2 - Care and Handling of Surgical Equipment and Supplies

Regardless of the sterilization technique used, instruments and linens (e.g., towels, gowns, drapes) must be cleaned of gross contamination.

Regardless of the sterilization technique used, _______ and ______ (e.g., towels, gowns, drapes) must be cleaned of gross contamination.

Instruments should be cleaned manually or with ultrasonic cleaning equipment and appropriate disinfectants as soon as possible after surgery, and linens should be laundered.

Instruments should be cleaned ______ or with ______ cleaning equipment and appropriate ________ as soon as possible after surgery, and _____ should be laundered.

Depending on use, surgical instruments and supplies must then be either sterilized or disinfected

Depending on ___, surgical instruments and supplies must then be either ______ or ______

Cleaning

This should be done as soon as possible after use of the instrument to prevent drying and caking of blood and other debris on the item.

Cleaning is a vital step as it removes organic material and inorganic salts that interfere with sterilization.

Cleaning is a vital step as it removes _____ material and ______ _____ that interfere with ________.

Cleaning

• Water with detergents or enzymatic cleaners are used, and it may be done mechanically (e.g., ultrasonic cleaner, dishwasher, utensil washer/ sanitizer) or manually

Cleaning

• _____ with _______ or ______ cleaners are used, and it may be done mechanically (e.g., ultrasonic cleaner, dishwasher, utensil washer/ sanitizer) or manually

High-level disinfectants destroy all microorganisms with the exception of some bacterial spores1 and may be accomplished via liquid immersion (see later) or pasteurization.

high-level disinfectants destroy all microorganisms with the exception of some ______ _______ and may be accomplished via _____ ______ (see later) or _______.

Low-level disinfection destroys vegetative bacteria, as well as some viruses and fungi, but typically does not kill spores or mycobacteria.

Low-level disinfection destroys ______ bacteria, as well as some viruses and fungi, but typically does not kill _____ or _________.

Disinfectants example

• peracetic acid–hydrogen peroxide

• glutaraldehyde,

• hydrogen peroxide,

• improved hydrogen peroxide (2%),

• ortho-phthalaldehyde (OPA),

• peracetic acid,

• ethylene oxide (EtO),

• heavy metal ions,

• or dyes.

  
  

Disinfectants example

The reliability of any sterilization method depends on the number, type, and inherent resistance of microorganisms on the items to be sterilized and whether other materials (e.g., soil, oil) that may shield against or inactivate the sterilizing agent are present on the items.

The reliability of any sterilization method depends on the _____, _____, and inherent ______ of ________ on the items to be sterilized and whether other materials (e.g., soil, oil) that may shield against or inactivate the sterilizing agent are ______ on the items.

(1) high temperature, (2) low temperature, or (3) liquid immersion.

Methods to sterilize equipment or supplies include

High-temperature (steam autoclave or dry heat) sterilization may be used for ____ tolerant _____ and ________ items; however, the high temperature and moisture of a steam autoclave make it _______ for many of today’s devices.

dry-heat sterilization

This produces temperatures that cannot be tolerated by most devices and is seldom used

Low-temperature sterilization systems (e.g., EtO gas, hydrogen peroxide gas plasma, hydrogen peroxide and ozone, hydrogen peroxide vapor; see Table 2.2) are used for heat-sensitive critical and semicritical items (

Low-temperature sterilization systems (e.g., EtO gas, hydrogen peroxide gas plasma, hydrogen peroxide and ozone, hydrogen peroxide vapor; see Table 2.2) are used for ___-sensitive critical and _______ items

Liquid immersion includes chemical sterilants such as

• glutaraldehyde,

• glutaraldehyde with phenol,

• and various concentrations of hydrogen peroxide with peracetic acid

Liquid immersion includes chemical sterilants such as

Devices cannot be wrapped when using liquid sterilants, and they typically need to be rinsed with water that often is not sterile, which limits their usefulness.

Devices cannot be ______ when using liquid sterilants, and they typically need to be ______ with water that often is not _____, which limits their usefulness.

Saturated steam under pressure

a practical and dependable agent for sterilization of heat-tolerant medical supplies and packaging

Steam rapidly destroys all known microorganisms by means of coagulation and cellular protein denaturation

______ rapidly destroys all known microorganisms by means of ______ and cellular protein ______

Steam Sterilization

To ensure the destruction of all living microorganisms, the correct relationship between temperature, pressure, and exposure time is critical.

Steam Sterilization

To ensure the destruction of all living microorganisms, the correct relationship between _______, _______, and _______ time is critical.

autoclave

The unit used to create this high-temperature, pressurized steam is called an

pores of thermophilic aerobes and anaerobes are the most resistant known forms of life to moist heat. Virus particles are more vulnerable to steam sterilization than are spores.

Spores of ______ ______ and _______ are the most resistant known forms of life to moist heat. ______ particles are more vulnerable to steam sterilization than are spores.

Enumerate the types of steam sterilizers

• Gravity Displacement Sterilization

• Prevacuum Sterilization

• Immediate-Use Steam Sterilization

• Chemical (Gas) Sterilization

• Plasma Sterilization

• Peracetic Acid Sterilization

• Ionizing Radiation

• Cold Chemical Sterilization

Gravity “downward” Displacement Sterilization

most commonly used steam sterilizer in veterinary practice

Gravity Displacement Sterilization

• This sterilizer works on the principle that air is heavier than steam.

• Supplies to be sterilized are loaded into the inner chamber.

• A narrow, outer jacket-type chamber surrounds the inner chamber.

• Pressurized steam from the narrow, outer chamber enters the inner chamber and surrounds the supplies.

• Air in the inner chamber is pulled downward by gravity to the floor and exits through a temperature-sensitive valve.

• As steam accumulates and the temperature increases, the steam-release valve closes.

Gravity Displacement Sterilization

• This sterilizer works on the principle that ___ is heavier than _____.

• Supplies to be sterilized are loaded into the _____ chamber.

• A narrow, _____ _________ _______ surrounds the inner chamber.

• Pressurized steam from the narrow, outer chamber enters the inner chamber and surrounds the supplies.

• Air in the inner chamber is pulled downward by gravity to the floor and exits through a temperature-sensitive valve.

• As steam accumulates and the temperature increases, the steam-release valve closes.

Gravity Displacement Sterilization

• This sterilizer works on the principle that air is heavier than steam.

• Supplies to be sterilized are loaded into the inner chamber.

• A narrow, outer jacket-type chamber surrounds the inner chamber.

• Pressurized steam from the narrow, outer chamber enters the inner chamber and surrounds the supplies.

• Air in the inner chamber is pulled downward by gravity to the floor and exits through a temperature-sensitive valve.

• As steam accumulates and the temperature increases, the steam-release valve closes.

Gravity Displacement Sterilization

• This sterilizer works on the principle that air is heavier than steam.

• Supplies to be sterilized are loaded into the inner chamber.

• A narrow, outer jacket-type chamber surrounds the inner chamber.

• ________ ______ from the narrow, outer chamber enters the inner chamber and ______ the supplies.

• Air in the inner chamber is pulled _______ by gravity to the floor and ______ through a temperature-sensitive valve.

• As _____ accumulates and the temperature ________, the steam-release valve _____.

Gravity Displacement Sterilization

Because the function of this sterilizer is based on the ability of air to move to the bottom of the autoclave, careful wrapping (see p. 12) and loading of supplies are critical.

Gravity Displacement Sterilization

Because the function of this sterilizer is based on the ability of air to move to the bottom of the autoclave, careful ______ (see p. 12) and ______ of supplies are critical.

The prevacuum sterilizer relies on air being actively pulled out of the inner chamber, thereby creating a vacuum. Steam is injected into the chamber to replace the air

The prevacuum sterilizer relies on air being actively _____ ____ of the inner chamber, thereby creating a ______. Steam is injected into the chamber to replace the air.

Prevacuum Sterilization

• This method of sterilization provides greater steam penetration in a shorter time than the gravity displacement sterilizer

Prevacuum Sterilization

• This method of sterilization provides ______ steam penetration in a _____ time than the gravity displacement sterilizer

Immediate-use, emergency, or “flash” sterilization is performed when an unwrapped, nonsterile item must be sterilized quickly.

Immediate-use, emergency, or “flash” sterilization is performed when an ______, _______ item must be sterilized quickly.

Immediate-Use Steam Sterilization

• The item is placed unwrapped in a perforated metal tray and is sterilized according to the manufacturer’s time and temperature recommendation

Immediate-Use Steam Sterilization

• The item is placed unwrapped in a _____ _____ ____ and is sterilized according to the ________ time and temperature recommendation

Immediate-Use Steam Sterilization

• With detachable handles, sterilized items are transported to the operating room (OR) in the metal tray

• It is difficult to deliver these devices aseptically; the tray is hot, wet, and unwrapped, which means it collects dust, debris, and microorganisms more readily than dry, cool trays with biobarrier protection.

Immediate-Use Steam Sterilization

• With detachable handles, sterilized items are transported to the operating room (OR) in the _____ ____

• It is difficult to deliver these devices aseptically; the tray is hot, wet, and unwrapped, which means it collects ___, _____, and ______ more readily than dry, cool trays with ______ protection.

Immediate-Use Steam Sterilization

This type of sterilization should be used only in emergencies when no alternative is available.

Immediate-use sterilization generally is not recommended for implantable medical devices or power equipment unless specifically approved by the manufacturer.

Immediate-use sterilization generally is not recommended for ______ ______ devices or ______ equipment unless specifically approved by the manufacturer.

In flash sterilization, it is important to minimize the risk of contamination during transportation. The sterilizer should be located in the restricted area of the surgical suite or treatment site.

In _____ sterilization, it is important to minimize the risk of contamination during transportation. The sterilizer should be located in the ______ area of the surgical suite or treatment site.

Alcohol: isopropyl alcohol (50%–70%); ethyl alcohol (70%)

• Practical Use: Spot cleaning; injection site preparation

• Good disinfectant, very good antiseptic

• MOA: Protein denaturation, metabolic interruption, and cell lysis

• Precautions: Corrosive to stainless steel; volatile; damage to shellac mountings of lensed instruments; hardens rubber and some plastic tubing after prolonged use; irritating to tissues

Alcohol: isopropyl alcohol (50%–70%); ethyl alcohol (70%)

• Practical Use: ____ cleaning; ______ site preparation

• ____ disinfectant, ______ antiseptic

• MOA: Protein denaturation, metabolic interruption, and cell lysis

• Precautions: Corrosive to stainless steel; volatile; damage to shellac mountings of lensed instruments; hardens rubber and some plastic tubing after prolonged use; irritating to tissues

Alcohol: isopropyl alcohol (50%–70%); ethyl alcohol (70%)

• Practical Use: Spot cleaning; injection site preparation

• Good disinfectant, very good antiseptic

• MOA: Protein denaturation, metabolic interruption, and cell lysis

• Precautions: Corrosive to stainless steel; volatile; damage to shellac mountings of lensed instruments; hardens rubber and some plastic tubing after prolonged use; irritating to tissues

Alcohol: isopropyl alcohol (50%–70%); ethyl alcohol (70%)

• Practical Use: Spot cleaning; injection site preparation

• Good disinfectant, very good antiseptic

• MOA: Protein ______, metabolic ______, and cell ____

• Precautions: Corrosive to ____ ____; volatile; damage to shellac mountings of lensed instruments; hardens rubber and some plastic tubing after prolonged use; irritating to tissues

Chlorine compounds: hypochlorite

• Practical Use: Cleaning floors and countertops

• Good disinfectant (Good; available as liquid (sodium hypochlorite) or solid (calcium hypochlorite), fair antiseptic

• MOA: Release of free chlorine and oxygen

• Precautions: Inactivated by organic material; corrosive to metal; may cause skin irritation and esophageal burns if ingested; discolors fabric

Chlorine compounds: hypochlorite

• Practical Use: Cleaning ____ and ______

• _____ disinfectant (Good; available as liquid (sodium hypochlorite) or solid (calcium hypochlorite), ____ antiseptic

• MOA: Release of free ______ and ______

• Precautions: Inactivated by ______ material; corrosive to _____; may cause ___ irritation and ______ burns if ingested; discolors ____

Iodine compounds: iodophors (7.5%) scrub solution

• Practical Use: Cleaning dark-colored floors and countertops

• Good disinfectant, good antiseptic

• MOA: Iodination and oxidation of essential molecules

• Precautions: Stains fabric and tissue; do not use on silicone tubing

Iodine compounds: iodophors (7.5%) scrub solution

• Practical Use: Cleaning _______ floors and countertops

• ____ disinfectant, _____ antiseptic

• MOA: ______ and ______ of essential molecules

• Precautions: Stains ____ and _____; do not use on _____ tubing

Glutaraldehyde: 2% alkaline solution

• Practical Use: Disinfection of lenses and delicate instruments

• Good (sterilizes) disinfectant, none antiseptic

• MOA: Protein and nucleic acid alkylation

• Precautions: Tissue reaction; odor; rinse instruments well before using; can be highly toxic

Glutaraldehyde: 2% alkaline solution

• Practical Use: Disinfection of _____ and ______ instruments

• ______ (sterilizes) disinfectant, _____ antiseptic

• MOA: Protein and nucleic acid _______

• Precautions: _____ reaction; odor; rinse instruments well before using; can be highly ______

Hydrogen peroxide

• Practical Use: Often used as an antiseptic; stabilized form used on environmental surfaces

• Good disinfectant, Very good (particularly against anaerobic bacteria) antiseptic

• MOA: Formation of free hydroxyl radicals (OH), which oxidize thiol groups in enzymes and proteins

• Precautions: May be irritating to skin at high concentrations; irritating to eyes

Hydrogen peroxide

• Practical Use: Often used as an _______; ______ form used on environmental surfaces

• _____ disinfectant, _______ (particularly against anaerobic bacteria) antiseptic

• MOA: Formation of ____________ (OH), which oxidize ____ groups in enzymes and proteins

• Precautions: May be irritating to _____ at high concentrations; irritating to _____

Ortho-phthalaldehyde (OPA)

• Practical Use: Chemical sterilant similar to glutaraldehyde but not irritating to eyes and nasal passages

• Good (sterilizes; fast acting) disinfectant, None antiseptic

• MOA: Aldehyde binds to the outer cell wall of the organism (similar to glutaraldehyde)

• Precautions: Doesn’t smell but wear personal protective equipment when handling; provide good ventilation; rinse equipment thoroughly

Ortho-phthalaldehyde (OPA)

• Practical Use: ______ ______ similar to glutaraldehyde but not irritating to ____ and _____ passages

• _____ (sterilizes; fast acting) disinfectant, ____ antiseptic

• MOA: _______ binds to the outer cell wall of the organism (similar to glutaraldehyde)

• Precautions: Doesn’t ____ but wear personal protective equipment when handling; provide good _____; _____ equipment thoroughly

Peracetic acid

• Practical Use: Used in automated machines to chemically sterilize instruments

• Good (effective in presence of organic material; very rapid kill; no harmful residue) disinfectant, None antiseptic

• MOA: Denatures proteins, disrupts cell wall permeability, and oxidizes sulfhydryl and sulfur bonds in proteins, enzymes, and other metabolites

• Precautions: Unstable; quickly loses activity, particularly when diluted; corrosive; irritating to eyes, skin, and respiratory system; can corrode copper, brass, bronze, and galvanized irony

Peracetic acid

• Practical Use: Used in ______ machines to ______ sterilize instruments

• ____ (effective in presence of organic material; very rapid kill; no harmful residue) disinfectant, ____ antiseptic

• MOA: _______ proteins, _____ cell wall permeability, and _____ sulfhydryl and sulfur bonds in proteins, enzymes, and other metabolites

• Precautions: ______; quickly loses activity, particularly when diluted; ____; irritating to eyes, skin, and _______ system; can corrode ____, _____, ____, and galvanized irony

EtO is a flammable, explosive gas that kills microorganisms by altering their normal cellular metabolism and replication through alkylation of proteins, deoxyribonucleic acid (DNA), and ribonucleic acid (RNA).

Ethylene Oxide is a _______, _______ gas that kills microorganisms by altering their normal cellular ________ and replication through ________ of proteins, deoxyribonucleic acid (DNA), and ribonucleic acid (RNA).

Chemical (Gas) Sterilization

The time required for sterilization depends on the concentration of EtO, the humidity level, the temperature, and the volume, density, and types of materials to be sterilized

Chemical (Gas) Sterilization

The time required for sterilization depends on the concentration of ____, the ______ level, the ______, and the _____, ______, and types of materials to be sterilized

Ethylene Oxide

• Most items are sterilized at 54.4°C (130°F) for approximately 2.5 hours

• heat-sensitive items are sterilized at 37.8°C (100°F) for approximately 5 hours

• The most common veterinary units run on 12- and 24-hour cycles and operate at room temperature.

Ethylene Oxide

• Most items are sterilized at _____°C (130°F) for approximately ____ hours

• heat-sensitive items are sterilized at _____°C (100°F) for approximately _ hours

• The most common veterinary units run on - and -hour cycles and operate at ____ ______.

Items should be clean and dry before EtO sterilization;

Reason: moisture and organic material bond with EtO and leave a toxic residue

Items should be clean and dry before EtO sterilization;

Reason: _______________ bond with EtO and leave a ____________