ch 9/10 iahcsmm

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Author:
Jaimilyn
ID:
105495
Filename:
ch 9/10 iahcsmm
Updated:
2011-10-04 22:17:49
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surg tech
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Description:
cleaning and decontamination and disinfection
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  1. cleaning
    • point of use
    • removal of all visible and non-visable soil
  2. deconatamination
    relates to removing or reducing contamination by infectious organisms or other harmful substances
  3. relative humidity
    • 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%
  4. floors and walls in the decontamination area should be constructed with...
    materials that can tolerate harsh chemicals
  5. safety stations should be accessible within...
    10 seconds or 30 meters of potential chemical exposure
  6. house keeping concerns
    • 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
  7. before any new staff member is assigned to the decontamination area, he/she must recieve a thorough and comprehensive...
    • orientation
    • topics including the use of PPE, general staff safety, hand washing, and the proper use
  8. original equipment manufacturer (OEM)
    improper usesage and/or use of the wrong leaning agent can damage and/or compromise the operation of a medical device
  9. effective cleaning agents should be:
    • 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
  10. water
    wetting agent that is the primary vehicle used in the cleaning process
  11. characteristics of water
    • ph level
    • hardness
    • temperature
    • purity
    • free of particles:
    • total dissolved solids
    • microbes
    • pyrogens
  12. wetting agent
    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
  13. pH level
    measure of alkalinity or acidity
  14. chelating agents
    chemicals that hold hard water minerals in solution, and prevent soaps or detergents from reacting with the minerals
  15. sequestering agents
    chemicals that remove or inactivate hard water minerals
  16. chelating or sequestering agents
    helps minimize formulation of insoluble deposits, and prevents both instrument spotting and equipment scaling
  17. softened water does not contain hard water minierals, so its use...
    reduces the formation of mineral scale
  18. enzymes
    • break down or "digest" large organic molecules to facilitate their removal
    • very specific in their action
  19. popular enzymes
    • protese-break down blood, mucous, feces, and albumin
    • lipase-break down fatty deposits such as bone marrow and adipose tissue
    • amylase-catalyzes (changes) starch
  20. temperatures above ______ can affect the chemical reaction, and cool temperatures may not activate the enzyme.
    • 40 degrees C
    • (140 F)
  21. when selecting an enzymatic detergent:
    • 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
  22. surfactant
    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
  23. detergeents for ultrasonic cleaners
    • 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
  24. water-soluble lubricants
    • 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
  25. instrument lubrication is often referred to as
    • "instrument milk"
    • because of its white milky appearance
  26. cleaning involves the removal..
    • 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
  27. one can clean ____ _____, but one can not sterilize _____ _____.
    • without sterilizing
    • without cleaning
  28. decontamination involves the use of physical or chemical procedures to ...
    • remove
    • inactivate
    • or destroy bloodborne pathogens on an item's surface
  29. the level of decontamination required depends on:
    • 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
  30. manual cleaning may be done:
    • 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
  31. to facilitate the cleaning process, the water temp should be below
    • 43 C (110 F)
    • this will help prevent the coagulation (denaturing) of proteins
  32. coagulation
    to cause to become viscous or thickened into a cherent mass; to clot
  33. when cleaning aluminum or stainless steel....
    a "to and fro" motion in the direction of the grain should be used rather than a circular motion
  34. all instruments should be cleaned in a wide open postion to allow cleaning of the
    • box lock
    • hinged areas
  35. 3 sink arrangement
    • a wash sink
    • intermediate rinse (2nd sink)
    • final rinse (3rd sink)
  36. brushes must be
    cleaned and disinfected, sterilized, and those showing wear should be disgarded
  37. washers
    automated equipment used to clean decon, or disinfect and dry medical devices
  38. cavitation
    process used by an ultrasonic cleaner in which low-pressure bubbles in a cleaning solution burst inward, and dislodge soil from instruments
  39. ultrasonic cleaner is superior to
    manual scrubbing
  40. after cavitation
    rinsing is necessary to remove any scum or sediment (including detergent) that remains on the instrument
  41. each time water is changed in the sonic cleaner, the water must be
    • degassed
    • degassing should only be done after the tank is filled, and not while it is being filled to avoid damage to the equipment
  42. all lumens must be completely filled with fluid so the cavitation process can be effective
    • inside the lumen
    • all instruments must be completely submerged in the solution so they are exposed to the cavitaion process
  43. items not to be put in a sonic cleaner
    • chrome-plated
    • ebonized
    • plastic
    • cork
    • glass
    • wood
    • rubber instruments
  44. impingement
    spray force action of pressurized water against instruments being processed to physically remove bioburden
  45. washers work on the principle of
    impingement
  46. mechanical impingement washers typically use several successive steps during the
    wash cycle
  47. multi level trays can cause the wash process to fail because tray layers
    • 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
  48. washer detergent levels should
    • frequently be monitored
    • should be able to select the appropriate cleaning cycle for the items to be processed in a washer
  49. the use of cart washers has automated the cleaning of
    • sugical case carts
    • rigid containers
    • other miscellaneous medical devices
  50. the best time to begin instrument cleaning process is
    within 15min to 1hr after the procedure for which it was used for
  51. dried blood becomes more difficult to remove. instruments to be cleaned should never be left to stand without being covered with a
    moistened towel
  52. if the instruments can't be immersed, they can be placed in a
    soak basin with water containing presoak or time-monitored enzymatic detergents
  53. instruments such as tissue retractor systems that must be taken apart for effective cleaning should be
    disassembled
  54. instruments with deep serrations and crevices can be
    cleaned manually with brushes, pip cleaners, and/or forced water and air
  55. lumens and suction tips require
    • 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
  56. instruments tagged for repair must still be
    cleaned and decontaminated
  57. power equipment
    • must be manually cleaned and decontaminated
    • the OEM's written guidelines should be consulted for cleaning and sterilization instructions
  58. OEM instructions should be
    consulted for specific cleaning instructions
  59. most common method of verifying the cleaning process is
    meticulous visual inspection after completing the cleaning process
  60. a chemical monitoring product is available that miimic dried blood, and
    test the effectiveness of automated washers
  61. the enviornmental protection agency (EPA)
    regulates infectious medical waste management
  62. medical waste is
    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
  63. some states require that all waste
    associated with surgical procedure be treated as infectious waste
  64. waste is categorized as:
    • 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
  65. most challenging step in medical device processing is
    • cleaning
    • if a device is not clean it cannot be sterile
  66. disinfectant
    a chemical which kills most pathogenic organisms, but does not kill spores, and is not a sterilant
  67. sterile
    completely devoid of all living microorganisms
  68. antiseptics
    a solution which inhibits the growth of bacteria. usually used topically and only used on animate objects
  69. disinfection
    the destruction of nearly all pathogenic microorganisms on an inanimate surface
  70. thermal disinfection
    the use of heat to kill all organisms except spores
  71. sterilization
    a process by which all forms of microbial life including bacteria, viruses, spores, and fungi are completely destroyed
  72. families (chemicals)
    a group of chemicals that have similar characteristics
  73. bactericidal
    relating to the destruction of bacteria
  74. excessive moisture must be removed from item before they are
    disinfected, because the disinfectant solution can be diluted by water that remains on surfaces and in the lumens of items
  75. effectiveness of disinfectants depends upon :
    • 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
  76. in the US, cheical germicides utilized in health care are regulated by
    • FDA
    • EPA
  77. selection of a disinfection agent is based upon
    • intended use of the device
    • degree of disinfection required
  78. nonlipid virus
    virus whose nucleic acid core is not surrounded by a lipidenvelope. these viruses are generally more resistant to inactivation by disinfectants
  79. lipid virus
    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
  80. high level disinfection
    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
  81. intermediate level disinfection
    process that utilizes an agent that kills viruses, mycobacteria, fungi, and vegetative bacteria, but not bacterial spores
  82. low level disinfectant
    process that utilizes an agent that kills vegetative forms of bacterial, SOME fungi, and lipid viruses
  83. critical items
    instruments used directly into the blood stream or body cavity
  84. semi-critical items
    come in contact with intact mucous membranes, do not penetrate body surfaces
  85. non-critical items
    come in direct conteact with the pt. but only with unbroken skin
  86. effectiveness of disinfectant depends on
    • 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
  87. shelf life of disinfectants
    the length of time a disinfectant can be properly stored after which it must be disgarded
  88. use life of a disinfectant
    length of time or number of times used after which the efficiency of a disinfectant is diminished
  89. the method for destruction of prions is
    extended sterilization times
  90. quats are ..
    • 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
  91. the germicidal action of quats is
    reduced in the presence of organic material
  92. quats are not disinfectant of choice because
    of their lack of activity against TB and some other gram-neg pseudomonas bacilli
  93. phenols are
    • 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
  94. stainless steel instruments should not be subjected to
    strong phenolics for any prolonged period of time becuase these compounds are markedly corrosive
  95. halogens
    • are intermediate-level disinfectants that have silimlar elements processing some unique properties
    • 2 members: chlorine and iodophors
  96. chlorine
    inorganic chlorine is most valuable for disinfection of water, sewage, swimming pools, and food and drinking utencils
  97. iodophors
    • buffered iodine is a water soluble
    • disinfecting properties are very depressed(inactivated) in the presence of organic(especially protein) matter
  98. glutaraldehyde
    • 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
  99. rooms in which glutaraldehyde are used
    • must be well ventilated ( a minimum of 10 air chages per hr)
    • and large enough to ensure adequate dilution of the vapor
  100. most glutaraldehyde-based instrument sterilants are labled for reuse for
    • 14-28 days
    • tested with strips recommended by manufacturer
  101. glutaraldehyde vapors increase whenever the solution is agitated such as when it is
    • 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
  102. ortho-phthalaldehyde
    • 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
  103. even tho OPA has no odor
    • the area of its use should still be well ventilated, and its containers should haved lids
    • (what you cannot smell can still hurt you!!)
  104. OPA soak time
    • 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
  105. following immersion in OPA solution
    device should be thoroughly rinsed by completely immersing it in a large volume of water. repeat this procedure twice with fresh rinse water
  106. ceiling limit
    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
  107. minimum effective concentration (MEC)
    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
  108. formaldehyde
    • carcinogen (1ppm, 8 hour TWA)
    • irritating fumes
    • AKA formalin, is available in differnet concentrations for use as a high, intermediate, and low-level disinfectant
  109. maintaining a log book
    when using high-level disinfectants such as gludaraldehyde and OPA
  110. safety disinfection tasks
    • 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

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