sterility

Asepsis

Absence of pathogenic microorganisms or disease

Bactericidal

A type of substance that kills bacteria and inhibits their growth and reproduction

Bioburden

Amount of organic debris on an object at any given time

Concurrent decontamination

Cleaning and decontaminating a spill or splatter on the floor while a surgical procedure is in progress

Contamination

Violation of the state of sterility

Cross Contamination

Contamination of a person, object, or environment by contact with contaminants from another source

Decontamination

Reduction of the microbial population on a surface

Disinfectant

Chemical agent that kills most microbes, but typically not spores

Event-related sterility

A package is considered sterile until opened or the integrity of packaging material is violated

Fomite

Inanimate object that harbors microorganisms, including dust, lint, droplets, and environmental surfaces

Fungicide

Agent that kills or destroys fungal organisms

HAI

Healthcare-associated infection; nosocomial infection

Indigenous microflora

Microorganisms that normally reside in body tissues (skin) or body systems

Infection

Invasion of the human body by microorganisms causing disease

Package integrity

The condition of packaging material remaining intact to prevent contamination

Pathogen

Any microbe capable of causing disease or infection

Sepsis

Infection

Spore

Resistant form of bacteria that forms a protective shell and remains dormant to survive adverse conditions

Sporicide

Agent that kills bacterial spores

Sterile

Item that has been rendered free of all living microorganisms

Sterile field

Specified area free of all microorganisms, including the incisional area and items around the patient

Sterile technique

Creating and maintaining a protected sterile field

Strike-through contamination

Occurs from the passage of fluid through a permeable sterile barrier

Surgically Clean

Mechanically cleaned and chemically disinfected but not sterile

Terminal disinfection

High-level disinfection process that renders items safe to handle before sterilization

Terminal sterilization

Mechanical dual decontamination and sterilization method that renders unwrapped items safe to handle prior to packaging

Transient microflora

Microorganisms that temporarily reside on body tissues or systems

Vector

Living carrier or host that transmits disease to another host

Virucide

Agent that destroys viruses

Wicking action

Absorption and spreading of a fluid through a porous or permeable material

Environmental Decontamination

Goal of minimizing microbial population counts in the OR environment to reduce the potential for SSIs for patients

Furniture

All furniture surfaces including legs, casters, and wheels are wiped down.

OR table

Table in the operating room thoroughly cleaned, including wheels.

Mattress pads

Pads removed and wiped down completely.

Patient positioning attachments

Attachments used during procedures are cleaned.

Equipment

Tables, stools, kick buckets, anesthesia machine, ESU, and suction unit cleaned and disinfected.

Horizontal surfaces

Cabinet shelves, doors, and handles are cleaned.

Disinfectant solution

Solution used to wet or flood the floor for cleaning.

Substerile rooms

Rooms for storage cleaned.

Stretchers

Equipment for patient transport cleaned.

Scrub sinks

Sinks requiring special cleaning due to heavy use.

Hallway floors

Floors cleaned similarly to OR floors.

Ceilings, walls, floors

Thorough cleaning inside and outside individual ORs.

Mounted lighting fixtures

Lighting fixtures in the OR cleaned.

Air vents and duct grills

Vacuumed to remove bacteria-containing dust.

Supply cabinets

Inside and outside surfaces, including shelves, are cleaned.

Sterile supply rooms

Rooms for storing sterile supplies are cleaned.

Housekeeping supply rooms

Rooms for storing housekeeping supplies are cleaned.

Dirty cases

Additional disinfection practices for cases involving patients with active COVID-19 infections.

Basin with sterile water

Used to soak and clean instruments within the sterile field.

Saline solution

Avoid using saline to prevent pitting and corrosion of instrument surfaces.

Enzymatic solution

Used to remove and destroy proteinaceous materials from instruments.

Lipolytic enzymatic cleaner

Removes fatty materials such as adipose tissue and bone marrow from instruments.

Detergent solutions

Cidezyme is an enzymatic cleaner for removing organic debris from surgical instruments.

Enzymatic foam

Sprayed over instruments to aid in breaking down proteinaceous debris.

Case cart system

Efficient method for transporting surgical equipment, supplies, and instruments.

Chelation

Process of binding minerals in the solution to prevent deposits on instrument surfaces.

Emulsification

Action of dispersing two liquids not capable of being mixed to break down organic soil.

Ultrasonic cleaning

Some solutions are specifically for use in ultrasonic cleaners to enhance wetting ability.

Manual cleaning

Detergent solutions used for manual cleaning, creating friction to remove soil and bioburden.

Washer-decontaminator

Liquid solution available in different pH levels for cleaning surgical instruments.

Moderate-pH product

Low-level alkaline product that may be combined with surfactants and chelating agents, safe for use on stainless steel instruments but could harm the chromium oxide layer.

High-pH product

Effective for removing heavy soil, but can be corrosive to stainless steel and requires neutralization with a rinse to prevent damage.

Three-sink arrangement

Manual cleaning setup involving a wash sink with detergent, intermediate rinse with distilled water, and final rinse with distilled water.

Rigid Endoscopes

Type of endoscope requiring thorough cleaning of channels, holes, and joints to remove blood and debris.

Flexible Endoscopes

Type of endoscope that must undergo immediate pre-cleaning after use to prevent microbial biofilm formation.

Ultrasonic cleaner

Utilizes cavitation with high-frequency sound waves to dislodge particles from instruments, not suitable for narrow channels.

Washer-disinfector (WD)

Machine for cleaning instruments that may require manual or automatic detergent addition, followed by rinse, wash, sterilization, lubrication, and drying phases.

Central Sterile Processing Department (CSPD)

Ensures adherence to AAMI standards, monitors cycle parameters, tests for residual soil, and oversees personnel competencies for consistent practices.

Creutzfeldt-Jakob Disease (CJD)

A rare, fatal neurodegenerative disorder caused by abnormal prion proteins, requiring special handling and reprocessing of contaminated instruments.

Prions

Resistant to typical sterilization methods

Iatrogenic transmission

No cases reported since 1976

Central nervous system (CNS)

Involves surgical procedures potentially transmitting prions

Corneal grafts

Potential transmission source for prions

Steam sterilization

Method used after soaking instruments in sodium hypochlorite or sodium hydroxide

CDC and WHO guidelines

Established for handling instruments potentially contaminated with prions

Lubrication

Process of lubricating instruments before sterilization

Nonwoven materials

Single-use wrappers for sterilization, fluid-resistant but not impervious

Woven textiles

Reusable materials like linen or muslin for sterilization wrappers

Sterilization packaging criteria

Includes ease of opening, strength, barrier efficiency, and material safety

Peel packs and pouches

Used for sterilizing surgical instruments in healthcare facilities

Instruments pouches

Positioned to ensure proper sterilant penetration, with sharp edges protected by sterilant-permeable covers.

Double peel-packing

Used for heavy or complex items, focusing on air removal and sterilant access.

Rigid instrument containers

Reusable, made of materials like anodized aluminum, stainless steel, or plastic, providing secure containment during sterilization.

Sterilization recommendations for rigid containers

Include sterilization below absorbent items, extended drying phase, and pre-vacuum sterilization for better air removal.

Key principles for wrapper packaging

Include size restrictions, double thickness for bacterial protection, and inspection for holes, tears, and seal integrity.

Instrument sets density

Should not be overly dense to ensure sterilant penetration and drying, generally accepted weight limit is 25 pounds.

Preparation of Instrument and Basin Sets

Involves inspection, reassembly, and preparation steps to ensure proper sterilization and functionality.

Steam Sterilization

Utilizes moist heat in the form of saturated steam under pressure within an enclosed environment to destroy all microorganisms.

Critical Steam Sterilization Parameters

Include time, contact, temperature, moisture, and pressure to ensure effective sterilization.