Sterile Processing Technology, Part 1 28986 20231214140530

Read each objective. Pay close attention to the main concepts and definitions. Complete each assignment as you come to it. When you're confident you understand the material, complete the lesson exam. Sterile Processing Technology, Part 1 / Start Here Start Here Start Here Start Here © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 3 of 90

STERILE PROCESSING TECHNOLOGY, PART 1: CAREER SYLLABUS 3 Contact Hour Calculation Unit Knowledge Acquisition Knowledge Application Unit 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations 9 hours 30 minutes 2 hours 48 minutes Unit 2: Principles of Aseptic Technique and Infection Prevention 8 hours 24 minutes 2 hours 42 minutes Unit 3: Cleaning, Decontamination, and Disinfection 10 hours 48 minutes 2 hours 54 minutes Unit 4: Surgical and Complex Surgical Instruments 10 hours 12 minutes 3 hours 30 minutes Total 38 hours 54 minutes 11 hours 54 minutes Total Contact Hours Total CEUs (Contact Hours/10) 50.8 hours 5.1 Grading Criteria Grades are calculated on the following scale: Grade (Percent) Letter Equivalent Rating 90–100 A Excellent 80–89 B Good 70–79 C Average 65–69 D Passing Below 65 F Failing An overall program average of 65% or above is required to graduate and earn your Career Diploma. Refer to the Academic Policies section of the Career Catalog for specific information on grades. Page: 6 of 90

In this lesson, you’ll learn about the important roles of the sterile processing technician as they relate to the sterile processing department, perioperative department, and hospital as a whole. Before you begin to read the next few sections, please read through Chapters 1 and 6 of your textbook. The sterile processing technician plays a vital role in ensuring quality and infection control not only for surgical patients but for all patients. Sterile processing technicians are truly the heart and lungs of the hospital. As a sterile processing technician, you’ll be responsible for sterilizing medical equipment and supplies, decontaminating medical instrumentation, preparing and packaging surgical instrumentation and medical equipment, distributing medical equipment and supplies, ensuring infection and quality control, and a plethora of other tasks. By the end of this lesson, you’ll be able to… Discuss the importance of the sterile processing department to the operation of healthcare facilities Explain the standards, ethics, guidelines, professional standards, and safety regulations that guide the sterile processing profession Discuss the specific roles, basic knowledge, skills, and functions of the sterile processing technician Review workflow within the sterile processing department Discuss the various federal and state regulatory agencies and how they’re pertinent to sterile processing Define regulations, standards, and recommended practices Discuss the HIPAA privacy and security rules and their implications in healthcare Distinguish between privacy and security Identify types of protected health information (PHI) within a healthcare setting Explain essential components of PHI policies and procedural protocols Discuss the role of a healthcare department’s privacy officer Sterile Processing Technology, Part 1 / Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 9 of 90

To summarize, the sterile processing department is responsible for quality patient care and helps to assist in providing services in medical facilities to all departments that are in need of supplies, equipment, instruments, and other products. It’s important to always remember that the hospital can’t function properly without you. The Sterile Processing Workflow When you envision workflow, what do you think of? Do you ponder the systematic structure of your day-to-day duties at work? What would happen if the structure was completely eliminated from your workplace? Would the work performance be efficient? Would your environment be chaotic? All of these things could potentially occur without proper workflow. Sterile Processing Workflow is established in just about any organization you can imagine. It’s a systematic design that provides efficiency and structure within an organization. Maintaining the highest quality of patient care and customer service can be initiated with proper workflow. The workflow in the sterile processing department is designed to prevent cross-contamination. Typically, sterile processing departments have three main areas: Decontamination Preparation, packaging, and sterilization Sterile storage Sterile Processing Workflow Sterile Processing Technology, Part 1 / Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 12 of 90

E. coli Fecal matter can contain the bacteria E. coli . If a nurse handles a patient bare-handed that has this pathogen residing within his or her gastrointestinal tract, it could easily spread directly to another patient or the nurse themselves. Only proper handwashing after exposure to the pathogen can prevent this. The following video explains the important benefits of sterile barriers in helping to protect patients from infection. https://www.youtube.com/embed/id-rRmhuCgg?rel=0&showinfo=0&wmode=opaque Direct Link: Protecting the Patient (https://www.youtube.com/embed/id-rRmhuCgg? rel=0&showinfo=0) Sterile Processing Technology, Part 1 / Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 15 of 90

The sterile processing department follows strict guidelines regarding employee and patient safety as well as handling outside vendors to protect their workers from preventable harm. If an employee witnesses these guidelines not being followed, it’s his or her duty to notify a supervisor. Moral Compass Here are a few examples of unethical practices and safety concerns that can result from not following the proper guidelines established in the sterile processing department: Not wearing the correct personal protection equipment when appropriate ± Accepting favors from outside vendors in exchange for the purchase of their products ± Distributing patient information for the purpose of selling it ± Sterile Processing Technology, Part 1 / Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 18 of 90

Association for the Advancement of Medical Instrumentation (AAMI) Association of periOperative Registered Nurses (AORN) Healthcare Sterile Processing Association (HSPA) Society of Gastroenterology Nurses and Associates (SGNA) Professional Organizations Let's take a closer look at specific practices of some of the organizations setting regulations, standards, and recommended practices in sterile processing. The EPA The Environmental Protection Agency (EPA) is responsible for establishing and issuing regulations that protect the environment. These regulations include legally forcing establishments to manage the way their products impact the air, water, and land when exposed to the environment. Because the sterile processing department relies heavily on products that could potentially be harmful to the environment when improperly used, strict regulations enforce how these products should be used and disposed of. The EPA is responsible for regulating the use of environmental disinfectants such as ethylene oxide (EO), chemicals used to sterilize instrumentation, and sporicides. Before any of these products can be sold or marketed, they first must be approved by the EPA. The EPA’s regulations fall under the Clean Air Act . One of the primary purposes of the Clean Air Act is to establish clean air on a national level by controlling the amount of pollutants released into the air. The FDA The Food and Drug Administration (FDA) enforces rules to ensure the safe use of medications and medical devices. Injuries or deaths that occur through the use of defective medical devices are tracked and documented. MedWatch is an FDA program that enforces mandatory reporting of defective medical devices and drugs. Medical devices are initially reviewed by the sterile processing department before they’re used on patients. Any medical device used on patients must be accompanied by an Instructions for Use (IFU) document, which is kept stored in the sterile processing department. IFUs provide specific instructions on how to properly clean, decontaminate, and sterilize medical devices. Sterile Processing Technology, Part 1 / Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 21 of 90

It’s critical that the sterile processing technician review IFUs before cleaning, assembling, decontaminating, preparing, packaging, and sterilizing medical supplies and instrumentation. IFUs are handy when a new or unfamiliar device is being processed. FDA regulations also apply to the reprocessing of single-use devices such as trocars and other medical devices used in laparoscopic surgery. Manufacturers are also required to validate their devices through in- house testing that confirms that a product can do what the label says it can do. OSHA Workplace safety is a key goal of the Occupational Safety and Health Administration (OSHA) . OSHA enforces how workplace hazards and bloodborne pathogens are managed in the workplace. Due to the nature of the sterile processing department, staff must follow these regulations to prevent potential risks that are associated with working with infectious waste. Exposure limits to ethylene oxide are also regulated by OSHA. Overexposure to this chemical can result in cancer. Other substances and hazards regulated by OSHA include: Glutaraldehyde Ozone Sharps such as blades, needles, and sutures Alcohols Hydrogen peroxide OSHA Workplace Sign To limit exposure to dangerous chemicals that are used, appropriate spill precautions and clean-up procedures are implemented to reduce or eliminate the effects these chemicals can have on staff and patients. Sterile processing technicians must also be knowledgeable of fire and reactivity hazards for each chemical to which they're exposed. All materials within the sterile processing department must be listed on a document that describes the ingredients of the chemical and any potential risks associated with the chemical. This information is provided on what’s known as a Safety Data Sheet (SDS) . Fire and reactivity risks, in addition to appropriate ways to dispose of and clean up the chemicals, are also located on the SDS. An important OSHA mandate is that eyewash stations be placed in all healthcare facilities where exposure to a hazardous material is possible. It’s important to know where the eyewash stations are located in your department. If you’re exposed, you should use the eyewash station immediately to limit your risk of contracting disease or overexposure to dangerous chemicals. Sterile Processing Technology, Part 1 / Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 22 of 90

The CDC The Centers for Disease Control and Prevention (CDC) provides guidelines on proper handwashing techniques and other recommended practices for infection control. Infection prevention is one of the sole goals of the sterile processing department. As mentioned previously, handwashing is essential for preventing the spread of infection from patient to patient. In regard to sterile processing, the CDC offers recommendations on the cleaning and sterilization of medical devices. The CDC has classified medical devices as critical, semi- critical, or noncritical according to Spaulding’s principles . Review the chart below to become more acclimated to Spaulding’s principles. Critic Items Process The Joint Commission The Joint Commission is a nonprofit organization that accredits more than 20,000 healthcare organizations in the United States. It’s responsible for evaluating these organizations to confirm and reinforce that the highest standards of care are being provided by providers and hospital employees in all areas. One of the primary goals of the Joint Commission is to reduce medical errors, address health and safety concerns, limit wrong-site surgeries, and minimize hospital- acquired infections. Compliance Sterile Processing Technology, Part 1 / Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 23 of 90

The Joint Commission performs anticipated and unannounced site inspections to ensure that organizations are following their standards. This can be a very stressful time for employees because surveyors may ask random workers a series of questions to ensure compliance; therefore, it’s critical that all workers are competent and up-to-date on workplace practices, not just supervisors and managers. You may be asked by an inspector to state departmental policies on the cleaning, decontaminating, disinfecting, and sterilization process during an evaluation. Unfortunately, in the past, some facilities have been shut down due to noncompliance with Joint Commission standards. This resulted in the loss of the facility’s accreditation. If a hospital fails to demonstrate all applicable standards per Joint Commission protocols and procedures, it runs the risk of not obtaining initial accreditation or accreditation renewal. It can also face revocation of accreditation. Participating in continuing education to become more familiar with the Joint Commission’s standards and procedures can prevent a failed site visit. Everyone must be involved to ensure compliance. Sterile Processing Technology, Part 1 / Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 24 of 90

Protected Health Information (PHI) There is no textbook reading assignment for this section. Privacy and security are critical elements to ensure that patients’ health data and/or medical records remain secure. To attain these goals, the Health Insurance Portability and Accountability Act (HIPAA) set minimum federal standards for both the privacy and security of protected health information (PHI) . In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act modified some parts of HIPAA and added the requirement that patients receive a notification if their privacy is breached. HIPAA applies to organizations and individuals who submit claims electronically. The rules aren’t limited to one specific job, but to all healthcare workers, volunteers, and interns, paid or unpaid, who have access to patient information. Basically, HIPAA controls what PHI is and how it’s used throughout the entire healthcare system. Patient Health Records PHI includes: Identi±able health information that’s transmitted by electronic media Identi±able health information that’s maintained in electronic media Identi±able health information that’s transmitted or maintained in any other form or medium, such as paper medical charts and records The most common types of PHI maintained by healthcare facilities may include a patient’s: 1. Name 2. Street address and zip code 3. Date of birth 4. Age 5. Telephone number (home, work, mobile) 6. Email address (if provided or requested) 7. Health plan number, including Medicare or Medicaid ID number 8. Diagnosis or diagnosis code(s) 9. Complete History and Physical (H&P) 10. Social Security number Sterile Processing Technology, Part 1 / Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 25 of 90

HIPAA permits disclosure of PHI for healthcare operations, treatment, and payment. This exclusion covers the vast majority of clinical uses of PHI. Most other disclosures require specific patient consent. Examples of safeguards include shredding paper waste, using privacy filters on computer screens visible to customers, limiting the number of employees who have full access to patient records, encrypting computer files that contain PHI, and using employee numbers and passwords for logins to track viewing of patient records and PHI. On surgical floors, employees are exposed to PHI in the form of the operating room schedule, medical records, equipment billing, and charging systems. It’s important to allow only individuals directly involved in a patient’s care to have access to certain PHI. HIPAA Privacy Rules In simple terms, HIPAA supplies rules to employees that enforces how PHI should be managed, and there are strict penalties for those that don’t follow those rules. All healthcare workers should be extremely careful in how they manage access to patient data. For example, a sterile processing technician may discuss clinical information with the healthcare provider that requests a medical device for a patient to obtain correct patient information for billing. Privacy This use of PHI falls under normal healthcare treatment. The technician, however, may not discuss PHI with a third party who has no treatment relationship or billing relationship with the patient, unless there’s documented patient consent. A patient’s own PHI may be disclosed to him or her personally. Because of the complexities of the HIPAA rules, employee training is required. Every facility must train all employees on the policies and procedures regarding PHI upon hiring and, at minimum, annually or as necessary thereafter. The amount of training required is determined by what’s necessary and appropriate for employees to carry out their work functions. Privacy is a patient’s legal right. This means that under no circumstances should the sharing and distribution of a patient’s PHI occur. It doesn’t matter whether it’s paper or electronic data, or even verbal communications; sharing of PHI is strictly prohibited by law. The security of PHI has to do with the safeguards a healthcare facility uses to keep patient information confidential. Sterile Processing Technology, Part 1 / Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 26 of 90

Two items are specifically required to be included in a medical facility’s PHI policies and procedures protocol: Select each item to learn more. Privacy officers assist with maintaining HIPAA regulations. They have numerous responsibilities, including: Work with the owner/manager to assess the facility’s current operations and identify areas that need to be addressed to comply with HIPAA Act upon patient requests for access to and photocopies of medical records Answer patient questions about HIPAA Respond in a timely fashion to patient complaints Establish an e²cient ±ling systems for all forms and documents Assist other sta³ members with questions for all forms and documents Monitor any changes in the HIPAA requirements and make necessary changes accordingly HIPAA rules require all healthcare entities to compile their privacy practices into a notice and share it with patients. The law requires that the notice be provided to all patients and that patients are informed if anything in the notice changes. To prove that the notice is provided, patients are asked to sign a paper or electronic form acknowledging that they’ve received the information. If a patient refuses to provide written acknowledgment, the facility must have a procedure in place to document refusal. The first requirement is a complaint process for violation of the policy and procedures. The complaint process must provide an opportunity for individuals to make complaints concerning the department’s policies and procedures or its compliance with the policies and procedures. A department must document all complaints received and the disposition of complaints, if applicable. Patients may file complaints with the privacy officer of the facility or with the United States Department of Health and Human Services, Office for Civil Rights, in Washington, DC. ± The second requirement is a sanctions process for employees who fail to comply with the privacy policies and procedures or the requirements of the HIPAA rules. If patient information is improperly released, the facility must try to limit any harmful effects caused by the release. It’s very important that all employees take HIPAA and patient privacy seriously. Violations may result in civil fines ranging from $100 for a single violation up to a total of $1.5 million for identical violations in a calendar year. Employers are required to have a policy regarding discipline for employees who violate HIPAA. Disciplinary measures may range from a verbal warning to dismissal. Although the privacy act doesn’t prevent one from sharing information with those the patient has given permission to be included in his or her care plan, it’s a HIPAA violation to discuss patient status or information in hallways, elevators, or cafeterias. It’s also a HIPAA violation to view medical records of friends or family members. ± Sterile Processing Technology, Part 1 / Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 27 of 90

It's important to understand patients' rights regarding their PHI. Select each item to learn more. Confidentiality of PHI for minor children receives special consideration for HIPAA privacy rules. The general principle used by HIPAA for minors is simple: If a person has a right to make a healthcare decision, then he or she has the right to control information associated with that decision. Parents generally have the right to make healthcare decisions for their children and are by default considered the personal representatives for decisions about PHI access, use, and disclosure for non-emancipated minors. This situation would also be true in the case of a guardian or other individual acting in loco parentis , which is Latin for “in the place of the parent.” However, as they grow older, minors have varying degrees of emancipation for healthcare decision-making, and with that comes the control over PHI associated with those decisions. The general rule of parental or personal representative control for minors’ PHI is subject to three important general exceptions: Patients may request copies of their PHI maintained by the facility. Although it’s likely that most places will accommodate patient requests for copies of records, the healthcare facility has the option to accept or deny these requests. It’s important that the facility document such patient requests and respond to them. ± Patients also have the right to request amendments to the PHI contained in the records if they believe that the PHI is incorrect or inaccurate. Again, the facility can accept or deny the request for amending patient records, but it must respond to requests within 60 days. ± Finally, patients have a right to place limitations on the facility’s disclosure of their PHI and request that the office communicates with them in a confidential manner. For example, if a husband and wife separated pending divorce, one or both of them may request that the doctor’s office use a specified personal mailing address, telephone number, or email address if it becomes necessary to contact either to keep his or her PHI away from the spouse. ± When state law doesn’t require consent of a parent or personal representative before a minor can obtain a particular form of treatment (for example, HIV testing or mental health services), the minor controls information associated with that treatment. When a court determines or other law authorizes someone other than the parent to make treatment decisions for a minor, that other person or entity controls the information associated with the treatment. When a parent or personal representative agrees to a con±dential relationship between a healthcare provider and a minor, the parent or personal representative doesn’t have access to information associated with that agreement, unless the minor permits it. Sterile Processing Technology, Part 1 / Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 28 of 90

Some doctors’ offices and other companies regulated by HIPAA have business associates who, because they have access to PHI, are also regulated by HIPAA. Examples of such business associates include attorneys, durable medical equipment billing services, contract shredding companies, and contract medical delivery couriers. These companies should have a formal agreement with the facility that outlines their responsibility to keep PHI secure and private and to report a breach to the facility immediately. Each medical facility must also have procedures in place to destroy medical records to protect PHI. Sterile Processing Technology, Part 1 / Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 29 of 90

Practice: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Open Link Sterile Processing Technology, Part 1 / Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 30 of 90

Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Exam Open Link Sterile Processing Technology, Part 1 / Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations Lesson 1: Introduction to Sterile Processing, Regulations, Standards, and HIPAA Regulations © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 31 of 90

Lesson 2: Principles of Aseptic Technique and Infection Prevention Sterile Processing Technology, Part 1 / Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 32 of 90

In this lesson, you’ll learn about aseptic technique and ways to prevent the spread of disease. Before you begin to read the next few sections, please read through Chapter 5 of your textbook. Understanding and properly applying the aseptic technique is critical to providing effective patient care. In some cases, it could mean the difference between life and death for a patient. This is especially true for those patients who have compromised immunity. Failure to utilize appropriate aseptic technique can result in hospital-acquired infections, critical illnesses, and patient deaths. It can also cost the hospital millions of dollars. Keep in mind that not only does the hospital suffer economic damage, but the department in which the incident occurred can also suffer tremendously. Understanding the aseptic technique starts with you and must always be applied within the healthcare setting. By the end of this lesson, you’ll be able to… Identify basic procedures and guidelines for establishing the aseptic technique Distinguish medical versus surgical asepsis Discuss five basic principles of aseptic technique Identify basic procedures and guidelines for transporting medical equipment and opening supplies using asepsis Explain what is meant by the chain of infection and ways to break it Discuss the role Personal Protective Equipment plays in the prevention of disease transmission In this lesson, you’ll be graded on… Lesson Quiz: Principles of Aseptic Technique and Infection Prevention There's one required quiz at the end of this unit. You need an overall average of 65% on all unit exams to successfully complete this course. Sterile Processing Technology, Part 1 / Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 33 of 90

Aseptic Technique Practices Read Chapter 5 in your textbook. Then, read this section. Aseptic technique can be defined as the process of utilizing various techniques to reduce the risk of microorganism transmission from one source to another. Have you ever taken a microbiology course? If so, you may already have some familiarity with aseptic technique. Your assignment in microbiology may have been to transfer a number of bacteria that were confined in a specific container to a petri dish or culture using an aseptic technique. The key to this technique should have been to carefully transfer the microorganisms without cross- contamination. Aseptic technique principles applied in the biology lab are very similar to those performed in the medical setting. Aseptic Technique Aseptic technique is utilized virtually everywhere. You may observe this technique being used in dental clinics, specimen or hematology labs, dermatology clinics, ambulatory centers, hospitals, and more. In health care, however, the primary goal is to reduce the risk of exposing the patient, medical device, or sterile product to microorganisms. Operating room personnel understand that using an aseptic technique is crucial for keeping live organisms out of the patient’s wound, as those organisms can spread disease and infection. These highly trained professionals utilize attire, materials, and surgical instruments that are free from microorganisms. Aseptic technique is critical in the operating room. The goal is to keep items sterile (free from all living microorganisms). Sterile Processing Technology, Part 1 / Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 34 of 90

Design and Workflow The aseptic technique in sterile processing starts with the design of the sterile processing department. The department should be designed so that the workflow and traffic are separated. To better understand this, you can apply this theory to real-life practices performed at home. Think about the design of your home. When guests enter, do they enter the kitchen where you perform most of your cooking duties or an area away from the kitchen? You can also use the restroom as an example. When guests enter your home, are they entering a dirty area to get to a clean area? You can apply those same questions to your job. Sterile Instruments The workflow for the sterile processing department begins in the operating room. This occurs when dirty items used on the surgical patient are sent down on a dumbwaiter or pushcart to the decontamination (dirty) room . Those items are cleaned and decontaminated and then sent to the preparation area where they’re assembled, packaged, and sterilized. After this process, the items are distributed or stored in a clean, uncontaminated area until a further distribution is required. The traffic in the sterile processing department should always flow from clean to dirty. If a technician exits the decontamination area and enters the clean area, the aseptic technique can’t be achieved because the area has now been compromised. Bacteria in the decontamination area could have been transmitted into the clean area. This is why the design of the facility is an important factor in the control of pathogen transmission. Workflow can be plainly stated as performing tasks from a dirty to clean area. Think about the way you wash your dishes at home. After washing them, do they remain in a dirty sink, or are they put away to a clean area of your kitchen to be used later? Sterile Processing Technology, Part 1 / Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 35 of 90

Sterile Items It’s important that you understand at minimum these five factors of maintaining aseptic technique: What Causes a Break in Aseptic Technique? Several factors can cause a break in aseptic technique. Some of the most common reasons are because personnel are uneducated in how to properly use aseptic technique, they’re rushed while giving care, or they’re neglectful in paying attention to detail. It’s critical that special attention is given when practicing aseptic technique. It’s your responsibility to be able to recognize and correct a break in aseptic technique. Sterile Gloves It’s mandatory that every item used within a sterile ±eld must be sterile. Any sterile barrier that has been penetrated or contained with moisture must be considered contaminated. After a sterile item is opened, the edges are always considered non-sterile. If there any uncertainties or doubts if an item has been sterilized, it must be treated as contaminated. Nonsterile personnel must touch only nonsterile items; sterile personnel must only touch sterile items to prevent contamination. Sterile Processing Technology, Part 1 / Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 36 of 90

The image here demonstrates a break in aseptic technique, with holes appearing in the gloves being used. By using gloves with holes, pathogens can potentially be transmitted to medical devices and the person wearing those gloves. They can also contribute to a major illness in the health care worker. What issues can you think of that may cause the transmission of pathogens if the technician handled devices with a torn glove? One issue would be the potential of bacteria from the technician’s hand being transmitted directly to a sterilized package. Unfortunately, even if a hand appears to be clean through the naked eye, there’s still a great possibility that microscopic organisms exist and reside on the surfaces of the hand, making them easily transmissible to an object or the patient contributing to the illness or disease. In the sterile processing department, there are many other ways to recognize a break in aseptic technique: Contaminated packages (dust, dirt, solutions, or moisture) Rigid containers that are missing ±lters or locking mechanisms Clean or sterilized supplies that are located on dirty carts Improperly sterilized items Although sterile processing technicians don’t work directly with patients, they’re ultimately responsible for ensuring that medical supplies and equipment are delivered to a specific department uncompromised so that they can be used with patients. Paying attention to detail can help eliminate the risk of contaminated supplies being delivered. For example, if a wrapped item that was just sterilized hits the floor before it’s able to get to the operating room, it’s the technician’s responsibility to take the instrument back to decontamination for reprocessing. There could be microscopic holes within the item that can’t be seen with the naked eye; therefore, it’s best to completely reprocess the item to ensure maximum effectiveness. Aseptic Technique Scenario Now you'll look at aseptic technique from a non-clinical standpoint. Can you recall a moment as a child playing outside and maybe scraping an elbow or knee? Did you run into your home for Mom to apply a bandage? Maybe it was oozing or even painful at that moment. Step 1 Sterile Processing Technology, Part 1 / Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 37 of 90

Now, imagine your mom preparing dinner. To be more specific, baked chicken casserole. Caught off guard, she rushes to apply pressure to your wound with her bare hands covered in uncooked chicken fat. Step 2 Panicking, she realizes she didn’t wash her hands, which are saturated from uncooked chicken residue. Step 3 She immediately goes to wash her hands and grabs a liquid disinfectant to wash off your contaminated wound to prevent further spread of infection. Sterile Processing Technology, Part 1 / Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 38 of 90

So, why use aseptic technique, you ask? To prevent the further spread of infection. The sterile processing technician plays a vital role in reducing the risk of pathogenic organisms being transmitted to the surgical patient. What could happen if the mom in this scenario didn't complete Step 3? If the parent hadn't reacted quickly by washing her hands and disinfecting the wound, the child could have suffered from a secondary infection (one that occurs after a primary, or initial, infection). Sterile Processing Technology, Part 1 / Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 39 of 90

Non-Touch, Clean, and Sterile Techniques There is no textbook reading assignment for this section. Non-Touch Technique Aseptic non-touch technique refers the manner in which wound dressings are changed without directly touching the wound, even if gloves are worn to avoid further infection. The only thing that should be applied directly to the wound is the bandage that will replace the old bandage. Aseptic technique should always be used when dealing with a patient. Of course, sterile processing technicians aren’t directly responsible for changing patients’ wound dressings, but they’re directly associated with preparing, packaging, and sterilizing wound-changing kits. Non-Touch Technique When changing dressings, the nursing staff will typically utilize examination or sterile gloves, depending on the type of wound and infection. Sterilized gauzes or bandages are typically used to change the infected wound. Think of how you may apply bandages at home. Rather than touching the wound itself to apply the bandage, you may have been utilizing non-touch technique all along without realizing it. Normally, you touch one end of the bandage while grasping the distal end, place the bandage directly over the wound, and seal it by pressing the adhesive straps to the skin. How is the medical professional in this image applying the bandage without physically touching the wound itself? The image shows the healthcare professional applying the bandage to the wound without contributing to any additional exposure to potential pathogens. You may observe a few things. The nurse is using gloves to protect themselves and the patient from possible bacteria that may Sterile Processing Technology, Part 1 / Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 40 of 90

lie dormant on their skin. Additionally, he or she is ensuring that the wound only makes contact with the sterile bandage. These are the fundamental principles of applying the non-touch technique. Clean Technique When you think of “clean technique,” what’s the first thing that comes to mind? Maybe an item that’s free of dirt, debris, and/or spills? What are some other examples you can consider? First start with defining the term clean. You probably don’t need a dictionary to identify what the term means. Since childhood, you may have heard, “Go clean yourself up, it’s time for dinner” or, “There you go, all nice and clean now” after getting out the bathtub. In simple terms, clean just means the removal of physical dirt. Clean technique is similar to aseptic technique. The ultimate goal is to prevent microorganism transmission from fomites to vectors or healthcare worker to patient. Select each item to learn more. fomites nonliving surfaces vectors living organisms that can spread disease A good example of a vector is the mosquito. Mosquitoes spread numerous diseases to humans such as zika, malaria, and the West Nile virus. Clean technique refers to maintaining an overall clean environment, washing hands frequently, and utilizing clean supplies and equipment while providing services or care for a patient. It should be enforced to reduce the number of microorganism transmissions that can occur in the healthcare environment. When is Clean Technique Used in Healthcare? You may observe clean techniques being used in environmental services, emergency departments, clinical care units, and of course the sterile processing department. Routine cleaning should be performed in every area of the hospital environment by the appropriately trained staff. Household items should not be used to clean within the clinical environment. Specific products, such as QUATs (quaternary ammonium compounds) , are generally used to disinfect in these areas. Sterile processing technicians are often responsible for delivering medical equipment to various departments within a hospital or other healthcare facilities. Sometimes the sterile processing technician must deliver medical equipment to a patient. In these cases, it’s absolutely imperative that the technician use clean hands or clean gloved hands. Clean technique is the preferred method for interacting with patients with intact skin. Sterile Technique The sterile technique is distinctively different than the clean technique. To understand this technique, you must first understand the term sterile, which will be discussed further in our upcoming lessons. For now, “sterile” can be described as an object that’s free from all living microorganisms. Sterile Processing Technology, Part 1 / Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 41 of 90

Sterile techniques , therefore, can be described as practices performed to eliminate exposure of microorganisms to supplies, devices, or living objects by keeping the area as free of microorganisms as possible. You’ll be responsible for applying these principles when you manage, prepare, and package medical devices that are delivered to the operating room. It’s important that the medical staff can access the sterilized instruments in a way that prevents them from being non-sterile once opened. Prep and packaging will be discussed later in the next lesson group. Sterile Technique There are several sterile technique principles being applied in the image shown here. Select each item to learn more. These principles are important for you to know because you may work closely with the operating room staff when delivering surgical supplies and equipment. Once you come into the operating room with sterile supplies you must wear a mask to prevent any exhalation of Firstly, the surgical technologist is wearing sterile attire. The gown and gloves should have been applied in a way that prevented the front of the surgical attire from becoming contaminated. These techniques in donning (putting on/wearing) sterile attire are taught to all operating room personnel to prevent the spread of microorganisms to the patient. ± Next, you can visualize the technician’s hand placement. Only the top of their table is considered “sterile.” The technician is ensuring that his or her hands remain on top of the table to prevent the spread of disease to the patient. ± All of the instruments and supplies you can visualize in this image are sterile. The technician will ensure that every device handed to the surgeon remains sterile by properly handling the items used and unused. All of the blue items in this image are sterile. ± Sterile Processing Technology, Part 1 / Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 42 of 90

microorganisms onto the sterile items. You must also ensure that you remain at a minimum 12 inches away from anything sterile in the room to prevent contamination. These are just a few of the principles you must be aware of when entering the operating room. Understanding the basic principles of aseptic technique can save the hospital large sums of money that would otherwise be paid out due to malpractice suits. In addition, improper aseptic technique can cost the facility in lost reimbursement from Medicaid and Medicare. Medicaid and Medicare have rules that apply to hospitals across the country that imply that if a patient leaves the hospital with an infection not previously caused before entry into the hospital (hospital- acquired infection), then they have the right to refuse payment to that facility for services rendered to the patient. Asepsis Asepsis is defined as the absence of microorganisms that contribute to pathogens. Generally, there are two types of asepsis: medical and surgical. Select each tab to learn more. Medical asepsis is also known as “clean technique” and is used to reduce the amount of pathogens on the human body. When you visualize medical asepsis, you can envision the principles you use at home if your child gets a scraped knee. What do you use to cleanse this area? Hydrogen peroxide or maybe betadine? If so, this is an excellent example of medical asepsis in which you’re utilizing chemical agents to reduce the amounts of microorganisms that can potentially lead to infection through the break in the skin. In healthcare, surgical skin prepping is a good example of medical asepsis. Skin can never be “sterile;” it can, however, be prepped with sterile solutions to reduce the number of microorganisms on the skin. Surgical asepsis is what healthcare providers practice within the perioperative environment. This technique, as previously discussed, is also referred to as “sterile technique.” The sterile technique eliminates all microorganisms. Sterile processing technicians should know the five principles of asepsis to prevent the spread of microorganisms that can contribute to infection in the surgical patient. Surgical site infections can occur in patients that have undergone surgery and are exposed to dirty instruments and/or poor aseptic technique from the surgical staff. The five principles are as follows: 1. Know what’s dirty. 2. Know what’s clean. 3. Know what’s sterile. 4. Keep dirty, clean, and sterile items separate. 5. Rectify contamination immediately. Sterile Processing Technology, Part 1 / Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 43 of 90

Infections in the Healthcare Setting There is no textbook reading assignment for this section. Hospital-Acquired Infections Did you know that some patients come into hospitals without infection and then acquire one once admitted into the hospital? As previously discussed, this is known as a hospital-acquired infection (HAI) . HAIs can be the direct result of a failure to utilize the appropriate aseptic technique. There are several types of HAIs. There are also many types of bacteria that reside within the healthcare environment and can be easily spread when proper asepsis isn’t utilized. Hospital-acquired infections have been a growing concern in hospitals across the nation. They’re a tremendous economic burden, resulting in over $30 billion in expenses each year. HAIs may make patients critically ill and require prolonged treatment. If not careful, HAIs can even be fatal. HAI - Hospital-Acquired Infection HAIs can occur for numerous reasons. The following are some of the most common types of HAIs: Select each item to learn more. Central line–acquired infections Occur when the appropriate aseptic technique isn’t utilized when a central line is placed in the vein of the neck, chest, groin, or arm to give fluids, blood, or medications or to conduct medical tests quickly. ± Ventilator-associated pneumonia occurs when the lung develops an infection that results from having a ventilator. Bacteria enter the ventilator tube from unclean hands or objects or when an improper aseptic technique is used. ± Sterile Processing Technology, Part 1 / Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 44 of 90

Common Infectious Microorganisms Thousands of microorganisms reside within the healthcare environment. As a sterile processing technician, it’s important for you to be aware of the numerous organisms you could potentially be exposed to. Not utilizing the appropriate methods of aseptic technique can cause these organisms to spread from patient to patient, healthcare worker to healthcare worker, or to even cause an outbreak outside of the medical facility. Utilizing proper aseptic technique can prevent this spread of microorganisms./p> The following list contains some of the common microorganisms encountered in the healthcare setting. Select each item to learn more. Surgical site infections occur when an incision site becomes contaminated by nonsterile items, dirty hands, or inappropriate aseptic technique. These infections are treated most commonly with antibiotics; however, they can be difficult to treat. ± Catheter-associated UTIs typically occur when a nurse or other medical professional inserts a Foley catheter to drain the bladder with contaminated gloves or inappropriate aseptic technique. ± Common gastrointestinal bacteria and a leading cause of urinary tract infections (UTIs), can also cause pneumonia, gastroenteritis, and neonatal meningitis ± Virus that results in an inflammation of the liver ± Virus that destroys CD4 + T cells and weakens the immune system, responsible for AIDS ± Virus responsible for the flu, a community-based infection transmitted in households and throughout the community ± Staph bacteria resistant to beta-lactam antibiotics ± Sterile Processing Technology, Part 1 / Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 45 of 90

Staph bacteria resistant to beta lactam antibiotics Most MRSA infections are skin infections. More severe or potentially life-threatening MRSA infections occur most frequently among patients in healthcare settings. Bacteria that attack the lungs, causing the disease tuberculosis ± Bacteria often linked to patients with ventilators or catheters This infection usually has a high mortality rate once patients acquire it. ± Enterococci bacteria resistant to vancomycin, usually spread through direct contact ± Staphylococcus bacteria resistant to vancomycin ± Sterile Processing Technology, Part 1 / Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 46 of 90

Chain of Infection There is no textbook reading assignment for this section. The chain of infection is the way a pathogen is transmitted between an infected and uninfected host. In order for an infection to spread, it must first acquire a host . A host can spread the disease in numerous ways, including through everyday tasks such as coughing, sneezing, and physical contact. Breaking any link in the chain of infection can stop the transmission of that infection. Chain of Infection Ways to effectively prevent the spread of infection include: 1. Education and training 2. Routine immunizations 3. Proper use of the aseptic technique 4. Meticulous hand washing 5. Following standard precautions You’ll hear quite often that following these principles can prevent the unnecessary spread of infection. Since you’ll be working in the healthcare environment, it’s imperative that you master these techniques. Traffic within the sterile processing department must be restricted to those personnel who are directly involved with sterile processing. Any vendor or other outside personnel must follow strict guidelines when entering the clean and dirty environments of the sterile processing department. As discussed earlier, traffic flow should always be from clean to dirty to prevent the spread of pathogens. In addition to this, the workflow is traffic moving from a dirty to clean environment. Designated Area Example Restricted Operating room Semi- Restricted Sterile storage and the preparation area in sterile processing Sterile Processing Technology, Part 1 / Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 47 of 90

Designated Area Example Unrestricted Lounge, break rooms, locker rooms, and any other general public areas There are numerous types of objects and devices that can spread disease. Fomites such as desktops, computers, sinks, and other objects within the sterile processing department can contribute to the transmission of pathogens. Vectors are living organisms that contribute to disease transmission. For an infection to be transmitted, it must have a carrier , which can be described as an infected person carrying an organism or a reservoir in which the infection develops and from which it can spread to other individuals To understand the chain of infection more, it’s necessary to recognize the elements of transmission that can lead to infection. These elements include: Select each item to learn more. The initial link of infection begins with the causative agent . This is the agent responsible for producing disease which can originate from a bacteria, virus, fungus, protozoa, or prion. ± The infection begins to grow with the second link, which is known as the reservoir . The reservoir is the actual source in which the infection thrives. This can be the patient themselves, the healthcare worker, family, friends, surgical instruments, food, water, and even I.V. fluids. ± The third link is the portal of exit in which the infection is released from the source or reservoir. This can occur from the coughing, sneezing, vaginal or seminal secretions, blood, vomit, or the skin. ± The fourth link in the spread of infection occurs with the actual mode of transmission . This can occur in numerous ways, including: droplet, airborne, pathogenic, vector- borne, or water, food, and blood transmission. ± The fifth link is the way the pathogen actually enters the host, which is referenced as th t l f t Thi l b th h i t ti ki d/ th ± Sterile Processing Technology, Part 1 / Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 48 of 90

Review the following process flow chart below to become more familiar with the steps of the chain of infection and how they occur. Chain of Infection the portal of entry . This can also be through respiratory secretions, skin, and/or the genitourinary and gastrointestinal tracts. The final link in the chain of infection includes the susceptible host . Infection occurs when a human or animal can’t resist the infection in which the host can become ill or, in worst-case scenarios, die from the infection. ± Sterile Processing Technology, Part 1 / Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 49 of 90

Video: Hygiene Games This fun video explains some of the practices that should be avoided to discourage nosocomial infections. https://www.youtube.com/embed/5uZjgGD_9vY?rel=0&showinfo=0&wmode=opaque Direct Link: Hygiene Games (https://www.youtube.com/embed/5uZjgGD_9vY?rel=0&showinfo=0) This video did a good job of explaining some of the practices that should be avoided to discourage nosocomial infections. There were a few additional things that should have been addressed that could contribute to the spread of disease that weren't addressed. Were you able to detect them? After reviewing the video, what practices could have contributed to a hospital- acquired infection? Select each contestant to reveal ways they could transmit nosocomial infections. Sterile Processing Technology, Part 1 / Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 50 of 90

Standard Precautions There is no textbook reading assignment for this section. Because exposure to airborne and bloodborne pathogens, among others, are inevitable in the healthcare facility, exposure control plans are required. Information within the plan should include the following: What actions to take if you’re exposed to bloodborne pathogens How to protect your workplace from becoming contaminated How to handle and dispose of medical waste How to use and dispose of personal protective equipment (PPE) How to handle needles and other sharps to avoid injury Information on receiving the Hepatitis B vaccine series Standard Precautions Standard precautions originated from universal precautions and are established guidelines intended to protect personnel from contracting infections and diseases from exposure to occupational blood and other body fluids. Universal precautions apply to all contact or potential contact with blood, bodily fluids, and body substances. These precautions outline the following: Proper use of personal protective equipment ±orough hand washing after using gloves Disposal of contaminated materials and items saturated with blood and/or other medical waste, such as gloves, bandages, and towels Training of custodial sta² to assist with cleanup and removal of contaminated materials Separation of sharps from regular waste that’s clearly and correctly labeled as biohazardous materials First-aid kits maintenance Hand Hygiene According to the Centers for Disease Control and Prevention (CDC), hand washing is the single most important procedure for preventing the spread of infection. That’s because microorganisms can enter the body by “hitching a ride” through hand-to-hand, food-to-hand, and surface-to-hand contact. Sterile Processing Technology, Part 1 / Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 51 of 90

In 2002, the CDC released new hand hygiene guidelines. These guidelines advise the use of alcohol-based hand rubs to protect patients and workers in healthcare settings. An alcohol sanitizer can be utilized to sanitize hands between contact with patients. Visibly soiled hands, however, should be washed with soap and water before using an alcohol-based rub. Hand Hygiene It’s important to also know that exposure to patients with Clostridium difficile (C. diff.) should be treated with soap and water, not an alcohol-based sanitizer. Even with these restrictions, alcohol-based cleansers are effective for eliminating microorganisms on the skin. Recent data indicates that alcohol-based cleaners are more effective than hand-washing for two reasons: Sterile processing technicians can ensure that an acceptable clean technique is being utilized within their department by practicing proper hand hygiene. Hands must be thoroughly washed with soap and water after all procedures and tasks. These include: using the restroom before and after eating before handling medical equipment and/or devices after removal of gloves Hands should be washed at minimum for 15–20 seconds with a hospital approved or clinically approved antibacterial soap to reduce the number of microorganisms that reside on the hands. Medical devices and packages should always be handled with clean hands. This is necessary to reduce the device’s exposure to microorganisms and prevent cross-contamination. Again, frequent but thorough handwashing is a requirement in healthcare. This is the single most effective way in preventing the spread of disease to you, the hospital’s patients, or your peers. The process for effective handwashing includes the following: Healthcare personnel are more inclined to use alcohol-based hand rubs because they’re convenient. Alcohol hand rubs reduce the number of bacteria on hands more effectively than soap and water. Sterile Processing Technology, Part 1 / Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 52 of 90

Ensure that all jewelry is removed. Apply soap and water to hands. Lather with soap by interlacing fingers under running water. Dry hands with clean disposable cloth. Turn faucet off with clean paper or disposable towel. Personal Protective Equipment If you have ever had the pleasure of living in a cold city like New York or Chicago, you may appreciate a nice warm coat, scarf, earmuffs, beanie, and boots when it’s time to go outside. But why would you wear this excessive layering of apparel? For protection against the brutal cold, correct? If you were to go out for a stroll without the additional protective layers, you could risk frostbite and become seriously injured. Personal Protective Equipment (PPE) serves the same purpose: protection. Sterile Processing Technology, Part 1 / Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 53 of 90

Personal Protective Equipment As you've previously discovered, the sterile processing department is filled with dangerous microorganisms. This is why it’s a mandatory practice to wear the appropriate PPE when exposed to areas in the department where it’s more common for microorganism transmission to occur. To prevent transmission of disease, it’s necessary to put on and remove PPE in the correct sequence, which is as follows: Adding PPE Removing PPE Any staff member working in the decontamination area without appropriate PPE is in violation of enforced standards and regulations and can be terminated per the facility’s policies. It’s always good practice to treat everything as if it’s infectious, even when it appears clean. Any materials coming from labs, surgical suites, or patient rooms must be handled with gloves and treated as contaminated devices. The use of puncture-proof gloves is a requirement when sorting and decontaminating instruments to minimize your risk of exposure. Sterile Processing Technology, Part 1 / Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 54 of 90

PPE - Gloves The following guidelines apply to PPE: Wear appropriate gloves when there’s a reasonable hazard of contact with blood or other potentially infectious materials and when handling or touching contaminated items or surfaces. Replace gloves if torn, punctured, or contaminated, or if they no longer function as a barrier for other reasons. Never wash or decontaminate disposable gloves for reuse. Wear face and eye protection, such as a mask with glasses and solid side shields or a chin-length face shield, whenever splashes, sprays, spatters, or droplets of blood can reach the eyes, nose, or mouth. Wear protective body coverings such as gowns, aprons, caps, and boots when occupational exposure is anticipated. Remove PPE and replace with new ones if they become saturated with blood or other potentially infectious materials. Remember to always stay vigilant and understand that your workplace has certain unavoidable hazards. Using simple precautions will help keep you safe, but you must be ready to act utilizing the appropriate steps to avoid disease transmission whenever necessary. Hospital Attire and Workplace Standards Employees must adhere to workplace standards in their department for appropriate dress, hygiene, conduct, and behavior. A strict dress code is enforced in the sterile processing department. Basic attire for sterile processing professionals includes cleaned/laundered scrubs, a scrub cap, and slip-proof shoes. Personal clothing is prohibited. It’s important to wear appropriate scrubs to prevent cross-contamination. Appropriate Hospital Attire As a sterile processing employee, you may also encounter workplace standards such as: Jewelry such as rings, necklaces, and large earrings are typically prohibited when in the work area. Sterile processing personnel should refrain from having long ³ngernails, acrylic nails, or chipped nail polish because they can harbor bacteria. Sterile Processing Technology, Part 1 / Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 55 of 90

Fingernails should be kept short (about ¼ inch) and clean while working in the sterile processing department. Heavy perfumes and colognes should not be worn and can interfere with a patient’s respiratory responses. Cell phones should be stored in secured locations and not in the workplace. ±ey tend to harbor numerous bacteria and debris. Food and drinks aren’t allowed within the sterile processing department under any circumstances. Following these guidelines can protect the employee and patients from transmission of disease. Sterile Processing Technology, Part 1 / Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 56 of 90

Practice: Principles of Aseptic Technique and Infection Prevention Open Link Sterile Processing Technology, Part 1 / Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 57 of 90

Principles of Aseptic Technique and Infection Prevention Exam Open Link Sterile Processing Technology, Part 1 / Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention Lesson 2: Principles of Aseptic Technique and Infection Prevention © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 58 of 90

Lesson 3: Cleaning, Decontamination, and Disinfection Sterile Processing Technology, Part 1 / Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 59 of 90

In this lesson, you’ll explore effective ways to clean, decontaminate, and disinfect medical supplies and devices. Before you begin to read the next few sections, please read through Chapters 7, 8, and 9 of your textbook. The sterile processing technician must know how to properly reprocess surgical instrumentation due to the nature in which the instruments are used. Surgical instruments are used in surgery, directly touching sterile, human tissues. Proper cleaning, disinfection, and decontamination are essential practices in the sterile processing department and must be mastered by the sterile processing professional. By the end of this lesson, you’ll be able to… Explain how to clean general, powered, and delicate instruments Define cleaning and decontamination and their processes Discuss water pH and quality Identify the various detergents used for decontamination Describe the various pieces of equipment used to decontaminate medical instrumentation Discuss the different types of disinfection In this lesson, you’ll be graded on… Lesson Quiz: Cleaning, Decontamination, and Disinfection There's one required quiz at the end of this unit. You need an overall average of 65% on all unit exams to successfully complete this course. Sterile Processing Technology, Part 1 / Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 60 of 90

Contamination and Decontamination Read Chapter 7 in your textbook. Then, read this section. Contamination In previous lessons, you've seen the term contamination, but you’ll explore it further in this lesson. Simply described, contamination or contaminated references the words dirty or unclean. As previously mentioned, the sterile processing department is a highly contaminated environment. Cleaning, Decontamination & Disinfection Because of its critical nature, it’s imperative that you’re aware of potential hazards or contaminants that you’ll be exposed to. Some contaminants that the sterile processing technician must be aware of include the following: 1. Blood 2. Urine 3. Fecal matter 4. Mucous membrane secretions 5. Dirt/debris 6. Bioburden/Bio±lms As a sterile processing professional, you’ll also hear about cleaning and decontamination . It’s important to understand that the process of cleaning is different from decontaminating. Before decontamination can occur, the device must first be cleaned. Before cleaning, precleaning typically occurs in the operating room at the point of use. Cleaning is considered the initial step in the decontamination process, and the goal of cleaning is to remove any gross soil. Scenario Now imagine a real-life scenario to understand the cleaning process a bit further. It’s been a long, busy day at work. You rush home to prepare dinner for the family. Sterile Processing Technology, Part 1 / Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 61 of 90

Step 1 One of the kids mistakenly drops a piece of silverware on the floor. You go to retrieve the silverware only to discover that it has specks of debris upon it. Instead of making a big fuss about the whole ordeal, you decide to “clean it.” By the way, all the other silverware is completely soiled. You don’t have time to run the silverware through a thermal disinfection process such as the dishwasher, so you choose to perform another action. Step 2 Sterile Processing Technology, Part 1 / Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 62 of 90

Grabbing the dropped silverware, you put a splash of detergent on it, rubbing very gently with your fingertips for a few seconds under running water, and rinse. You go back to the dinner table to enjoy your meal with your family. This real-life scenario describes cleaning. This process is quite similar to how instruments are cleaned in the sterile processing department, with some slight variations, of course. Decontamination In the operating room, the surgical technician must make sure that excessive soil is removed from medical instruments and devices before sending them down to the decontamination area. Any item used after surgery to be reprocessed should be transported to the decontamination area. Decontamination - Washer Disinfector Chamber Decontamination can be described as the physical removal of gross debris. This gross debris is often found on medical equipment or surgical instrumentation. These items are decontaminated by the following sources: Select each item to learn more. used often to decontaminate case carts after each use ± uses thermal disinfection and mechanical processes to decontaminate surgical instruments ± uses extreme heat to destroy microorganisms in various thermal disinfection devices ± utilizes various chemicals to destroy microorganisms depending on the device ± Sterile Processing Technology, Part 1 / Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 63 of 90

Washer Disinfector Decontamination Mechanical Washer After cleaning, surgical instruments must be thoroughly rinsed in a third sink, which is considered to be the final rinse. The final rinse should always be done with demineralized waters such as distilled, deionized, or reverse osmosis water. This step is critical because it can help to prevent the formation of pyrogens, which can occur from bacterium formation on medical devices that have not been properly rinsed, contributing to fever once released into the bloodstream. Decontamination in an Instrument Rack Decontamination typically occurs in the mechanical washer. After surgical instruments are cleaned, they’re placed on an instrument rack and sent through the mechanical washer for decontamination. Instruments loaded in the washer-decontaminator must be open and free of gross debris to ensure optimum decontamination. The instruments are washed with a low- sudsing detergent at temperatures ranging from 140°F to 180°F (60°C to 82°C). Instrument Rack for Decontamination decontaminated Sterile Processing Technology, Part 1 / Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 64 of 90

Note that contaminated items should always be transferred in a biohazardous container to limit cross-contamination, which is the mixing of clean and dirty items together. As you can recall from earlier, the decontamination area is a highly regulated area. Anyone entering or working within this area must wear the appropriate forms of personal protective equipment (PPE). The following guidelines describe the composition of the decontamination department: Negative air pressure for contaminant containment Sharps collection device within the area Proper disposal area for hazardous waste Eyewash station in visible area Area for wearing and removing PPE Su²cient space to accommodate all equipment, supplies, and instrumentation Have an area with a separate hand-washing sink Have a distinct area for cleaning and decontaminating instruments and medical equipment Sterile Processing Technology, Part 1 / Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 65 of 90

Cleaning Read Chapter 8 in your textbook. Then, read this section. Before a device can be cleaned, it must undergo specific steps. This process should be conducted in the following order: 1. Sorting 2. Washing 3. Rinsing 4. Presoaking 5. Drying Sorting is a critical step in the cleaning process. How do you sort items that need cleaning? In sterile processing, gentle items must be kept separate from heavy items to discourage irreversible damage. Washing, as you may already assume, includes the friction needed to remove debris from items. Debris that’s packed on may require presoaking. Cleaning Instruments, however, should not be soaked for extended periods because it can result in the production of thick masses of bacteria cells referred to as biofilms. Items not thoroughly rinsed before decontamination can also result in biofilm formation. Biofilms contain bacteria that can be resistant to detergents used for the decontamination of surgical instruments. This step is especially important when caring for instrumentation used on the eye. TASS is an inflammatory response that impacts the sterile anterior chamber of the eye, caused by surgical instruments that weren’t properly rinsed, containing detergent Sterile Processing Technology, Part 1 / Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 66 of 90

residue. TASS can occur in patients approximately 24−48 hours after surgery. Finally, some instruments must be thoroughly dried before undergoing specific sterilization processes. Cleaning surgical instruments that have lumens , which are hollow openings or passageways, can present challenges during the cleaning process. When cleaning lumens, brushes should match the lumen width to adequately clean the space and ensure that trapped particles of debris are completely eliminated. Any instruments with hinges should be opened for effective cleaning. Some instruments that contain multiple parts must also be disassembled prior to cleaning. This is necessary to ensure that hazardous organisms aren’t left behind in unexposed crevices and joints. Cleaning Medical Tools Thoroughly inspecting instruments is key to sterilization effectiveness. Ensuring that scissors are sharp before packaging is an essential process after the instrument is cleaned. To do this, the technician should utilize a latex material that simulates sterile tissues to test for sharpness. This can be done by making several cuts into the material. If the cuts are snagged, the scissor will need to be sharpened. Methods of Cleaning Instruments must be cleaned using the appropriate water quality and temperature. Some cleansers, such as enzymatic cleansers, require a specific water temperature to work effectively. Water temperatures of a minimum of 109°F and a maximum of 140°F (43°C to 60°C) are the recommended temperatures for enzymatic cleaners. Sterile Processing Technology, Part 1 / Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 67 of 90

Decontamination The pH of the water is also important to ensure adequate cleaning. A variety of different detergents are available, including enzymatic, acidic, alkaline, and organic detergents, to decontaminate surgical instruments. Neutral pH is 7. Anything below a pH of 7 is considered to be acidic, and anything above a pH of 7 is considered to be alkaline. The water used for cleaning should also be free of any ions. Technicians should become familiar with IFUs for the detergents they use to ensure that the correct detergent is being used based on the facility’s water quality. Two methods of cleaning are manual and mechanical. Select each tab to learn more. Manual cleaning involves the use of detergents, brushes, and/or cloths to physically remove debris. Soft, nonmetal brushes and towels that are free from lint are recommended for cleaning medical equipment and instruments. Delinting must occur because the lint, if entrapped in the patient, can contribute to adverse reactions, while metal brushes can damage surgical instruments. For manual cleaning, a minimum of three sinks is required. The first sink is used to clean the instruments with water and enzymatic cleaners. The second sink is for an “intermediate rinse” and should be filled with softened water. The third sink is used as a “final rinse” and should contain water free from ions. Distilled, deionized, or reverse osmosis is the preferred water used on a final rinse. Mechanical cleaning involves the use of the ultrasonic cleaner to remove debris. Ultrasonic cleaners use cavitation to loosen tiny particles of debris from small crevices that can be hidden within instruments. They do an excellent job of cleaning laparoscopic and robotic instruments and instruments with lumens. Before putting instruments in an ultrasonic cleaner, the item must be precleaned, which will facilitate the removal of any residual debris from the surgical operation. Instruments must be fully submerged and lumens completely filled with fluid from cleaners for effective cleaning during the cavitation process. Finally, any items with hinges should be completely opened. Sterile Processing Technology, Part 1 / Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 68 of 90

Other sources of mechanical cleaners include: Irrigating sonics Washer-disinfectors Cart washers Automated endoscope reprocessors Pasteurizers Most of these mechanical processes use thermal disinfection to clean and decontaminate items. More on thermal disinfection will be discussed later. Irrigating sonics are excellent tools to effectively clean laparoscopic devices. These sonics have connectors that attach to irrigation ports that flush fluid throughout the instrument, helping to facilitate cleaning and removal of gross debris. Washer-disinfectors work by a process known as impingement . This process works by allowing a spray-force action of water under pressure to remove gross bioburden from surgical instrumentation once it’s placed into the chamber of the disinfector. There are typically three steps that occur in these types of mechanical washers. Cool pre-rinse which saturates instruments with water or enzymatic detergent Detergents are added to heated temperatures, employing impingement reaction within the chamber of disinfector Instruments are rinsed and, in some washers, lubricated Watch the this video for a behind the scenes look at the sterilization process for surgical tools. https://www.youtube.com/embed/TfqT-QiKOqE?rel=0&showinfo=0&wmode=opaque Direct Link: Behind the Scenes: Sterile Processing Department (https://www.youtube.com/embed/TfqT-QiKOqE?rel=0&showinfo=0) Detergents Detergents are picked based on the type of soil needing penetrating. Typically, there are four types of soil that are present in humans: 1. Lipids (fat) 2. Blood or fecal matter 3. Mucous and albumin (protein) 4. Starches Proteolytic or protease enzymatic detergents are used to decontaminate instruments engulfed in proteins. Lipolytic or lipase detergents are used to cleanse and break down fatty tissues from surgical devices. Amylase detergent is used to break down starches on surgical devices. Detergents are chosen based on these factors mentioned and more. Sterile Processing Technology, Part 1 / Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 69 of 90

For instance, emulsifier detergents may need to be used when it might be necessary to combine oil and water. Surfactants are used to increase the solubility of specific organic compounds. Chelating agents are used when hard water is used to decontaminate surgical instruments. This detergent reacts to hard water, disallowing its minerals from interfering with the effectiveness of the detergent. Neutral, acidic, and alkaline detergents are also used, depending on the type of soil present. This video features an informative walk-through of the decontamination process and includes an explanation of the use of detergents. https://www.youtube.com/embed/xKWBWRQ51WY?rel=0&showinfo=0&wmode=opaque Direct Link: Decontamination and Cleaning (https://www.youtube.com/embed/xKWBWRQ51WY? rel=0&showinfo=0) pH: 1.6− 3 Used to remove hard water, urine, and other mineral deposits pH: 6− 8 Used to decontaminate certain organic compounds and soil pH: 8− 11 Used to destroy organic compounds such as blood and fats Sterile Processing Technology, Part 1 / Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 70 of 90

Disinfection Read Chapter 9 in your textbook. Then, read this section. Disinfection is a process used in the sterile processing department to disinfect and, in some cases, sterilize surgical instruments and equipment. Before moving on, think of any household disinfectants you utilize at home. Where do you use these products? What gets accomplished by using them? When you think about the responses to these questions, you’ll quickly find that some of the disinfection practices used at home correlate with the practices of disinfecting in the sterile processing department. Disinfection Types of Disinfectants Although there are similarities in how you disinfect at home and within the sterile processing department, the types of products used are distinct, depending on the environment and device used. The two most common types of high-level disinfectants are glutaraldehyde and ortho- phthaldehyde . Cidex is one of the most common types of glutaraldehydes used in sterile processing departments. It’s used for flexible and/or rigid endoscopes that can be immersed within the solution according to the manufacturer’s IFU’s. Glutaraldehyde 2% is often classified as a sterilant because of its ability to destroy spores once a device is soaked in the formula for 8 to 12 hours. Ortho-phthaldehyde is non-toxic and doesn’t have to be activated, which occurs by the mixing of acidic or alkaline chemicals with glutaraldehyde for use. Items must be immersed for 5 to 12 minutes to achieve high-level disinfection. One of the distinct qualities of using ortho- phthaldehyde is one in which the medical device disinfected will stain the color blue when not properly disinfected. High-level disinfectants can be used on instrumentation and/or equipment High-level disinfectants are highly toxic and must be rinsed thoroughly off of instruments before being used on patients. Because of the nature of the toxins found in disinfectants such as cidex, glutaraldehyde, and ortho-phthaldehyde, the appropriate PPE must be worn when handling disinfectants. Sterile Processing Technology, Part 1 / Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 71 of 90

that will be used within the human body. This type of disinfectant is strong enough to kill most spores, depending on the concentration, but it can also kill certain bacteria, such as mycobacteria, which is the bacteria that produces tuberculosis. Thermal Disinfection As you've learned, there’s a system for reprocessing instruments that incorporates Spaulding’s principles. High-level disinfection or thermal disinfection is used for these items touching the patient’s mucous membranes, except in dental procedures. There are other ways to disinfect surgical instruments. These methods include the use of extreme temperatures to destroy microorganisms. The use of thermal disinfection can destroy all living microorganisms with the exclusion of bacterial spores. This disinfection method utilizes heat to minimize the number of microorganisms on items. Pasteurization equipment is a type of thermal disinfection device that destroys microorganisms at temperatures ranging between 150 degrees to 170 degrees Fahrenheit. Before any item can be thermally disinfected, the same principles of decontamination must be applied. Objects must be thoroughly cleaned before they can be disinfected. Thermal Disinfection After cleaning and decontaminating, instruments can go through a mechanical washer in which they can become thermally disinfected. After these items are removed from the washer, the sterile processing technician can handle them with clean, bare hands to prepare them for the next phase of the reprocessing cycle. You've already learned about the cleaning actions in washer-disinfectors and ultrasonic cleansers. Washer-disinfectors also use thermal disinfection to disinfect surgical instrumentation. To reprocess devices such as flexible endoscopes, an automated endoscope reprocessor (AER) device is used for thermal disinfection. These machines are great for reprocessing scopes in the sterile processing department because they limit the exposure of liquid disinfectants (such as glutaraldehyde) to the technician. This process allows for continuous exposure of the cleaning agent within the reprocessor. The technicians should always ensure that they’re following the appropriate manufacturer’s instructions before using an automated endoscope reprocessor. Sterile Processing Technology, Part 1 / Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 72 of 90

Practice: Cleaning, Decontamination, and Disinfection Open Link Sterile Processing Technology, Part 1 / Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 73 of 90

Cleaning, Decontamination, and Disinfection Exam Open Link Sterile Processing Technology, Part 1 / Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection Lesson 3: Cleaning, Decontamination, and Disinfection © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 74 of 90

Lesson 4: Surgical and Complex Surgical Instruments Sterile Processing Technology, Part 1 / Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 75 of 90

In this lesson, you’ll become familiar with surgical instrumentation. Before you begin to read the next few sections, please read through Chapters 10 and 11 of your textbook. Surgical instruments are utilized in many areas within the hospital, not just the operating room. As you’re getting acclimated to this new field, you may find that it’s overwhelming to identify the thousands of surgical instruments that are made available to the perioperative staff. Don’t get discouraged. With frequent practice, you’ll begin learning these instruments in no time. By the end of this lesson, you’ll be able to… Identify basic and complex instrumentation Describe the design of instrumentation and guidelines for reprocessing Identify how surgical instruments are used in specific surgical procedures and are pertinent to their specialties In this lesson, you’ll be graded on… Lesson Quiz: Surgical and Complex Surgical Instruments There's one required quiz at the end of this unit. You need an overall average of 65% on all unit exams to successfully complete this course. Sterile Processing Technology, Part 1 / Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 76 of 90

Introduction to Surgical Instruments Read Chapter 10 in your textbook. Then, read this section. Proper identification of surgical instruments, knowing how they’re used, and for what specialties they’re used is a much-needed skill for the sterile processing technician. Demonstrating this proficiency in knowledge can prevent some of the following errors: Damage to instruments Missing instruments Malfunction of instruments Instruments displaced out of correct containers Surgical Instruments Utilized Within the Hospital To master the identification of surgical instruments and what specialties they’re used in, it’s important that the technician become familiar with the various surgical specialties practiced within the perioperative environment. The following are the most common surgical specialties: General Vascular OB/GYN Neurology Orthopedics Plastics Ear, nose, and throat (ENT) Cardiothoracic Genitourinary (GU) Robotic, endoscopic, and laparoscopic The tables below list some of the most common procedures in each specialty. Please keep in mind that this is only a small list of procedures that are a part of a broader scale of procedures per each specialty. Sterile Processing Technology, Part 1 / Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 77 of 90

General Vascular OB/GYN Neurology Orthopedics Inguinal hernia repair AV fistula Hysterectomy Craniotomy Total knee arthroplasty Appendectomy Thrombectomy Tubal ligation Burr holes Total hip arthroplasty Colectomy Greenfield filter Dilatation and curettage Laminectomy Distal radius repair Colostomy Abdominal aortic aneurysm Hysteroscopy Cervical fusion Anterior Cruciate Ligament repair Plastic ENT Cardiothoracic Genitourinary Robotic/Endoscopic/Laparoscopic Breast reduction Tympanoplasty Pacemaker Hydrocelectomy Laparoscopic cholecystectomy Breast augmentation Myringotomy CABG Prostatectomy Laparoscopic robotic hernia Abdominoplasty Stapedectomy Thoracotomy Nephrectomy Laparoscopic robotic hysterectomy Skin graft Cochlear implant VATS Penile implant Colonoscopy Sterile Processing Technology, Part 1 / Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 78 of 90

Overview of Surgical Instruments There is no textbook reading assignment for this section. Classification of Surgical Instruments Surgical Instruments Instruments can be classified as suctioning, probing, dilating, retracting, exposing, grasping, cutting, clamping or occluding, and viewing. These terms match the instrument’s function. For example, clamping instruments are used to clamp off bleeders. Select each item to learn more. Suctioning devices are used to suction blood and other bodily fluids during a surgical procedure. Common suctioning devices include Fraziers, Pooles, and Yankauer suctioning devices. ± Clamping and occluding instruments are used to clamp off bleeders and provide hemostasis. Hemostasis is a term used within the perioperative environment that describes the control of bleeding. An example of a clamping and occluding instrument would be a hemostat clamp. Other common clamping and occluding instruments include the Kelly and Kocher clamping instruments. ± Cutting instruments are used to dissect tissues and cut suture material, drains, and dressings. Metzenbaum scissors , which are a very common instrument used within the operative environment, can be used to cut or dissect delicate sterile tissues. Other common scissors include straight and curved mayo scissors. ± Sterile Processing Technology, Part 1 / Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 79 of 90

The sterile processing technician should also become knowledgeable about eye and dental instruments used within the operative setting. Some dental and eye instruments have very delicate tips and must be handled carefully by the sterile processing professional when packaging. It can cost thousands of dollars to have these instruments repaired. Dental instrumentation can be classified as noncritical, semicritical, or critical. Critical dental instrumentation penetrates the bone or soft tissue inside the mouth. Eye instruments are used on surgical procedures such as cataracts, detached retinas, and vitrectomies. Deionized or distilled water must be used to thoroughly rinse eye instrumentation because of the potential risk of the patient contracting toxic anterior segment syndrome (TASS), which is a rare but devastating complication of eye surgery. Grasping and/or holding instruments are used to “pick up” or grasp tissues and other structures within the human body. These instruments can also be used to exert traction. Many grasping and holding items come in the form of forceps. Many common forceps in the operative environment include Debakeys, Adson, Gerald, Russian, and many more. ± A Richardson retractor would be used to retract or expose an organ or organs in the abdominal cavity for visualization. In thoracic surgery, a rib spreader may be used to retract or expose the chest area. Other common retractors you may become accustomed to seeing include the Army-Navy, Deaver, and Malleable retractors. ± The surgical team has to have exposure to view the area they’re operating on. A 30- degree lens would be used to visualize the internal organs in a minimally invasive or endoscopic procedure. ± Cutting instruments are used to dissect tissues and cut suture material, drains, and dressings. Metzenbaum scissors , which are a very common instrument used within the operative environment, can be used to cut or dissect delicate sterile tissues. Other common scissors include straight and curved mayo scissors. ± Dilating instruments are used to widen a space, such as a cervix. Examples of dilators may include Hegar and Pratt. Finally, cannulas may be inserted for drainage of a specific structure within the human body. These instruments have a lumen through their center. ± Sterile Processing Technology, Part 1 / Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 80 of 90

Anatomy of the Surgical Instrument Just as the human body has anatomical parts and functions, so do the surgical instruments surgeons use every day. Each of these parts serves a specific function. The major parts of a surgical instrument include the finger rings, ratchets, shanks, jaws, and box locks. Review the image below for the various components of the surgical instrument. Select each item to learn more. The jaws touch the human tissue. Jaws can be used to dissect human tissue or clamp bleeders during surgery. Several of the jaws of instrumentation contain serrations, which can be indicated by their parallel grooved appearance. ± Box locks typically have a tiny screw placed on them to keep them secure and assist in keeping the jaws of the instrument together. The box lock is considered to be the weakest part of the surgical instrument and can be extremely difficult to clean. ± Ratchets keep surgical instruments closed. This part of the instrument must properly function to ensure that the instrument doesn’t slide off of tissue or suture needles once the jaw makes contact with the tissue or needle. Ratchets are one of the most difficult areas of the surgical instrument to clean. Picture this example: The surgical technician, who is the professional in the operating room assisting the surgeon during surgery, begins to hand a needle holder (instrument used for suturing) with a needle attached to it to the surgeon. While the surgical technician is passing the instrument to the surgeon, he or she ensures that the ratchet is closed so that the needle doesn’t fall from the jaw of the instrument, which can lead to getting lost in the patient. ± Sterile Processing Technology, Part 1 / Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 81 of 90

Disposable, floor-grade, and surgical-grade instruments are the most common instruments used within the hospital system. Disposable instruments , which are often utilized in emergency departments, are used once and then discarded. These instruments are easily distinguished from reusable instruments because they’re clearly marked as being single use. Technicians should have a keen eye in ensuring that these instruments don’t get mixed with surgical-grade instruments for reprocessing. Surgical instruments should never be engraved because of the potential for harmful microorganisms to hide in the crevices of the portion of the instrument engraved. These instruments can be chemically etched if marking the instruments is a necessity. Surgical-grade instruments are the highest grade of instrumentation. These instruments are used during various surgical procedures. Surgical-grade instruments can be decontaminated and sterilized numerous times without rusting. They should be lubricated daily with a water- soluble lubricant to maintain their quality. The FDA mandates that surgical-grade instruments be stamped with their country of origin. Floor-grade instruments are those marked as being made in Pakistan. These instruments have limited use and should never be placed on surgical instrument trays. They have a tendency to rust and are manufactured with a very low-quality grade of stainless steel. These instruments have a mirror finish to them and can be easily distinguished from surgical-grade instruments. The most noncorrosive instruments are 300 series (austenitic) stainless steel . This series is used to make basins, bowls, and various retractors. The 400 series (martensitic) instruments are stain-resistant as long as they’re not exposed to harsh substances such as sodium- hypochlorite, saline, or iodine. Examples of 400 series instruments include forceps, chisels, and scissors. Protecting Surgical Instruments As you may have already discovered, it’s critical to prevent cost inflation and patient injuries by protecting surgical instruments from preventable damage. It’s always the sterile processing technician’s duty to ensure that surgical instruments are well-managed within the sterile processing department. Instruments should never be soaked or cleaned with bleach, saline, or any other non-approved detergent or disinfectant. Some of the following guidelines should be followed to protect surgical instruments from damage: to getting lost in the patient. The finger rings are what the surgeon uses to grasp and physically open and/or close the instrument. ± Shanks are used as a reinforcement to keep an instrument closed. This area of the instrument is typically where the surgeon places his or her hand to assist with suturing. ± Always follow the manufacturer’s instructions. ± Never place heavy items on lighter ones. ± Sterile Processing Technology, Part 1 / Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 82 of 90

Watch this informative video on handling different types of surgical instruments. https://www.youtube.com/embed/LLXPX4oz6es?rel=0&showinfo=0&wmode=opaque Direct Link: Preparation and Packaging and Surgical Instruments (https://www.youtube.com/embed/LLXPX4oz6es?rel=0&showinfo=0) Keep delicate, mini, or microscopic/small instruments in an approved protective container away from other instruments to prevent damage. ± Use metal stringers (instrument holders) to assemble hinged instruments; this is e±ective and e²cient. ± Always nestle forceps closely together when packaging. ± Curved instruments should always be curved the same way. ± Never put too many instruments into a container. ± Neutral pH lubricant (instrument milk) can be used, according to the manufacturer’s speci³c directions, to extend the life of surgical instruments. ± Sterile Processing Technology, Part 1 / Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 83 of 90

Complex Surgical Instrumentation Read Chapter 11 in your textbook. Then, read this section. Complex instruments have special requirements for reprocessing. Examples of complex instruments utilized within the sterile processing department include drills, powered instruments, microscopic instruments, robotic and laparoscopic instruments, endoscopes, and instruments with lumens. Sterile processing technicians may need additional training on how to properly clean, decontaminate, disinfect, package, and sterilize these types of instruments. Complex Surgical Instrumentation Powered and Microscopic Instruments Powered instruments can be difficult to clean because of how they’re constructed. These items contain numerous electrical components that can make them difficult to reprocess without proper training. Items such as some batteries and drills can’t be immersed in water because it impacts their ability to function properly once the water saturates the electrical units. These instruments should be wiped down with soft cloths and the appropriate disinfectant according to the manufacturer’s instructions. Examples of these powered instruments include the following: Sternal saws Dermatomes and dermabraders Dental drills Wire drivers Cebatomes Orthopedic drills such as reciprocating, sagittal, and oscillating saws Microscopic instruments should not be mixed in with heavy instruments during cleaning or decontamination because of the potential risk of damage. Some microscopic instruments may require manual cleaning because the force of mechanical cleaning could potentially damage them as well. Vascular instruments and instruments used within the orbital cavity are often classified as microscopic. Special care must be used when handling these items. Microscopic items should always be placed on top of heavier items to protect the fine parts of these instruments. Sterile Processing Technology, Part 1 / Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 84 of 90

Minimally Invasive Instruments Surgeons perform minimally invasive surgery for numerous reasons. It has numerous benefits such as less bleeding and chances for infection, smaller scars, and less pain and discomfort for the surgical patient. Patients who have undergone multiple previous procedures aren’t good candidates for minimally invasive surgery. They might have numerous types of surgical scar tissue that obstruct the view of organs on the screen. This type of surgery requires the use of multiple stab incisions and small instrumentation that’s inserted to visualize the inside cavity. Patients typically have shorter recovery times when they undergo minimally invasive procedures because the incisions are not as invasive and are quicker to heal. Most patients having this type of surgery can also go home on the same day. Robotic and laparoscopic instruments have complex tips and working components that can make cleaning and decontamination difficult as well. Some laparoscopic instruments must be disassembled before reprocessing. Minimally Invasive Instruments Many minimally invasive instruments feature flush ports that can be used to flush water through them to remove hidden debris. These items may also have lumens that must be carefully inspected and cleaned with the appropriate-sized brush to ensure the removal of all microorganisms. The insulation on these instruments should be inspected to ensure that the patient or surgical team aren’t injured by damaged equipment. Damage to the insulation can result in thermal damage to the patient’s tissues or electrocution of the operative staff. Cameras, light cords, and lenses should be handled appropriately as well because they can be easily damaged if mismanaged and cost several thousands of dollars to repair. These items typically can’t sustain extreme heat. Most of these items are cleaned manually and sterilized using low temperatures. Light cords have microscopic fibers and wires within them that can break if coiled too tightly. The technician must take this into consideration when cleaning and preparing the instrument. The tips of camera lenses should be separated from other surgical instruments and carefully inspected and handled before processing. Endoscopes Endoscopes , whether rigid or flexible, must be cleaned and processed according to the manufacturer’s instructions. Most endoscopes are processed in Automated Endoscope Reprocessors (AERs) . Flexible endoscopes are complex and expensive devices that require Sterile Processing Technology, Part 1 / Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 85 of 90

special training to reprocess. Most of these scopes require leak testing to ensure there’s no leaking of the endoscope and that a watertight seal exists. The flexible endoscope being used will determine which body structure is viewed. Bronchoscopes are used to visualize the bronchus, which includes the air sacs and lungs. The upper digestive tract can be visualized by utilizing a gastroscope . Visual inspection of the large intestine can be done using a colonoscope . Cystoscopes are complex, flexible instruments used to visualize the urethra or bladder. The flexible endoscope consists of several parts that include: Select each item to learn more. Specific steps must be followed when reprocessing flexible endoscopes to ensure reprocessing effectiveness and safety before the endoscope makes contact with the surgical patient. These are precleaning, leak testing, cleaning, disinfection with a high-level disinfectant, drying (some facilities use alcohol to facilitate the drying of the endoscope by flushing it down the ports), and storage in a clean, dry area until it’s ready to be used. allows for suction and irrigation and contains the control knobs that rotate distal tip ± contains a biopsy post, inserted into the patient’s body ± the portion of the endoscope most prone to the fluid invasion ± portion of scope that attaches to light source ± Sterile Processing Technology, Part 1 / Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 86 of 90

Surgical Instrumentation - Endoscope Count Sheets Count sheets are used to inventory complex or general instrumentation that are assembled and packaged for sterilization. This process assists the operative team in identifying when instruments are missing. If an instrument is missing before a surgical procedure begins, it’s documented so that an accurate count of instruments in the room are accounted for prior to beginning the surgical procedure. Every instrument within a surgical tray must be accounted for. Count sheets also aid the sterile processing technician in properly assembling specific surgical instrument trays with the correct instruments. These sheets are often used in the operating room as well to keep an accurate account of instruments open. Before a surgical procedure begins, instruments are counted according to the inventory indicated on the count sheet. After the procedure, an inventory is taken again to ensure that the instruments initially accounted for are present after the procedure. Sterile Processing Technology, Part 1 / Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 87 of 90

Practice: Surgical and Complex Surgical Instruments Open Link Sterile Processing Technology, Part 1 / Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 88 of 90

Case Study Practice: Decontamination Principles Open Link Sterile Processing Technology, Part 1 / Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 89 of 90

Surgical and Complex Surgical Instruments Exam Open Link Sterile Processing Technology, Part 1 / Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments Lesson 4: Surgical and Complex Surgical Instruments © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 90 of 90