Module 1-12 (textbook)

Sorting means

to organize the preparation work area so that tasks can be carried out efficiently

Inspecting instruments means

carefully checking each item (or part) for cleanliness and working condition

Working condition means

The instrument is both undamaged and complete

Silicone spray

A common type of lubricant commonly used in the preparation area

Every set or package that will be sterilized

must include an internal and external chemical indicator

Muslin (reusable wrapper)

Is a relatively loosely woven material having about 140 threads per square inch (70 threads running each way

cotton/polyester blend.

Microfiber wrappers

is a closely woven synthetic e.g. polyester with a thread count of 15,000 threads per square inch.

Single use (Disposable) wrappers

are made from cellulose (paper) or synthetic fibres.

Synthetic wrappers

have 3 layers of polypropylene that have been bonded together by heat

140 thread

Paper (cellulose) wrappers

used as a packaging material should be of “medical” grade

Peel pouches

are packages manufactured with one side of plastic film, backed with either paper or a synthetic material (TyvekTM)

Sterilization Containers

They may be made of aluminum, stainless steel, or high density plastic and do not require wrappers

Loading the sterilizer

Container with instrument set ≤ 10 Kg

Wrapped basin set ≤ 3 Kg

Labeling packages

Package identification (package code or name)

initial of the person who assembled the package

Sterilizer load identification

• Sterilizer number

• Load number in the sterilizer

• Sterilization date

Sterile means

free from viable (living) microorganisms

Requirements for steam sterilization

Moisture (steam)

Temperature (heat)

Time

Air removal

the atmospheric pressure is

14.7 psia

0 psig

Chamber is

the vessel in which sterilization takes place

Jacket

surrounds the chamber of the sterilizer.

It heats the chamber walls, preventing the condensation that would occur at the start of a cycle also maintains a supply of steam ready to enter the chamber immediately.

Baffle is

a metal plate or nozzle located at the steam inlet into the chamber. It deflects steam as it enters the chamber, helping to distribute it evenly throughout the chamber

Drain or Air Outlet

provides a path for air to flow out of the chamber at the beginning of a sterilization cycle in the same way in which water flows through a sink drain.

Steam Trap

In order to raise the pressure inside the sterilization chamber, once the air is removed, the chamber must be completely sealed so that it is air/pressure tight

Gravity displacement (passive)

relies on temperature differences and the heavier weight of cooler air compared to steam for air to fall to the bottom of the chamber and flow out of it

Dynamic (active)

to rid the chamber of air at the start of a cycle.

 Prevacuum

 Steam-flush/pressure pulse (SFPP)

Prevacuum air removal

a vacuum pump, situated in the drain line mechanically removes air from the chamber before the actual sterilization (exposure) phase begins.

132°C for 4 minutes.

A negative chamber pressure is created. As steam is injected into the chamber again, the pressure in the chamber increases from negative to positive.

Steam-flush-pressure-pulse (SFPP)

Pulses of steam are injected into the chamber and turbulence is created

132°C for 4 minutes.

Pressure in the chamber never falls below 0 psig, there’s a positive pressure

Phases of a Prevac Air Removal Sterilizing Cycle

Condition

Sterilize (exposure)

Exhaust

Wet Packs

in the form of dampness, droplets of water on or in the package, or a dried watermark on the wrapper.

Causes of wet packs

Improper packaging

Plugged drain line

Items wet prior to sterilization

Dirty chamber

wet steam

storage while hot

Immediate Use Steam Sterilization (IUSS) Flash Sterilization

Emergency steam sterilization of a medical device by the unwrapped method

Not be used to sterilize implants, nor should it be used to sterilize complete sets or trays of instruments.

Leak test

Part of the quality assurance process for a Prevac steam sterilizer is to routinely test it to ensure that there is no air in the chamber during sterilization (exposure) phase.

Air Removal (Bowie Dick) test

Verifies that the vacuum pump in the sterilizer is working as it should and all air present in the chamber at the start of the cycle is drawn out of the chamber before the sterilization exposure phase begins

Performed daily, first thing in the morning in an empty sterilizer.

1 Process Indicators

All external CLs

Sterilizer tape and indictor labels

2 Specific test Indicators

measures attribute/condition

Bowie-dick test

3 Single variable Indicators

Time or temperature

Steris system

4 Multi Variable Indicators

2 or more sterilization variable

Internal CLs, Sterrad, VP4 and ETO

5 Integrating Indicators

react to all the critical sterilization variables

Steam CIs

6 Emulating Indicators

react to all the critical sterilization variables for on specific cycle

Done by manufacture

Chemical indicators (CIs) are?

ink that responds to one or more sterilization parameters

External chemical indicators

Placed on the outside of the package to confirm that the outside of the package was exposed to the sterilant

Indicator tap, pouches and rigid container tags

Internal chemical indicators

Placed inside the package prior to wrapping to tell what types of conditions were achieved inside the package

paper strips, cards or tape

PCD

Designed to challenge or resist the ability of the sterilant (steam) to penetrate and reach the test indictor within it

Performed first thing in the morning, place horizontally bottom of an empty chamber, above the drain.

Biological indicators (BI’s)

used to provide confirmation that conditions during sterilizing cycle were sufficient to kill microorganisms (spores)

Made up of non-pathogenic spore

BI test

If all spores have been killed, there will be no color change

performed every day/each cycle full load, first load of the day or any load containing implants

Place on lower shelf, near the drain

Incubated from 30 min to 49 hrs

Negative BI means:

No spore growth

No color change (remains purple)

Control test:

an unprocessed BI is crushed and incubated alongside a processed BI.

Perform once a week or when a new box is opened

Physical indicator

conditions in the sterilizer chamber

Chemical indicator

condition in and around the packages

Physical monitors for sterilization includes:

Printouts, recording charts and digital displays

Hydrogen Peroxide vapour/gas plasma

H2O2 kills microorganisms via oxidation

Operate at a low temperature (e.g. 40- 60°C)

Have a cycle time that is often shorter than steam

endoscopes, telescopes, light cords, and batteries to be sterilized quickly and safely.

Sterrad® 100S Boosters

a sterilization system that uses a device to deliver a dose of H2O2 into a long or narrow lumen

Ethylene Oxide Gas

ETO an odorless gas

kills microorganisms via alkylation.

Operate at a low temperature (about 45°C)

Have a longer cycle time 72 hrs turn over time

Requirements for ETO Sterilization

Gas concentration 600-700mg

Humidity 30-60%

Temperature 50-60

Time 1-2 hrs

Vacuum (100% ETO)

Aeration

makes the items safe by allowing the toxic ETO residue to dissipate.

Aeration temperature 20 C (room temperature)

7 days

Aeration temperature 55 C

12 hours

Aeration temperature 60 C

8 hours

ETO BI spore is

Bacillus atrophaeus

Steam BI spore?

Geobacillus stearothermophilus

Ozone-hydrogen peroxide vapour sterilization

Kills microorganisms via oxidation

Operates at a low temperature. (20-26°C)

Has a cycle time that is shorter (45 min)

BI should be placed top right

Peracetic Acid Immersion (Steris System 1E)

Sterilizes medical devices by immersing them in 35% PAA. commonly used for reprocessing rigid and flexible endoscopes and their accessories.

A just-in-time system

25 min

Solution is heated to between 46 and 60°C.

Diagnostic Cycle is run every day

Medical asepsis

When handling processed packages, their cleanliness must be protected by applying

Time-Related

A package was considered sterile until a specific expiration date was reached.

Event-Related

Is based on the principle that microbial contamination of a sterile package such as damage to a package

the shelves should be at least

45 cm (18 in) from the ceiling

5 cm (2 in) from an outside wall

25 cm (10 in) off the floor

Sterile storage area temp should be

18 - 23 C

Centralized dispatch system

Individual items are stored in the storage area and released to user areas in response to a specific request

Top-up or PAR

Assesses the supplies required by areas and identifies the ones that are used most frequently

Exchange cart system

Use two identical supply carts. one for point of use, and other to provide needed supplies and the other in the MDRD being restocked

Case cart

Contain a standard, predetermined selection of supplies that are required for a particular procedure

Specialty carts

hold a variety of supplies that could be used for a specific type of procedure, when the actual size or item cannot be predicted in advance.

Stockless/Just-in-Time (JIT)

inventory is usually stored off-site and delivered to the facility on a regular schedule.

Universal or Umbilical cord

Delivers light, air, water and suction to the scope and a video image from the scope

Control Head

houses the eyepiece and/or video components, control knobs to flex the distal tip, and channel openings for water, suction and air.

Insertion Tube

A flexible shaft, a portion is inserted into the patient during a procedure.

Distal Tip

The end of the insertion tube.

Lumens are capped with “valves” or control buttons must be

removed for cleaning and then kept separately but with the scope while it is stored.

Decontamination of Flexible Endoscopes

Pre-clean

Leak test

Manually clean and rinse

AER

Dry

Store

Quality Management System (QMS)

Is to ensure that the organization’s products or services consistently meet predetermined standards

Management’s responsibilities

Develop policies and procedures, provide resources, determine which KPI’s will be used to assess MDRD performance, develop corrective action protocols for non-conformance, assess departmental processes regularly

Staff’s responsibilities

Follow MDRD policies and produces, use resources responsibly, monitor and measure the required KPI’s, identify and communicate non-conformance, follow established protocols, document action, participate in ongoing assessments/audit of MDRD practices

In MDR SOP's stand for?

Standard Operating Procedure

SOPs includes:

Title, purpose, unique identification and date information

Three top priorities in MDR Department

Patient safety, Occupational health and Safety, Infection control and prevention

clear purpose, specific, relevant, actionable, timely, balanced.

effective feedback should be

safety, quality care, accountability

3 reasons MDR techs follow guidelines

Site-specific practices, current standards, and manufacturers instructions

SOP's are based on:

the way that infections move from person to person is called

the cycle of infection

Microorganisms are classified as:

bacteria, fungi, and virus

most common cause of healthcare aquired infection is:

dirty hands

Modes of transmission

direct contact, indirect contact, droplet, airborne, vector, common vehicle.

routine practices to help prevent the transmission of infections:

hand hygiene, PPE, reprocessing medical devices and environmental controls

decontamination area dress code:

Gloves, gown, face mask and eye protection

A person who has an infection is considered a?

Infected host

transmission of pathogens from an infected person to an intermediate object is considered

indirect contact

transmission of pathogens through physical contact, such as shaking hands

direct contact

Transmission of pathogens through a shared source, like contaminated food, water, or medical equipment

common vehicle

Droplet

Transmission of pathogens through respiratory, such as when an infected person coughs or sneezes

transmission of pathogens through tiny particles or droplets that remain suspended in the air

airborne

transmission of pathogens via an organism, such as an insect, mice

vector