What should the sterilizer access area pressure be?
Negative w/10 air exchanges per hour
What two steps are involved in decontamination?
1. Manual and/or automated mechanical cleaning
2. application of a thermal or c
...
What should the sterilizer access area pressure be?
Negative w/10 air exchanges per hour
What two steps are involved in decontamination?
1. Manual and/or automated mechanical cleaning
2. application of a thermal or chemical disinfection process
Define Cleaning...
The removal of contamination from an item to the extent necessary for further processing or for the intended use.
nosocomial infections are well documented and caused by...
poor or ineffective decontamination of instruments
What are Employee hazards in the decontamination process?
Technicians work with a large amount of 1) unidentified bioburden 2) wet enviornment 3) handling contaminated sharps 4) must know procedures for proper handling, equipment, cleaning/sterilization agents
How do you properly clean a device?
follow the device manufacturer's written instructions
What is the starting point in sterilization?
Cleaning
Define decontamination
The process of cleaning surgical instruments, patient care devices, and all involved surfaces in order to render areas and items safe for handling and/or further processing
What are physical safety hazards?
-good body mechanics -correct body techniques and posture for lifting, pushing, pulling, and reaching -should be alert and correct anything that is a potential injury -lifts to lift heavy supplies, available work material, adjustable chairs, padding on sharp edges, correct height tables -proper clothing can prevent injury
What is the weakest point of an instrument?
Box lock and jaws
What does the ABC system stand for?
A: large dollar amount items not used frequently
B: moderately priced and used frequently
C: items w/ low dollar value
What is just in time distribution?
Items are distributed to department by vendor no need for sterile storage or inventory control.
What are specialty/ procedure carts?
Carts placed in specific departments based on procedures
personalized to needs of departments easily accessible.
What is case cart distribution?
visually in specialty areas case carts are delivered to department case cart is specialized to departments needs
What is the exchange cart distribution?
Two identical carts are made one is out in the department and other stays in SPD
What is par level distribution?
There is fixed inventory and when items become low they are replenished from the stockroom per department/specialty
What is demand distribution?
An instrument/cart must be ordered in order to get it
What are the most common distribution systems?
1) demand 2)par-level 3)Exchange 4)case carts 5) Specialty 6) Just in time
What is the air pressure of the sterile storage area?
positive air flows out
What is shelf life
period of time which a sterile item is considered safe to use
event related not time related
When are packs most vulnerable to contamination?
Immediately after sterilization
What is it when a sterilizer's ability is tested under worst case conditions?
Small load testing
What is it called when a sterilizer is tested for sterilization under actual use conditions?
Max load testing
How often is a Bowie Dick test ran?
Daily for dynamic air removal sterilizers
How much space should be between packages and chamber wall?
one inch
How should paper-plastic pouches be placed in a sterilizer?
plastic to paper or paper to plastic
tilted on side
How should basins be placed in a sterilizer?
on tilted side same direction
What should be placed on the bottom of the rack in a mixed load?
metal instruments
basin
other metal items
What should be placed on the top shelf?
textile packs and paper/plastic pouches
Textile packs should be placed how in a sterilizer?
sides
Solid bottom trays should be loaded now?
tilted on sides
How should mesh bottom containers be loaded into the sterilizer?
flat on rack
If packages are still moist when the sterilizer doors are open bacteria can do what?
wick through the package
How does steam sterilization occur?
by condensation
What cases are proven to have prions?
1) neurosurgery
2) opthamology (eye)
When should a flash sterilizer be monitored?
Weekly with a biological and a class 5 or class 6 indicator
What can not be processed in an express cycle?
porous items
items with lumens
When should a flash sterilizer be used?
In an emergency; a one of a kind instrument is dropped
How are liquids sterilized?
only through gravity displacement liquid cycles
What occurs during the drying phase?
Dynamic Air Removal: Filtered air is drawn in achieve drying
Gravity: Heat in chamber evaporates moisture
*Approx.: 30 min. for both
What occurs during the exhaust phase?
steam is exhausted from the chamber drain line
What occurs during he sterilization/exposure/"holding phase"?
exposure temperature is maintained for the prescribed amount of time
What occurs during the conditioning phase of steam sterilizers?
Air is removed and steam is injected
Where should the bowie dick test be placed in a steam sterilizer
drain line
Where is the sterilizers heat-sensing thermometer located?
Drain- line
What provides heat inside the chamber and prevents condensation in a steam sterilizer?
the jacket
where is the dedicated steam supply made?
a boiler
Steam kills microorganisms by_______ the protein
denaturing (coagulation)
True/false
Removing as many microorganisms as possible before sterilization enhances the probability of microbial kill
true
What is the air exchange in sterile storage
4 per hour
What is the suggested release temperature of packs?
70 to 80 degree farenheit
How far from the floor should medical devices be stored?
8-10 inches from the floor
How far should shelving be from outside walls?
2 inches
What kind of pressure should the sterilization area be under?
positive
What is the coldest area of the sterilizer?
drain line
What are the three parameters of steam sterilization?
1) Steam under pressure
2) time
3) Exposure/temperature
What are the two types of cycles in steam sterilization?
1) dynamic air removal (pre-vac)
2) Gravity Displacement (immediate use)
What are the phases of the cycle?
1)conditioning (air is removed)
2)sterilization/Exposure/ Hold (temperature is held)
3) Exhaust (steam out drain line)
4) drying (approx. 30 min.)
It takes a certain ______ to reach a certain ____________
Pressure
temperature
What are the types of sterilization processes used?
1) steam
2) EtO
3) Dry Heat
4) Gas plasma
5) Ozone
6) liquid chemical
What does a class on indicator respond to?
Only one parameter of the process
(ex.: autoclave tape)
Geobacillus steurothermophilus must be incubated at what temp.?
132 degrees farenheit
What should the incoming saturated steam dryness be?
ideally 97% to 100% saturated steam
What should the sterility assurance level be?
10^-6
When a new sterilizer comes in or relocated how many consecutive biologicals be ran in an empty sterilizer?
three
How many air exchanges should there be in the sterilization area?
ten
Class five responds to
all critical parameters
Class three responds to
single parameter respond to one chemical parameter
Biological monitors contain...
spores geobacillus stearothermophilus
The biological used for team, ozone, and pareacetic sterilization contains....
Geobacillus Stearothermophilus
The biological used for EtO, gas plasma, and dry heat contains...
Bacillus atrophaeus
True/False
Adequate cleaning will lead to easier sterilization b/c it reduces present bioburden
true
When must a control biological be ran?
Daily or when a new lot number is present
When are biologicals placed for steam sterilization?
Coldest point (drain line)
Where do you place biologicals for EtO sterilization?
Approximately the center of the load
Where are biologicals placed for gas plasma sterilization?
First shelf back of chamber
If no microorganisms survived, the biological test is the positive or negative?
Negative
If microorganisms survive the biological test is considered positive or negative?
posititve
If bacteria lives what color does the biological turn?
yellow
When a BI tests positive you must...
Determine why it failed and recall everything from that cycle and reprocess it
Steam sterilizers should be monitors at a minimum of...
weekly
Each package ran through sterilizers should be labeled with what?
1)lot number
2)date
3)cycle number
What must CSD comply with?
local and state regulations
What is decontamination?
contaminated items are rendered safe for handling by personnel who are not wearing protective attire
What does the EPA regulate?
EtO manufacturing and emissions, and labeling
What agencies govern central sterile departments?
-joint commission (JC)
-occupational safety (OSHA)
-Environmental (EPA)
-Food and Drug (FDA)
Is JCAHO a government agency?
no it is a volunteer organization
The standards of _____________ affect most areas of the health care facility.
Joint Commision
What should large items be lifted with?
If too large, then a lift must be used; if can be lifted with body use legs not back/arms
What can an incident report lead to?
Work practices that need improvement
What should be in an incident report?
-how the accident happened
-where/ when it occurred
-any witnesses
-medical treatment given
-any work time lost due to accident
-description of corrective actions to prevent the recurrence of the accident
When should an incident report for an accident/injury be reported?
immediately
What items can be disinfected?
CONTINUED..
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