Chapter 14- Postoperative Cleaning

Powerpoint based questions for chapter 14

Where should the cleaning equipment for the surgical room be used?

Surgery room only

What are the guidelines for environmental infection control from the CDC?

Prevent opportunistic, environmentally related infection from occurring in immunocompromised patients, proper use of disinfectants, proper maintenance of equipment that uses water, proper ventilation

What areas in the surgery room are highly contaminated?

anesthetic machine, floors, IV poles, operating room entry door handle

What is the preferred cleaning method in the surgery room?

Wet vacuuming at the end of the day

What method of cleaning is more effective than disinfectants?

physical removal of microorganisms

What does AORN stand for?

Association of periOperative Room Nurses

What is AORN recommendation one for environmental cleaning?

Cleaning is performed on a regular basis to reduce the amount of dust, organic material, and microbial presence in the surgery room

What is AORN recommendation two for environmental cleaning?

The surgery room should be cleaned before and after
each surgical procedure

What is AORN recommendation three for environmental cleaning?

All horizontal surfaces in the surgery room should be damp-dusted before the first surgery of the day.

What is AORN recommendation four for environmental cleaning?

Surgical room equipment and furniture that are visibly soiled should be cleaned at the end of each procedure

What is AORN recommendation five for environmental cleaning?

Surgery rooms should be “terminally cleaned” daily

What is AORN recommendation six for environmental cleaning?

Surgery rooms should be cleaned daily whether they are used or not

What is AORN recommendation seven for environmental cleaning?

Mechanical friction should be used to clean all surfaces

What is AORN recommendation eight for environmental cleaning?

Refillable soap dispensers are not recommended because they can harbor bacterial growth

What is AORN recommendation nine for environmental cleaning?

Surgery rooms should be wet-vacuumed at the end of the day

What is AORN recommendation ten for environmental cleaning?

Cleaning equipment such as mops, vet vacuums, should be disassembled, cleaned, and dried before storage

What factors does disinfectant effectiveness depend on?

type of microorganism, degree of contamination, amount of protein in the area, organic matter, additional sanitizing compounds, concentration and quantity of the chemical, contact time and temperature

What are the four types of disinfectants?

chlorine, phenol, quaternary amine, chlorhexidine

What is the common name for sodium hypochlorite?

bleach

What are the advantages of sodium hypochlorite?

Effective, cheap

What are the disadvantages of sodium hypochlorite?

corrosive, toxic, irritating to eyes, mucus membranes, skin, deactivated by organic debris

What are the advantages of phenol based disinfectants?

broad spectrum, easy to use, good for surface disinfection

What are the disadvantages of phenol based disinfectants?

not sporicidal, inactivated by organic debris, irritating to the skin, eyes, and respiratory tract, more expensive

What are the advantages of quaternary amine based disinfectants?

broad spectrum, low toxicity, long shelf life, easy to use

What are the disadvantages of quaternary amine based disinfectants?

less effective against non-enveloped viruses, spores, and some gram - bacteria, reduced activity caused by hard water, respiratory and skin irritation, toxic to aquatic organisms

What are the advantages of chlorhexidine based disinfectants?

broad spectrum, long lasting (binds to keratin), effective for handwashing

What are the disadvantages of chlorhexidine based disinfectants?

may irritate the skin, not effective against spores and some viruses

What are the rules of chemical disinfection?

1. All items must be thoroughly cleaned first

2. Only surfaces in direct contact with the solution are disinfected

3. Items should be dry before placing in disinfectants to avoid diluting the solution

4. Some disinfectants are for inanimate objects

How should the correct disinfectant be selected?

1. What is the contact time required

2. Will it affect instruments, cages, floors

3. How toxic to people and animals

4. Is it inactivated by organic material

5. Does water hardness affect the disinfectant

6. Does soap or detergent deactivate the disinfectant

What are the three cornerstones that relate to providing sterile instruments?

cleaning, decontaminating or sanitizing, sterilizing

What is the process of presoaking the instruments?

placing the soiled instruments in distilled water mixed with a detergent solution approved for instruments

Why do we not use tap water to clean surgical instruments?

it can contribute to staining and rust

How does presoaking benefit the cleaning process?

it helps to soften dried blood and other debris, and prevent further drying

What temperature should the water be for a presoak?

cold

When can enzymatic cleaners be used?

as a presoak or as part of the cleaning cycle

How long may surgical instruments be left in an enzymatic solution?

5 to 10 minutes

What is the process of decontaminating the instruments?

manual cleaning of instruments in a commercial instrument deterfent

Where on the instrument needs additional attention during cleaing?

teeth, ridge, box lock

What are the steps of decontamination?

1. Prepare cleaning solution

2. Open all box locks and rachets

3. Wash all surfaces with soft bristle brush

4. Rinse each instrument in distilled water

5. Place instruments on a lint free cloth

6.  Inspect all instruments

What is ultrasonic cleaning?

use of sound waves to remove dirt and debris

How does ultrasonic cleaning work?

sound waves produce microscopic bubbles on the surface of the instrument, which collapse and create a scrubbing effect known as cavitation

How long are ultrasonic cleaners used?

3-6 minutes

When is lubricant applied to surgical instruments?

After ultrasonic cleaning

What are the two methods of applying lubricant?

Spray, solution

How do you apply spray lubricant?

place instruments on a towel, liberally spray instrument milk onto the instruments

How do you apply solution lubricant?

make a solution using distilled water and concentrate, place instruments in solution for 1-2 minutes (or per manufacturer instructions)

What do pack recipes include?

name and number of each instrument, types and quantities of supplies, photo or illustration of each instrument, wrap material to be used, instrument special instructions, warranty information, manufacturer’s phone number

What is wrapping material normally made of?

cotton, linen, polypropylene, paper

What are the ideal characteristics of wrap?

1. selective permeability

2. resistance to tears

3. flexibility

4. memory

What does selective permeability mean?

allows steam and gas to pass through, blocks microbes and dust

What does flexibility mean?

easy to fold

What does memory mean?

ability to return to a flat position

When inspecting cloth gowns and drapes, what are you monitoring for?

holes and worn areas in the cloth

Water resistant, reusable cloth should have a ____?

Washing grid

What is the purpose of a washing grid?

used to tract the number of uses, one box filled in per wash- once the grid is filled, item must be removed

Which organizations does the FDA recognize the standards for drape protective levels?

American National Standards Institute (ANSI)
Association of the Advancement of Medical Instrumentation (AAMI)

Describe a level 1 drape.

Provides a slight barrier to small amounts of fluid penetration for minimal risk situations

Describe a level 2 drape.

Provides a barrier to larger amounts of fluid penetration through splatter and some fluid exposure through soaking in low-risk situations

Describe a level 3 drape.

Provides a barrier to larger amounts of fluid penetration through splatter and greater fluid exposure through soaking than Level 2. Ideal for moderate risk situations

Describe a level 4 drape.

Prevents all fluid penetration and may prevent virus penetration for up to one hour in high-risk situations

What are the biggest factors in selecting drapes?

amount of risk, fluid exposure

Where are the critical zones of the surgery gown?

Sleeves and front of gown

What does “critical zones” mean?

Defined as the areas where direct contact with blood, bodily fluids, and other potentially infectious material is most likely

What level of protection must a surgical gown provide?

all areas of the gown must have a barrier performance of level 1 or higher

Why must surgical drapes be lint free?

lint is a recognized vector for causing surgical site infections as well as a medium of transport for microbes

Why should drapes be flame resistant?

to reduce fire hazards in the surgical room- a oxygen (very flammable)  rich room

Why is it important that drapes are flexible?

allow ease of placement on patients, surgical sites, surgery tables, or other equipment

Do the Surgical Drapes pass the ASTM F1670 and F1671 tests?

The CDC and FDA recognize these two tests as the definitive assessments for determining the fluid and microbial barrier properties of Surgical Drape fabrics.

What thread count of cotton muslin is used?

140 (must be doubled) or 270/280

What are the advantages of cotton muslin?

durable, flexible, reusable, easy to handle

What are the disadvantages of cotton muslin?

initial cost, last 75 autoclave cycles, requires double layer, generates lint, not moisture resistant

What can be used to sterilize cotton muslin?

steam or ethylene oxide

What can help remove excess soap from cotton muslin after being washed?

additional rinse cycle

What is nonwoven barrier material?

paper- most commonly crepe

What are the advantages of paper?

inexpensive

What are the disadvantages of paper?

single use, poor memory, requires double layer, not moisture resistant

What can be used to sterilize paper?

Steam or ethylene oxide

What are the polypropylene wrap materials?

Spunguard, Spunbond

What are the advantages of Spungard?

flexible, durable, excellent bacterial barrier, puncture resistant, lint free, level 2 protection

What are the disadvantages of Spunguard?

single use, requires double wrap

What can be used to sterilize Spunguard?

steam, ethylene oxide, plasma

What are the uses of Spunguard?

Making disposable table covers, gowns, PPE kits, face mask, bouffant caps, shoe covers etc.

Making D/W cut bags

Hygiene Industry (Sanitary Napkin & diapers)

How is Spunbond made?

Thermal bonding

What are the advantages of Spunbond?

durable, good temperature resistance, recyclable, excellent moisture resistance, level 2 protection

What can Spunbond be made to create?

disposable bed sheets, wet wipes, baby wipes, surgical gowns, wash gloves

How is SMS material layered?

Spunbond-Meltdown-Spunbond

What are the advantages of SMS?

non-toxic, odorless, highly resistant to bacteria, level 3 protection

What properties can SMS possess if treated with special equipment?

anti-static, anti-alcoholic, anti-plasma, water repellent and water-producing properties

What are the uses of SMS?

surgical gowns, wraps, cover clothes, sterilized bandages, wound wraps

What are the two types of plastic peel packs?

Tyvek, Mylar

What are the advantages of peel packs?

convenient, long shelf life, water resistant, more puncture resistant

What are the disadvantages of peel packs?

instruments may puncture pouch

What can be used to sterilize peel packs?

steam, plasma, ethylene oxide

How do you use peel packs correctly?

Use the correct size (1inch space between instrument and end of pack), place in handle first with the ratchet open, can self seal or bulk roll (heat sealer needed)

What side of the peel pack do you write on?

plastic side only

When using peel packs, what can be used on instruments with sharp tips?

protective tips to prevent the peel pack from being punctured

What is a Steri-drape?

adhesive drape that covers entire surgical site, creates a sealed barrier against contaminates

What are the advantages of a Steri-drape?

decreased risk of infection, fit multiple sizes/shapes easily, no fluid strikethrough

When placing an item with a lumen into a surgical pack, what must be done before sterilization?

Flush with a small amount of distilled water

What is a drape with a pre-cut hole in the center called?

fenestrated drape