STERILE PROCESSING FINAL EXAM STUDY GUIDE CHAPTERS 1-23 – Flashcards
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What is Central Service ?
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Centralized distribution of supplies to all customers in the hospital.
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What is the Central Service One Way Work Flow ?
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-Decontamination (soiled) -Preparation, Packaging, Sterilization (clean) -Sterile Storage (sterile)
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What is the purpose of a One Way Work Flow ?
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To prevent cross contamination.
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Decontamination
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Physically or chemically render instruments or equipment that may be contaminated with harmful micro organisms to make it safe to handle.
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Negative air flow
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Air flows into a room from other surrounding areas, pressure is less than other adjacent areas.
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Positive Air Pressure
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Maintains air flow out of a room, this helps with keeping all dust particles and microorganisms out.
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Standard Precautions
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Treat everyone and everything as infected /contaminated.
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Job Description
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Define and communicate job duties and requirements in organization.
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Nosocomial Infection
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Hospital Acquired Infection.
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Textile Packaging Materials should be held at a room temperature of ______ and a relative humidity of ____ for a minimum of __ ____ prior to sterilization.
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-64-72 degrees F -35-70% -2 Hours
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Superheating
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When steam is at a temperature which exceeds that of saturated steam at the same pressure.
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Linen packaging material is limited to a size of _______,not weigh more than _______, and maximum density must not exceed ______.
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-12x12x20 -12 lbs -7.2 lbs
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What is a wet pack?
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Containers with moisture after the sterilization process is complete.
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What are the 2 flat wrapping techniques and the 2 folds?
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-Sequential -Simultaneous -Square Fold -Envelope Fold
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Wrapped pans of instruments should not exceed ____ in weight.
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16 lbs
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What is the maximum weight for containerized instrument sets recommended by AAMI/ANSI?
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25 lbs
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Wrapped basin sets should not exceed _____.
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7 lbs
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Sterility (time-related)
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Package is considered sterile until a specific expiration date is reached.
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Sterility (event-related)
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Items are considered sterile unless the integrity of the packaging is compromised or suspected of being compromised.
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Name the 4 things that event-related sterility depends on.
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1. Quality of the wrapping material. 2. Handling procedures. 3. Storage and transport conditions. 4. Number of times the package has been handled (4 times).
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Name 4 concerns when it comes to packaging.
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1. Moisture contamination. 2. Dirt, Dust, and Debris. 3. Physical damage. 4. Breakdown of packaging material due to wear of age.
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Sterile Storage standards, temperatures should be at ______ and relative humidity should be less than ____.
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- 64-75 degrees F - 75%
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Sterile storage standards, sterile items should be stored at least ___ away from exterior walls, ______ above the floor and from the ceiling.
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-2 inches -8-10 inches
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What is Passivation?
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A chemical process applied during instrument manufacture that provides a corrosion-resistant finish by forming a thin transparent oxide film.
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Scissors 4 1/2" and larger use a ____ test material and scissors 4" or smaller use ______ material to check blades for sharpness.
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-red -yellow
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____ ____ are tested with an index card at least 5 times. ______ should be tested using 3"x 5" index cards.
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-Bone cutters -Rongeurs
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Name at least 10 of the 15 solutions that can damage surgical instruments.
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1. Saline 2. Betadine 3. Peroxide 4. Dish soaps 5. Soaking in water 6. Soaking in saline 7. Bleach 8. Iodine 9. Hand soaps 10. Laundry detergents.
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How is an eraser test performed? Explain and be specific.
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After a stain is discovered, use the eraser to remove the discoloration, look at the metal below the discoloration to determine if there are any tiny pit marks. If pit marks are discovered, this is corrosion. Take instruments out of rotation.
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Why do we use lubricants on instruments? Where is it applied? Please explain.
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-Extends the life of instruments and makes it easier for surgeon to use. -Lubricants are applied at instruments' hinged area or any working component such as a moving/sliding area.
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Name the 9 body systems.
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1. Skeletal 2. Muscular 3. Nervous 4. Endocrine 5. Reproductive 6. Urinary/Excretory 7. Respiratory 8. Digestive 9. Circulatory
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Cells reproduce by a phase called ______.
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Mitosis.
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What are the 5 main functions of the skeletal system ?
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1. Give the body shape and support. 2. Allow movement. 3. Protect vital organs. 4. Reproduce vital organs. 5. Store calcium.
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What are the different types of joints?
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-Gliding joints -Ball and socket joints -Pivot joints -Hinge joints
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What are the 3 membranes that surround the brain and provide nourishment and protection?
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1. Pia mater (inner) 2. Arachnoid mater (middle) 3. Dura mater (outer)
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The brain is divided into 3 parts, what are they?
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1. Cerebrum (largest portion) 2. Cerebellum 3. Brain Stem
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What is the primary function of the Endocrine System?
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To secrete hormones.
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The pancreas has 2 primary hormones that it produces, what are they? What is their function?
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1. Insulin- reduces the level of sugar in the blood stream. 2. Glucagon- increases the blood sugar level.
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What is the alimentary canal? What does it consists of?
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Pathway that food takes through the digestive system. Consists of; mouth, esophagus, stomach, small intestine, large intestine, rectum, and anus.
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What is plasma?
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A yellow fluid that contains dissolved proteins, glucose, clotting factors, minerals and hormones.
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What are the 4 chambers of the heart?
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1. Left Atria (upper) 2. Right Atria (upper) 3. Left Ventricle (lower) 4. Right Ventricle (lower)
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Bacteria are often classified by their what?
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-Shape -Color change -Need for oxygen
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What are the 2 common stain tests?
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-Gram stain (purple is gram positive) (pink is gram negative) -Ziehl-Nelson (acid-fast stain) (bright red)
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_______ likes cold temperatures, ______ likes moderate temperatures, and _______ likes warm temperatures.
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-Psychrophiles -Mesophiles -Thermophiles
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What does MRSA stand for?
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Methicillin-Resistant Staphylococcus aureus
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What does VRE stand for?
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Vancomycin-Resistant Eneterococcus
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How do bacteria reproduce?
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By a process called Binary fission.
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What is the chain of infection? Please explain.
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1. Causative agent- microorganism that causes infection 2. Reservoir of the agent- where infectious agent stays 3. Portal of Exit- where infectious agent leaves 4. Mode of transmission- method of transfer from reservoir to a susceptible host 5. Portal of Entry- path used to enter susceptible host 6. Susceptible Host- Person fighting off infection
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What does FDA regulate?
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The manufacturer of all medical devices.
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What is the classification of medical devices? What is the risk? Does it require a 510k or pre-market approval? Please explain and give an example of each.
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1. Class I Medical devices-low risk, no pre-market approval. Ex:Ultrasonic cleaners 2. Class II Medical devices- medium risk, needs 510k. Ex: Sterilizers 3. Class III Medical devices-high risk, requires pre-market approval. Ex: Heart valves
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What is a 510k application vs Pre-market approval ?
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-510k application is used when there are changes in the product. -Pre-market approval is done when there is a new product being released.
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Due to the Safe Medical Devices Act of 1990, healthcare facilities are required to report events to the FDA and manufacturer within ___ working days.
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10
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What are the categories for FDA recalls ? What is their risk? What can it cause?
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Class I-High risk, causes serious health/death Class II-medium risk, causes temporary health problems Class III-low risk, low chance of causing health issues
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What is the Umbrella? Please illustrate.
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(U.N.S.A.F.E.J.O.E)
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CDC
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Centers for Disease Control. Federal agency that issues infection control guidelines.
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EPA
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Environmental Protection Agency. Establishes in 1970 to enforce federal laws pertaining to air and water pollution and other environmentally related statues.
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DOT
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Department of Transportation. Federal agency that regulates labeling and containment of hazardous waste, biohazard items and minimally processed items for transport.
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OSHA
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Occupational Safety and Health Administration. Primary role is to protect workers from conditionally caused illnesses and injuries.
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AAMI
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Association for the Advancement of Medical Instrumentation. Develops recommended practices and standards.
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ANSI
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American National Standards Institute. Standards are submitted to ANSI for approval, such as AAMI.
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AORN
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Association of Operating Room Nurses. Dedicated to providing optimal care to the surgical patient.
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APIC
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Association for professionals in Infection Control and Epidemiology. Voluntary international organization dedicated to the prevention and control of infections and related outcomes.
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ISO
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International Standards Organization. Globally based non-governmental standards organization.
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Joint Commission
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Independent non-profit organization, sets healthcare quality standards and protects patients and visitors, conducts inspections of healthcare facilities.
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NFPA
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National Fire Protection Association. International association that works to reduce the burden of fire and other hazards; sets fire safety standards.
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USP-NF
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United States Pharmacopeia-National Formulary. Sets standards for packaging, labeling, bacteriological purity, pH, and mineral content.
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WHO
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World Health Organization. Combats infectious diseases and promotes the general health of the people of the world.
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SGNA
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Society of Gastroenterology Nurses and Associates. A non-profit organization that collects information and establishes standards and guidelines relating to the processing of flexible endoscopes.
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IAHCSMM
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International Association of Healthcare Central Service Material Management
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At what length should fingernails be maintained and y?
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1/4" or less because they may harbor microorganisms.
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What is the temperature, humidity, and air exchange in each area of CPD?
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-Decontamination: temp is 60-65 degrees F, humidity is 30-60%, air exchanges is 10 per hour. -Prep and Pack: temp is 68-73 degrees F, humidity is 30-60%, air exchanges is 10 per hour. -Sterile storage: temp is 75 degrees or lower, humidity is less than 75%, air exchanges is 4 per hour.
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What do you wear in the different areas ?
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-Decon: scrubs, hair cover, shoe cover, gown, eye goggles, face shield, gloves, and face mask. -Assembly and Sterile storage: scrubs and hair cover. -OR: scrubs, hair cover, and face mask may be required. -Normal traffic areas: regular street attire.
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Fomites
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Inanimate objects that can transmit bacteria.
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Any items brought in by the vendors should be kept in the __________.
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Breakout area
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Asepsis
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The absence of microorganisms tat cause disease.
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Aseptic Technique
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Any activity or procedure that prevents infection or breaks the chain of infection.
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Medical Asepsis
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Procedures performed to reduce the number of microorganisms or minimize their spread.
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Surgical Asepsis
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Procedures performed to eliminate the presence of all microorganisms and/or to prevent the introduction of microorganisms into an area.
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What are the 5 basic principles of Asepsis?
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1. Know what is dirty. 2. Know what is clean. 3. Know what is sterile. 4. Keep the 3 conditions seperate. 5. Remedy contamination immediately.
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Conductivity
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A measurement of the ability of water to carry an electric current.
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What causes hard water stains ?
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Calcium and Magnesium
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What causes rainbow stains on stainless steel?
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Silicates
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Purified water should have a pH of _____.
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6.5-7.5
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What is the level of Silicates in water used for cleaning ?
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100 ppm or less
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What is the level of Chloride ?
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100 ppm
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What is Reverse Osmosis?
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The diffusion of water through a semi-permeable membrane to eliminate impurities in the water.
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What are enzymes ?
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Catalysts that breakdown or "digest" large organic molecules to facilitate their removal.
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Protease
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Enzymes that break down proteins.
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Lipase
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Enzymes that break down fats.
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Amylase
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Enzymes that break down starches.
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Free Rinsing
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Removal of any residue of cleaning agents and chemicals remaining after the cleaning process.
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What is the preferred transportation method ? Why?
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Closed transport system to avoid cross contamination.
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Please fill in the blanks on the pH table.
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-_____ _______ -_____ _______ -_____ Neutral -_____ _______ -_____ _______
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Sequestering agent
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Chemicals that remove hard water minerals.
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Surfactant
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A surface-acting agent that lowers the surface tension of a liquid so it can penetrate deeper.
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Chelating agent
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Chemicals that hold hard water minerals in solution and prevent soaps or detergents from reacting with minerals.
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3-sink setup
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1. Wash sink-water and detergent 2. Intermediate rinse sink- plain deionized water 3. Final rinse sink- deionized water
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Water temperatures should be below ____ to prevent coagulation.
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110 degrees F
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Name 8 items that should not be placed in the ultrasonic cleaner.
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1. Chrome-plated instruments 2. Ebonized instruments 3. Plastic 4. Cork 5. Glass 6. Wood 7. Chrome 8. Rubber
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What process is used for Ultrasonic Cleaners? please explain.
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Cavitation process, which is when ultrasonic vibrations create tiny air bubbles that grow larger until they implode (collapse). This process reaches small areas that brushes cannot reach.
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What process is used for Mechanical Washers?
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Impingement, which is a spray force of water.
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What are prions? What do they cause?
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A sort of virus that is hard to kill, has a misfolded protein, it lacks DNA and RNA. It causes Mad Cow Disease, and TSE (Transmissible Spongiform Encephalopathy)
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Shelf life vs Use life?
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-Shelf life: Length of time a disinfectant can be properly stored till expired. -Use life: Length of time or number of times disinfectant can be used until efficiency (strength) or disinfectant is diminished.
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What is MEC and what level should it be at?
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MEC is a test used to check the effectiveness of the chemical concentration level, which should be at 0.3% or higher for OPA.
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Fill in the blanks in the Spaulding Classification System.
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Body Contact Destruction Method Item Class Intact skin High-Level Critical
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Name 3 types of PSI?
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1. Electrically powered instruments 2. Pneumatic powered instruments 3. Battery powered instruments
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What is an AER?
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Automatic Endoscope Reprocessors, they clean, disinfect, and rinse flexible endoscopes.
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Name 5 advantages of using AERs.
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1. Timed cleaning 2. Consistent exposure 3. Timed contact 4. Air flush cycle 5. Use of of copious rinse water
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What is a leak test? How is it done?
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It is done to check for holes on the scopes' shaft. Close all port openings with proper caps, submerge endoscope shaft in water, force air through it using a syringe or wall powered air then look for continuous bubbles, if there is a leak take it out of rotation.
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What are the different Endoscope channels?
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-Instrument Channel -Suction Channel -Optical Channel -Air/Water Channel -Some flexible scopes have separate air and water channels.
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Tell me what each scope is used for. (Endoscope man)
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1. Laryngoscope-to visualize the larynx. 2. Esophagoscope-to visualize the esophagus. 3. Colonoscope-to visualize the large intestine. 4. Sigmoidoscope-to visualize the lower part of the large intestine. 5. Esophagogastro Duodenoscope-to visualize esophagus, stomach, and duodenum. 6. Bronchoscope-to visualize the tracheobronchial tree. 7. Gastroscope-to visualize the upper GI tract and stomach. 8. Laparoscope-to visualize the abdominal cavity. 9. Cystoscope-to visualize the urethra and bladder.
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Point of use Processing
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Occurs immediately before an item is used and/or close to a patient care area.
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Flash Sterilization
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The process by which unwrapped instruments are sterilized for immediate use when and emergency situation arises.
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Trays must be _______ or _______ bottom ensure good circulation.
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-perforated -meshed
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To properly decontaminate instruments must be ______ and _________ to the smallest part.
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-opened -disassembled
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Up to ___ of microorganisms can be removed with thorough cleaning.
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-99%
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Terminal Sterilization
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Sterilizing wrapped instruments in full cycle.
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What are the 3 types of Flash Sterilization cycles?
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-gravity displacement -pre-vacuum -express
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What are the phases for flash sterilization ?
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1.Condition 2.Exposure 3.Exhaust/Dry
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What is the Atmospheric room pressure at sea level ?
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-14.7^15 psi
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At 270 degrees, pressure should be at least ______.
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-27 psi
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Chemical Indicator vs Class 5 integrator ?
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-CI reacts to one or more parameter. -Class 5 monitors all critical parameters.
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Peracetic Acid
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A liquid oxidiZing agent that is an effective biocide at low temperature.
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Bowie Dick Test
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AKA Residual Air Removal test, must be ran everyday to check the efficiency of the sterilizers air removal system during the pre-vac cycle to detect inadequate air removal or air leaks in the chamber.
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What should Flash Documentation contain ?
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-Patient's name -contents of the flash cycle -type of sterilization cycle -cycle parameters -reason for flash sterilization -signature of staff person responsible for release of the load
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Negative BI result should not be the only one depended on to prove all items in loads are sterile, also check for what?
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-chemical indicators -class 5 integrators -mechanical monitor printout -Bowie dick test results
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Conduction
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Heat transfer from one part of an item to another.
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Convection
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Heat transfer from one point to another as gas or liquid circulates.
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Saturated steam
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Steam that contains the maximum amount of water vapor.
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What are the common temperatures for Steam sterilization ?
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-250 and 270-275 degrees F
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What is the time frame for items to cool down before use?
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30-60 minutes, heavier items can take several hours.
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Validation
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Procedures used by equipment manufacturers to obtain, record, and interpret test results required to establish that a process consistently produces a sterile product.
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Verification
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Procedures used by healthcare facilities to confirm that the validation undertaken by the equipment manufacturer is applicable to the specific setting.
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What is the most common temperature for Dry Heat sterilization ?
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320 degrees F for preferably 2 hours.
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D-Value
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The amount of time required to kill 90% of the microorganisms present.
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Please explain how you clean the chamber drain filter.
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Clean daily, under running water with mild detergent using a non-abrasive brush.
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Name 4 factors that impact sterilization.
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1. Type of microorganisms present 2. Number of microorganisms present 3. Amount and type of soil present 4. Amount of protection the medical device provides
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Residual (EtO)
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The amount of EtO that remains inside the materials after they have been sterilized.
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PEL
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Limits developed by OSHA to indicate the maximum airborne concentration of a contaminant to which an employee may be exposed over the duration assigned to that contaminant.
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What is the aeration time for EtO sterilized items ?
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-8 hours at 140 degrees F -12 hours at 122 degrees F
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Aeration
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A process in which a device is actively subjected to moving air.
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When transferring loads to the aerator, ____ do not _____ the load to prevent from inhaling any fumes.
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Pull, push
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Gas plasma kills by what process ?
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Oxidation
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Name the different inventory control methods.
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-Min/max System -Economic Order Quantity -Stockless supplies -Just-in-time System -Consignment System
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What are 2 inventory tracking systems ?
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-Bar codes -Radio Frequency Identification
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Patient Care Equipment
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Portable equipment used to assist in the care and treatment of patients.
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Who is responsible for performing safety inspections and function tests on medical equipment ?
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-Biomedical Engineering Department
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Biomed Techs perform periodical or scheduled safety inspections established by ________.
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-Joint Commission
