapping and sterilization Flashcards
what are the instruments usually made of?
stainless steel which resists rust, retains sharpness, and can come in matte or polished finish
what are some rules for instrument care before cleaning?
delicate instruments should be separated from general instruments, multiple-component instruments should be disassembled, power equipment shouldn’t be submerged, blood should be rinsed off instruments ASAP with cool water
what type of water should be used for cleaning off instruments?
distilled or deionized water since tap water could stain or corrode
what type of instrument detergent should be used for cleaning?
a neutral pH detergent diluted in cool water
how should you manually clean the instruments?
- submerge instruments in diluted instrument detergent with box locks open
- one at a time clean each surface of each instrument, scrub all sides of box lock
- inspect for organic debris
- rinse with cool water
why should you use an ultrasonic cleaner to clean the instruments after manual cleaning?
it can clean areas of the instruments that a brush can’t reach
how do you use an ultrasonic cleaner?
- place instruments in with box locks open and only put similar metals in at a time
- let the machine run
- rinse off instruments and lay out to dry
how does an ultrasonic instrument cleaner work?
cleaning cycles are usually set to 5-15 minutes, works by making little bubbles which implode in the hinges and box locks
which instruments should be lubricated?
instruments with hinges or box locks
when should you lubricate the instruments?
after every cleaning
what types of lubricant are there?
a milk bath or a spray
sometimes the lubricant can even be included in the detergent
what are some properties of instrument lubricant?
water soluble, inhibits rust formation, doesn’t interfere with steam sterilization
what should you look for when doing a final inspection of the instruments?
look for organic debris (like tissue, blood, hair) or debris (like lint or detergent)
also look for any sign of defectiveness
how do you dry the instruments?
neatly set on a towel or potty pad with box locks open
methods: air dry, blot with clean lint free towel, instrument dryer, pressurized air
what is the order of how you should clean an instrument?
- presoak/ manual cleaning
- ultrasonic cleaner
- lubricant (if it isn’t in the detergent you used)
- dry
- wrap
- sterilize
what are sterilization indicators?
strips or tape that can indicate exposure to the sterilization process via change of color
reacts to specific chemicals like steam, EO, or H2O2
what are some things that could be misleading when using chemical indicators?
they don’t indicate that the minimum sterilization requirements were met (if autoclave hits the correct temp and then temp goes right back down indicator will change color but packs won’t be sterile), tape could changes color while the strip in the pack doesn’t (troubleshoot if it’s an autoclave or tech error)
where do you place indicator strips?
in the innermost area of the pack
where do you place indicator tape?
on the outside of the pack to secure it and hold the drapes closed
what should be written with permanent marker on the outside of a pack?
date, contents, and initials
what are the 6 indicator classes?
process indicators, specific-use indicators, single-variable indicators, multi-variable indicators, integrating indicators, emulating indicators
what are sterilization pouches made of?
heat-soluble paper or plastic
when would sterilization pouches be used?
for single or paired instruments
especially for specialty instruments
how do you wrap a sterilization pouch?
- slide instrument (with blade away from pouch opening) and indicator strip into pouch
- peel off adhesive tape and fold over at perforations
can double wrap
what is used for wrapping packs?
muslin or disposable drape material
what are some important things to know for wrapping packs?
usually double wrapped with a smaller outermost cloth than the inner one, make tight but not super tight, remember to put a sterilization strip inside (for gown packs put strip in the innermost portion of the folded up gown, not just right on top of it)
how do you wrap a pack?
- place the pack in the middle of the 2 stacked muslins
- pull and fold the top part of the inner drape over the pack with the corner pointing toward you
- pull and fold over 1 of the side corners
- pull and fold over the other corner
- rotate pack 180 degrees, pull and tuck remaining corner (leave courtesy tab)
- repeat with smaller muslin
- secure with tape and label
how do you fold gowns in a pack?
should be folded in a manner in which it may be easily shuck opened and where the inside is facing out
warp the same way as instrument packs and don’t forget to note the size (to write as part of the label) and indicator strip
sterile
absence of any living microorganism
when is sterilization radiation and filtration usually used?
mainly used during the production and packaging of products
sterilization filtration
separation of particulate material from liquids or gases under a filter
common for pharmaceuticals
sterilization radiation
gamma radiation, x rays, or high energy electrons
ionizing-radiation kills microorganisms
common for gloves, sutures, and blades
how does sterilization through thermal energy work?
microbes die from protein denaturation
the only issue with this is that there isn’t one certain temperature at which all microbes die
when is dry heat sterilization used?
for materials that can’t tolerate moist heat because it doesn’t rust or corrode needles or sharp instruments
how does sterilization through dry heat work?
kills microbes by protein oxidation
how does sterilization through moist heat work?
kills microorganisms by coagulation of critical cellular protein
it can kill bacteria and spores at lower temps than dry heat
why is sterilization through boiling not usually used?
it’s not reliable, most likely results in more of a disinfectant effect, bacterial effect may be enhanced by alkalization with sodium hydroxide or sodium carbonate
how does sterilization through steam under pressure work?
increased pressure causes steam to achieve higher temps
which sterilization method is used by the autoclave?
steam under pressure
what is the most commonly used autoclave temperature?
121 C (250 F) at 15 psi for 20 minutes
how does the gravity displacement sterilizer autoclave method work?
steam is introduced at the top of the chamber and forces air to the bottom
how does the prevacuum sterilizer autoclave method work?
vacuum pump evacuates air before steam is introduced
when is the flash autoclave sterilization technique used?
to immediately and quickly sterilize instruments like instruments that were dropped during surgery and needed back
how do you autoclave instruments through flash sterilization?
place unwrapped instruments directly into autoclave, after sterilization door is cracked open for 10 minutes to allow moisture to evaporate, instrument is transported untouched in the tray
what are the different autoclave cycles?
fill with water (if using an older version), steam/ sterilize, vent and dry
when is ethylene oxide used?
for heat/ moisture sensitive materials
what is important to know about ethylene oxide?
it’s a colorless gas at room temp, it’s flammable, explosive, and highly toxic
it can penetrate paper, plastic, and film packaging
how does ethylene oxide sterilization work?
destroys metabolic pathways within the cells by alkylation, effectiveness based on EO gas concentration, time, temp, and relative humidity
how long do instruments need to be exposed to ethylene oxide to be sterilized?
48 minutes - 12 hours
what should be done with the instruments after being sterilized with ethylene oxide?
they should be ventilated for 7 days or placed in aerator for 12-18 hours
how do you use ethylene oxide sterilizator?
- turn on, select settings
- place purge pump in bag and secure bag with velcro
- break ampule
- close door and get away
what is H2O2 gas plasma sterilization used for?
slowly replacing ethylene oxide sterilization since it is safer and can sterilize most items
how does H2O2 sterilization work?
H2O2 is injected and vaporized, pressure is lowered, and radio waves are applied to create a gas plasma
this creates a free radical which kills microbes
what different things are used to test for quality control when sterilizing instruments?
autoclave tape: identifies exposure to steam but not proper time, temp, or psi
fusible melting pellet glass: indicates that temperature reached 118 C nut not that proper time or temp was reached
culture test: contain controlled spore and bacteria population, most accurate test in identifying destruction of microorganisms but results are not immediate and doesn’t assess steam penetration
chemical sterilization indicators: undergo color changes when subjected to saturated steam or chemicals for adequate periods of time
how often should the autoclave be cleaned?
it’s recommended that it should be cleaned every 1-4 weeks and cleaning will help extend longevity and efficiency of the autoclave
how do you store sterile packs?
store in a dust-free, dry, and well ventilated area, closed cabinets provide the ideal clean storage area rather than open cabinets, usually stored in pass-thrus
how long will a single-wrapped muslin pack stay sterile in a closed vs open cabinet?
closed cabinet: 1 week
open cabinet: 2 days
how long will a double-wrapped muslin pack stay sterile in a closed vs open cabinet?
closed cabinet: 7 weeks
open cabinet: 3 weeks
how long will a single-wrapped crepe paper pack stay sterile in a closed vs open cabinet?
closed cabinet: at least 8 weeks
open cabinet: 3 weeks
event-related sterility
deems packs are sterile unless an event occurs that contaminates the contents
what are things that cause a break in sterility and deems packs as contaminated?
pack dropped on floor, sealing tape is broken, becomes wet, punctured or torn, organic debris gets on pack, pack becomes expired
disinfectant
agent that destroys bacteria or inactivates viruses
doesn’t kill spores
what influences the maximal effect that a disinfectant can have?
nature of the material disinfected, degree of soil, degree of microbial contamination, and concentration and potency of disinfectant
how do you perform cold sterilization?
by soaking the instruments in disinfecting solution for 12 minutes - 10 hours depending on the chemical that is used
what are some disinfectants that can be used for cold sterilization?
chlorohexidine, glutaraldehyde, benzalkonium chloride
is cold sterilization effective?
not really, instruments are considered disinfected because sterility is not guaranteed
when is cold sterilization used?
only in minor procedures or endoscopic equipment that is sensitive to steam/ chemical sterilization
how are scope equipment sterilized?
through cold sterilization
submerge for adequate time then rinse thoroughly with sterile water and dry, sterile covers can be used to cover cables/ parts that may not be sterilized/ submerged
