ch. 7 delmar
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absense of microorganisms
device to accomplish steam or gas sterilization
amount of gross organic debris or the number of microorganisms on an object at any given time
biological indicator (BI)
a method for testing the sterilization capability of a sterilizer
**only test that GURANTEES that items are sterile and conditions necessary for sterilization have been met.
specifically designed for use with a prevacumm steam sterilizer to test for air entrapment
method of cleaning instruments in which the choosen cleaning solution uses the process of binding ions to prevent their deposit on the surface of surgical instruments
internal or external monitor that changes color when exposed to the sterilization process
the growth and collection of microbes into a group that lives in a particular area
soiled with gross debris or by the presence of microbes
a method of cleaning instruments in which the chosen cleaning solution acts by dispersing 2 liquids that are not capable of being mixed to remove organic and inorganic soil
used to describe the various types of flexible or rigid scopes used to view internal structures of the body
sterility determined by how a sterile package is handled rather than time elapsed
process of quickly sterilizing unwrapped items using prevacumm or gravity steam sterilizers
placing an item in a container so it is completely covered by liquid
complete with no breaks or tears
level of disinfection in which most microorganisms are killed EXCEPT spores
calendar days that are sequentially numbered through the year
established principles of asepsis in the operating room
microorganism that is capable of causing disease
the condition of being permeable; capable of allowing the passage of fluids or substances
area of sterility maintained by surgical team during a procedure
methods used to prevent contamination of the sterile field and prevent the pt. from aquiring a postoperative wound infection
- procedure to render an individual incapable of reproduction
- process by which microorganisms incuding spores are destroyed
basis for the practice of strict adherence to sterile tech. by all surgical team members
surgical site infection (SSI)
an infection of the surgical wound that was aquired during the course of surgical procedures
machine used to remove min. organic particles and soil from the areas of instrumentation hardest to reach by manuel or other mechanical methods of cleaning
skin of pts., operating team members, and visitors constitute ...
- disperse 30,000 particles per min.; they present an additional hazard
- populated with virulent organisms that they shed with skin cells into the enviornment
- usually staphylococcus aureus
microbial shedding is contained most effectively by ...
maximum skin coverage
hair in a gross contaminant and major source of...
- hair also harbors resident and transient flora
nasopharynx/respiratory tract, organisms are forcibly expelled by..
- all 3 give rise to bacteria-laden dust and lint as droplets settle on surfaces and skin
all employees with respiratory infections should be...
barred from the surgical site
_____ during the procedure should be kept to a minimum
persons known as carriers harbor _____ and _____ which may be carried pharyngeally or rectally
- staphylococcus aureus
transmission by direct contact is
person to person
nasopharynx tubercle bacillus is AKA
gastrointestinal tract consists of what common bacteria
pseudomonas (aerobic, gram neg. bacilli) is seen in...
- burn pts.
- pseudomonas aeruginosa
clostridium (anaerobic, gram positive bacteria) seen in...
- gang grene infection
- clostridium perfringes
2 diseases circulating in blood
air and dust
- are vehicles for transporting microorganism-laden particles
- 80-90 percent of microbial contamination found in the operative wound comes from ambient (room) AIR
because airborne contamination is generated by personnel, every movement increases potention for..
an effective ventilation system is essential to prevent pts. and staff from ...
breathing contaminated air
contaminated particles are present on inanimate objects such as ...
- or surfaces (wall, floors, cabinets, shelves)
- **important to clean shelves at least once a week with a microbial solution.
articles used in the wound and on the sterile field such as...
when a solution soaks through a sterile drape to an unsterile drape is termed...
microorganisms that reside in an area are called...
microbes that live on the skin...
a person who harbors a microbe but shows no symptons is termed a...
number one microorganism that causes SSI is..
antibiotics given prior to the surgical procedure to prevent infection
SSI increases with..
- preoperative hospitalization
- if the pt. has hair removed prior to surgical procedure
- preexisting illness
surg. conscience is the basis for the ...
strict adherence of aseptic tech.
what part of the heat seal is considered the line between sterile and unsterile?
paper wrappers are considered sterile except for...
the 1 inch marginal edge around it
when the STSR is removing items from a sterile package the items must be...
lifted straight up, and not allowed to slide over the 1 inch margin
if a sterile item is discovered in an unsterile area, it would have to be...
before opening a sterile item the integrity of the package must be checked by...
- checking the exp. date
- no strike-through
- no holes
- seal intact
- **never handle a sterile package with wet hands
permeable or penetrating
if a pervious package is dropped on the floor it is...
- considered contaminated and should not be used
- **NEVER gown and glove from back table (may contaminate the back table)-use another flat surface
pts. skin is...
surgically clean and NOT sterile
is the term used when an infection is caused from the pts. OWN body
what parts of surgical personnel are reservoirs for bacteria?
- respiratory tract
sources of contamination of the pt.
- GI tract
- respiratory tract
- circulating blood
sources of contamination of the enviornment
- dust in the air
- articles used in the wound and sterile field
modes of contamination
- direct contact-sterile field
- nonsterile air-sterile field
- nonsterile moisture droplets-sterile field
- hematogenous(pts.blood)-sterile field
gowns are considered sterile
- from waist to chest level in front
- sleeves to 2 inches above elbow
unsterile and sterile persons should never walk _____ two sterile areas
the stockinette cuff of a gown
- not serile
- must be covered by the gloves
a sterile person turns his/her ____ to a _____ person or area when passing
sterile team members pass each other ...
an unsterile person should maintain a distance of...
12 inches / 1 foot from the sterile field to minimize accedental contamination
how do you pour solution into a sterile basin?
only lip of the bottle is held over the basin at a level which ensures a safe margin and which prevents spilling and splashing of the contents
the container to be filled with solution should be set ....
at the edge of the sterile table by the sterile person
a nonsterile person opens a pack how?
far side first and the near side last
instruments used in contact with the skin...
are disgarded and not reused
when opening sterile packages, secure the end flaps in your hand so they do not ...
seal integrity of the package:
- exp date
- appearance of indicator tape and strip (before dispensing)
tb is caused by:
father of antiseptic surgery
father of bacteriology
all items used on a sterile field must be sterile....
whether it comes in contact with the pt or not
kills all microorganisms EXCEPT spores and prions that cause CJD
kill most microorganisms EXCEPT some viruses and funi and spores
kills some funi and viruses, most bacteria, NOT effective against spores and TB
- must be sterile!
- ex: surg instruments, implants, hypdermic needles, IV caths
- *used on sterile areas of the body - on tissue or within a body cavity
- must be free of ALL microbes EXCEPT spores !
- ex: cytoscopes, colonoscopes, laryngoscopes
- **come in contact with mucous membranes and non-intact skin
- **not used within a body cavity
- must be disinfected !!
- ex: blood pressure cuffs, OR furniture, OR table
- **comes in contact with intact skin and enviornmental surfaces
- **no contact with any mucous membranes
factors influencing disinfectant efficiency
- concentration level
- number and they of microbes present-bioburden
- contact time
- physical factors: temp, water hardness, pH level, exposure time
high-level disinfectant: glutaraldehyde
- cidex (commercial name)
- one of the best disinfectant/liquid sterilants
- used on semicritical devices that can be completely immersed ; endoscopes
- once activated lasts 14-28 days
- concentration must be checked often
- items must be clean and dry before immersion and rinsed with sterile water
glutaraldehyde (cidex) ...
- kills microbes in 10 min-sterile
- kills spores in 10 hours-sterile
- a minimum 20 min. soak is required for disifection
- cleans blood spills on floors
chemical safety considerations
- MSDS easily accessible
- wear PPE
- must be stored in closed container in well ventilated room
- follow manufacturer's directions for mixing
- do not mix chemicals
- phenolic (carbolic acid) compounds-general use by housekeeping on floors and countertops & alcohol can be used to neutralize it in contact with skin
- quaternary ammonium compounds (quats)-wetting agent compound, NOT disinfectant choice for central service
- alcohol-useful in cleaning small noncritical surfaces, recently shown to work well as a surg. scrub and skin prep
- prior to first case of the day
- between procedures
- terminal cleaning
between procedures ...
- remove all linen and waste bags
- wipe down furn. and lights
- mop floor
- spot clean walls
- disconnect suction canisters and dispose of accordingly
- dipose of sharps in a rigid sharps container
- seal linen and trash bags
- **all instruments will go in case cart or open cart with solid bottom covered in plastic for transfer to the deconamination area of CSPD
- end of day cleaning in the OR
- weekly cleaning
- dirty cases
decontamination is the first step in prevention of transmission of microbes and renders the instruments safe for handling by CSPD personnel
takes place in decontamination room
- filtered air exhausted to outside
- minimum air exhange rate: 10 per hour
- temperature: 64-70
- humidity: 35-72%
- negative air pressure
- first step is "point of use" processing
- STSR presoaks instruments
- proteolytic-removes materials such as (protien) blood
- lipolytic-removes fatty material (adipose tissue/bone marrow)
- 0 - highly acidic
- 14- highly alkaline
- 7 - neutral
- *can get burned on either side of spectrum
3 sink arrangement
- 1st sink-wash with water and detergent
- 2nd sink-rinse with distilled water
- 3rd sink-rinse with distilled water
- *cleaning is the first step when instruments are brought to decontamination room
- emmersed in water,detergent, and/or enzymatic cleaner with neutral pH
- individually cleaned with soft bristled brush
- clean in back and forth motion NOT circular motions
- keep brush and instrument immersed during cleaning to avoid droplets from aerosolizing
- rinse in distilled water
- decontaminater- does NOT sterilize
- sterilizer- terminal sterilization to protect the staff in the prep and pack area
- uses the process of cavitation
- uses high frequency sound waves
- bubbles implode
- when solution is changed, rum one empty cycle to degas the chamber
- lid must be closed
instruments requiring special care
- with a lumen should be flushed
- power instruments must NEVER be submerged
- keep air hoses attached
- last step is lubrication or instrument "milk"
prep and wrapping
- packaging material must:
- be able to maintain sterility of the item
- permit the package to be opened to allow for easy removal
- allow for sterilizing agent to penetrate and reach all surface areas of items
woven materials -packing
- if hole, must be repaired with heat sealed patch
- patch can never be stitched on-will leave holes
- ex:muslin -140 thread count
nonwoven materials -packing
- paper has "memory"
- wraps and pouch packaging
- paper-plastic peel packs for steam and EtO
- tyvek for EtO and sterrad
paper-plastic peel packs:
- do not use staples to close
- do not use rubber bands, paper clips, tape to bind
- felt tip marker used to label on plastic side only
- if dbl packed - inner pack is not sealed or folded
- placed on their edge in sterilizer paper to plastic
- can be sterilized in same load with supplies
- placed on bottom shelf, placed flat
- disposable filters are replaced after every use
general principles of packaging
- max size of linen wrapped in muslin: 12x12x20 and 12 pounds
- dbl sequential wrapping
- dbl ply wraps eliminate the use of 2 wraps
- may use towel to cushion
- max weight of instrument set: 25 lbs rigid pan set; 16 lbs in container paper wrap
- dust cover when item not used frequently
instruments placed in mesh bottom tray lined with ...
instruments with lumen have a ...
risidual amount of distilled water left inside lumen
- labeled before sterilized with felt tip marker (on plastic side of peel pack)
- label info should include: contents, date of sterilization, ID of sterilizer, cycle #, initials of employee, department to which to be sent
when using a label gun
- date of sterilization - julian date
- identification of the sterilizer
- cycle number
steam under pressure
- uses saturated steam under pressure
- microbes are killed by heat -denatures and coagulates protein within the cells
- *pressure is needed to increase the temp of steam
factors critical to outcome of sterilization process:
- moisture and air
prevacuum cycle temp/time
reasons for sterilizing issues
- strainer is obstructed - needs cleaning daily
- incorrect placement of containers
- items inadequately cleaned
- wrapped items too close together on cart
- items wrapped too tightly
how steam sterilizer works:
steam enters top rear and exits bottom front
types of sterilizers
- gravity displacement sterilizers - air is passively removed from the sterilizer chamber by gravity; slower than a prevac
- prevacuum steam sterilizer - vacuum pump removes air; total cycle times is less than gravity
- bowie-dick test run daily to check for air entrapment - place in bottom front in empty chamber
- sterilizes unwrapped items
- sterilizes items that are needed immediately (emergency)
- **implantables are not to be flash sterilized per AORN and AAMI
- ~metal,nonporous, NO lumens-3min
exposure time, temp, and pressure::
- gravity(flash)- 250, 15-17 psi, minimum of 15 min exposure
- prevacuum- 270, 27-30 psi, minimum of 4 min exposure
monitoring of steam sterilizer
- mechanical-recoders&gauges, digital printouts, changed every 24 hrs.
- chemical- external/internal indicators to verify items exposed (most pop. autoclave tape); change color when exposed to steam or heat, have ink impregnated on pack
- biological- only test that gurantess sterility
the BI for steam sterilization contains the bacterial spore...
**BI test pack is placed in a mesh tray in the bottom front over the drain which is (the most difficult area for the sterilant to reach and the coldest point)
- after cycle, remove BI vial, crush to release growth medium, incubate for 24 hrs, with a control vial (that was not sterilized)
- neg. result means spores have been killed and sterilizer is doing its job
- pos. result means spores are NOT killed, sterilizer closed and items must be recalled
BI must be read...
before implantables are used
a wet pack or instrument set MUST be considered..
- **the instruments must then be repackaged and resterilized
- must look for reason for wet pack
ethylene oxide gas sterilization (EtO)
- used for heat or moisture-sensitive materials such as plastic, rubber
- process can take up to 16 hours - longest turn over time for 1 item
- aeration is the final step- occurs after sterilization and preferably in the same chamber. if not must pull cart to aerator
- EtO is flammable and toxic.
EtO sterilizer monitoring
- mechanical with digital printouts
- chemical indicators-tape is different
- biological indicator- bacillus subtilus
- placed in the center of load- hardest place for gas to reach
- EtO is monitored more frequently
- recommended for every load
- filed in a permanent record
liquid chemical sterilization
- steris tabletop machine
- uses pericidic acid
- used to sterilize endoscopes
- cycle takes 30 min
- sterilant is used for a single cycle
- products cannot be stored because they are sterilized within a plastic cassette which is carried to the sterile field for immediate use only
- ionizing radiation-cobalt 60 used commerically
- plasma sterilization- sterrad - limited items can be sterilized based on the items material, specific wrapping materials only; tyvek(peel packs)
- can not be used for long cannulated instruments
- most commonly used is hydrogen peroxide in plasma form
even related sterility
- sterility determined by how a package is handled not by time - no expiration date
- *package will remain sterile unless wet, torn, seal broken, or other compromise
- shelf life is determined by: quality of wrapper material, storage conditions, conditions during transport, amount of handling
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