ch 9/10 iahcsmm

• point of use
• removal of all visible and non-visable soil

relates to removing or reducing contamination by infectious organisms or other harmful substances

• amount of water vapor in the atmosphere expressed as a percentage of the total amount of vapor the atmosphere could hold without condensation
• range from 30%-60%

materials that can tolerate harsh chemicals

10 seconds or 30 meters of potential chemical exposure

• horizontal work surfaces should be cleaned and disinfected at the beginning and end of each shift
• spills should be spot-cleaned immediately
• floors should be cleaned and disinfected daily
• biohazardous waste should be removed at frequent intervals

• orientation
• topics including the use of PPE, general staff safety, hand washing, and the proper use

improper usesage and/or use of the wrong leaning agent can damage and/or compromise the operation of a medical device

• non-abrasive
• low-foaming
• free rinsing
• biodegradable
• allow for rapid soil dispersion
• non-toxic
• effective on all types of soil
• long shelf-life
• cost-effective
• can be monitored for effective concentration and useful life

wetting agent that is the primary vehicle used in the cleaning process

• ph level
• hardness
• temperature
• purity
• free of particles:
• total dissolved solids
• microbes
• pyrogens

substance that reduces the surface tension of a liquid, and allows the liquid to penetrate or spread more easily across the surface of a solid

measure of alkalinity or acidity

chemicals that hold hard water minerals in solution, and prevent soaps or detergents from reacting with the minerals

chemicals that remove or inactivate hard water minerals

helps minimize formulation of insoluble deposits, and prevents both instrument spotting and equipment scaling

reduces the formation of mineral scale

• break down or "digest" large organic molecules to facilitate their removal
• very specific in their action

• protese-break down blood, mucous, feces, and albumin
• lipase-break down fatty deposits such as bone marrow and adipose tissue
• amylase-catalyzes (changes) starch

• 40 degrees C
• (140 F)

• water temp in the decon area
• room temp in the decontam area
• useful life and stability of the product being considered
• expiration date
• material used to construct the device to be cleaned
• wheater the detergent is approval and registered with the EPA

a ssurface-acting agent that lowers the surface tension of a liquid so it can penetrate deeper, and prevents debris from being re-deposited on the item to which the soil was attached

• must be low-foaming to prevent interference with the cleaning process
• these detergents are usually formulated with surfactants and chelating agents to prevent the re-depostit of soil

• prolongs instrument lubrication
• performed after cleaning
• may be performed mechanically as one of the final steps in the mechanical wash process
• can be applied manually in the clean assembly area

• "instrument milk"
• because of its white milky appearance

• usually with a detergent and water
• of both visible and non-visible soil
• from the surfaces, crevices, serrations, joints, and lumens of instruments, devices, and equipment

• without sterilizing
• without cleaning

• remove
• inactivate
• or destroy bloodborne pathogens on an item's surface

• how the item was last used
• how the item will next be used
• how an item was, or will be used detwermines the level of decontamination required

• prior to mechanical cleaning
• when the decon area does not have an ultrasonic cleaner or washer sterilizer-washer decontaminator
• for delicate or complex instruments that cannot be processed in mechanical equipment
• to clean powered equipment that cannot be immersed in water
• for instruments with lumens

• 43 C (110 F)
• this will help prevent the coagulation (denaturing) of proteins

to cause to become viscous or thickened into a cherent mass; to clot

a "to and fro" motion in the direction of the grain should be used rather than a circular motion

• box lock
• hinged areas

• a wash sink
• intermediate rinse (2nd sink)
• final rinse (3rd sink)

cleaned and disinfected, sterilized, and those showing wear should be disgarded

automated equipment used to clean decon, or disinfect and dry medical devices

process used by an ultrasonic cleaner in which low-pressure bubbles in a cleaning solution burst inward, and dislodge soil from instruments

manual scrubbing

rinsing is necessary to remove any scum or sediment (including detergent) that remains on the instrument

• degassed
• degassing should only be done after the tank is filled, and not while it is being filled to avoid damage to the equipment

• inside the lumen
• all instruments must be completely submerged in the solution so they are exposed to the cavitaion process

• chrome-plated
• ebonized
• plastic
• cork
• glass
• wood
• rubber instruments

spray force action of pressurized water against instruments being processed to physically remove bioburden

impingement

wash cycle

• impede contact between the spray action and the items within the tray
• trays with lids/covers should be opened so that contents may be exposed to the washer spray

• frequently be monitored
• should be able to select the appropriate cleaning cycle for the items to be processed in a washer

• sugical case carts
• rigid containers
• other miscellaneous medical devices

within 15min to 1hr after the procedure for which it was used for

moistened towel

soak basin with water containing presoak or time-monitored enzymatic detergents

disassembled

cleaned manually with brushes, pip cleaners, and/or forced water and air

• special attention
• they can be cleaned with brushes, and/or have water forced through them with a plastic syringe filled with water and enzymatic detergents

cleaned and decontaminated

• must be manually cleaned and decontaminated
• the OEM's written guidelines should be consulted for cleaning and sterilization instructions

consulted for specific cleaning instructions

meticulous visual inspection after completing the cleaning process

test the effectiveness of automated washers

regulates infectious medical waste management

any solid or liquid waste generated in the diagnosis, treatment, or immunization of human beings or animals, in applicable research, or in the production or testing of bilogicals

associated with surgical procedure be treated as infectious waste

• general trash: garbage disposed of as municipal solid waste
• regulated medical waste or infectious waste: capable of transmitting infectious diseases. must be RED BAGGED
• hazardous waste: may cause mortality or serious illness if disposed of improperly, and must be RED BAGGED
• low-level radioactive wastee: exhibits radiologic characterisitics such as tadioactive decay. if radioactive material is recieved in central service, call facility's assigned nuclear or radiologic officer, or handle as per facility policy

• cleaning
• if a device is not clean it cannot be sterile

a chemical which kills most pathogenic organisms, but does not kill spores, and is not a sterilant

completely devoid of all living microorganisms

a solution which inhibits the growth of bacteria. usually used topically and only used on animate objects

the destruction of nearly all pathogenic microorganisms on an inanimate surface

the use of heat to kill all organisms except spores

a process by which all forms of microbial life including bacteria, viruses, spores, and fungi are completely destroyed

a group of chemicals that have similar characteristics

relating to the destruction of bacteria

disinfected, because the disinfectant solution can be diluted by water that remains on surfaces and in the lumens of items

• type and level(number) of microorganisms
• direct contact with them
• time, direct contact by the disinfecting agent for a requireed amount of time is essential to achieving the desired bactericidal effect
• timperature of the disinfectant
• pH
• hardness of water
• material compatibility
• positioning of the device

• FDA
• EPA

• intended use of the device
• degree of disinfection required

virus whose nucleic acid core is not surrounded by a lipidenvelope. these viruses are generally more resistant to inactivation by disinfectants

virus whose core is surrounded by a coat of lioprotein. viruses included in the structural category are generally easily inactivated by meany types of disinfectants, including low level disinfectants

process that utilizes a sterilant for a shorter contact time than that used for sterilization, and that kills all microbial organisims but not necissarily large numbers of bacterial spores

process that utilizes an agent that kills viruses, mycobacteria, fungi, and vegetative bacteria, but not bacterial spores

process that utilizes an agent that kills vegetative forms of bacterial, SOME fungi, and lipid viruses

instruments used directly into the blood stream or body cavity

come in contact with intact mucous membranes, do not penetrate body surfaces

come in direct conteact with the pt. but only with unbroken skin

• the types of materials or devices on which the disinfectant is used
• weather items are partially disassembled
• manufacturer's recommended disinfection
• process to be measured or monitored including how the tests are used, and how frequently they are used
• expiration date for shelf life and use
• whether mixing is required
• reuse factors
• additional inspections from the manufacturer

the length of time a disinfectant can be properly stored after which it must be disgarded

length of time or number of times used after which the efficiency of a disinfectant is diminished

extended sterilization times

• are low level disinfected
• they lower surface tension of the solution which allows greater penetration of the disinfectant into the soil
• these compounds are cationic, they carry a positive ionic charge
• they are incompatible with soap which is anionic, possesses a neg charge

reduced in the presence of organic material

of their lack of activity against TB and some other gram-neg pseudomonas bacilli

• intermediate- to low-level disinfectants
• use: housekeeping
• recommended for decon area for disinfection of hard surfaces
• copious rinishing is required to eliminate the potential for skin burns

strong phenolics for any prolonged period of time becuase these compounds are markedly corrosive

• are intermediate-level disinfectants that have silimlar elements processing some unique properties
• 2 members: chlorine and iodophors

inorganic chlorine is most valuable for disinfection of water, sewage, swimming pools, and food and drinking utencils

• buffered iodine is a water soluble
• disinfecting properties are very depressed(inactivated) in the presence of organic(especially protein) matter

• high-level disinfectant used for sem-critical devices such as endoscopes and ultrasonic probes
• its use as a high-level disinfectant very by manufactureer
• time for sterilization is extended to 10 hours or more depending on the concentration and manufacturers recommendations

• must be well ventilated ( a minimum of 10 air chages per hr)
• and large enough to ensure adequate dilution of the vapor

• 14-28 days
• tested with strips recommended by manufacturer

• poured or dumped out of a soaking bin, when instruments are placed into and removed from the solution, and when instruments are rinsed
• during disposal can be greatly reduced by adding a glutaraldehyde neutralizing agent to the solution immediately prior to disposal

• commonly called OPA
• a new high-level disinfectant that provides fast and effective way to disinfect a wide range of instruments and endoscopes
• NOT classified as a sterilant

• the area of its use should still be well ventilated, and its containers should haved lids
• (what you cannot smell can still hurt you!!)

• 12 min at room temp (65F) in a manual system
• 5 in at (77F) in an automatic endoscope processor (AER) to destroy all pathogenic microorganisms

device should be thoroughly rinsed by completely immersing it in a large volume of water. repeat this procedure twice with fresh rinse water

accodring to OSHA, the employee's exposure to an air contaminant which shall not be exeeded during any part of the work day. if instantaneous monitoring is not feasible, then the ceiling shall be assessed as a 15 in time weighted average exposure which shall not be exceeded at any time over a working day

the percentage concentration of the active ingredient in a disinfectant or chemical sterilant that is the minimum concentration at which the chemical meets all its label claims for activity against specific microorganisms

• carcinogen (1ppm, 8 hour TWA)
• irritating fumes
• AKA formalin, is available in differnet concentrations for use as a high, intermediate, and low-level disinfectant

when using high-level disinfectants such as gludaraldehyde and OPA

• staff must wear PPE
• an exhaust hood is needed since some disinfectants produces fumes
• develop a spill plan and routine disposal procedures for each solution
• provide an eye wash shower
• easy access to phone and phone numbers
• yearly staff training that addresses chemical disinfectants usage
• monitor disinfectants and share results with staff