CSSD 2024 PDF

CSSD Table of Contents Module 1 INTRODUCTION TO CENTRAL SERVICS Module 2 MEDICAL TERMINOLOGY, ANATOMY AND PHYSIOLOGY Module 3 MICROBILIOGY FOR CENTRAL SERVICE TECHNICIAN. Module 4 INFECTION PREVENTION Module 5 REGULATION AND STANDARDS Module 6 SURGICAL INSTRUMENTATION Module 7 QUALITY ASSURAN...

CSSD Table of Contents Module 1 INTRODUCTION TO CENTRAL SERVICS Module 2 MEDICAL TERMINOLOGY, ANATOMY AND PHYSIOLOGY Module 3 MICROBILIOGY FOR CENTRAL SERVICE TECHNICIAN. Module 4 INFECTION PREVENTION Module 5 REGULATION AND STANDARDS Module 6 SURGICAL INSTRUMENTATION Module 7 QUALITY ASSURANCE Module 8 DECONTAMINATION POINT ZONE Module 9 ASSEMBLY AND PACKAGING ZONE Module 10 STERILIZATION ZONE Module 11 STERILE STORAGE AND TRANSPORT Module 12 SAFETY AND RISK MANAGEMENT Module 13 PERSONAL AND PROFESSIONAL DEVELOPMENT Introduction to Central Services Welcome to the Medical Device Reprocessing (CSSD Officer) program. This introductory module helps the students prepare to come back to an educational environ - ment. This module highlights basic concepts of adult learning as well as key requirements to be successful in the clinical or hospital working environment. The aim of this module is to help the student study and learn with confidence. The module will look at some of the unique issues the student may face as adults re-entering of the educa- tion system. Becoming familiar with the material in this module will help the student achieve success with this program. We strongly advise that students must t ake the time to study the content, as it will help to understand how to retain and apply what was learned. We wish all the students an interesting and productive program. Pre-Module Quiz Keep these questions in mind as you go through the content and don’t worry if you don’t know the answers yet—that’s what you’re here to learn. Q: Can you list five different learning approaches you used in your previous studies? Q: What are the characteristics of an adult learner? Q: What are some of the challenges you may face as a returning student? Q: Do you know what conscious incompetence means? Q: In what ways could a colleague from another country be different from you? Q: What are good traits to ensure effective communication in work? Q: What does confidentiality mean to you and how might that be different in a hospital? Adult Learning Students participating in this program must have a bachelor’s degree in science, which requires strong skills for studying and learning. Some of you completed this degree recently, while others completed it years ago. This gap in learning may present challenges, as you may have forgotten previous study prac - tices or they may not be as strong due to lack of practice. To help reduce the frustration of returning to the learning environment we will look at ways to achieve successful learning and many of the common challenges that returning students may face. Approaches to Learning The table below illustrates different approaches to learning and how they impact learners and their ability to retain and apply knowledge. On-the-job training has the highest impact on learning while reading has the lowest.  High On-the-job training Case studies and teaching others Mentoring and coaching Application Simulations and virtual learning Problem solving group activities Interactive discussions Lectures Low Reading Which of these approaches to learning do you think works best for you? These approaches help guide us to effective techniques for learning, but for education to truly be successful, we must also consider the characteristics of you, the adult learner. Char - act eristics of adult learners—adults are: Autonomous and self-directed Experienced and knowledgeable Goal oriented Relevancy oriented Practical and learn by doing Respectful and want to be respected Autonomous Adult learners resist learning when they feel others are pushing information, ideas or actions. The foundation of this program is based on reading materials to encourage self-di- reacted learning and we use interactive exercises such as questionnaires and checklists for students to complete on their own. Experienced Adults like the opportunity to use their existing foundation of knowledge and apply their life experiences to their professional development. This program is designed to recognize the knowledge from your bachelor’s degree and build additional learning through your interaction with your instructors. Goal Oriented Adult learners are more effective when they feel a need to learn in order to cope more satisfyingly with real life tasks or problems. We will ask questions that motivate reflections, inquiry, and further research to increase the motivation to learn. Relevancy Oriented Adult learners want to know the relevance of what they are learning to what they want to achieve. Through the instructors, we will check meaning, understanding and relevance to the context of the work throughout the learning experience. Practical Classroom and textbook learning create a foundation but hands on exercises and practice provide the highest impact of learning and retention. We will use competency documents with clear content and rationale explaining how it is applicable to the specialist’s work. The strongest focus for this program will be to provide opportunities for repetition to promote skill development, confidence, and competence. Respectful Adult learners like to be respected. We will demonstrate this by acknowledging the wealth of knowledge and experience each student brings and encouraging the expression of new ideas, reasoning and feedback throughout the program. Challenges for Returning Students We may understand approaches to learning and the importance of adult student character- istics but additional challenges can also impact students returning to study after time away.  Responsibilities   Social fears   Learning curve   Diversity  Responsibilities Family and work responsibilities are among the greatest challenges to returning students as many will now have spouses and children. This program will require a commitment from students to apply themselves and focus on learning the content and participating in assigned tasks. It is also structured to allow for self-study through reading, tutorials, and on-the-job training to ensure your success. Social Fears Age doesn’t stop the impact of social pressure and personal fears so this program is struc-tured with the expectation that it may take some practice to return to learning. This program allows for mentoring to help discuss challenges. Diversity As the world becomes more globalized so does the classroom, with students from different age groups, experiences and backgrounds. In the workplace it is also common to work with people of different nationalities. Learning Curve Returning students often learn how things have changed since their first classroom experi-ence. This program will include teamw ork, group discussions and mentoring to help new learners through these four stages of competence.  Acquire new knowledge whilst thinking over the old, and you may become a teacher of others. —Confucius The Four Stages of Competence You don’t understand or know how to do something. You must Unconscious recognize your incompetence before moving on tothe next stage. Incompetence Though you do not understand or know how to do some- thing, Conscious you recognize the deficit and see the value in learn-ing a new skill. Incompetence You know how to do something but must use strong Conscious concentration to execute the new skill. Competence You have had so much practice with the new skill that it has become Unconscious second nature and can be performed easily. At this level the skill Competence can be performed while doing another task and you may be able to teach it to others. Multicultural Workplace In a multicultural team people come from many different countries and backgrounds and may have different perspectives and perceptions based on influences like: Age Ethnicity Education Class Gender Religion Race Language Disability These items are the foundation of a person’s identity and can lead to an increased chance of disagreements and conflicts if they feel their view is challenged. At the least this would only negatively affect individuals but could also negatively impact the performance of the whole team. To help reduce the chance of conflict in a diverse internal environment there needs to be a clear system for communication that allows sharing of ideas while respecting each other’s diversity. Multiculturalism can be defined as acknowledging, understanding, accepting and valuing differences among people with respect to things like age, class, race, ethnicity, gender, language, education, religion and disabilities. Treating people differently can constitute harassment or a hostile work environment. Basic Tools for Communication Do Don’t Show respect and positive regard for the other Insult, name call or put down people or their ideas person through couresy. politeness and kindness Actively listen to try to understand the other perspective and allow them to finish expressing Never speak over or cut off another person their viewpoint Focus on sharing praise more frequently than criticism and encourage all members of the team Share negative criticism to do the same Initiate discussion that encourages idea sharing Make decisions in isolation that may impact your to solve problems as a team colleagues Be aware of your body language, tone of voice and demeanor as they can negatively impact the Shout and negatively gesture perception of your communication Treat people the same no matter their race, religion, gender, size, age or country of origin so Treat others in a way you would not want to be treated they feel they are treated fairly and equally  Treat others as you wish to be treated. We may have all come on different ships, but we’re in the same boat now —Martin Luther King, Jr Confidentiality Data regarding recruitment, compensation, and management of employees is naturally sensitive in organizations and workplaces. In the wrong hands, this information could be used to commit fraud, discrimination, and other possible violations. Professionalism, safety, and security for all members of an organization are dependent on confidentiality. In a health care environment, confidentiality is given an even higher priority as there are legal and ethical obligations to protect a patient’s health information and ensure it is only accessed by authorized users. Confidentiality in the workplace is important—to maintain it you will: Capture documentation accurately Share information only if you are authorized Document and store information as per local legislation requirements Disclose information only to those who have the right and need to know Handle confidential records securely and store them in the correct place Take appropriate precautions when communicating confidential or sensitive information to those who have the right and need to know In order to meet this higher obligation of confidentiality it is important to know your local policies and who to contact if you have questions. Ethical Guidance A good guideline for ethical behavior is to ask yourself the following questions when consid-ering your actions: Is the action legal? Does the action hurt anyone? Is the action fair to others? Am I being honest as I carry out the action? Would I publicize my actions? What if everyone did it? Equal Opportunity All people should be treated similarly, unhampered by artificial barriers, prejudices or preferences, except when particular distinctions can be explicitly justified. Principle of non-discrimination emphasizes that opportunities in education, employment, advancement, benefits and resource distribution, and other areas should be freely available to all citizens irrespective of their age, race, sex, religion, political association, ethnic origin, or any other individual or group characteristic unrelated to ability, performance, and qualifi-cation. We all should know that diversity makes for a rich tapestry, and we must understand that all the threads of the tapestry are equal in value no matter what their color. —Maya Ange- lou Introducing Khaled and Maryam Meet our fictional characters, Khaled, a manager, and Maryam, a newly arriving Decontami- nation Specialist student. Throughout this program, Maryam asks common questions that new students may have, and Khaled provides answers that are typical for most CSSDs. Khaled Khaled is the CSSD Manager, originally from Tabuk and has been working in CSSD for 20 years. After high school, he completed a two-year diploma and started working at a local hospital as a pharmacy technician. He really enjoyed this role as he worked closely with pharmacists, doctors and nurses and felt he was doing important work. The pharmacy was located next to CSSD so he frequently had lunch with their team and found it exciting to hear their stories of assisting surgery with complex surgical instruments sets and all the equipment required to sterilize surgical instruments. The manager in CSSD noticed Khaled’s interest and recommended he complete one of the distance learning programs from the United States. After completing the IAHCSMM technician course Khaled was hooked, and after 5 years working in pharmacy decided to apply and switch to CSSD. Khaled worked diligently to learn about surgical instruments and processes and after a year felt knowledgeable but was interested in learning more. He asked for additional training from the equipment manufacturers and alsotook a course on surgical instruments. Within two years of working in CSSD, because of his initiative, the manager promoted him to a lead technician role so he could share his learn- ing with others and mentor new employees. This new role was fulfilling for Khaled as he really loved to share his experience, so he decided to take additional training in education, and a distance program for leadership. After a couple of years of practice and education Khaled was one of the favorite mentors for new employees, respected by his CSSD team, and recognized throughout the hospital as a CSSD expert. Khaled completed a Bachelor of Science degree in healthcare management and became the CSSD manager after his manager retired. Maryam Is from Riyadh, and after high school completed a bachelor’s degree in science as she had an interest in chemistry and research. At the end of her studies, she got married and as she began her search for work, found out she was blessed with her first child. Being a mother became her priority and within the next few years she had two more children, a girl and another boy. When her children went to school, she had more spare time and was interested in looking for work but was nervous as she had completed her degree almost 10 years ago and had not worked before raising her family. That’s when she found out about the new Decontamination Specialist program being offered for graduate’s return- ing to work. Maryam I’m concerned about my ability to study, it’s been over 10 years since I was in school! Khaled We’ve designed this program with you in mind Maryam. Each module introduc - es new material and builds on the previous module. We do require a commitment from you to apply yourself and focus on learning the content and participating in assigned tasks. There is a mixture of reading, self-directed learning, practical exercises and checklists to help you get used to learning again. Exercises and Checklists Introductory Exercise: Meet and Greet Go to your logbook and complete the exercise. Introduction Decontamination is an entry-level program for new entrants to the field of decontamination and sterilization in a hospital, dental or ambulatory clinic setting. In this module, Introduction to Decontamination, we will talk about reusable medical device reprocessing, the facilities required to carry out this function, and how the life cycle of a reusable medical device fits in. Pre-Module Quiz What is CSSD? Keep these questions in mind as you go Central Sterile Service Department (CSSD) through the content and don’t worry if you is a place in hospitals or healthcare facilities don’t know the answers yet—that’s what that performs reprocessing of reusable you’re here to learn. medical devices used by health workers in the operating room for surgical and other patient procedures. This department is sometimes Q: Can you describe what called the sterile processing department manufacturing means? (SPD), central supply department (CSD) and Q: Can you list five items that you use central decontamination unit (CDU). Any of daily that are manufactured? these or other variations will be referred to as Q: Can you describe the CSSD in this program. decontamination life cycle? Manufacturing Q: Decontamination facilities are separated into key zones to maintain Manufacturing is the term most safety, how many do you think there commonly applied to industrial production, are? where raw materials are transformed into Q: Can you list five items used to finished goods on a large scale. Cars, assist in cleaning reusable medical electronics, appliances, and furniture are devices? examples of items we buy that are manufactured with standards to ensure Q: Do you know what the acronym PPE they are reliable and safe for use. Most means? consumables we purchase in supermarkets Q: What should the air pressure be are also manufactured and need to be in the sterile storage room of a produced in a consistent safe process to decontamination unit? ensure no harm to consumers. With RMD, producing quality results is especially Q: What should the temperature be in a important as they will be used on patients decontamination unit? with compromised health. Medical Device Manufacturing Medical devices are defined by international regulatory bodies, such as the US Food and Drug Administration (FDA) and the European Medical Devices Directive, as any object or component used in the diagnosis, treatment, prevention, or cure of medical conditions or diseases, or affects body structure or function through means other than chemical or metabolic reaction to humans or animals. This includes all medical tools, excluding drugs, ranging from tongue depressors to surgical instruments and radiology treatments. Most medical procedures require the use of medical supplies, surgical instruments and equipment. Some of these items are single use and used once then discarded, while many are designed for reuse. RMD must be thoroughly cleaned, disinfected, inspected, packaged and sterilized before they can be safely reused on another patient. In healthcare, CSSD is where the critical function of reprocessing reusable medical devices occurs. In a hospital setting, reusable medical devices and surgical instruments are more commonly used than disposable ones, as it is more cost effective and creates less environmental waste. This is especially true for surgical procedures in operating rooms where 50 or more surgical instruments are commonly used.  Association for the Advancement of Medical Instrumentation ST79 - Comprehensive guide to steam sterilization and sterility assurance World Health Organization Decontamination IAHCSMM International Association of Healthcare Central Service Material Management Technical Manual CBSPD Certification Board for Sterile Processing and Distribution AORN Association of perioperative Registered Nurses Recommended Practices for Cleaning and Care of Surgical Instruments UK DH Decontamination of Surgical Instruments (HTM 01-01) IE HSE Ireland Health Service Executive Standards and recommended practices for Central Decontamination Units Table M1– 1 Standard practices and procedures for reusable medical device reprocessing There is such a wide variety of equipment classified as reusable medical devices, that regulatory agencies have no single standard, but they do have an international standard, ISO 17664, that specifies what all manufacturers must do to create procedures or instructions for use (IFU) when processing their specific RMDs. Professional groups and associations use research and evidence-based practice to define minimum standards used to help set guidelines for standard practices and procedures for reusable medical device reprocessing. These and other similar professional bodies are used to ensure policies and procedures will produce safe, high quality and reliable RMD.  Maryam: Do all hospitals have the same setup for Khaled: All hospitals follow specific guidelines for optimum Decontamination Life Cycle The decontamination life cycle model shows the critical steps required for reprocessing reusable medical devices, and the pathway through the whole organization. This model will be referenced throughout this program, to detail how to safely meet standards and keep patients safe. ACQUISITION 1. Purchase 2. Loan CLEANING DISINFECTION TRANSPORT INSPECTION At all stages Location Facilities USE Equipment PACKAGING Management Policies/Procedures DISPOSAL 1. Scrap 2. Return to lender STORAGE STERILIZATION TRANSPORT Table M1–1 Decontamination life cycle Purchase Loan 1 TRANSPORT INSPECTION 2 USE DISPOSAL Scrap Return to lender PACKAGING 3 STORAGE TRANSPORT Table M1–2 Cleaning and disinfection life-cycle  Stage Frequency Cleaning involves removing all visible soil such as body fluids and tissues from reusable medical Cleaning devices. This may involve wiping or pre-cleaning, ultrasonication, manual or automated cleaning. At completion of this stage, 95% of microorganisms are removed from the device. Disinfection follows cleaning and kills the majority of remaining microbes, usually by chemical or heat treatment. Spores, some mycobacteria, and prions may not be inactivated by this. For flexible Disinfection endoscopes and other delicate reusable medical devices, this may be the final hygiene stage and must be as rigorous as possible. The reusable medical device is then inspected for functionality, visible soil, and damage. Remaining Inspection soil or damaged areas on reusable medical device may harbor clusters of microorganisms that are difficult to remove. Such reusable medical device are rejected or returned to the cleaning stage again. Reusable medical device which have been cleaned and disinfected are wrapped in special barrier Packaging packaging, ready for sterilization of the contents. This packaging will prevent microorganisms from entering the pack until time of use. Sterilization kills any remaining microorganisms in the reusable medical device pack. There is no such Sterilization thing as a device being more or less sterile—sterile means zero live microorganisms. Sterile reusable medical devices are transported to the storage zone or to the point of use in a careful Transport way to prevent damage or rupture to the packaging and prevent recontamination. Packed sterile reusable medical devices must be stored in a zone having cleanroom conditions in a Storage way that does not damage or rupture the packaging during handling or storage. Sterile reusable medical devices are used on patients in surgeries, theatres and wards. Once used, Use the reusable medical device is contaminated by microorganisms on or in the patient. Used reusable medical devices are contaminated by microorganisms and must carefully be Transport transported back to the decontamination facility. Loss, spillage or carelessness could result in the spread of infection. Standard Precautions are implemented. Table M1–3 Reprocessing life cycle Decontamination design Before the CSSD, the critical role of design, construction and equipping of the zone areas were often neglected but are now recognized as significant factors in ensuring safe practices in the reprocessing of RMD. Some building design resources are: HBN 13 Health Building Note: Sterile Services Building for the Future Guidelines for Design and Construction in Health Care Facilities Ensuring a proper one-way flow is a key part of safe reprocessing of reusable medical devices. Separating dirty, clean, and sterile items avoids routes and workflows that could re-contaminate processed reusable medical devices. In CSSD this is achieved by using walls to separate the work areas into three primary functional zones. ZONE 2 ZONE 3 INSPECTION, ASSEMBLY STERILE STORAGE & PACKAGING (IAP) Clean Items Sterile Items Inspection Storage Assembly Dispatch Packaging Sterilization  Zone 1 Figure M1–2 Decontamination zone 1. Decontamination Zone ‣ Gowning room—provides controlled entry and exit to the wash area, space for Decontamination is the combination changing into PPE, a hand wash sink for of processes (including cleaning, hand hygiene, and an eye wash station in disinfection and sterilization) used to case of eye splash render reusable medical devices safe for ‣ Washroom—space to carry out preparation, handling by staff and for use on patients. All reusable medical devices returned to cleaning and disinfection of contaminated the decontamination zone are considered reusable medical devices contaminated and potentially infected. You, as a decontamination specialist, must have ‣ Environmental cleaner room— dedicated an in-depth knowledge of microbiology, to cleaning only the decontamination room infection control and safe cleaning practices To ensure safety and prevent exposure to ensure safety for yourself and for patients. Ideally this zone is defined by to pathogens and other contaminants, specific rooms or at minimum segregated decontamination specialists must wear personal areas to ensure safety to staff and a protective equipment such as: unidirectional flow of reusable Cover gown with sleeves medical devices. Face mask Eye protection ‣ Contaminated returns room—provides Gloves outside staff with secure and controlled Shoe covers or alternative shoes access into the zone, allowing delivery of or boots contaminated containers and trolleys Head covering With the wide variety of surgical specialties and procedures, there is an extensive range of complex reusable medical devices being used. In order to clean these specialized reusable medical devices, processes and appropriate tools are required such as: Hand wash sink– with liquid soap and paper towels Instrument cleaning sink— with two or three basins Brushes Figure M1–3 Personal Protective equipment in CSSD Air guns Water guns Magnifiers Additional lighting Detergents Disinfectants Lubricants Ultrasonic washers Automated washer disinfectors Cart washer Figure M1–4 Hand wash sink and instrument cleaning sinks Automated endoscope re-processer Environmental monitors— temperature, humidity and pressure Figure M1–5 Brushes Figure M1–6 Air/Water Gun Figure M1–7 Magnifying Lamp Spill kits In the decontamination zone: PPE is worn to ensure specialist safety Reusable medical devices Figure M1–8 Enzymatic Detergents Figure M1–9 Disinfectants Figure M1–10 Environmental Monitoring received are checked for missing parts, manually pre-cleaned and prepared for automated washing Reusable medical devices not compatible with automated washers are manually cleaned and disinfected Figure M1–11 Automated washer disinfectors Figure M1–12 Ultrasonic washers Figure M1–13 Inspection, Assembly and Packaging (IAP) Zone 2. Inspection, Assembly and Packaging (IAP) Zone After cleaning and disinfection, reusable Gowning room—provides controlled medical devices are received in the entry and exit to the IAP zone, allows Inspection, Assembly and Packaging for changing into personal protective zone to prepare for sterilization. Reusable equipment, and a hand wash sink for hand medical devices are now safe for handling hygiene to protect clean instrumentation and extra care must be taken to ensure that from the risk of contamination they are not re-contaminated. Strict hand hygiene must be maintained, and personal Materials transfer room—maintains an protective equipment must be used at air-lock to bring raw materials in and out of all times. Ideally this zone is defined by the IAP zone specific rooms or at minimum segregated areas to ensure safety to staff and ensure a Environmental cleaner room—dedicated unidirectional flow. to cleaning materials and equipment for use only in the IAP zone Inspection, assembly and packing (IAP) room—this room is restricted only Sterilization room—in newer CSSD to specialists who inspect, assemble designs sterilization equipment is located and package cleaned RMD to prepare in a room separate from IAP and Storage for sterilization. Sterilizers are frequently to further reduce contamination risks to located in this room. unwrapped RMD The extensive range of complex instrumentation requires specialized processes and appropriate tools for inspection and packing such as: Packing tables Figure M1–14 View Pack Pouches Figure M1–15 Tip Protectors Chairs Magnifiers Additional task lighting Wrappers and containers View pack pouches Heat sealers Surgical instrument tip protectors Tray liners Air guns Figure M1–16 Heat Sealers Figure M1–17 Packing tables Pass through hatch’s Drying cabinets Sterilizers—high temperature Sterilizers—low temperature Biological incubators Environmental monitors temperature, humidity and pressure In the Inspection, Assembly Figure M1–18 Surgical Instrument Wrappers and Packaging zone, surgical instruments are unloaded from automated washers or pass through hatches (if manually cleaned) and: Visually checked to ensure cleanliness Manually inspected against a checklist to ensure items are correct and functional Packaged in appropriate materials and labelled Sterilized with the correct process or passed to a sterilization room if separate Figure M1–19 Pass-through hatch from IAP Figure M1–20 Steam Sterilizers Figure M1–21 Low Temp Sterilizers Figure M1–22 Low Temperature Formaldehyde sterilizers Figure M1–23 Drying Cabinets  Zone 3 STERILE STORAGE ZONE Figure M1–24 Inspection, Assembly and Packaging(IAP) Zone 3. Sterile Storage Zone CSSD requires a safe storage zone for sterile and clean supplies used in production. Sterile reusable medical devices are packaged, and stored safely in an 3 environmentally monitored (temperature, humidity and pressure) room using: Figure M1–25 Sterile Storage Shelving Washable, round-edged shelving designed to avoid damage to packaging Additional CSSD Support Transport carts Areas Workstations The CSSD is segregated into three primary zones and additional areas are required In the Sterile Storage zone processed to support the safety of specialists and reusable medical devices are: surgical instruments. Transferred from the sterilizer to this Staff Facilities—Changing, Toilets, room where they will either be kept until and Showers required or staged for end-user delivery Male and female toilets and areas to Removed from shipping boxes and change from outdoor to working clothing containers before being transferred here Lockers to accommodate storage of for storage or staged for end-user delivery specialist belongings  Showers located close to the decontamination area to ensure quick access in case of a workplace spill or contamination incident Hand hygiene station Mirrors to check PPE Staff Rest Room Facilities to prepare hot and cold drinks for staff breaks Area for eating and drinking (restricted to this area) Materials Storage Separate segregated area for bulk storing of production materials Sufficient stock levels of materials to ensure smooth operations Not used to store sterile processed items Education, Training and Meeting Rooms Separate from the work area and provides space for teaching materials and work samples Support for important regular Figure M1–26 Transport carts training and education for all grades of staff Central Detergent Dosing Room Adjacent room for detergent replacement without entering the contaminated area, reducing the opportunity for automated washer contamination General CSSD Requirements The unit is used exclusively for reprocessing reusable medical devices, must be physically separated Figure M1–27 Workstations from other work areas and never used as a thoroughfare to other units.  Air Pressure Unit Access Air pressure is regulated to prevent cross Due to the critical nature of this unit, access contamination of airborne pathogens is restricted to authorized personnel and between each zone. A ventilation system trained specialists. is used to either exhaust air out of a room, creating negative air pressure, or vent air Lighting into the room, creating positive air pressure. The light is kept at a brightness and color balance for good working practices Work Surfaces and visual examination of reusable Walls are smooth, non-shedding, medical devices. Additional task lighting water resistant and withstand frequent and magnification are available in cleaning. decontamination and IAP areas. Floors are a washable non-slip material and have no exposed seams or Temperature openings. Room temperature is controlled between All tables, workstations and shelving 18– 25°C (64– 77°F) and kept at a relative are made of easily cleanable materials humidity of 30– 60% depending on the with non-glare surfaces. Adequate activities carried out in the area. spacing allows for staff and equipment movement. Figure M1–32 Sterile storage zone  ∞ ∞ General General Changing Room Domestic Contaminated (Male & Female Offices Waste Services Returns Lobby Disposal/ + WCs) Room § Contaminated Laundry Returns One-way transfer Staff Returns Holding Area § entrance hatch Domestic Test Equip Gowning * Trolley WC Reception ervices and Data Room Wash Room Room Materials Store * * Training Wash Room Transfer * C Hahtecm h ic Tran sferal Hatches * * M a t e r ls Tran er Staff * Washer- IAP Washer- Room Roo disinfectors disinfectors IAP G w oonm ing Packed Product oR Goods Transfer Facility entrance Domestic Services Room Sterilizer loading area Despatch Cooling Area Processed Products Store * Waste Interlocking doors Workflow Raw materials ∞ Controlled exterior access Departmental personnel § Controlled interior access (within wash room) Note: this diagram does not provide for specialist plant Non-departmental personnel areas, ie ventilation plant, reverse osmosis, clean steam and compressors Figure M1–29 SSD layout (source: DH Estates and Facilities and HBN 13 https://www.gov.uk/government/publications/the-planning-and-design-of-sterile-services-departments) Exercises and Checklists You have been introduced to a central sterile service department and what an important function it provides to safe patient care. The following exercises will help you compare what you have learned to real-world examples in your current training environment. Assignment Compare what you have learned to real-world examples in your training environment. Explore your current department by completing the exercise in your logbook. MEDICAL TERMINOLOGY, ANATOMY AND PHYSIOLOGY  2 MEDICAL TERMINOLOGY, ANATOMY AND PHYSIOLOGY Introduction While learning medical terminology, you will also learn some basic anatomy (body struc- tures), physiology (body functions), and pathology (body diseases). Because medical terms describe the human body in health and in disease, attaining an elementary understanding of these topics will help you retain a working memory of medical language. Learning medical terms can be easy if you approach the subject from a proper perspective. Begin by telling yourself that medical terms do not make up a separate language. Medical terms are simply words that you can add to your vocabulary. As with all words, medical words are meant to convey information. As you enter a medical profession, you will be communicating with other medical profes-sionals and with patients. Therefore, your job will include choosing words and sentence structures that convey accurate information and reflect a professional attitude. That is to say, both your communication skills and your attitude toward patients are very important. As you are about to discover, learning medical terminology can be easy at times and challenging at others. Analyzing Medical Terms Introduction There are many ways and various books to help you learn medical terminology. This book is intended for a short course in medical terminology and focuses on medical terms, their definitions, and brief exercises to help you quickly gauge your understanding. That means this book can be worked through in as little as 8 weeks. Our goal is to give you all the basics you will need to be successful in your career, while allowing you to have a little fun learning. Latin and Greek word parts are found here. These word parts can be combined to make thousands of medical terms and understanding the basic word parts is the first step toward understanding complete words. While it is possible to memorize the definitions of individual medical words, understanding just the parts that make up the medical word is easier and faster than learning every word because there are fewer word parts than complete words. In fact, approached the right way, medical terminology may be the easiest subject in your program. Learning it takes a bit of thought and an open mind; but it need not involve sweat- ing or ripping out your hair in frustration. Why is medical terminology important? Can’t medical professionals just use simple words like “gut” and “cut”? Unfortunately, these aren’t always specific enough. Gut can refer to the stomach, small intestine, large intestine, or any part of your digestive system. If you have pain in one of these areas, you would want to be able to easily identify a single area and have all medical professionals recognize that specific area. The term “cut” could mean just an incision, or in other cases it could mean cutting off a body part. For example, “She cut her hand” indicates an incision, but “Cut the hand distal to the wrist” could mean an amputation. Luckily medical terminology allows us to specifically identify places in the body and even what type of cut it is with words. Figure 1-1 The foundation of medical terminology is rooted in learning the four basic word parts: prefixes, roots, suffixes, and combining forms. You’ll learn how to distinguish among these word parts in order to combine them into meaningful medical terms. First, let’s examine some medical term characteristics. Most medical terms are derived from Latin and Greek languages. While this may make them seem “foreign,” 75% of all English words are derived from Latin and Greek. When you look up a term in the dictionary, its etymology, or word origin, is usually given along with its definition. For example, demen-tia is an impairment of cognitive function marked by memory loss. MEDICAL TERM PARTS Nearly every medical term contains one or more roots. It may also contain one or more prefixes and one or more suffixes. When you start combining parts into words, you will also use a combining form of a root. This means a single medical term may consist of one part or several parts, but every part of a term behaves in one of three ways: root, prefix, or suffix. The good— and maybe surprising—news is that these three parts also make up all other English words. The even better news is that as an English speaker, you already know a lot of these parts, especially prefixes and suffixes. Here is the order of word parts used in forming words: prefixes first, roots second, and suffixes last, assuming a word contains all three parts. If a prefix is present, it appears at the beginning of the term. A root is next. The root is found in the middle of the word, and they form words by adding prefixes or suffixes to them. Suffixes are always the endings of words. A combining form is used in combination with another word part that is distinct from a prefix or suffix that adjusts the sense or function of the word. Some words, such as nontraditional, contain all three-word parts. The prefix is non- (not), the root is tradition (established customs or norms), and the suffix -al (makes the word an adjective meaning “relating to”). This word is thus an adjective meaning “not relating to customs or norms. EXAMPLE: There are movements that encourage women to seek nontraditional occupations such as firefighting. Some words contain only two parts, such as traditionist. Tradition is the root and–it is the suffix that refers to “adhering to a system of beliefs or customs.” So, a traditionist is a person with established beliefs or customs. EXAMPLE: Mr. Brown, who asked that boys in his classroom removed their hats, was consid- ered a traditionist. Other words contain other combinations, such as nontradionalist (the prefix non- = not; the root tradition = established customs or norm; the suffix-al = adjective form meaning relat- ing to; and another suffix –ist = refers to adhering to a system of beliefs or customs). So, a no traditionalist is a person without established beliefs or customs. EXAMPLE: Mrs. Brown, who didn’t mind boys wearing hats in her classroom, was consid- ered a nontradionalist. Analyzing Medical Terms Learning to pick out prefixes, roots, and suffixes, as is done for you in Table 1-1, will permit you to define many, or even most, medical terms. Before going any further, we must deal with what has been traditionally referred to as a fourth word part: the combining form. A co mbining form is simply a root that includes one or more vowels tacked onto the end of it to make a root – suffix combination pronounceable, as in the word psychology. The main root is psych (mind), and the suffix is -logy (study of). But “psychology” doesn’t flow as well as psychology, thus we insert the “o” to create a more English- sounding word. So, as the example shows, the combining form concept is all about vowels, consonants, and pronuncia-tion. A problem thus arises. That problem is that we remember a word (or a word part, for that matter) in two ways: by recalling the sound it makes when we hear it spoken and by the sound a visual combination of its letters makes when we see it written. Table 1-1 Analysis of example words Term Prefix Root Suffix Term Meaning Fibromyalgia pain in the heart; also, cardialgia cardi (heart) heartburn (a digestive Neuralgia disorder) -logy (study of) Study of the heart and its cardiology cardio (heart) disorders -itis Inflammation of the carditis card (heart) heart (inflammation) diagnosis dia-(across; gnosis (Greek word meaning Discovery of the causeof through) “knowledge”) signs and symptoms iatrogenic iatro -ic (adjective Disease caused by health (physician); gen(origin, care (whether an individual disease cause) suffix) worker, particular institution, o the system as a whole) d psycho (mind); path(disease) Personwitha(serious) psychopath mental disease The root psycho comes from the Greek word psyche, which means soul or mind. The suffix-es -ist and -ician mean practitioner, and the suffixes -y and - ics mean practice. The final two items in the list introduce two new roots: ger/oand ped/o, the meanings of which you may deduce from the meanings of the term’s geriatrics and pediatrician. The root ger/o (also sometimes ger/onto) comes from the Greek word geron, which means old man. The root ped/o is derived from the Greek word pais, which means child. See Tables 1-2, 1-3, and 1-4, which list a sampling of roots, suffixes, and prefixes. Study these so you can start building and defining terms. TABLE 1-2 WORD ROOTS TO BEGIN TABLE 1-3 PREFIXES TO BEGIN BUILDING BUILDING TERMS TERMS Word Root Meaning Prefix Meaning arthr/o joint epi- upon, following, or subse- quent to card/i/o heart micro- small derm/o/ato skin peri- around gen/o origin, cause, formation post- after ger/o/onto old age pre- before hem/a/ato blood TABLE 1-4 SUFFIXES TO BEGIN BUILDING TERMS iatr/o physician Suffix Meaning muscul/o muscle -al adjective suffix natal birth; born -algia pain neur/o nerve -dynia pain os/teo bone -gen, origin, cause, formation path/o disease -genesisa -ic adjective suffix denoting of ped/ia child phren/o diaphragm, mind -itis inflammation psych/o mind -logy study of skelet/o skeleton -pathy disease tend/o, tendon -scope viewing, an instrument used for ten/o viewing Common Prefixes and Suffixes ORD ROOTS INTRODUCED IN THIS CHAPTER Table 2-1 lists common word roots with their meanings to get you started on your task of learning hundreds of medical terms. You may wish to memorize the roots given in the table now, because there are just a few. Or if you prefer, just give them a quick glance now and, as you go through the chapter, refer back to this table whenever you run across a term with a root you do not recognize.  TABLE 2-1 COMMON WORD ROOTS AND MEANINGS Word Root Meaning arter/i/o artery arthr/o joint card/i/o heart derm/at/o skin gen/i/o origin, cause, formation ger/o/onto old age hem/a/t/o blood iatr/o physician muscul/o muscle neur/o nerve, nerve tissue oste/o bone path/o disease ped/i/o child phren/o diaphragm, mind psych/o mind skelet/o skeleton spin/o spine tend/i/n/o tendon CATEGORIES OF PREFIXES Not all medical terms include a prefix, but when one is present, it is critical to the term’s meaning. For example, hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar) are conditions that are exact opposites. Confusing those two prefixes creates errors. Two other similar- sounding prefix pairs prone to creating errors are ante- and anti-. The prefix ante- means “before,” and the prefix anti- means “against.”  Term Part Meaning hypoglycemia prefix: hypo- = low root: glyc/o- = sugar suffix: -emia = condition antecubital prefix: ante- = before anterior to the elbow root: cubitum = elbow anticoagulant prefix: anti- = against preventing coagulation(clotting) root: coagulant = substance that causes blood to clot. Prefixes of Time or Speed Prefixes denoting time or speed are used in everyday English. Prehistoric and postgraduate are common words with a prefix relating to time. Prefixes denoting speed, such as tachy- (fast) and brady- (slow), are often used to describe heart rate. Table 2-2 lists prefixes relat- ed to time or speed. Table 2-2 PREFIXES OF TIME OR SPEED Prefix Refers to Example Meaning ante-, pre- before antepartum, premature before birth, before full development brady- abnormally slow rate of bradycardia abnormally slow heartbeat speed neo- new neonatal newborn (adjective) post- after postscript a written thought added after the main message tachy- rapid, abnormally high rate tachycardia abnormally fast heartbeat of speed Prefixes of Direction The word abnormal is an example of a word containing a prefix that signifies direction. We use such prefixes in everyday life without bothering to analyze them. For example, we normally would not take the time to think about the prefix contra- (against) in the word contradiction, yet we understand its meaning. Prefixes related to direction are listed in Table 2-3. Table 2-3 PREFIXES OF DIRECTION Prefix Refers to Example Meaning away from, outside of, ab- beyond abnormal not normal ad- toward, near to adjective toward a noun con-, sym-, with, within congenital, sympathetic, with (or at) birth, with feeling toward, with syn- synthetic the same idea or purpose contra- against contraband substance against the law dia- across, through diameter a line through the middle Prefixes of Position Infrastructure (infra-means inside or below), interstate (inter- means between), and paralegal (para- means alongside) are all words we frequently use that include prefixes of position. Having these prefix meanings already in our working vocabularies makes it easier to learn their medical uses. Prefixes of position are commonly used during diagnostic andtreatment procedures. Table 2-4 lists prefixes relating to position. Table 2-3 PREFIXES OF POSITION Prefix Refers to Example Meaning ec-, ecto-, removal to the outside outside extraction ex-, exo- en- inside encephalopathy disease inside the head, brain disease endo- within endoscopy visual examination of the inside of some part of the body epi- upon, subsequent to , epigastric adjective referring to something above the stomach above extra- outside extracellular adjective referring to something outside a cell or cells hyper- above, beyond normal hyperglycemia high blood sugar hypo- low, below, below hypogastric region beneath the stomach normal infrarenal adjective referring to something infra- inside or below below the kidneys inter- between interosseous between bones entra- inside, within intracerebral inside the cerebrum  meso- middle mesothelioma tumor arising from the mesothelium meta- After, beyond metacarpal the bone beyond the carpus; one of five bones in either hand pan- All or general pancarditis general inflammation of the heart para- Beside, near paraplegia paralysis of the lower half of the body peri- Surrounding perivascular in the tissues surrounding a vessel retro- behind retrosternal adjective referring to something behind the sternum Prefixes of Size and Number A semiannual (semi- means “half,” annual means “yearly”) sale is one that occurs every 6months. The unicorn (uni- means “one”) is a fictitious creature that has one horn. Prefixes of size and number are very common. Table 2-5 lists prefixes related to size and number. Table 2-5 PREFIXES OF SIZE AND NUMBER Prefix Refers to Example Meaning bi- two biannual twice per year di-, dipl- two, twice diplopia double vision hemi- half hemiplegia paralysis of one body side macro- big macrocyte big call small microscope micro- instrument to view small objects mono- one monocyte cell with one nucleus a few, a little oliguria scant urine production olig-, oligo- pan- all or everywhere pancarditis whole heart inflammation poly- many polydactyly more than five hand or foot digits four quadriplegia quadri- paralysis of all four limbs semi- half, partial semiannual occurring every half year tetra- four tetradactyl having only four hand or foot digits tri- three triceps three-headed muscle uni- one unicellular one-celled Prefixes of Negation Negation means absence or opposite of something. These include words like antidepres- sant (anti- means “against”) and decriminalize (de- means “without”). Table 2-6 lists prefixes related to negation. Table 2-6 PREFIXES OF NEGATIONR Prefix Refers to Example Meaning a-, an- not anuria not able to urinate anti- against, opposed antibiotic drug that inhibits microbes de- without dehumidifier device that removes water dis- remove disable put out of action Suffixes Signifying Medical Conditions The suffix -porosis, which means porous, is added to the root oste/o, to form the term osteo- porosis, which means “a porous condition of bone.” See Table 2-7 for more examples. Table 2-7 SUFFIXES THAT SIGNIFY MEDICAL CONDITIONS Suffix Refers to Example Meaning -algia, -dynia pain Biannual Twice per year -cele Accumulation of fluids in Hydrocele Swelling in the scrotum any sack like cavity or duct -cyte Cell Hematocyte blood cell -ectasis, Dilation Bronchiectasis dilation of airways of the lungs -ectasia -edema (also a Swelling papilledema Swelling of the optic disc standalone word) -emesis Vomiting Hematemesis Spitting of blood -emia Blood Anemia Not have enough healthy red blood cells -iasis Condition or process Cholelithiasis Gallstones -ism Condition, state of Hypersplenism Spleen becomes overactive Inflammation Osteoarthritis Degenerative joint disease -itis -lith Stone Fecalith Mass of accumulation of hardened fecal matter -lysis Losing, breaking down , Onycholysis Nail separates from its nail bed freeing from adhesion , separation -malacia Condition of softening Osteomalacia Softening of the bones  Enlargement Cardiomegaly Enlarged heart -megaly -oid resembling or like opioid substance that resembles opium -oma tumor gastroma tumor of the stomach -osis abnormal condition osteoporosis condition of porous bones -pathy disease myopathy disease of the muscle -penia reduction of size or leukopenia low number of white blood cells quantity -phobia fear carcinophobia fear of cancer abnormal formation neoplasia abnormal growth of cells -plasia -plegia hemiplegia paralysis on one side of the body paralysis -pnea breathing tachypnea rapid breathing producing erythropoiesis production of red blood cells -poiesis -porosis porous condition osteoporosis porous -ptosis downward nephroptosis downward displacement of a kidney displacement -rrhage flowing forth significant discharge of blood from hemorrhage blood vessels discharge rhinorrhea discharge from thenose (runnynose) -rrhea -rrhexis rupture hysterorrhexis rupture of the uterus -sclerosis hardness atherosclerosis hardening of the arteries -spasm muscular angiospasm muscular contraction of a vessel contraction -stasis level, unchanging thermostasis a constant, consistent internal body temperature -stenosis a narrowing arteriostenosis narrowed arteries Suffixes Signifying Diagnostic Terms, Test Information, or Surgical Procedures Suffixes that form terms related to test information, diagnoses, and procedures are often attached to a root that signifies a body part. The term appendectomy is an example. The suffix - ectomy means “removal of,” and append is the root for appendix. Thus, the term means “removal of the appendix.” Table 2-8 lists common suffixes that signify Table 2-8 SUFFIXES THAT SIGNIFY DIAGNOSTICTERMS, TEST INFORMATION, OR SURGICAL PROCEDURES Suffix Refers to Example -centesis surgical puncture thoracentesis -desis surgical binding arthrodesis -ectomy surgical removal appendectomy -gen, -genic, origin, producing osteogenic - genesis a recording, usually by an instrument electrocardiogram -gram -graph instrument for making a recording electrocardiograph -meter instrument for measuring audiometer -metry audiometry act of measuring -opsy examination autopsy -pexy surgical fixation hysteropexy -plasty surgical repair rhinoplasty -rrhaphy suture herniorrhaphy -scope instrument for viewing arthroscope -scopy act of viewing arthroscopy -stomy artificial or surgical opening tracheostomy -tome instrument for cutting dermatome -tomy incision colotomy -tripsy crushing lithotripsy diagnostic terms, test information, or surgical procedures. Suffixes That Name a Medical Practice or Practitioner Some suffixes relating to a medical practice or practitioner are derived from the Greek word iatros, which means “physician” or “medical treatment.” This Greek word is the source of the root iatr/o. For practical purposes, you may consider the root iatr as an integral part of the suffixes - iatric and -iatr, as in the terms geriatrics, psychiatric, psychiatry, psychia - trist, pediatrics, and pediatrician. Although both -ician and -ist are used in referring to a specialist, the suffix -ist is perhaps the more common one. An example is gerontologist, a physician who diagnoses and treats disorders of aging. Terms denoting a field or medical specialty may also end with the suffix - logy. Table 2-9 lists the suffixes for medical practice and practitioners. Table 2-9 SUFFIXES THAT SIGNIFY MEDICAL PRACTICE AND PRACTITIONERS Suffix Refers to -ian specialist -iatrics medical specialty -iatry medical specialty -ics medical specialty -ist specialist ina field of study -logy study of Suffixes That Denote Adjectives As with suffixes that signify medical practice and practitioners, suffixes used to create adjective forms are not governed by a clear set of rules. Nevertheless, there are some rules that come into play, such as the rules of English pronunciation. For example, we replace the final letter, x, in the word appendix with a c to form the adjective appendicitis because “appendixitis” does not sound much like an English word. In creating adjectives, we also sometimes change noun terms that name specialties. For example, psychiatry and pediatrics are the names of specialties. Dropping the y from psychi-atry andadding the adjective suffix -ic converts the specialty name to an adjective: psychiatric medicine psychiatric hospital With pediatrics, on the other hand, all we need to do to form the adjective is drop the s: pediatric medicine pediatric hospital Examples of adjective suffixes are listed in Table 2-10. Table 2-10 SUFFIXES THAT DENOTE ADJECTIVES Suffix -ac, -al, -an, -aneous, -ar, -ary, -eal, -eous, - iac, -iatric, -ic, -ical, -oid, -otic, -ous, -tic, - ular Prefixes and suffixes presented in this chapter will become familiar as you progress through the next chapters on body systems. Review the following study tables and do theself-testing exercises.  ORGANIZATION OF THE BODY Learning Outcomes Upon completion of this chapter, you should be able to: 1 Discuss the levels of body organization. terms used in relation to the body. chapter. Introduction Learning about how the human body is constructed will help you retain new medical terms by creating a mental picture of where things are. To begin, it is also useful to know the difference between the terms anatomy and physiology. Anatomy comes to us from the Greek word anatomy, which means “dissection.” You may have recognized the word part “tome,” which indicates that anatomy has something to do with cutting. Physiology, on the other hand, is one of the many “ology” words; in this case, it means study of how the body’s parts work together. In short, anatomy reveals the “what it is” and physiology the “how it works.” The “what it is” begins with chemicals that act together to form cells. The cells process the food we eat and the air we breathe. Cells also reproduce themselves, each cell according to the DNA code it contains. WORD PARTS RELATED TO BODY ORGANIZATION Table 3-1 lists many of the word parts that make up terms related to the body as a whole. Not surprisingly, many of them have to do with how the body is divided or where things are located. Table 3-1 WORD PARTS RELATED TO BODY ORGANIZATION Word Part Meaning anter/o front, anterior cerv/o neck chondr/o cartilage cyt/o, -cyte cell dors/o back gastr/o stomach, abdomen inguin/o groin my/o muscle myel/o spinal cord  neur/o nerve, neuron poster/o posterior, back proxim/o near super/o superior thorac/o chest thorac/o chest (thorax) (thorax) trans- across trans- across LEVELS OF ORGANIZATION The body is divided into different levels of organization, starting with the smallest level: cells, tissues, organs, organ (body) systems, and finally organism, which is the body as a whole. Each level is further examined under its own heading (see Figure 3-1). FIGURE 3-1 The levels of organization in the body beginning with the cell and ending with the organism. Cells A human body is said to have 10 trillion to 100 trillion cells, depending on whom you ask. Of course, no one has ever actually counted the number of cells in a body, but as all the esti- mates are in the trillions, it’s easy to appreciate the body’s complexity as a functioning whole. Cells work both individually and together. Although cells differ from one another and consist of different components, they do have some common elements (see Figure 3- 2): A cell membrane that allows certain substances in and out A nucleus that directs activities within the cell Mitochondria that generate energy for the cell Cytoplasm that is a watery fluid that fills the spaces outside the nucleus  FIGURE 3-2 Basic structure of a cell. The basic structure of a cell includes the cell membrane, nucleus, mitochondria, and the cytoplasm. Tissues Cells make up tissues, which are composed of similar cells working together to perform similar tasks. The four types of body tissues are muscle, connective, nerve, and epithelial. Organs Tissues with common functions come together to form the body’s organs, which perform specialized functions. Examples of organs are the brain, stomach, and heart. Systems A group of organs forms an organ (body) system, and each system has its own special purpose. Therefore, the rest of this book discusses each system in a chapter of its own. NAVIGATING THE BODY Health care professionals need to be familiar with directional and positioning terms. These terms are frequently used during patient examinations, diagnostic procedures, and treat- ments. Anatomic Position Directional terms in the field of human anatomy differ from plain language in two ways: first, unlike terms of location, directional terms are language- specific; second, directional terms are specified relative to the anatomic position. In the anatomic position, the body is erect and facing forward, and the arms are at the sides with the palms of the hands facing forward). Left and right are from the subject’s perspective, not the observer’s perspective. FIGURE 3-3 Anatomic position. In the anatomic position, the person is standing erect, and palms and body are facing forward. Directional Terms Directional terms are adjectives that help describe a complaint, symptom, body part, or process. These terms often have anoth- er term that is its opposite, and it is helpful to memorize these terms with their oppo- site in order to differentiate and under- stand them. Superior means above or nearer to the head. Two other words, cranial and cephal- ic, also mean “toward the head.” For exam- ple, “The bruise is superior to the eyebrow.” Inferior and caudal mean below or toward the feet, as in “The mouth is inferior to the nose.” Anterior is a direction- al term that relates to the front of the body. An example of the use of anterior would be, “The rash covered the entire anterior of the left thigh.” Ventral, usually used in veterinary anatomy, pertains to the front (anterior) or undersurface of an animal. Posterior specifies the back or toward the back of the body. Dorsal, generally used in veterinary anatomy, pertains to the back (posterior) or upper surface of an animal. Medial means toward the midline of the body, and lateral means away from the body’s midline or toward the side. You may see the adjective lateral used for descriptive purposes as in, “The tumor is located on the lateral wall of the left lung.” The final two directional terms are proximal and distal. Proximal refers to something nearer to the body trunk or point of attachment to the body: The shoulder is proximal to the elbow. Distal means further from the body trunk or point of attachment: The wrist is distal to the shoulder and the elbow. See Figure 3-4 for an illustration showing directional terms. FIGURE 3-4 Directional terms describe the body part in relationship to another. Two terms are used for placing patients in a lying down position. Both are common English words that have been adopted by medical terminology. The two terms are supine and prone. Supine refers to a position in which the patient is lying face up. (It means the same thing in plain English, but it can also mean lazy or simply reluctant to act.) Noticing that the word “up” is included in the first syllable of the word “supine” will help you remember its mean- ing of “face up” in medical terms. Prone is the opposite of supine and means that the patient is lying face down. Prone, too, means the same thing in plain English with another meaning: “tending toward,” as in “Smith is prone to making poor choices.” Both supine and prone are frequently used in the operat- ing room and in X-ray reports. For example, “The patient was placed in the supine position.” This means that the patient was placed on the operating table on his or her back, lying face up. See Table 3-2 for body position and direction terms. Table 3-2 BODY POSITION AND DIRECTIONAL TERMS Term Direction Example Anterior toward the front The eyes are on the anterior surface of the face. Ventral toward the belly or The nipples were on the ventral body surface. undersurface Posterior toward the back The spine is on the posterior side of the body. dorsal toward the back or The vertebrae are on the dorsal surface. upper surface superior above, toward the The neck is superior to the chest. head cranial relating to the head The brain is in the cranial cavity. cephalic relating to the head The neck is cephalic to the hips. inferior below, toward the The knee is inferior to the hip; the stom- ach is soles of the feet inferior to the chest. caudal pertaining to the tail The coccyx is caudal to the sacrum. proximal near the point of attach- ment The elbow is proximal to the wrist. to the trunk distal farther from the point of The fingers are distal to the wrist. attachment to the trunk lateral pertaining to the side; away The eyes are lateral to the nose. from the middle medial toward the middle of The nose is medial to the eyes. the body prone lying flat and face downward The patient was placed on the operating table in a prone position. supine lying flat and face The patient was placed on the operating table in upward a supine position.  Body Planes Body planes are imaginary surfaces within the body (see Figure 3-5). The anatomic position is always their reference point. Three planes are frequently used to locate structural arrangements. Frontal (coronal): The frontal (coronal) plane separates the front (anterior) of the body from the back (posterior). Sagittal: The sagittal plane is any vertical plane that divides the body or organ into unequal left and right sides. Transverse (horizontal): This transverse (hori- zontal) plane separates the body into upper (superior) and lower (inferior) planes, cutting “across” the body. FIGURE 3-5 Body planes divide the body into halves in different ways for reference purposes. BODY CAVITIES AND DIVISIONS A body cavity is defined as a hollow space that contains body organs. The body has several major cavities, including the cranial, spinal, thoracic, and abdominopelvic. The cranial cavity houses the brain, and the spinal cavity houses the spinal cord. The thoracic cavity contains the lungs, whereas the abdominopelvic cavity contains digestive and repro- ductive organs. The abdominopelvic cavity is divided into a superior abdominal cavity and an inferior pelvic cavity. The diaphragm is the muscle of breathing known and it physically divides the thoracic and abdominopelvic cavities (see Figure 3-6). FIGURE 3-6 The major body cavities shown in lateral view.  Divisions of the Abdominopelvic Cavity A person documenting a physical exam- ination or a surgical procedure needs to describe incisions, procedures, and location of organs. In order to do this effectively, the abdominopelvic cavity is divided into two different ways: either nine regions or four quadrants (see Figure 3-7A, B; Tables 3-3 and 3- 4). FIGURE 3-7 Abdominopelvic cavity. A. The nine regions of the abdominopelvic cavity. Table 3-3 NINE REGIONS OF THE ABDOMEN Region Description left hypochondriac region left lateral region just below the ribs left lumbar region left lateral region in the middle row left inguinal region left lower region of the lower row by the groin epigastric region middle region in the upper row umbilicus middle region in the middle row hypogastric region middle section in the lower row right hypochondriac region right lateral region just below the ribs right lumbar region right lateral region in the middle row right inguinal region right lower region of the lower row by the groin Table 3-4 FOUR QUADRANTS OF THE ABDOMEN Term Organs in Quadrant right upper quadrant (RUQ) right lobe of liver, gallbladder, portions of the pancreas, small intestines, and colon Left upper quadrant (LUQ) left lobe of liver, spleen, stomach, portions of the pancreas, small intestines, and colon Right lower quadrant (RLQ) contains portions of small intestine and colon, right ovary and uterine tube, appendix, and right ureter Left lower quadrant (LLQ) contains portions of small intestine and colon, left ovary and uterine tube, and left ureter Nine Regions Regions are used to describe the location of underlying organs. Note that in the following list, the number in parentheses refers to two sides within the region, a left and a right, and counts as two regions (see Figure 3-7A and Table 3-3). The regions are named as follows: Hypochondriac (2): There are right and left hypochondriac regions. Chondr- means “carti- lage,” and you will recall that the prefix hypo- means “below.” Hence, these areas are below the cartilage of the ribs on the left and right sides. Epigastric: This area is just superior to the stomach. Epi- is a prefix that means “beside” or “upon.” This area is above the stomach and is situated between the left and right hypochon- driac regions. Lumbar (2): There are right and left lumbar regions. They are located at waist level on either side of the navel. Umbilical: If you look at the nine regions as a tic-tac-toe chart, the umbilical region is the middle section. It contains the umbilicus (navel). Hypogastric: This is the bottom square in the middle column of the tic- tac-toe chart, just inferior to the umbilical section. Inguinal (2): There are right and left inguinal regions. They lie on either side of the hypogas- tric section. Inguinal also refers to the “groin” area. Doesn’t the word hypochondriac have another definition? Yes, someone with imagi- nary pains is called a hypochondriac, and the reason for this usage came about because the left side hypochondriac region is roughly where a hypersensitive person might interpret any discomfort as a heart attack. Four Quadrants Four quadrants identify the abdomen (see Figure 3-7B and Table 3-4). The center point is the navel. The quadrants are abbreviated as follows: right upper quadrant (RUQ), left upper quadrant (LUQ), right lower quadrant (RLQ), and left lower quadrant (LLQ). FIGURE 3-7 B. The four quadrants of the abdominopelvic cavity. (continued) Table 3-5 REGIONS OF THE SPINAL COLUMN Region Location cervical Neck Thoracic Chest Lumbar Lower back below waist Sacral Lower back Coccyx tailbone The terms for each region describe a part of the back. The cervical section describes the cervix (meaning neck). The thoracic section describes the thorax (meaning chest), the lumbar section describes the lumbus (meaning loin, or part of the side and back between the ribs and the pelvis), the sacral region describes the sacrum (lower back), and the coccygeal region describes the coccyx (tailbone). It is important to recognize which word is the body part and which word is the adjective describing the region in which that body part is located. Notice that lumbar is used to describe abdominopelvic regions and is also used to describe a section of the back. The lumbar is “the part of the back and sides between the ribs and the pelvis,” so it makes sense that it could be used to describe both of these divisions.  THE SKELETAL SYSTEM Learning Outcomes Upon completion of this chapter, you should be able to: 1 Name the major structures and functions of the skeletal system. 2 Differentiate between the axial and appendicular skeleton. 3 State the medical terms that name the three types of joints. 4 Pronounce, spell, and define medical terms related to the skeletal system and its disorders. 5 Interpret abbreviations associated with the skeletal system. Introduction Our skeletons form the basic structures of our bodies, much like the framework of concrete and steel does in a tall building. Buildings constructed in earthquake zones are designed to move and sway so they won’t fall down when the earth moves beneath them. We look upon such buildings as marvels of modern engineering, perhaps without giving a thought to the human skeleton, which allows us to walk, run, talk, gesture, throw things, and even draw up plans for tall buildings. WORD PARTS RELATED TO THE SKELETAL SYSTEM Many terms having to do with the skeletal system are made up of the word parts listed in Table 5-1. Other word parts you have already learned are also used to make up some terms in this chapter. Prefixes you learned in Chapter 2, such as dia- (through), epi- (outside), endo- (inside), and peri- (around), for example, will be evident in terms introduced under the “Structure and Function” heading. Important word parts to know for this chapter are related to the Greek words, osteon for bone and mys for muscle. It is also important to know that not every term has a root. The reason is simple: we borrow freely from Greek and Latin, and if you stop to think about that practice, you will realize that every word or word fragment we use is—in a narrow sense at least—a potential root. In other words, prefixes and suffixes can sometimes form the central idea of a term. Table 5-1 WORD PARTS RELATED TO SKELETAL SYSTEM Word Part Meaning -algia pain amphi- both sides ankyl/o stiff, fused, closed arthr/o joint btachi/o arm calcane/o calcaneus,