Chapter 21_Principles and Techniques of Instrument Processing and Sterilization

Critical instruments
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Critical instruments
○ Items used to penetrate soft tissue or bone
○ Greatest risk of transmitting infection and must be sterilized by heat
Semi-Critical instruments
○ Touch mucous membranes or non intact skin
○ Lower transmission risk
○ Sterilized by heat or receive minimum high-level disinfection if not heat tolerant
Noncritical instruments
○ Contact only intact skin
○ Low risk of infection transmission
○ Cleaned and processed with EPA-registered intermediate- or low-level disinfectant
1. Transport
2. Cleaning
3. Packaging
4. Sterilization
5. Storage
6. Delivery
7. Quality
Seven Steps for Instrument Processing
Transport contaminated instruments to the processing area in a manner that minimizes the risk of exposure to people and the environment
Use appropriate PPE and a rigid, leakproof container
Transport
Clean instruments with a hands-free, mechanical process such as use of an ultrasonic cleaner or instrument washer. If instruments cannot be cleaned immediately, use a holding solution.
Cleaning
In the clean area, wrap/package instruments in appropriate materials. Place a chemical indicator inside the package next to the instruments. If an indicator is not visible on the outside of the package, place an external process indicator on the package.
Packaging
Load the sterilizer according to the manufacturer's instructions. Label packages. Do not overload the sterilizer. Place packages on their edges in single layers or on racks in increase circulation of the sterilizing agent around the instruments. Operate the sterilizer according to the manufacture's instructions. Allow packages to cool before removing them from the sterilizer. Allow packages to cool before handling.
Sterilization
Store instruments in a clean, dry environment in a manner that maintains the integrity of the package. Rotate packages so that those with the oldest sterilization date will be used first.
Storage
Deliver packages to point of use in a manner that maintains sterility of the instruments until they are used. Inspect each package for damage. Open package aseptically.
Delivery
An effective quality assurance program should incorporate training, record keeping, maintenance, and the use of biologic indicators.QualityUtility gloves, mask, eyewear, and protective clothingWhat does Personal Protective Equipment (PPE) include?Through percutaneous injury (e.g., needle sticks, cuts)What exposure can occur when transporting processing contaminated patient care items (instruments)?○Dedicated only to instrument processing ○Physically separated from operatories and laboratoryInstrument-Processing AreaDirty, Clean, SterilizeWhat is the workflow pattern in the instrument-processing area?Biological IndicatorVials known spores test, used to determine if sterilization has occurredBiologic MonitoringVerifies sterilization by confirming that all spore-forming microorganisms have been destroyedHolding SolutionPrevents the drying of blood and debris on the instrumentsFlash SterilizationMethod for sterilizing unwrapped patient care items for immediate useChemical Indicatorchange color when exposed to heat temperatures and timeHand scrubbing Ultrasonic cleaner Instrument-washing machineInstruments may be preclean in one of three ways:Hand Scrubbingthe least desirable method of cleaning instruments because it requires direct hand contact with the contaminated instrumentCavitation and implosionWhat does the ultrasonic do?