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What are the 2nd most frequent nosocomial infections?

SSI's

What is the most plentiful packaging material?

paper

What kills most microbes EXCEPT spores?

intermediate-level disinfectant

Any condition caused by a fungus

mycoses

What is an advantage to presoaking in tap water?

prevents the drying of organic material

Sterlization time for Wrapped Instruments

Prevacum, 270 - 4 mins
Gravity, 250 - 30 mins

Metal, Nonporous, no lumens

Gravity, 270 - 3 mins
Prevacum, 270 - 3 mins

unwrapped instruments w/ no lumens

Gravity, 270 - 10 mins
Pravacum, 270 - 4 mins
Gravity, 250 - 20 mins

metal, porous w/ lumens

Gravity, 270 - 10 mins
Prevacum, 270 - 4 mins

wrapped basin set

Prevacum, 270 - 4 mins
Gravity, 250 - 20 mins

unwrapped instruments, no lumen

Gravity, 270 - 3 mins
Prevacum, 270 - 3 mins
Gravity, 250 - 15 mins

Cross-Contamination

the contamination of a person or object by another person or object

The stockinet cuffs of the surgical gown are considered ...

non-sterile, contaminated

The area to be prepped for a breast surgery ...

shoulder, upper arm and extending down to the elbow, axilla and the chest to the table line and the shoulder opposite from the infected side

Bioburden

amount of gross organic debris or the number of microorganisms on an object at any given time

HBV coexists with ...

Hepatitis D

An infection is usually accompanied by a fever.

True

HIV compromises what?

The Immune System

What type of packaging material is easily torn or punctured?

paper

What type of packaging material is economical, reusable?

woven

What should be labeled on an item for sterilization?

1. Contents of the package
2. shelf-life
3. date of sterilization
4. ID of sterilizer
5. cycle number
6. employee initials
7. department to be sent to

Cidex is AKA ...

2% glutaraldehyde

Immersion time for sterilization with chlorine compound?

1 hour

Immersion time for sterilization with glutaraldehyde?

10 hours

Immersion time for sterilization with peracetic acid?

12 minutes

Intermediate disinfectants

phenolic compounds, quaternary compounds, Iodophors, Alcohol

Cleaning

physical removal of soil, debris, blood and body fluids

In what unit is peracetic acid used?

Steris

Name the performance characteristics of packaging materials.

1. efficiency
2.ease of opening
3. sterilization suitability
4. strength
5. barrier efficiency and support impermeability
6. seal integrity
7. safety
8. sterility maintenance

What can also serve as sterilants w/ adequate exposure time?

disinfectants

Name the disinfectant efficiency factors

1. concentration level of agent
2. number and type of microbes present
3. contact time
4. physical factors

high- level disinfection takes how many minutes of exposure time?

20-30 mins

low-level to intermediate level disinfection takes how many minutes of exposure time?

10-15 mins

Presoaking in a detergent is an advantage, why?

keeps organic debris moist while loosening dried-on debris

What is the advantage for enzymatic presoaking?

breakdown organic soil

What is necessary before disinfection?

cleaning

What are the methods of sterilization?

steam, chemical agents, high velocity electron bombardment, ultraviolet radiation

What is the 3 sink method used for?

manual cleaning of instruments

What are the principles of the decontamination room environment?

1. filtered air is exhausted outside the facility
2. the minimum air exchange rate is 10X p/hr
3. Tempuratue between 64-70 degrees F w/ a humidity of 35 - 72%
4. negative air pressure is maintained

Sterilization

the destruction of all microbes in or about an object

What are the duties carried out before prep?

wipe down the OR, postion the Pt, and anesthesia

Is chemically induced hypothermia infectious?

No

What provides rapid reduction in skin microbial counts and should be removed in 2-3 minutes to prevent skin irritation?

Iodine

How far away must an unsterile person remain from a sterile field?

12-18 inches

What type of packaging material is not recommended for ETO sterilization?

Woven

How should a sterile person pass an unsterile person?

With their back to the unsterile person.

Is anyone permitted to walk between two sterile fields?

No

What performance standards should sterilization packaging meet?

1. maintain sterility
2. allowing opening while maintaining sterility
3. allow for pentration of the sterilant

Infection

multiplication of organisms in the tissues of a host

How does the FDA list sterilization wraps?

Class II

What hepatitis are health care workers at particular risks for?

Hepatitis C

At any time, is covering a sterile table for later use permitted?

No

Which machine lubricates in one of it's cycles?

Washer-Sterilizer

What is the perimeter that is considered sterile inside the sterile wrap?

Everything except the 1" border around the edges.

Once a drape has been placed, can it be moved? Even with careful positioning?

No

When opening a sterile package, what is the order of the flaps?

Away from you, Sides and then toward you

What is the order for opening the initial sterile field?

back table, basin, instruments and gown & glove

Any item extending below the table edge is considered contaminated.

True

Tubes and cords are secured to the field by what?

drapes and towel clips, hemostats

Where can an unsterile person touch sterile drapes and how can they help drape the patient?

below table level they can touch; they can help by plugging in cords and suction and straigtening the bottom of the drapes.

Can sterile solutions be recapped why or why not?

no, contamination will occur

Cidex, without surfactant, has a shelf life of what?

14 days

Which antiseptic must be used several days in advance of surgery to build up a cumulative antimicrobial effect?

hexachlorophene

Which antiseptic is less likely to cause skin irritation and does not need to be removed?

Iodophors

When does draping begin?

after prep

How long should the cuffs on the towel drapes be and which why should the fold be?

2" cuff, 3 toward yourself and 1 away from you

Maximum size of linen packet?

12X12X20

By the rules of sterile technique, should drapes be passed over a nonsterile field?

no

What is the order of placing towel drapes?

side closest to you, superior, inferior and side farthest away from you

Which type of packaging material is inexpensive and one time use?

paper

Can misplaced drapes be covered with another drape?

yes

A contaminated drape is removed by whom?

circulator

What is the lowest point in the sterile person's body considered sterile?

waist or table edge

Are sterile gloved hands ever allowed to fall below waist or table level during draping?

No

Gas Sterilization Adavantages:

1. can be used to sterilize materials too heat sensitive for steam sterilization
2. less corrosive on metals
3. less damaging to sensitive plastic and rubber materials

Gas Sterilization Disadvantages:

1. personnel hazards are created by the use of EtO gas
2. the Eto sterilization processf is damaging to certain materials, requiring the availibility of more than one alternative process
3. Aeration times required with the EtO sterilization process can be extraordinarily lengthy - up to 21 days with internal pacemakers

How is Cidex used?

used as a disinfectant or as a sterilant it is sporicidal

How long does a complete cycle in a Steris unit take?

30 minutes

What type of packaging material is least effective at providing a bacterial barrier when compared to other wrapping materials?

woven

The water in the Steris unit is warmed to what degrees?

50 - 55 degrees C

What type of sterilization should be used for plastic, rubber and porous instruments?

Gas

In steam sterilization what factors are critical to the outcome of the sterilization process?

1. Time
2. Contact
3. Tempurature
4. Moisture
5. Pressure

What are the methods of monitoring the sterilization method?

mechanical, chemical, and biological

Enzymatic Cleaner

breaks down organic debris, usually used as a soaking solution, requires dilution in warm water because it increases the speed of chemical reaction

Ultrasonic Cleaner

for use in ultrasonic cleaners, may contain surfactant and chelating agents

Manual Detergent

used for hand cleaning & presoaking, must be diluted, safe for use on most materials, mechanical action is required for soil, must be throughly rinsed

Washer-Decontaminator Detergent

Liquid solution available in 3 different pH levels.
1. neutral pH - less corrosive to instruments but less effective
2. moderate pH- low level alkaline, may be combined w/ surfactant & chelating agents, safe for use on stainless steel instruments but could be harmful to the chromium oxide layer that protects the instruments from corrosion
3. high pH- most effective for removing heavy amounts of soil, can be corrosive to stainless steel, must be neutralized in a neutralizing rinse to prevent damage to the instruments

Step One - Rigid Containers - Sterilization Recommendations

can be safely sterilized in the same load with other supplies. the containers should be places on shelves beneath absorbent items to prevents condensate from the containers dripping onto the absorbing items

Step Two - Rigid Containers - Sterilization Recommendations

drying phase should be increased to allow for revaporization of moisture and condensation on the outside and inside of the container

Step Three - Rigid Containers - Sterilization Recommendations

prevaccum sterilization should be used instead of gravity because of the increased difficulty of adequate air removal

Step Four - Rigid Containers - Sterilization Recommendations

gaskets should be inspected and replaced if torn or cracked or nonpliable

Step Five - Rigid Containers - Sterilization Recommendations

disposable filter should be replaced after every use

What are the cycles for a washer - decontaminator?

1. Pre-rinse cycle - enzymatic solution
2. Cleaning Cycle- detergent solution
3. Final Rinse - hot water, 180-195 degrees F
4. Dry Phase - high tempurature dry air

What are the cycles for a washer-sterilizer?

1. Pre-rinse - removes blood and tissue
2. Automatic Detergent Injection - injects the measured amount of detergent
3. Fill Phase - chamber is filled with water for total immersion and cleaning
4. Wash Phase - water is agitated for soil removal, machine controls water tempurature
5. Post-Rinse - loose soil and detergent film are rinsed off
6. Sterilization Phase - steam sterilization
7. Lubrication - "milking"
8. Drying

Thermal sterilization items

most metal surgical instruments, powered instruments (per manf. instructions), microinstruments (per manf. instructions)

Gas sterilization items

powered instruments, delicate instruments, fiber-optic instruments, lensed instruments, plastic, rubber porous instruments, moisture or heat sensitive instruments

Chemical sterilization items

lensed instruments, fiber-optic instruments and cables, heat-sensitive instruments

What is the instrument cycle in order?

1. Inspection - decontamination room, cleaned and disinfected
2. Moved to clean processing area where they are reassembled and sterilized.
3. Prepared and stored in sterile supply room where cases are pulled.

Disinfection

destruction of pathogenic microbes and their toxins

antisepsis

process in which most but not all microorganisms located on animate surfaces, such as skin, are destroyed

antiseptic

refers to an agent used to interfere with the growth and development of microorganisms

sterilization

the destruction of all microorganisms, including spores, on inanimate surfaces, through the use of steam or chemical sterilization, electron bombardment or irradiation

cleaning

the physical removal of soil or debris, blood and body fluids

disinfection

destruction of pathogenic microbes or their toxins

how does an ultrasonice washer work?

uses high-frequency sound waves which are converted to vibrations in the solution. these waves travel through the cleaning agent, causes molecules to be set in rapid motion forming microscopic bubbles on the surface if the instruments. The bubbles enlarge and become unstable and implode causing a vacuum dislodging minute particles of soil and organic material from the instruments.

Technique for pouring fluids onto the sterile field:

1. Verify the "five rights"
2. Verify Pt. allergy status
3. Circulator should approach the field maintaining @ least a 12 inch distance.
4. The STSR and circulator will verify the solution (name, strength and exp. date)
5. Hold the solution approx. 12 inches above the container.
6. Once poured perform ad third visual/verbal verification.
7. Recap fluid and dispose. NEVER recap and reuse.
8. STSR labels fluid.
9. Fluid is prepared for use.

How should a sterile person pass another sterile person?

back to back or front to front

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