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CBIC Section 8

Cleaning, Sterilization, Disinfection, Asepsis

QuestionAnswer
The destruction of pathogenic (disease-causing) microorganisms, usually by Disinfection physical or chemical means. Disinfection
A device used to monitor the presence of one or more predefined process parameters required for a satisfactory sterilization process. The six classes are defined in ANSI/AAMI ST79 Chemical indicator
A processing step using warm circulating air to enhance the removal of a chemical sterilization agent residue from processed items and wrapping material Aeration
The use of physical or chemical methods to remove, inactivate, or destroy bloodborne pathogens, rendering them no longer able to transmit infectious particles and rendering the item safe for handling. Decontamination
Chemical (gas) that is used to sterilize heat- or moisture-sensitive items; also used as a fumigant Ethylene oxide
This device contains a viable population of highly resistant bacterial spores that are resistant to the type or method of sterilization being monitored. Biological indicator
Declaration by medical device manufacturers that a product is sterile on the basis of physical or chemical process data after validating the cycle using BIs. Parametric release
Equipment that uses hot water for a definite period to destroy pathogenic bacteria; often used for respiratory therapy and anesthesia equipment Pasteurizer
Concept that items are considered sterile unless the integrity of the packaging is compromised (i.e., torn, soiled, wet, or showing evidence of tampering). Shelf life is indefinite. Event-related sterility
A popular low-temperature sterilization method used to process heat- or moisture sensitive items because of its short cycle and faster turnaround time but with packaging and lumen limitations Hydrogen peroxide
Process designed for the cleaning, steam sterilization, and delivery of patient care items for immediate use Immediate-use steam sterilization
Liquid oxidizing agent used in automated endoscope reprocessors. Items processed with this agent need to be used immediately because they are wet and cannot be packaged and stored for later use Peracetic acid
State of being free from all living microorganisms Sterile
A visible monitor (time, temperature, and pressure recorders, digital printouts, and gauges) that enables the operator to determine if sterilizing parameters were met Physical monitors
Part of the CI labeling that provides a value or values of a critical variable at which the indicator is designed to reach its end point as defined by the manufacturer Stated value
Class 1 CIs used as an external CI on the outside of packages or containers to demonstrate that the unit has been exposed to the sterilization process and to distinguish between processed and unprocessed units Process indicators
Item designed to create a challenge to the sterilization process and used for routine and qualification testing of sterilizers. Previously referred to as a test pack PCD
Probability of a single viable microorganism occurring on an item after sterilization. Normally expressed as 10−6, which means there is less than or equal to one chance in a million that a single viable microorganism is present on a sterilized item SAL
In the late 1950s and early 1960s, ethylene oxide (EO) sterilizers were developed to address the reprocessing of heat-sensitive devices. True or False True
Is it recommended for instruments with lumens to be flushed with saline? No, Instruments with lumens should be flushed with water (not saline, as salt is corrosive to most instruments).
Work Area Soiled/Decontamination 1) Air exchanges 2) Airflow 3) Temperature 4) Humidity 1) Air exchanges: 10 2) Airflow: Negative 3) Temperature: 60-65 F (16-18C) 4) Humidity: 30-60%
Work Area Assembly or prep & pack areas 1) Air exchanges 2) Airflow 3) Temperature 4) Humidity 1) Air exchanges 10, down draft 2) Airflow: Positive, Out 3) Temperature: 68-73 F (20-23 C) 4) Humidity 30-60 (Ideally 35-60)
Work Area Sterilizer loading/unloading 1) Air exchanges 2) Airflow 3) Temperature 4) Humidity 1) Air exchanges: 10 2) Airflow: Positive, out 3) Temperature: 68-73 F (20-23 C) 4) Humidity: 30-60%
Work Area sterile storage 1) Air exchanges 2) Airflow 3) Temperature 4) Humidity 1) Air exchanges: 4, down draft 2) Airflow: Positive, out 3) Temperature: may be as high as 75 F (24C) 4) Humidity: <70%
Work Area Sterilizer equipment access rooms 1) Air exchanges 2) Airflow 3) Temperature 4) Humidity 1) Air exchanges: 10 2) Airflow: Negative 3) Temperature: 75-85 F (24-29 C) 4) Humidity 30-60%
The cleaning process is the most critical step in the sterilization process Very Important!
A disadvantage to the use of the ultrasonic cleaner is: B. The implosion of the tiny bubbles may damage fragile instruments
To facilitate drying and to reduce microbial contamination and proliferation in an endoscope, you should: B. Blow compressed air through the channel and rinse with 70% ethyl or isopropyl alcohol
Which of the following statements is true regarding the storage of sterilized items in the Sterile Processing Department? 1) Sterilized items should be stored on a shelf with a solid bottom 3) Sterilized items should be stored in a room with positive air pressure 4) Sterilized items should be stored 8 to 10 inches from the floor
Prior to opening a sterile package, the end user should inspect the package for: 1) Tears 2) Moisture 3) Date of manufacture 4) The name of the person who packaged the kit A. 1, 2 Before use, sterile packages should always be inspected for signs of contamination such as moisture, tears, or discoloration in addition to the expiration date.
Which of the following recommendations related to disinfection and sterilization in healthcare facilities is a CDC category 1A recommendation? 1) “Before use on each patient, sterilize critical medical and surgical devices and instruments that enter normally sterile tissue or the vascular system or through which a sterile body fluid flows”
Vaginal probes with probe covers require which type of disinfection: A. Low-level disinfection B. Intermediate-level disinfection C. High-level disinfection D. Sterilization C. High-level disinfection
An ambulatory clinic will be transporting equipment to the local hospital for sterilization. Asked to write a policy for safety. The policy should include which of the following points on handling the instruments at the point of use? 1) Devices are to be cleaned before biofilm can form 2) Keep instrumentation moist to prevent bio-burden from drying 4) Contaminated devices are to be placed in a sealed container to prevent exposure to staff and patients
An inspection of the Sterile Processing Department reveals several incorrect practices. Which of the following would be a correct practice? C. Daily use of a biological indicator in the sterilizer
Event-related storage of sterile items allows packaged, sterile items to be used any time after processing provided that: 2) The packing wrapper is intact 3) The item has not gotten wet 4) The storage area is well-ventilated, dry, and free of dust and insects
A biological indicator from one of the sterilizers in Sterile Processing turns positive. The first action should be: A. Retrieve unused items from the load
During rounds in several patient care areas, the IP discovers several cardboard boxes being used to store patient care supplies. She informs the unit manager that another method of storing supplies must be implemented because: D. The boxes may harbor dust, bacteria, and insects
What is the temperature required for flash steam sterilization? A. 100°C/212°F B. 132°C/ 270°F C. 150°C/302°F D. 172 °C/342 °F B. 132°C/ 270°F Flash sterilization is done at 132C/270F and may be used on both porous and nonporous items although the time needed for sterilization may vary from 3 to 10 minutes, depending on the item being sterilized.
Under the Spalding system, which of the following is classified as a semi-critical item when considering methods for sterilization. A. Surgical instrument B. Prosthetic implant C. Endoscope D. Blood pressure cuff C. Endoscope
The Spalding system Critical Contact w/ sterile tissue or the vascular system, including surgical instruments, IV catheters, and prosthetic implants. Contamination poses a high risk of infection.
The Spalding system Semi-critical: Contact w/ mucous membranes or non-intact skin, including endoscopes, diaphragm fitting rings, and laryngoscope blades. These tissues tend to be more resistant to spores, so these items can by disinfected with high-level disinfectants.
The Spalding system Non-critical Contact w/ intact skin only, including patient care items such as blood pressure cuffs and bedpans and environmental surfaces. Decontamination can be done at point care.
The primary disadvantage to passive air sampling with settle plates for environmental monitoring is: A. Difficulty of use B. Potential for contamination C. Inaccuracy D. Cost-effectiveness B: The primary disadvantage to passive air sampling with settle plates for environmental monitoring is the potential for contamination during transport, handling, and laboratory evaluation as this contamination may result in inaccurate findings.
The risk for a surgical site infection increases when the cut point is above the: A. 25th % B. 50th % C. 75th % D. 85th % C: The risk for SSI increases when the cut point is above the 75th %, indicating that the duration of the surgery was longer than expected. The cut point (in minutes) varies according to type of procedure.
Which of the following antibiotics should be initiated within two hours prior to surgery instead of one hour? A. Vancomycin B. Ampicillin C. Fluconazole D. Metronidazole A: Vancomycin should be infused over 60 minutes, so this drugs should be given within two hours of surgery.
Are used to monitor EO and dry heat sterilization processes Bacillus atrophaeus spores
Are used to monitor steam sterilization, hydrogen peroxide with or without gas plasma, and ozone sterilization processes. Geobacillus stearothermophilus spores
Biofilm A matrix of microorganisms and extracellular material attached to a surface that is difficult to remove
Chemical Sterilants Liquid chemical agents cleared by the Food and Drug Administration (FDA) for reprocessing reusable medical devices
Cleaning The physical removal of organic and inorganic material from objects and surfaces
Duodenoscope A complex endoscope instrument that has a flexible, lighted tube that is threaded through the mouth, throat, and stomach into the top of the small intestine (duodenum) used during endoscopic retrograde cholangiopancreatography (ERCP) procedure.
HLD The elimination of all forms of microbial life with the exception of low levels of bacterial spores
Port an opening that provides access to an internal channel of the endoscope
Endoscopic accessories biopsy forceps, brushes, snares, or other devices introduced through the internal channel of the endoscope during procedures
Reprocessing to the validated cleaning and high-level disinfection or sterilization of reusable endoscopic devices by either manual or automated methods
Endoscope broad category referring to a flexible device used to visualize the interior of a hollow organ or body space
Sterilization the complete elimination or destruction of all forms of microbial life
Spaulding Classification Developed classification to identify how an object is disinfected depending on its intended use
Critical objects which normally enter sterile tissue or the vascular system through which blood flows. Sterile areas of the body including blood: surgical instruments. Sterilization
Semi-critical objects which touch mucous membranes or skin that is not intact
Non-critical objects that touch only intact skin. stethoscope, BP: Low or intermediate level disinfection
According to the Spaulding classification system, flexible endoscopes are considered: A. Non-critical B. Semi-critical C. Non-critical B. According to the Spaulding classification system, flexible endoscopes are considered semicritical devices because they come into contact with mucous membranes but do not ordinarily enter sterile tissue or the vascular system
What items require only high-level disinfection based on the Spaulding criteria? A. Non-critical items B. Semi-critical items C. Critical items Semi critical: Mucous membranes or non-intact skin: endoscopes; Vaginal probes; High level Disinfection
Outbreaks may not be limited to infectious events with endoscopes 9 episodes of anaphylaxis following cystoscopy were associated w/ use of orthophthalaldehyde for high-level disinfection of cystoscopes in bladder cancer pts.
Staff assisting w/ Bronchoscopy of a pt w/ suspected TB must wear which type of respiratory protection? A. Surgical/procedural mask B. Face Shield C. Protection is not required D. A fit-tested respiratory or PAPR D. A fit-tested respiratory or PAPR. HCP assisting w/ Bronchosocpy should wear appropriate PPE including a fit-tested respiratory or a PAPR
In an effort to reduce cost and decrease turn around time, the endoscopy manager has asked if the enzymatic detergent can be used for multiple patients. Your response is: B. The enzymatic detergent must be discarded after each use. The CDC recommends that the enzymatic detergent be discarded after each use since these products are not antimicrobial & will not retard microbial growth.
A staff nurse informs the IP that a patient with confirmed multidrug-resistant TB requires an immediate bronchoscopy. In which of the following rooms must the procedure be performed? D. Airborne infection isolation room
Which of the following are CDC requirements for storing endoscopes? 3. Store hanging in a vertical position to facilitate drying 4. Store in a manner that protects the scope from contamination Store in a manner that protects them from contamination. Hang it in a vertical position to facilitate drying
When performing an audit of the Endoscopy Department, the IP observes the following practices. Which one is cause for concern? B. Equipment is immersed in enzymatic cleaner that is discarded every 24 hours Enzymatic detergents must be discarded after each use, as these products are not microbicidal and will not retard microbial growth.
A pt in Droplet Precautions is scheduled for a procedure in Endoscopy. In addition to following respiratory hygiene & cough etiquette, which of the following is the most appropriate method to reduce the transmission during transportation of the pt? C. Place a surgical mask on the patient
Of the recommendations for reprocessing flexible GI endoscopes listed below, the one that is most strongly supported by well designed experimental, clinical, or epidemiological studies is: A. Cleaning of endoscopes is essential before manual or automated disinfection
Created by: JRWeidenaar