ch. 7 delmar

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ch. 7 delmar
2011-09-07 22:49:23
surg tech

asepsis and sterile technique
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  1. asepsis
    absense of microorganisms
  2. autoclave
    device to accomplish steam or gas sterilization
  3. bioburden
    amount of gross organic debris or the number of microorganisms on an object at any given time
  4. 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.
  5. bowie-dick test
    specifically designed for use with a prevacumm steam sterilizer to test for air entrapment
  6. chelation
    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
  7. chemical indicator
    internal or external monitor that changes color when exposed to the sterilization process
  8. colonization
    the growth and collection of microbes into a group that lives in a particular area
  9. contaminated
    soiled with gross debris or by the presence of microbes
  10. emulsification
    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
  11. endoscope
    used to describe the various types of flexible or rigid scopes used to view internal structures of the body
  12. event-related sterility
    sterility determined by how a sterile package is handled rather than time elapsed
  13. flash sterilization
    process of quickly sterilizing unwrapped items using prevacumm or gravity steam sterilizers
  14. immersion
    placing an item in a container so it is completely covered by liquid
  15. integrity
    complete with no breaks or tears
  16. intermediate-level disinfection
    level of disinfection in which most microorganisms are killed EXCEPT spores
  17. julian date
    calendar days that are sequentially numbered through the year
  18. lister
    established principles of asepsis in the operating room
  19. pathogen
    microorganism that is capable of causing disease
  20. permeablility
    the condition of being permeable; capable of allowing the passage of fluids or substances
  21. sterile field
    area of sterility maintained by surgical team during a procedure
  22. sterile technique
    methods used to prevent contamination of the sterile field and prevent the pt. from aquiring a postoperative wound infection
  23. sterilization
    • procedure to render an individual incapable of reproduction
    • process by which microorganisms incuding spores are destroyed
  24. surgical conscience
    basis for the practice of strict adherence to sterile tech. by all surgical team members
  25. surgical site infection (SSI)
    an infection of the surgical wound that was aquired during the course of surgical procedures
  26. ultrasonic cleaner
    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
  27. skin of pts., operating team members, and visitors constitute ...
    a hazard
  28. shedders...
    • 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
  29. microbial shedding is contained most effectively by ...
    maximum skin coverage
  30. hair in a gross contaminant and major source of...
    • staphylococcus
    • hair also harbors resident and transient flora
  31. nasopharynx/respiratory tract, organisms are forcibly expelled by..
    • talking
    • coughing
    • sneezing
    • all 3 give rise to bacteria-laden dust and lint as droplets settle on surfaces and skin
  32. all employees with respiratory infections should be...
    barred from the surgical site
  33. _____ during the procedure should be kept to a minimum
  34. persons known as carriers harbor _____ and _____ which may be carried pharyngeally or rectally
    • streptococcus
    • staphylococcus aureus
  35. transmission by direct contact is
    person to person
  36. nasopharynx tubercle bacillus is AKA
  37. gastrointestinal tract consists of what common bacteria
    e. coli
  38. pseudomonas (aerobic, gram neg. bacilli) is seen in...
    • burn pts.
    • pseudomonas aeruginosa
  39. clostridium (anaerobic, gram positive bacteria) seen in...
    • gang grene infection
    • clostridium perfringes
  40. 2 diseases circulating in blood
    • hepatitis virus
    • HIV
  41. 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
  42. because airborne contamination is generated by personnel, every movement increases potention for..
    wound infection
  43. an effective ventilation system is essential to prevent pts. and staff from ...
    breathing contaminated air
  44. contaminated particles are present on inanimate objects such as ...
    • furniture
    • or surfaces (wall, floors, cabinets, shelves)
    • **important to clean shelves at least once a week with a microbial solution.
  45. articles used in the wound and on the sterile field such as...
    • linens
    • instruments
    • sutures
  46. when a solution soaks through a sterile drape to an unsterile drape is termed...
  47. microorganisms that reside in an area are called...
    normal flora
  48. microbes that live on the skin...
    resident flora
  49. a person who harbors a microbe but shows no symptons is termed a...
  50. number one microorganism that causes SSI is..
    staph. aureus
  51. prophylaxis antibiotics
    antibiotics given prior to the surgical procedure to prevent infection
  52. SSI increases with..
    • preoperative hospitalization
    • immunosuppresion
    • if the pt. has hair removed prior to surgical procedure
    • age
    • obesity
    • preexisting illness
  53. surg. conscience is the basis for the ...
    strict adherence of aseptic tech.
  54. what part of the heat seal is considered the line between sterile and unsterile?
    inner edge
  55. paper wrappers are considered sterile except for...
    the 1 inch marginal edge around it
  56. 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
  57. if a sterile item is discovered in an unsterile area, it would have to be...
  58. 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
  59. pervious
    permeable or penetrating
  60. 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
  61. pts. skin is...
    surgically clean and NOT sterile
  62. endogenous
    is the term used when an infection is caused from the pts. OWN body
  63. what parts of surgical personnel are reservoirs for bacteria?
    • hair
    • skin
    • nares
    • clothes/shoes
    • respiratory tract
  64. sources of contamination of the pt.
    • GI tract
    • skin
    • respiratory tract
    • circulating blood
  65. sources of contamination of the enviornment
    • dust in the air
    • articles used in the wound and sterile field
  66. modes of contamination
    • direct contact-sterile field
    • nonsterile air-sterile field
    • nonsterile moisture droplets-sterile field
    • hematogenous(pts.blood)-sterile field
  67. gowns are considered sterile
    • from waist to chest level in front
    • sleeves to 2 inches above elbow
  68. unsterile and sterile persons should never walk _____ two sterile areas
  69. the stockinette cuff of a gown
    • not serile
    • must be covered by the gloves
  70. a sterile person turns his/her ____ to a _____ person or area when passing
    • back
    • nonsterile
  71. sterile team members pass each other ...
    • back to back
    • face to face
  72. an unsterile person should maintain a distance of...
    12 inches / 1 foot from the sterile field to minimize accedental contamination
  73. 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
  74. the container to be filled with solution should be set ....
    at the edge of the sterile table by the sterile person
  75. a nonsterile person opens a pack how?
    far side first and the near side last
  76. instruments used in contact with the skin...
    are disgarded and not reused
  77. when opening sterile packages, secure the end flaps in your hand so they do not ...
    dangle loosely
  78. seal integrity of the package:
    • exp date
    • appearance of indicator tape and strip (before dispensing)
    • holes
    • dampness
  79. tb is caused by:
    mycobacterium tuberculosis
  80. joesph lister
    father of antiseptic surgery
  81. louis pasteur
    father of bacteriology
  82. all items used on a sterile field must be sterile....
    whether it comes in contact with the pt or not
  83. high-level disinfectant
    kills all microorganisms EXCEPT spores and prions that cause CJD
  84. intermediate-level disinfectant
    kill most microorganisms EXCEPT some viruses and funi and spores
  85. low-level disinfectant
    kills some funi and viruses, most bacteria, NOT effective against spores and TB
  86. critical items
    • 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
  87. semi-critical items
    • 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
  88. noncritical items
    • 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
  89. factors influencing disinfectant efficiency
    • concentration level
    • number and they of microbes present-bioburden
    • contact time
    • physical factors: temp, water hardness, pH level, exposure time
  90. 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
  91. glutaraldehyde (cidex) ...
    • kills microbes in 10 min-sterile
    • kills spores in 10 hours-sterile
    • a minimum 20 min. soak is required for disifection
  92. sodium hypochlorite
    • bleach
    • cleans blood spills on floors
  93. 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
  94. intermediate-level disinfections
    • 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
  95. enviornmental decontamination
    • prior to first case of the day
    • intraoperatively
    • between procedures
    • terminal cleaning
  96. 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
  97. terminal cleaning...
    • end of day cleaning in the OR
    • weekly cleaning
    • dirty cases
  98. instrument decontamination
    decontamination is the first step in prevention of transmission of microbes and renders the instruments safe for handling by CSPD personnel
  99. 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
  100. cleaning
    • first step is "point of use" processing
    • STSR presoaks instruments
  101. enzamatic solution
    • proteolytic-removes materials such as (protien) blood
    • lipolytic-removes fatty material (adipose tissue/bone marrow)
  102. pH scale
    • 0 - highly acidic
    • 14- highly alkaline
    • 7 - neutral
    • *can get burned on either side of spectrum
  103. 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
  104. manual cleaning
    • 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
  105. washer...
    • decontaminater- does NOT sterilize
    • sterilizer- terminal sterilization to protect the staff in the prep and pack area
  106. ultrasonic cleaner
    • 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
  107. 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"
  108. 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
  109. woven materials -packing
    • reusable
    • inspected
    • if hole, must be repaired with heat sealed patch
    • patch can never be stitched on-will leave holes
    • ex:muslin -140 thread count
  110. nonwoven materials -packing
    • disposable
    • paper has "memory"
    • wraps and pouch packaging
    • paper-plastic peel packs for steam and EtO
    • tyvek for EtO and sterrad
  111. 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
  112. rigid containers
    • can be sterilized in same load with supplies
    • placed on bottom shelf, placed flat
    • disposable filters are replaced after every use
  113. 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
  114. instruments placed in mesh bottom tray lined with ...
  115. instruments with lumen have a ...
    risidual amount of distilled water left inside lumen
  116. labeling
    • 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
  117. when using a label gun
    • date of sterilization - julian date
    • identification of the sterilizer
    • cycle number
  118. steam under pressure
    • "autoclave"
    • 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
  119. factors critical to outcome of sterilization process:
    • time
    • contact
    • remperature
    • pressure
    • moisture and air
  120. gravity cycle temp/time
    • 250 degrees F
    • 30 min
  121. prevacuum cycle temp/time
    • 270 degrees F
    • 4 min
  122. 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
  123. how steam sterilizer works:
    steam enters top rear and exits bottom front
  124. 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
  125. flash sterilization
    • 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
    • ~metal,porous,lumens-10min
  126. 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
  127. 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
  128. the BI for steam sterilization contains the bacterial spore...
    bacillius steorothermophilus

    **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)
  129. biological monitors
    • 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
  130. BI must be read...
    before implantables are used
  131. a wet pack or instrument set MUST be considered..

    • **the instruments must then be repackaged and resterilized
    • must look for reason for wet pack
  132. 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.
  133. 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
  134. 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
  135. alternative methods
    • 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
  136. 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