ch. 7 delmar

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

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

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

a hazard

• 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

maximum skin coverage

• staphylococcus
• hair also harbors resident and transient flora

• talking
• coughing
• sneezing
• all 3 give rise to bacteria-laden dust and lint as droplets settle on surfaces and skin

barred from the surgical site

talking

• streptococcus
• staphylococcus aureus

person to person

TB

e. coli

• burn pts.
• pseudomonas aeruginosa

• gang grene infection
• clostridium perfringes

• hepatitis virus
• HIV

• are vehicles for transporting microorganism-laden particles
• 80-90 percent of microbial contamination found in the operative wound comes from ambient (room) AIR

wound infection

breathing contaminated air

• furniture
• or surfaces (wall, floors, cabinets, shelves)
• **important to clean shelves at least once a week with a microbial solution.

• linens
• instruments
• sutures

strike-through

normal flora

resident flora

carrier

staph. aureus

antibiotics given prior to the surgical procedure to prevent infection

• preoperative hospitalization
• immunosuppresion
• if the pt. has hair removed prior to surgical procedure
• age
• obesity
• preexisting illness

strict adherence of aseptic tech.

inner edge

the 1 inch marginal edge around it

lifted straight up, and not allowed to slide over the 1 inch margin

reprocessed

• checking the exp. date
• no strike-through
• no holes
• seal intact
• **never handle a sterile package with wet hands

permeable or penetrating

• considered contaminated and should not be used
• **NEVER gown and glove from back table (may contaminate the back table)-use another flat surface

surgically clean and NOT sterile

is the term used when an infection is caused from the pts. OWN body

• hair
• skin
• nares
• clothes/shoes
• respiratory tract

• GI tract
• skin
• respiratory tract
• circulating blood

• dust in the air
• articles used in the wound and sterile field

• direct contact-sterile field
• nonsterile air-sterile field
• nonsterile moisture droplets-sterile field
• hematogenous(pts.blood)-sterile field

• from waist to chest level in front
• sleeves to 2 inches above elbow

between

• not serile
• must be covered by the gloves

• back
• nonsterile

• back to back
• face to face

12 inches / 1 foot from the sterile field to minimize accedental contamination

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

at the edge of the sterile table by the sterile person

far side first and the near side last

are disgarded and not reused

dangle loosely

• exp date
• appearance of indicator tape and strip (before dispensing)
• holes
• dampness

mycobacterium tuberculosis

father of antiseptic surgery

father of bacteriology

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

• concentration level
• number and they of microbes present-bioburden
• contact time
• physical factors: temp, water hardness, pH level, exposure time

• 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

• kills microbes in 10 min-sterile
• kills spores in 10 hours-sterile
• a minimum 20 min. soak is required for disifection

• bleach
• cleans blood spills on floors

• 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
• intraoperatively
• between procedures
• terminal cleaning

• 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

• 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

• 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

• with a lumen should be flushed
• power instruments must NEVER be submerged
• keep air hoses attached
• last step is lubrication or instrument "milk"

• 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

• 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

• disposable
• paper has "memory"
• wraps and pouch packaging
• paper-plastic peel packs for steam and EtO
• tyvek for EtO and sterrad

• 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

• 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

towel

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

• date of sterilization - julian date
• identification of the sterilizer
• cycle number

• "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

• time
• contact
• remperature
• pressure
• moisture and air

• 250 degrees F
• 30 min

• 270 degrees F
• 4 min

• strainer is obstructed - needs cleaning daily
• incorrect placement of containers
• items inadequately cleaned
• wrapped items too close together on cart
• items wrapped too tightly

steam enters top rear and exits bottom front

• 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
• ~metal,porous,lumens-10min

• gravity(flash)- 250, 15-17 psi, minimum of 15 min exposure
• prevacuum- 270, 27-30 psi, minimum of 4 min exposure

• 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

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)

• 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

before implantables are used

contaminated

• **the instruments must then be repackaged and resterilized
• must look for reason for wet pack

• 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.

• 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

• 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

• 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