Chapter 11 Sterilization

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A process that greatly reduces the number of microorganisms on skin and other tissue

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Antisepsis

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Able to kill bacteria

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Bactericidal

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Chemical agent capable of inhibiting the growth of bacteria

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Bacteriostatic

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Is the authoritative source of standards for sterilization and disinfection

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Association for the Advancement of medical instrumentation. AAMI

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Dense colonies of bacteria that adhere tightly to surfaces. They are resistant to chemical disinfectants and scrubbing, are a matrix of extracellular polymers produced by microorganisms

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Biofilms

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A quality control mechanism used in the process of sterilization. It consists of a closed system containing harmless spore forming bacteria that can be rapidly cultured after the sterilization process

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Biological indicator

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A method of receiving clean and sterile equipment and preparing it for transportation to a central decontamination area. All equipment is contained within a covered movable storage cart

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Case cart system

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a process in which air bubbles are imploded releasing particles of soil or tissue debris

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Cavitation

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The area of the hospital where medical devices and equipment are processed also called central surgical supply or surgical processing department

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Central processing department

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A method of testing a sterilization parameter. Chemical strips sensitive to physical conditions such as temperature are placed with the item being sterilized and change color when the parameter is reached sometimes called a chemical monitor

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Chemical indicator

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A process that uses chemical agents to achieve sterilization

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Chemical sterilization

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A process that remove organic or inorganic soil debris using detergent and washing

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Cleaning

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A method of institutional bulk sterilization used by manufacturers to sterilize prepackaged equipment using ionizing radiation

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Cobalt 60 radiation

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Rendered non-sterile or unacceptable for use in critical areas of the body

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Contaminated

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A process in which recently used in soil medical devices including instruments are rendered safe for personnel to handle

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Decontamination

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A chemical that breaks down organic debris by emulsification to aid in cleaning

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Detergent

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Destruction of microorganisms by heat or chemical means. Spores usually are not destroyed by this

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Disinfection

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A special chemical used in detergents and cleaners to penetrate and break down biological debris such as blood and tissue

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Enzymatic cleaner

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a highly flammable gas that is capable of sterilizing

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Ethylene oxide

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A rap style item may become contaminated by environmental conditions or events such as a puncture in the wrapper. This refers to sterility based on absence of such events. The shelf life of a sterilized pack is event-related not time related

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Event-related sterility

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Methods methods and procedures proven to be valid by rigorous testing and professional research

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Evidence-based practices

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This is the amount of time goods are held at a specific time temperature and pressure during a sterilization process. This varies with the size of the load type of materials being sterilized and type of sterilizer. Sometimes called hold time

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Exposure time

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Able to kill fungi

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Fungicidal

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A process that uses the form of matter known as plasma or hydrogen peroxide plasma to sterilize an item. Also referred to as plasma sterilization

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Gas plasma sterilization

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Able to kill germs or bacteria

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Germicidal

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A type of sterilizer that removes air by gravity

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gravity displacement sterilizer

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A process that reduces bioburden to an absolute minimum

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High-level disinfection

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Use a high vacuum system to quickly and forcefully evacuate air from the chamber and replace it with burst or pulses of steam

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High vacuum sterilizer dynamic sterilizer

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Means nonliving

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Inanimate

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Define by the US Food and Drug Administration as a device that is placed into a surgically or naturally form cavity of the human body if it has intended to remain there for a period of 30 days or more

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Implant

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Items items to be sterilized shortly before surgery must be processed so they are ready as close to the time of surgery as possible. Previously called flash sterilization

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Immediate use sterilization

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International organization that represents central service technicians by providing opportunities for continuing education professional development and communication among its members

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International Association of healthcare central service material management

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A government mandated requirement for all chemicals used in the workplace. They describe the formulation safe use precautions and emergency response. They must be available for each chemical and employee is required to handle in his or her business

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Material safety data sheets

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Any equipment instrument implant or material or apparatus used for diagnosis treatment or monitoring of patient

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Medical device

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Items that are not required to be sterile because they do not penetrate intact issues. Patient care items such as blood pressure cuff and stethoscope are examples

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Non critical items

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A fabric or material that is bonded together as opposed to a process of interweaving individual threads

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Nonwoven

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A chemical used in sterilization of critical items

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Peracetic acid

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Approved attire worn during the reprocessing of medical devices and the cleaning of patient areas. Protects the wire from contamination by microorganisms

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Personal protective equipment

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Proteinaceous infectious particle a unique pathogenic substance that contains no nucleic acid. It is transmitted by direct contact or ingestion and is resistant to all forms of disinfection and sterilization normally used in the healthcare setting

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Prion

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A bacterial sample can be exposed to sterilization process and tested for viability

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Process challenge monitoring

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Activities or tasks that prepare used medical devices for use on another patient these activities include cleaning disinfection decontamination and sterilization

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Reprocessing

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A designation used by manufacturers to indicate that a medical device can be reprocessed for use on more than one patient

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Reusable

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A method that reduces the number of bacteria in environment to a safe level

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Sanitation

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the length of time a wrapped item remain sterile after it has been subjected to sterilization process

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Shelf life

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Instruments and devices intended for use on one patient only sometimes called disposable items

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Single use items

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A system used to determine the level of microbial destruction required for medical devices and supplies based on the risk of infection associated with the area of the body where the device is used . Categories include critical semi critical and non critical

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Spalding system

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Able to kill spores

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Sporicidal

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A process in which all microorganisms including spores are destroyed

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Sterilization

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Thorough cleaning and disinfection of supplies or an environment such as an operating room sweet after patient use

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Terminal decontamination

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Equipment that cleans instruments using ultrasonic waves

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Ultrasonic cleaner

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Equipment that washes and decontamination instruments after an an operative procedure.

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Washer sterilizer disinfector

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Also called linen or cloth wrappers these are fabric los used to wrap clean disinfected supplies in preparation for a sterilization process

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Woven wrappers

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This is a skilled certified profession that requires expertise in the science and practice of materials management decontamination and sterilization

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Central Processing Technician

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The cycle of reprocessing

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Point of use, sort and disassemble, clean, decontaminate, inspect, assemble and wrap, sterilize, storage

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Preparation of equipment and instruments for patient use begins at

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The point of use in surgery

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Is never used for cleaning or soaking instruments because it causes pitting rusting and corrosion

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Saline

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At the close of surgery are separated out to prevent injury

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Sharps

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Suction tips are cleaned with a fine wire that can be passed through the instrument to push out the debris. This is called

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A stylet

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Ophthalmology instruments requires special handling in order to prevent

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Toxic anterior segment syndrome. TASS

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Is used to process instruments that can tolerate water turbulence and high pressure steam

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Washer sterilizer disinfector

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Steel instruments may be dipped in a combined lubricating and protective instrument

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Instrument milk

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The sterility of an item must not be

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Assumed

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When goods are wrapped in cloth or synthetic material the most common method is

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The envelope technique

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Combination synthetic and paper wrappers are called

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Sterilisation pouches or peel pouches

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Items in the pill pouches should clear the seal bye at least

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1 inch

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Common methods of sterilization in the patient health care setting include

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High temperature steam, ethylene oxide, gas plasma sterilization, peracetic acid processing, ozone, dry heat, ionizing radiation

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This method of sterilization is used outside the healthcare facility and commonly used for both sterilization of equipment and

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Ionizing radiation

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The most efficient method of sterilization this is the first choice wherever possible

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Steam sterilization

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These are process indicators this can be tape or label indicating only that an individual item or unit was directly exposed to sterilization process. An example is tape that changes color when exposed to critical temperature required and steam sterilization

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Class 1 indicator

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These are used for specific tests that measure parameters. Examples include Bowie dick and daily hair removal test for the presence of pure air no steam in the sterilization chamber

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Class 2 indicator

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This class includes indicators that respond to only one critical parameter with an exact value. An example is a heat sensitive pellet that melts only on a certain temperature that is consistent with sterilization method

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Class 3 indicator

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These are represented by multi-variable indicators that react to two or more parameters. An example is internal chemical indicators printed on paper strip

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Class 4 indicator

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This class includes indicators that react to all critical values over a specified range in sterilization process. These aren't the most exacting an accurate of all indicators

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Class 5 indicators

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These indicators are used for internal pack control of each cycle run not for the overall performance of the sterilizer for all cycles

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Class 6 emulating indicators

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Is a high level disinfectant that is a sporicidal bacteriocidal and viricidal

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Glutaraldehyde

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Is a non glutaraldehyde best high level disinfectant that can be used for immersible medical devices

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Orthophhalaldehyde

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Is formulated as a detergent for hospital cleaning. Is not a sporicidal but a turberculocidal fungicidal, viricidal, bacteriocidal

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Phenol

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Are fungicidal and bacteriocidal but not effective and killing spores. This group of disinfectant is less effective in hard water which can limit their use in some regions

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Quaternary ammonium compounds

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Is a sporidal and tuberculocidal and effective against the HIV. The CDC recommend this product for use in spot cleaning of blood spills because it is fast acting

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Hypochlorite

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Used to sterilize objects that cannot tolerate heat,moisture, and pressure of steam sterilization . Can be used on delicate instruments

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Ethylene gas

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Is used on items that are heat and moisture sensitive. Time required for sterilization is much shorter then that required from EO

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Gas plasma sterilization

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This solution is a liquid chemical made up of 35% parasitic acid, hydrogen peroxide, acetic acid, sulfuric acid, and water

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Peracetic acid

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Utilizes a molecular format of oxygen at low heat for sterilization of moisture and heat sensitive instruments and equipment through three process of oxidation.

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Ozone sterilization

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Most equipment available prepackaged from a manufacturer has been sterilized by ionizing radiation which destroys all microorganisms through destruction of DNA

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Cobalt 60 radiation

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The accreditation agency for all healthcare organizations in the United States. It overseas compliance with environmental and patient safety regulations and enforces compliance with standards

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The Joint Commission. TJC

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Refers to any surface or tissue that has come in contact with a potential or actual source of microorganisms

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Contaminated

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Is the process of removing surface wheel blood body fluids and other kinds of organic debris

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Cleaning

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Is the process in which instruments and supplies are first cleaned and then process through chemical or mechanical means so that they are safe for handling

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Decontamination

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Is a process that removes most but not all microbes on inanimate nonliving surfaces

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Disinfection

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Refers to all steps necessary to render soiled medical devices including surgical instruments safe for use on the next patient

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Reprocessing

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Is a process that results in complete destruction of all forms of life on an object. An item is either sterile or not sterile. There is no levels of sterility

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Sterilization

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Before and after surgical case the floors walls and tables are cleaned using a

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Detergent

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Procedures and methods for reprocessing medical devices must be monitored to ensure patient safety. Monitoring means

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Checking, recording and reporting

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Preparation of equipment and instruments for patient use begins at the

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Point of use

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The instruments are submerged during cleaning to prevent the release of contaminated

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Airborne droplets

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Ultrasonic cleaner has one or more recessed cavities that are filled with

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Enzymatic cleaner

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The clean processing area is separated from decontamination area to prevent

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Cross contamination

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Before instruments are assembled and wrapped for sterilization they are

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Inspected for soil, stains, erosion, proper function, and structural soundness

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Instrument trays should not contain

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Separate items wrapped in Peel pouch packages

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Can be trapped and peel pouches and prevents steam from reaching all surfaces of the items inside

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Air

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Do not use for wrapping material two separate instruments inside the tray or for lining the tray bottom. This May prevent penetration of sterilant to the instruments

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Non-woven disposable wrapping

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The purpose for wrapping an item before sterilization is to

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Protected from contamination

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Are sufficiently dense to protect goods from contamination yet porous enough to allow penetration of steam or gas

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Woven wrappers

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Are intended for one time use only these materials are manufactured from spun he bonded fibers such as polypropylene

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Nonwoven wrappers

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Is not used for wrapping items for sterilization because paper recoils when the package is open making it difficult to distribute the goods inside aseptically

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Paper derived from cellulose

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Should be evacuated from peel pouch before sealing

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Air

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Incorporate disposable filters into the construction of the container and these must remain in place after sterilization to maintain the sterility of enclosed items

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Sterilization containers

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Parameters must be regularly tested for all sterilization methods, the fact that items have been subjected to sterilization process does not ensure that there was no mechanical or human error that may have prevented actual sterilization. This is called

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Challenge or challenge test

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This class indicator can be tape or label indicating only that the individual item or unit was directly exposed to sterilization

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Class 1 indicator

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This class includes indicators that react to all critical values over a specific range of sterilization process. These are the most exacting an accurate of all indicators

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Class five indicators

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These indicators are used for specific tests that measure parameters. Example includes the Bowie dick and daily air removal test for presence of pure air in sterilization chamber

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Class two indicators

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These are represented multivariable indicators that react to two or more parameters. An example is internal chemical indicators printed on paper strip

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Class 4 indicator

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these indicators are used for internal pack control of each cycle run not for the overall performance of the sterilizer for all cycles

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Class 6 indicators

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This class indicator respond to only one critical parameter with an exact value. An example is a heat sensitive pellet

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Class 3 indicator

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The following are the bacteria used for the biological monitoring of steam sterilization, high speed steam sterilizer, ozone sterilization

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Gebacillus stearothermophilus

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The following are is bacteria used for biological monitoring for dry heat and EO, hydrogen peroxide gas plasma

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Bacillus subtilis

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The test used to monitor the efficiency of the high vacuum steam sterilizer is a test called

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Daily air removal test. Dart

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When air is removed from the chamber and replaced with steam

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Conditioning

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Two types of steam sterilizer are used in the clinical setting

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Gravity displacement and dynamic also called pre-vacuum or high vacuum sterilizers

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Sterilizer that operates on the principle that air is heavier than steam

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Gravity displacement sterilizer

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Sterilizer in which air from the chamber is pulled with vacuum force and replaced which steam

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Dynamic air Removal sterilizer

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The amount of moisture in the steam is referred to as

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Steam quality

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At this temperature steam is an ineffective for sterilization

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212 degrees

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Are used for bulk processing of hospital equipment including surgical instruments, basins, linens, drapes, and towels

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Large steam sterilizer

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Items that have been steam sterilizer should remain in the sterilizer chamber four

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15 - 30 minutes

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Solutions in this cannot be sterilized by ethylene oxide process

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Glass containers

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Item sterilized with ethylene oxide require this to dissipate any residual gas remaining on the items

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Aeration

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Is used on items that are heat and moisture resistant. During this sterilization process hydrogen peroxide is exposed to a vacuum.

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Gas plasma sterilization

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The gas sterilization process has 4 phases they're

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Vacuum phase, injection phase, diffusion phase, plasma phase,

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Is a fatal disease caused by prions

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Creutzfeld- Jakob disease. CJD

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Factors that affect disinfectants activity include

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Concentration of solution, the bioburden on the object, water hardness or pH, presence or absence of organic matter

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High-level disinfection is a process that is used on instruments used on semi critical areas of the body

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Anesthesia equipment, gastrointestinal equipment , bronchia scopes, respiratory therapy equipment

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Is the process by which surfaces materials and equipment are clean with specific substances that render them safe for intended use

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Disinfection or sanitation

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Is recommended practice of damp dusting of surgical lights, furniture, and fixed equipment in the operating suite. This is performed

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The work day

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Is commonly used disinfectant that is composed of two components ethyl alcohol and isopropyl alcohol

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Alcohol

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Alcohol is best effective at what percent dilution

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60 - 70% dilution