Chapter 7: Surgical Asepsis and Sterility: Best Practices and Techniques

_____________ refers to the process by which most, but not all, the organisms located on inanimate (non-living) surfaces are destroyed

Disinfection

______________, also called trioxygen gas, oxidizes bacteria by penetrating cell membranes and causing them to rupture. It is destructive to rubber and plastics and corrodes some metals and cannot be used for long, cannulated instruments.

Ozone

What is another name for phenol?

Carbolic acid

All of the following are environmental specifications for the decontamination room in CSPD EXCEPT:

• air exchange rate, minimum of 10 per hour

• humidity between 35% and 72%

• positive air pressure maintained

• temperature between 64°F and 70°F

positive air pressure maintained

During manual cleaning of surgical instruments, what type of solution should be used?

• cold water, detergent, and enzymatic cleaner with high pH

• hot water, detergent, and enzymatic cleaner with high pH

• lukewarm water, detergent, and enzymatic cleaner with neutral pH

• cold sterile water and enzymatic solution with low pH

lukewarm water, detergent, and enzymatic cleaner with neutral pH

T or F?

Gravity displacement steam sterilizer cycles are much shorter than prevacuum cycles.

False

__________ ____________ gas is a non-carcinogenic, EPA-registered sterilant that has been used for decades as a sterilant for suture material, joint prostheses, and implantable lens. It also can be used to sterilize devices containing embedded batteries.

Chlorine dioxide

Which gas sterilants are used with non-cellulose packaging materials such as Tyvek or Mylar and Geobacillus stearothermophilus as the BI for sterilization?

• Ozone

• Chlorine Dioxide

• Vaporized peracetic acid

• Steam

Which gas sterilant uses the bacterial spore-forming Bacillus atrophaeus as the biological indicator

EtO or EO????

p.. 162 What happens when the chemical indicator does not change when the CST opens their container of sterile supplies while getting ready for a procedure.

All instruments need to be recalled???

What is the fourth state of matter?

Plasma

The two types of ___________ _____________ processes do not require aeration, drying, or cooling at the completion of the cycle. No toxic fumes, residue, or excessive heat are created by this sterilization method.

hydrogen peroxide

1. HP gas plasma (HPGP) at 95 percent H2O2 at 37^o-44^o C (98^o-111^o)

2. Vaporized HP (VHP) at 59 percent at H2O2 at 28^o-40^o C (82^o-104^o)

7-11d

What are the phases for gravity displacement steam sterilizers.

1. Conditioning phase - Creates the conditions necessary for the autoclave to reach the pressure, pre-set temperature, and steam saturation required.

2. Exposure phase - Items loaded in the chamber are exposed to the steam under pressure.

3. Exhaust phase - Period of time when the steam in the autoclave chamber is removed.

4. Drying phase -

?What are the basic components of a steam autoclave?

• Pressure chamber

• Steam generator

• Heating element

• Safety valve

• Pressure gauge

• Door gasket

• Thermostatic trap

• Control system

What are the three main pipes in a steam autoclave?

1. A pipe to bring the steam to the sterilizer jacket and the chamber

2. A drainpipe to remove the steam, air, and water from the inner chamber

3. A pipe to deliver filtered air into the chamber at the end of a cycle to replace the steam as the chamber returns to atmospheric pressure

Which instruments require special care in cleaning and disinfection?

Items with lumens such as trocar sheaths, non-disposable suction tips, and endoscopic instruments require special care to ensure adequate cleaning and decontamination.

Why should sterile water be used for rinsing instruments and not saline?

The salt and chloride ions can cause pitting and corrosion of the metallic surfaces.

_____________ is a process of destruction of most, but not all, microorganisms located on animate (living) surfaces, such as the skin.

Antisepsis

_____________ are chemical agents used by the sterile surgical team members to perform the surgical hand scrub or the prep solutions used for preoperative skin preparation of the patient's anatomical surgical site

Antiseptics

True or false: living tissue such as skin can be sterilized

False; it can NOT be sterilized

Do surgical hand scrubs make you sterile

No, it makes you surgically clean (Note: the tapwater is non-sterile)

_____________ is the removal, inactivation, or destruction of gross contaminants, including bioburden, bloodborne pathogens, or other potentially infectious materials (OPIMs) by physical or chemical means

Decontamination

What pertains to the initial process of removing proteinaceous material such as blood and tissue from surgical instrumentation prior to the preparation for the final step of sterilization

Decontamination

______________ is the destruction of all microorganisms, whether pathogenic or non-pathogenic, including spores, living on inanimate surfaces

sterilization

The _____ and _____ utilizes a classification system for patient care items and surgical devices. The system rates to degree of risk to patients for infection based on how and where the items will be used.

CDC; FDA

The three classifications that rates the degree of risk to patient for infection based on how and where items will be used are :

1. Critical
2. Semi-critical
3. Noncritical

Items used for invasive procedures or vascular access and carry a high potential for causing SSI; these items must be sterilized....falls under what classification according to the CDC and FDA

Critical

Items that come into contact with mucus membranes are non-intact skin requires high-level disinfection that may be used for items in this category, but sterilization following decontamination is frequently preferred... falls under what classification according to the CDC and FDA

Semi critical

Items that come into contact with a patient's intact skin and clean equipment and these devices pose the least risk of infection; these items require either intermediate level or low level disinfection...falls under what category according to the CDC and FDA

Noncritical

The physical removal of blood, body fluids, and gross debris (bioburden) from an inanimate object is known as what

Cleaning

What are the three levels of disinfection?

high, intermediate, low

What level of disinfection kills all microorganisms except spores and prions that cause CJD

High-level disinfection

What level of disinfection kills most microorganisms, including bacteria, most viruses and fungi, M. tuberculosis and HBV; ineffective against spores

Intermediate level disinfection

What level of disinfection kills some fungi and viruses, and most bacteria, but is not effective against spores and M. tuberculosis

Low-level disinfection

True or false: disinfection destroys pathogenic microorganisms or their toxins or vectors by direct exposure to chemical or physical agents

True

True or false: sterilization destroys microorganisms using steam under pressure, chemical agents, high velocity electron bombardment, ultraviolet, or gamma irradiation

True

It is important for contaminated items to be thoroughly _________ prior to the decontamination process

cleaned

Certain disinfecting compounds also serve as __________ when used in sterilization systems or when items are immersed and exposed to the liquid chemical agent for a certain amount of time as with activated glutaraldehyde

sterilants

While the high concentration of a disinfectant increases the level of disinfection, the concentration may be too corrosive for use on certain items such as _________

Rubber

True or false: disinfectants vary in their lethality and which microbes they are effective against

True

The Safety Data Sheet (SDS) was previously called the ___________ _________ ______ __________

Material Safety Data Sheet (MSDS)

True or false: the selection of a disinfectant is based solely the item to be disinfected.

False; it is based on the item to be disinfected AND itspatient care classification (critical, semi-critical, or noncritical)

How many minutes of contact time is generally recommended for high-level disinfection?

20-30 (unless the manufacturer requires other exposure times)

How many minutes of contact time is generally recommended for intermediate and low level disinfections?

10-15

True or false: all surgical personnel must be instructed that disinfectants are solutions that contains strong chemicals that can damage skin and tissue and complete training in their proper use

True

______________ is the only disinfectant that can be used as a low-temperature, liquid chemical sterilant on moisture stable, heat-sensitive surgical instruments and endoscopes

Glutaraldehyde

__________ ___________ is the only high-level disinfectant discussed that is appropriate for environmental surface disinfection

Sodium hypochlorite

Glutaraldehyde is not suitable for environmental service disinfection because of its potential _________ and ______ ___________

Toxicity; skin irritation

True or false: Glutaraldehyde is used disinfectant items that are considered Noncritical in the patient care classification

False; it's used for semi-critical patient care items

As an activated chemical mixture, Glutaraldehyde has an alkaline pH, capable of sterilizing, moisture-stable, heat-sensitive instruments or devices when exposed to the liquid sterilant for a period of ____ hours

10

Glutaraldehyde is used for devices that can withstand complete ______________

Immersion

The shelf life for Glutaraldehyde without a surfactant is ____ days; with a a surfactant the shelf life is increased to ____ days

14; 28

A _______________ is a component of detergents that works by breaking down the barriers between water and oil or organic soil to facilitate their removal.

Surfactant

The name surfactant derived from the term _________ _________ ________

Surface active agent

Commercially produced test strips are available to test the minimum effective concentration (MEC) to ensure it is at least _____ strength by comparing the color change on the strip to the sample color strips on the test strip container

1.8%

Prior to immersion items should be _________ and __________

Cleaned and rinsed

Thorough rinsing with sterile water must be done for all items disinfected with Glutaraldehyde before use on the patient to prevent potential ___________ __________ on the patient's tissue

Chemical burns

A minimum exposure of ____ minutes at room temperature is required for high-level disinfection for most Glutaraldehyde brands

20

True or false: Cidex OPA Shortens the exposure time to 12 minutes (as opposed to the 20 minutes that Glutaraldehyde minimally requires) for the same classes of semi critical patient care items to achieve high-level disinfection

True

Sodium hypochlorite is also known as

Household bleach

True or false: OSHA recommends the use of sodium hypochlorite in cleaning blood and body fluid spills

False; the CDC recommends it

Sodium hypochlorite should never be mixed with what? (2)

1. Formaldehyde (Produces carcinogenic, bis-chloromethyl ether)
2. Ammonia (Produces chloramine gas)

True or false: intermediate level disinfectant solutions, do not kill all non-spore forming bacteria

False; they DO kill all non-spore forming bacteria

True or false: intermediate level disinfectant solutions are used to disinfect countertops, OR furniture, and floors

True

True or false: if used for patient care items, intermediate level disinfection is appropriate for non-critical instruments or devices that only come into contact with the intact skin of the patient

True

isopropyl and ethyl alcohol and dilutions of ___% to ___% concentration are tuberculocidal, bactericidal, virucidal, and fungicidal, but they are NOT sporicidal

60 ; 70

Alcohol is most useful in cleaning and disinfecting small __________ surfaces

noncritical

_________ is commonly used as a component and anti-septic agents used by surgical team members for the surgical skin scrub and for pre-operative patient skin preps

Alcohol

Alcohol must be allowed to completely ___________ if used as a skin prep as it is highly flammable and may contribute to causing a fire

evaporate

True or false: alcohol is effective against HIV

True

Why shouldn't you use alcohol to clean an endoscope?

It breaks down the cement

You should not use alcohol to clean surgical instruments because it is highly _____________ to stainless steel

corrosive

What service personnel is involved with the OR decontamination?

Environmental services

Who requires that HCF departments including surgery have exposure control plans in place that explain the protective measures needed to create a safe working environment?

OSHA

Regulated waste must be placed in leak proof bags that are clearly marked with the biohazard symbol and are typically _____ in color

Red

Prior to the start of the first surgical procedure of the day, the OR furniture, equipment, surfaces, and lights must be "damp-dusted" with a _____________ ___________ on a lint free cloth

disinfectant solution

Who is responsible for discarding soiled sponges from the sterile field into the plastic-lined sponge or kick bucket?

The CST

Who recommends that the ORs should be cleaned between procedures

The CDC

True or false: the CST along with environmental services personnel may be involved in the "turnover" of the room that marks a preparation for the next procedure

True

Who is responsible for placing instruments in a closed case cart or onto an open cart or table that is covered with plastic for transfer to the decontamination room

The CST

_______-__________ _________ have been known to contaminate disinfectant solutions, soap dispensers, and surgical scrub solution dispensers in the surgery department

Gram-negative bacilli

Containers, such as (soap) dispensers should be sterilized before refilling and should not be _______ _____

Topped off

True or false: every patient is considered potentially colonized with every possible pathogen

True

What cases are scheduled as a last case of the day and require additional cleaning measures

" dirty cases"

The process of surgical instrumentation _________________ is both the beginning of the cycle and the end of the cycle from point of use to point of use (POU)

decontamination

A basin with sterile water should be available within the sterile field to soak and clean instruments; the basin should never be filled with ____________

Saline

True or false fat may cause instruments to become stiff in the surgeons hand

False; fat causes instruments to become slippery... dried blood may cause instruments become stiff

If an instrument cannot be cleaned easily with a sponge, it should be kept in what?

A basin of sterile water

True or false: instruments with lumen should be periodically flushed with sterile water to prevent the lumen from becoming clogged

True

The _______ ______ _________ is an efficient method for transporting surgical equipment, supplies, and instruments to the OR and back to the CSPD for reprocessing

case cart system

A small elevator called a ________ may be used to transfer the cart to the CSPD

Dumbwaiter

If the CSPD is located adjacent to the OR, the case cart can simply be transferred to the ____________ ______

Decontamination room

__________________ is the first step in the prevention of transmission of potential pathogenic microbes from instruments to surgical patient or from contaminated instruments to personnel

Decontamination

Filtered air is exhausted where from the decontamination room

Exhausted to the outside of the HCF

The minimum air exchange rate in the decontamination room is ____ times per hour

10

What type of air pressure is maintaining in the decontamination room?

Negative

Temperature should be maintained between ____ and ____ with a relative humidity of _____ to ____ in the decontamination room

64° ; 70°
35% ; 72%

Personnel performing decontamination duties must don ____

PPE

The first step in the overall decontamination process begins at the _______ ___ _____

Point of use

True or false: CST's can soak instruments in enzymatic solutions

True