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What are the written procedures based on MSDS information for the action and evacuation of people in the event of a HLD spill?
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Who is responsible for providing instructions on cleaning reusable accessories?
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Scope Infection Cont
Infection Control Principles for Endoscope Reprocessing
| Question | Answer |
|---|---|
| What are the written procedures based on MSDS information for the action and evacuation of people in the event of a HLD spill? | Spill Containment Plan |
| Who is responsible for providing instructions on cleaning reusable accessories? | The FDA requires that manufacturer are responsible for providing instructions for cleaning and disinfection of accessories. |
| Devices that break the mucus membrane and/or come into contact with sterile tissue or the vascular system are called what? | Critical devices |
| Devices which are not intended for reuse are labeled in what way? | A circled number 2 with a line drawn through it. |
| True or False Critical items for single use should not be reused without reprocessing. | False,any single use items is never to be reused or reprocessed. |
| Is suctioning of fluid is sufficient for removing debris from internal lumens at the end of the procedure. | No, suctioning air and water is more effective at removing debris than fluid alone at the end of case pre-cleaning. |
| What action in the room precludes drying of organic and inorganic debris on lumen surfaces and may remove large numbers of microorganisms? | Immediate flushing of the biopsy/suction and air/water channels. |
| Transport the endoscope to the reprocessing area in what? | In an enclosed container. |
| Containers, sinks, and basins should be large enough why? | To ensure that the endoscope will not be damaged by being coiled too tightly. |
| Leak testing detects what? | Leak testing detects damage to the interior or exterior of the endoscope. |
| The leak test is done before immersion of the endoscope in reprocessing solutions why? | To minimize damage to parts of the endoscope not designed for fluid exposure. |
| What is the most common finding of a failed leak test? | The appearance of bubbles. |
| During a leak test what must be moved? | You must move the knobs on the control head in order to move the distal part of the scope in all directions. |
| In completing a manual leak test all valves should be removed before or after the test? | Before |
| True or False: Attach the leak tester and pressurize the scope before submerging it in water. | True |
| What type of cleaning solution is used in after leak testing in cleaning scopes? | Enzymatic cleaning solutions |
| What is necessary immediately after removing the endoscope from the patient and prior to automated or manual disinfection? | Manual cleaning of endoscopes. |
| What type of products can be found on a soiled endoscope? | The composition of soil found on endoscopes includes, proteins, fats,carbohydrates and the various chemical salts that exist in blood and other body fluids. |
| Freshly prepared detergent solution should be used for each endoscope to prevent what? | Cross contamination. |
| Low-foaming detergents are recommended for manual cleaning why? | So that the device can be clearly visualized during the cleaning process |
| True or false: Excessive foaming can inhibit good fluid contact with the device surfaces. | True |
| True or False: Endoscopes exposed to synthetic lipids require no additional precleaning. | Endoscopes exposed to synthetic lipids may require additional precleaning with a detergent formulated to remove synthetic lipids. |
| The endoscope should be left under water during the cleaning process to prevent what? | To prevent splashing of contaminated fluid and aerosolization of bioburden. |
| The small cleaning brush should be used to clean what? | To clean all removable parts, including inside and under the suction valve, air/water valve, and biopsy port cover and openings. |
| When brushing the scope it is important to do what after each pass? | After each passage, rinse the brush in the detergent solution, removing any visible debris before retracting and reinserting it. |
| You continue to see debris on the brush after two passes, how long should you continue to brush? | After each passage, rinse the brush in the detergent solution, removing any visible debris before retracting and reinserting it. |
| What should be done with reuseable brushes between cases? | Clean and high-level disinfect reusable brushes between cases. |
| Reusable brushes should be inspected between uses and replaced when worn, frayed, bent, or otherwise damaged.Why? | Worn bristles are ineffective in cleaning, and damaged brushes may damage endoscope channels. |
| Why is cleaning a duodenoscope unique? | The elevator channel of a duodenoscope is a small lumen, this channel requires manual reprocessing. |
| If, due to time constraints, it is not possible to complete the reprocessing immediately, the endoscope should be leak-tested, flushed, brushed, and then what? | Allowed to soak in a detergent solution until it can be thoroughly reprocessed. |
| Who's recommendations should be followed for the minimum and maximum exposure soak time for endoscopes? | The manufacturer of the solution used. |
| Why do we dry the exterior of the endoscope with a soft, lint-free cloth after rinsing and flushing with air? | To prevent dilution of the liquid chemical germicide used in subsequent steps. |
| What is the only circumstance where the endoscope needs to be sterilized? | When it is used in a sterile,operative field. |
| True or False: HLD destroys all vegetative microorganisms and all bacterial spores. | False; HLD may not necessarily all bacterial spores. |
| Testing of HLD is done to assure what? | They must be tested to assure that they remain above their minimum effective concentration. |
| Where non-surfactant 2% glutaraldehyde products are used, multiple scientific studies and professional organizations support the following position: after meticulous cleaning, high-level disinfection is achievable with what soak time? | Twenty minute soak |
| Reuse of a HLD is dependant on what factors? | Dilution,time/temperature, and number of uses. |
| True or False: The MEC may never be used beyond the date specified on activation. | True |
| Testing to prove MEC is done how? | Use a product-specific test strip, and keep a log of the test results. |
| For manual disinfection the soaking basin is covered with a tight-fitting lid why? | Exposure to chemical vapors may present a health hazard. |
| If manually cleaning a scope, it is important to ensure what two factors for HLD to be effective? | Proper temperature and use a timer to verify needed time. |
| Rinsing the endoscope with water after manual soaking prevents what? | Rinsing prevents exposure and potential injury of skin and mucous membranes from chemical residue. |
| Why do we purge all channels with air until dry after manual cleaning? | Bacteria such as Pseudomonas aeruginosa have been identified in both tap and filtered water, and may multiply in a moist environment. |
| Flush all channels, including accessory channels, with alcohol until the alcohol can be seen exiting the opposite end of each channel. Why? | Alcohol is used to assist in drying the interior channel surfaces. |
| What type of alcohol is used in flushing the channels? | 70% isopropyl alcohol |
| True or False: Alcohol flushes should be used even when sterile water is used for rinsing. | True |
| True or False: During storage it is acceptable to attach removable parts (valves)to the scope. | False. Storage of endoscopes with the removable parts detached lowers the risk of trapping liquid inside the instrument and facilitates continued drying of the channels and channel openings. |
| True or False: Drying of the endoscope is important. | True, drying the endoscope after every reprocessing cycle, both between patient procedures and before storage is a requisite practice crucial to the prevention of bacterial transmission and nosocomial infection. |
| A storage area with good ventilation will encourage continued air drying of the surfaces, and prevent what? | Prevent undue moisture build-up, thus discouraging any microbial contamination. |
| Padding the lower portion of the scope storage area with non-porous material may prevent damage to what? | To the distal end of the scope. |
| What decreases personnel exposure to high-level disinfectants and sterilants? | Endoscope reprocessors. |
| True or False? The AER should also feature a self-contained or external water filtration system. | True |
| True or False ? With an AER if cycles/phases are interrupted, HLD cannot be ensured and full cycle must be repeated. | True |
| True or False? If your AER does not include the final alcohol rinse cycle, it is acceptable to omit this step. | False. If a final alcohol rinse cycle is not included in the automated reprocessor cycle, this step should be done manually followed by purging all the channels with air until dry. |
| According to the Spaulding Classification System an Endoscope is which type of device: critical, semi-critical and non-critical? | Semi Critical as it comes in contact with mucous membranes or non-intact skin and should be sterilized or receive high level disinfection. |
| An example of a non critical device is: | Blood pressure cuff,stethescope, tympanic thermometer. |
| Flexible endoscope reprocessing has been shown to have a (wide or narrow) margin of safety. | Narrow. Any slight deviation from the recommended reprocessing protocol can lead to the survival of microorganisms and an increased risk of infection. |
| True or False Each individual who reprocesses instruments should complete the initial infection control orientation/reprocessing competency and subsequent annual competency review and infection control updates, with documentation. | True. All individuals who reprocess endoscopes and accessories require detailed knowledge of the instruments and the specific methods required to produce an instrument safe for use. |
| Quality assurance is of the highest priority in settings where gastrointestinal endoscopy is performed. Name some of the key components of quality assurance. | Supervision, training, annual competency review, methods of assuring the availability of appropriate equipment and supplies, and procedures for reporting infections. |
| When must HLDs and sterilants be changed? | HLDs and sterilants must be changed when the solutions fail to meet minimum effective concentration or exceed the HLD manufacturer’s recommended reuse life, whichever comes first. |
| HLD and sterilant vapor levels should be monitored and documented when? | 1.change in the disinfection phase of the reprocessing protocol occurs 2. different high-level disinfectant or sterilant is used or 3. staff member exhibits symptoms of overexposure |
| True or False: To prevent cross-contamination in an endoscopic procedure room, most areas of the room should be designated as clean areas. Contaminated areas where accessories and specimens are handled should be separated from clean counter areas. | True |
| All contaminated areas must be cleaned and decontaminated between patients with what? | With an Environmental Protection Agency registered, hospitalgrade disinfectant. |
| True or False: When endoscopy is performed on patients with known or suspected tuberculosis, rooms with air circulated through high-efficiency particulate air (HEPA) filters, also known as zero pressure rooms, are recommended | False, the rooms are negative pressure rooms. |
| Water used in the reprocessing area should be filtered by passage through a 0.2 micron filter. True or False | True. Water of equivalent quality (i.e., suitable for drinking)or sterile water may be used. |
| Performing routine cultures of endoscopes is not currently recommended, but may be done when? | In the event of an identified outbreak. |
| True or False: A scope used on a patient with suspected Hep C should be processed twice through the AER. | False: Every patient must be considered a potential source of infection and all endoscopes must be decontaminated with the same degree of rigor following every endoscopic procedure. |
| When microflora found on the mucosal surfaces of the GI or respiratory tract gain access to the blood stream or normally sterile body sites as a result of a procedure it is called what kind of infection? | Endogenous Infection. |
| Exogenous infections result from microrganisms introduced from where? | Outside the body. |
| Name three types of exopenous infections. | Hepatitis C, Tuberculosis, Pseudomonas aeruginosa |
| The most common factors assosciated with exogenous transmission from endoscopy procedures comes from what factors? | Inadequate manual cleaning, inadequate rinsing and drying, improper use of AER's. |
| The ability of bacteria to form this structure and maximize growth potential, is an important factor in endoscopy related infections. | Biofilm. |
| True or false: The inertnal channels of endoscopes have been found to contain biofilms. | True |
| What term describes the physical or chemical procedure used to destroy all forms of microbial life, including spores. | Sterilization. |
| What regulatory body classifies levels of disinfection as sterilization, HLD, intermediate level disinfection and low level disinfection. | The Centers for Disease Control and Prevention. |
| What is always necessary before an endoscope can undergo HLD or sterilization? | Decontamination, Cleaning. |
| Why are non-immersable endoscopes now unacceptable in gastroenterology? | Because it is impossibl to suffiently clean and disinfect endoscopes that cannot be completely immersed in liquid. |
| What is the most common agent used for HLD? | Glutaraldehyde. |
| Glutaraldehyde is compatable with all but one AER, which one? | Steris. |
| Name two advantages of glutaraldehyde. | Resistant myobacterium, it is an irritant, it fixes protein and can allow for biofilm formation. |
| Sensitivities to Glutaraldehyde can include what symptoms? | Itching and redness of skin, irritation of the eyes and nasal membranes, asthma-like symptoms, headache, coughing, sneezing. |
| What are the routes of absorbtion for gluaraldehyde? | Inhalation, ingestion and through the skin. |
| Mixing, adding and removing equipment or disposing of glutaraldehyde solution breaks the surface tension and releases what? | Vapors. |
| OSHA has set ceiling limits for glutaraldehyde vapors at what level? | .05 part per million |
| Equipment that helps to maintain ceiling limits are: | Ducted exhaust hoods, 7-15 air exchanges per hour, ductless fume hoods with absorbents for the vapors, tight fitting lids and AER's. |
| True or False: The FDA has approved products containing 7.5% hydrogen peroxide as a HLD. | True. |
| Hydrogen peroxide is not compatible with flexible endoscopes by which 3 manufacturers? | Olympus, Pentax and Fujinon. |
| The Steris Corporation uses what chemical as a HLD in their system? | Paracetic Acid 0.2% |
| In order to be considered sterile, scopes from a Steris system must be used when? | The endoscope must be used immediately upon removal. |
| True or False : Scopes placed in the Steris system do not require as meticulous a precleaning as those placed in glutaraldehyde. | False. |
| Peracetic Acid has the advantage of not creating biofilm and what else? | It can remove glutaraldehyde-hardened biofilm from biopsy channels. |
| Are there organisms that are now resistant to peracetic acid? | No there are no resistant organisms. |
| Which endoscope manufacturers list Steris systems as compatible for their scopes? | Pentax and Fujinon. |
| True or False:Peracetyic Acid and water mixed to a .2% concentration can be disposed of down the sewer and be non-toxic and environmentally safe. | True |
| How does the cost of Peracetic acid compare to other HLD's? | It is significantly higher in cost. |
| Cosmetic discoloration of scopes, damage to the seals of reprocessors and exposing leaks of internal channels of previously glut cleaned scopes are all what? | Disadvantages of Peracetic Acid. |
| What is the chemical name and concentration for Cidex OPA? | Ortho-phthaldehyde 0.55% |
| What is the required HLD immersion time for Cidex OPA? | 12 minutes at 20 degrees Celsius and 5 minutes a 25 degrees Celsius. |
| True or False: Evidence based studies show Cidex OPA to be effective against glutaraldehyde resistant myobacterium. | True. |
| Which agent glutaradehyde or Cidex OPA reaches it's MEC level first ? | Glutaraldehyde (40 cycles, compared to OPA's 82 cycles) |
| The maximum reuse life of Cidex OPA is? | 14 days |
| What number of large volume rinses are required after HLD with Cidex OPA? | Three. |
| True or False: Large volume spills may be cleaned up with an absorbent pad. | False. |
| What one disease process with scope use requires consultation with an infection control professional? | Creutzfeld-Jakob Disease |
| What product is used to deactivate Cidex OPA according to the MSDS? | Glycine(free base)powder 25 grams/gallon |
| The ability of an AER to heat disinfectants reduces what? | Contact time. |
| All AER's should have a prefiltered water and what for the final rinse? | A 0.2 micron filter. |
| ERCP and Duodenal scopes may not be able to be HLD in an AER why? | The elevator channels have small lumens and many AER's do not generate enough pressure to clean the small lumens. |
| What are the the steps recommended for handling reuseable biopsy forceps? | Manually clean, use an ultrasonic cleaner cycle, rinse, dry and then use steam sterilization. |
| If using reusable water bottles, how often are they to be cleaned and disinfected (or sterilized)? | Daily. |
| What should be used for wipe down of non-critical items such as carts or stretchers? | An EPA registered tuberculocidal hospital grade disinfectant. |
| Visible spills of blood or blood contaminated body fluid should be cleaned with what? | A 1:100 solution of household bleach or a hospital grade disinfectant. |
Created by:
WCHENDO