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unwrapped instruments w/ no lumens
Gravity, 270 - 10 mins
Pravacum, 270 - 4 mins
Gravity, 250 - 20 mins
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
amount of gross organic debris or the number of microorganisms on an object at any given time
What should be labeled on an item for sterilization?
1. Contents of the package
3. date of sterilization
4. ID of sterilizer
5. cycle number
6. employee initials
7. department to be sent to
Name the performance characteristics of packaging materials.
2.ease of opening
3. sterilization suitability
5. barrier efficiency and support impermeability
6. seal integrity
8. sterility maintenance
Name the disinfectant efficiency factors
1. concentration level of agent
2. number and type of microbes present
3. contact time
4. physical factors
Presoaking in a detergent is an advantage, why?
keeps organic debris moist while loosening dried-on debris
What are the methods of sterilization?
steam, chemical agents, high velocity electron bombardment, ultraviolet radiation
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
What provides rapid reduction in skin microbial counts and should be removed in 2-3 minutes to prevent skin irritation?
What performance standards should sterilization packaging meet?
1. maintain sterility
2. allowing opening while maintaining sterility
3. allow for pentration of the sterilant
What is the perimeter that is considered sterile inside the sterile wrap?
Everything except the 1" border around the edges.
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
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.
Which antiseptic must be used several days in advance of surgery to build up a cumulative antimicrobial effect?
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
What is the order of placing towel drapes?
side closest to you, superior, inferior and side farthest away from you
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
What type of packaging material is least effective at providing a bacterial barrier when compared to other wrapping materials?
In steam sterilization what factors are critical to the outcome of the sterilization process?
breaks down organic debris, usually used as a soaking solution, requires dilution in warm water because it increases the speed of chemical reaction
used for hand cleaning & presoaking, must be diluted, safe for use on most materials, mechanical action is required for soil, must be throughly rinsed
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"
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.
process in which most but not all microorganisms located on animate surfaces, such as skin, are destroyed
the destruction of all microorganisms, including spores, on inanimate surfaces, through the use of steam or chemical sterilization, electron bombardment or irradiation
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.
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