Sterilization and Infection Control Techniques

Questions and Answers

Explain the difference between a Class 3 chemical indicator and a Class 5 chemical indicator.

Class 3 Chemical Indicator refers to a single parameter of the sterilization process whereas a Class 5 Chemical Indicator refers to all the parameters of a sterilization process.

Provide an example of an item that falls into each of the Spaulding Classification categories and rationale for that classification: Critical, Semi-critical, Noncritical.

Critical - Forceps: Going directly into human cavity

Semi-critical - Scopes: Will penetrate the body in a natural orifice which the mucous membranes will act as a barrier

Noncritical - BP cuff: Human skin will act as a protective barrier

All of the above (correct)

Define sterile.

Absence of all living microorganisms including spores.

Define aseptic.

Absence of all pathogenic microorganisms. Signup and view all the answers

Define sterile field.

The area surrounding the site of incision or perforation that has been prepared for an invasive procedure. Signup and view all the answers

Define sterile technique.

The use of specific actions and activities to prevent contamination and maintain sterility of identified areas during invasive procedures. Signup and view all the answers

Define aseptic practices.

Patterns of behavior and processes that are implemented to prevent microbial contamination. Signup and view all the answers

What are the goals of sterile technique and aseptic practices?

Prevent SSI, optimize primary wound healing, minimize the length of recovery from surgery. Signup and view all the answers

Define surgical conscience.

The concept which allows no compromise in the principles of aseptic technique. Signup and view all the answers

Risk factors which contribute to surgical site infections include: ______

Pre-existing infection, surgical technique, length/type of surgery, pre-existing conditions, impaired defense mechanisms, nutritional status, age, impaired skin integrity. Signup and view all the answers

What is a clean wound?

Clean wound means a clean operative wound with no inflammation encountered, and no tracts entered. Signup and view all the answers

What is a clean-contaminated wound?

Operative wounds in which respiratory, alimentary, or genitourinary tract is entered under controlled conditions and without contamination. Signup and view all the answers

What is a contaminated wound?

Surgery that involves open, fresh, traumatic wounds or major breaks in sterile technique. Signup and view all the answers

What is a dirty wound?

Dirty or infected wounds that include old traumatic wounds with retained devitalized tissue. Signup and view all the answers

What are the three categories of the Spaulding Classification system?

Critical, Semi-critical, Noncritical. Signup and view all the answers

Compare and contrast sterilization, disinfection, and decontamination.

Sterilization destroys all microorganisms; disinfection destroys pathogenic microorganisms; decontamination removes pathogens. Signup and view all the answers

What are the steps of sterilization?

Cleaning, Decontamination, Assembly, Packaging, Sterilization, Storage, Transportation. Signup and view all the answers

What are the three AORN guidelines for cleaning and care of surgical instruments?

<ol> <li>Instruments should be cleaned according to manufacturer's instructions; 2. Instruments kept free of gross soil; 3. Cleaning should occur as soon as possible after use.</li> </ol> Signup and view all the answers

What are the objectives of cleaning?

Remove visible soil, remove invisible soil, prepare surfaces for sterilization/disinfection. Signup and view all the answers

Name the four principles of decontamination.

Enzymatic Wash, Appropriate detergent, Cool Water Rinse, Disassembly. Signup and view all the answers

Name some types of sterilization techniques.

Saturated steam sterilization, Immediate use steam sterilization, Chemical sterilization, Ethylene Oxide Sterilization, Low-temperature hydrogen peroxide gas plasma sterilization, Low-temperature hydrogen peroxide vapor sterilization, Ozone Sterilization. Signup and view all the answers

Name some automated cleaning and decontamination devices.

Ultrasonic Cleaner, Washer decontamination/disinfection, Washer/sterilizer. Signup and view all the answers

When is immediate-use steam sterilization used?

Only when there is insufficient time to process by the preferred wrapped or container method. Signup and view all the answers

Name the two basic types of steam sterilizers.

Gravity Displacement and Dynamic Air Removal. Signup and view all the answers

What are the four parameters required that affect the steam sterilization process?

Steam saturation, Pressure, Temperature (121-135°C for Gravity Displacement, 132-135°C for Dynamic Air-Removal), Time. Signup and view all the answers

After steam sterilization, how long should items not be moved or touched?

Wrapped, sterilized items should be left untouched to cool for 30-60 minutes. Signup and view all the answers

Define IUSS.

Immediate use steam sterilization, used under specific conditions. Signup and view all the answers

What is PCD?

Process challenge device used with routine process monitoring to demonstrate that sterilization conditions have been met. Signup and view all the answers

What is biological monitoring?

After exposure to sterilization, absence of growth indicates appropriate conditions were met. Signup and view all the answers

What is peracetic acid sterilization?

A low-temperature liquid chemical sterilization agent with equal efficacy to steam and ethylene oxide sterilization. Signup and view all the answers

What is ethylene oxide sterilization?

A colorless, flammable, and toxic gas used to sterilize heat and moisture sensitive items. Signup and view all the answers

What are the primary variables dependent on complete ethylene oxide sterilization?

Gas concentration, Proper exposure time (2-10 hours), Temperature (38-60°C), Chamber humidity (45-75%). Signup and view all the answers

What is low-temperature hydrogen peroxide gas plasma sterilization?

A sterilization method utilizing vaporized hydrogen peroxide, effective for moisture and heat-sensitive items. Signup and view all the answers

What are the six classes of chemical indicators?

Class 1, Class 2 (Bowie-Dick), Class 3, Class 4, Class 5 (Integrating Indicator), Class 6 (Emulating Indicator). Signup and view all the answers

What class chemical integrating indicator should be run with the load including a surgical implant?

Class 5. Signup and view all the answers

Perioperative documentation of implants should include:

Placement and location of implants, name of the manufacturer, lot and serial numbers, type and size of implant, expiration dates, any other information required by the FDA. Signup and view all the answers

What is the FDA time definition for implants?

Any material that will remain in the body for longer than 1 year. Signup and view all the answers

What is FIFO?

First in first out, utilized with stock rotation of sterile items. Signup and view all the answers

What are the conditions that are important considerations in maintaining the sterility of an item?

Condition of storage area, cleanliness, temperature (72°F - 78°F), air exchange (at least 4/hr), relative humidity (60-70%). Signup and view all the answers

Define disinfection.

A chemical or physical process of destroying all pathogenic microorganisms, except spores, on inanimate objects. Signup and view all the answers

Define decontamination.

The use of physical or chemical means to remove, inactivate, or destroy pathogens on a surface or item. Signup and view all the answers

Define sterilization.

The process of destroying all microorganisms on a substance by exposure to physical and chemical agents. Signup and view all the answers

Define high-level disinfection.

A process that destroys all microorganisms except for high numbers of bacterial spores. Signup and view all the answers

The length of time an item is considered sterile depends on factors that include:

Type and configuration of packaging materials, number of times handled, conditions of the storage area, etc. Signup and view all the answers

Study Notes

Chemical Indicators

Class 3 indicators: Measure a single parameter of the sterilization process.
Class 5 indicators: Evaluate all parameters of the sterilization process.

Spaulding Classification

Critical Items: Instruments like forceps that enter sterile areas; require sterilization.
Semi-Critical Items: Scopes that contact mucous membranes; require high-level disinfection.
Non-Critical Items: BP cuffs that contact intact skin; require intermediate to low-level disinfection.

Definitions

Sterile: Complete absence of all living microorganisms, including spores.
Aseptic: Absence of pathogenic microorganisms.
Sterile Field: Area ready for invasive procedures, covered by sterile drapes and attended by sterile-clad personnel.
Sterile Technique: Actions to prevent contamination and maintain sterility during procedures.
Aseptic Practices: Protocols to prevent microbial contamination.

Goals of Techniques

Prevent Surgical Site Infections (SSI).
Optimize primary wound healing.
Minimize recovery time from surgery.

Surgical Conscience

Adherence to aseptic principles is crucial; any compromise increases infection risk.

Risk Factors for Infections

Pre-existing infections, surgical technique, duration/type of surgery, and overall patient condition.

Wound Classification

Class I (Clean Wound): No inflammation; respiratory/alimentary tracts not entered; examples include eye surgery and hernia repairs.
Class II (Clean-Contaminated Wound): Controlled entry into the respiratory/alimentary tracts; examples include D&C and laparoscopic surgeries.
Class III (Contaminated Wound): Open wounds with major sterile technique breaks; examples include traumatic wounds and surgeries that encounter acute inflammation.
Class IV (Dirty/Infected Wound): Old wounds with infected tissue and existing clinical infections.

Sterilization and Disinfection

Sterilization: Destroys all microorganisms.
Disinfection: Destroys pathogenic microorganisms, not spores.
Decontamination: Reduces bioburden and contaminants.

Steps of Sterilization

Cleaning, Decontamination, Assembly, Packaging, Sterilization, Storage, Transportation.

Cleaning Objectives

Removal of visible and invisible soil, preparation for sterilization, and ensuring safety.

Decontamination Principles

Enzymatic wash, appropriate detergents, cool water rinses, and disassembly of instruments.

Sterilization Techniques

Methods include saturated steam, chemical sterilization, ethylene oxide, and low-temperature hydrogen peroxide.

Biological Monitoring

Confirms sterilization effectiveness; no growth indicates appropriate parameters met.

Peracetic Acid Sterilization

Environmentally safe, low-temperature of liquid chemical sterilization agent; similar efficacy to steam.

Ethylene Oxide Sterilization

Effective on moisture/heat-sensitive items, but requires aeration and poses significant health risks.

Immediate Use Steam Sterilization (IUSS)

Used when there isn't enough time for the preferred sterilization method; requires adherence to strict conditions.

Equipment for Sterilization and Cleaning

Automated devices like ultrasonic cleaners and washer-disinfectors ensure efficient decontamination.

Chemical Indicators Classes

Range from Class 1 (package exposure) to Class 6 (specific cycle parameters).

FDA Definitions and Guidelines

Implants: Remain in the body over one year; documentation must include extensive details.

Environmental Considerations for Sterility

Cleanliness, temperature (72-78°F), air exchange (min. 4/hour), and humidity (60-70%) critical for maintaining sterility.

First in, First Out (FIFO)

Stock rotation method for maintaining sterile item integrity.

High-Level Disinfection

Destroys all vegetative microorganisms with some resistance to bacterial spores.

Factors Affecting Sterility Duration

Includes the type of packaging, handling frequency, storage conditions, and transport situations.

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Description

This quiz covers essential concepts related to sterilization and infection control, including chemical indicators, the Spaulding classification, and definitions relevant to aseptic practices. It will test your understanding of critical, semi-critical, and non-critical items in healthcare settings, as well as techniques to maintain a sterile environment. Get ready to enhance your knowledge of surgical safety and infection prevention.