Sterile Processing Study Guide: Key Concepts & Responsibilities

Sterile Processing Study Guide Advancing Technologies Minimally Invasive Surgery  Surgical procedure that causes little or no trauma or injury to the patient.  Involves smaller incisions, less tissue damage and bleeding, less pain etc. Decontamination  Decontamination is the physical or chemical process that renders an inanimate object safe for further handling.  The decontamination area is where all soiled instruments from the OR are received along with other items such as medical equipment.  When medical devices are received, they must be properly sorted, disassembled and cleaned.  All items returned to the decontamination area are considered contaminated and potentially infectious.  Items cannot be considered sterile or high level disinfected if they are not effectively cleaned; therefore, cleaning is the first step of the sterilization process.  To meet the facilities and the occupational safety and health requirements, SP must wear personal protective equipment (PPE).

 Personal Protective Equipment – is part of Standard Precautions for all healthcare workers to prevent skin and mucous membrane exposure when in contact with blood and body fluids of any patient. o Scrubs o Gloves o Face Masks o Shoe Covers o Eye Protection Preparation & Packaging  After items are safe for handling, they are delivered to the prep and pack area.  Each item should be inspected for cleanliness, proper function and possible defects.  Instruments and other devices should be inspected, packaged and labeled in preparation for sterilization. Sterilization  Sterilization - process by which all forms of microbial life (bacteria, spores, viruses) are destroyed.  Instructions for use (IFU)- information provided by a device manufacturer that provides detailed instructions on how to properly use or process the device.  Anyone working in this area must wear scrub suit and hair coverings. Sterile Storage & Distribution

 The major portion of the work area involves receiving, storing, and dispensing supplies and sterile instruments.  Major focus in this area is servicing the OR.  Case cart system - inventory control system for products and equipment that involves use of an enclosed or covered cart.  Case cart- cart prepared for an individual procedure. Usually contains instruments, supplies needed for a specific procedure.  Doctors (physicians) preference card- document that identifies a physician’s needs for a specific medical procedure.  Case cart pull sheet (pick list)- list of specific supplies, utensils and instruments for a specific procedure. SP use these lists to assemble the items needed for an individual procedure.  Supply Chain Management (Materials Management Department)- department that procures and distributes resources and manages supplies, goods, and services to providers.  Personnel working in this area usually gather instruments and supplies needed for all scheduled surgical procedures during the day or evening before they will be used. Ancillary Areas & Equipment  Specialty procedure carts such as isolation and emergency carts can be processed by the SPD.  They are cleaned, inventoried and restocked between patient use and may be stored in the SP area until needed.

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Loaned Instruments  Loaned instruments are brought in for a specific patient procedure for evaluation of new technology or to use while existing devices are being repaired. Safety Practices  Use standard precautions to control the spread of infection.  Standard Precautions- method of using appropriate barriers to reduce the risk of transmission of bloodborne and other pathogens. Basic Job Responsibilities  Job description- Human Resources tool that identifies the major tasks performed by individuals in specific positions. Medical Terminology Hemi = Half Chole = Bile Ectomy = Surgical Removal Al = Pertaining to the skin Arthro = Joint Electro = Electrical Activity Plasty = Surgical Restoration Ic = Pertaining to blood Gastro = Stomach Encephalo = Brain Ac = pertaining to the heart Ary = Pertaining to the lungs Colo = Colon Gram = Written record of Procto = rectum Endo = within

Para = Beside/Near Ous = Pertaining to cancer Ittis = inflammation Broncho = bronchus Septo = Dividing Wall Herni = rupture Pexy = Fixatation Ectomy = Removal Rhino= nose Rrhapy = to suture Chir = hand Arterio = artery Otomy = Cutting into an organ Fascia = fibrous membrane Oscopy = Visual examination Cise = cut Bacteria  Endoscopes (spores) – microorganisms capable of forming a thick wall around themselves, enabling them to survive in adverse conditions.  Gram negative bacteria – have an outer membrane that will not retain the purple stain after treatment with iodine (E coli)  Gram positive bacteria – have no outer membrane and will retain the purple stain (Staphyloccus aureus)  Prions – infectious protein particle that does not trigger an immune response and is not destroyed by extreme heat or cold. Principles of Asepsis  Aseptic technique – any activity or procedure that prevents infection or breaks the chain of infection.

 Asepsis (medical) – clean technique, procedures performed to reduce the number of microorganisms and minimize their spread.  Asepsis (surgical) – surgical technique, procedures performed to eliminate the presence of all microorganisms and prevent the introduction of microorganisms to an area. Personal Hygiene 1. Remove all jewelry. 2. Turn on faucet using a paper towel. 3. Wet hands and apply soap. 4. Work soap into a lather and scrub hands for at least 20 seconds. 5. Keep hands at a lower angle than elbows to prevent dirty water from running back onto arms. 6. Interlace fingers to clean between them. 7. Rinse hands thoroughly. 8. Dry hands with clean disposable towels. 9. Turn off the faucet using a clean disposable towel. How to Don (Put on) PPE (Before beginning, don surgical scrubs, a head cover and appropriate shoes and perform hand hygiene). 1. Gown 2. Mask

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3. Goggles 4. Shoe covers 5. Gloves Doffing PPE 1. Remove shoe covers. 2. Remove gown and gloves. 3. Remove goggles. 4. Remove mask. 5. Remove face cover. 6. Wash hands.  Restricted Areas- areas where sterile surgical procedures are performed and the decontamination area of the SPD. o Surgical attire, hair coverings and mask  Semi restricted- areas include peripheral support areas to the OR o Scrub attire and hair coverings  Unrestricted areas - include normal traffic areas such as hospital corridors.  The use of fluorescent orange or orange red biohazard labels to identify contaminated items.  The decontamination area has a negative (lower) air pressure.  SP temperature and humidity are controlled by the facility heating, ventilation and air conditioning (HVAC) system. Elements of Transmission & The Chain of Infection

 6 elements  Causative agent- microorganism (pathogen) that causes an infectious disease.  Reservoir – Place where an infectious agent (microorganism) can survive.  Portal of exit – path by which an infectious agent leaves the reservoir.  Mode of transmission – method or transfer of an infectious agent from the reservoir to a susceptible host.  Portal of entry - the path used by an infectious agent to enter a suspectable host.  Susceptible host – person or animal that lacks the ability to resist an infection by an infectious agent.  Colonization – process that occurs when microorganisms live on or in a host but do not invade tissues or cause damage. Regulations & Standards  Regulation – Rules issued by administrative agencies that have the force of the law.  Standard – uniform method of defining basic parameters for processes, products, services and measurements. Regulatory Agencies  U.S. food and Drug Administration (FDA) – responsible for ensuring that medical devices are safe and effective for patient care.

o Regulates sterilizers, high disinfectants, packaging materials and biological indicators. o Medical Device Classification:  Class I devices – low risk devices (surgical bed, instruments)  Class II devices – devices considered to pose potential risks great enough to warrant a higher level of regulation (BI & Chemical Indicators)  Class III devices – most stringently regulated devices (heart valves, pacemakers)  Must obtain premarket approval.  Pre-market approval (PMA) – FDA Process of scientific and regulatory review to evaluate the safety and effectiveness of Class III medical devices.  Centers for Disease and Prevention – federal agency that works to promote health and quality of life by preventing and controlling disease, injury and disability.  U.S. Department of transportation (DOT) - federal government agency dedicated to ensuring a fast, safe and efficient transportation system.  U .S. Environmental Protection Agency – regulatory agency responsible for maintaining greenhouse gases and toxic emissions, regulating the

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reuse of solid wastes, controlling indoor air pollution and developing and enforcing chemical regulations.  Occupational Safety and Health Administration (OSHA)- primary role is to protect workers from occupationally caused illnesses and injuries.  Association for the Advancement if Medical Instrumentation – develop standards and technical information reports. o Recommenced practices for contaminated item transport o Standards (AAMI)- voluntary guidelines representing a consensus of AAMI members that are intended for use by healthcare facilities and manufacturers to help ensure that medical instrumentation is safe for patient use. o Technical Information Reports (TIRs)— reports developed by experts in the field that contain valuable information needed by the healthcare industry,  American National Standards Institute- primary mission is to enhance the global competitiveness of the U.S. business and American quality of life by promoting and facilitating voluntary consensus standards.  Association of perioperative Registered Nurses (ARON) – professional organization dedicated to providing optimal care to the surgical patient.  Association for Professionals in Infection control and epidemiology (APIC)- voluntary organization whose members work to prevents HAIs.

 The Joint Commission (TJC)- private, independent organization that develops standards for healthcare facilities (quality) o They conduct on site surveys at least every three years.  World health Organization (WHO)- agency that works to further international cooperation in improving health conditions. Point of Use Treatment Guidelines  Follow the manufacturers instructions for point of use treatment.  Separate reusable sharps from the other instruments. Place instruments with sharp points or edges in a separate container to reduce the risk of injuries from sharps.  Protect delicate instruments from damage during transport by segregating them into different containers or placing them on top of heavier instruments.  Separate reusable linen. Reusable linen should be removed and placed into appropriate bag or container.  Sharp items should be placed a hard sided container labeled biohazard. Ensure that reusable items are not removed and discarded with disposable components.  Open hinged instruments, disassemble multi part instruments and place instruments in the appropriate instrument tray in an orderly manner.  Opening and disassembling instrumentation allows pretreatment solutions to reach all areas of the instrument.

 Place heavy instruments on the bottom of the tray with lighter instruments on the top.  Do not place any items on top of handle cords, endoscopes and cameras. Transport of Soiled Items  The best way to transport soiled instruments is in enclosed carts.  If an open transport cart is used, the cart must have a solid bottom shelf to prevent drips and spills and the cart must be covered during transport.  Smaller number of instruments from other departments can be transported in dedicated transport containers or in plastic bags that are clearly labeled biohazard.  Large items can be transported in special carts designed for soiled item transport.  Metal trays and containers should not be placed on top of more fragile plastic trays and containers.  Do not mix sterile and soiled instruments in the same cart, it can cause contamination.  SP technicians should always yield to patients and visitors I hallways and at elevators. Decontamination Engineering Controls  The ventilation system should allow for no less than 10 air exchanges per hour.

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 The decontamination area should be under negative pressure. Sinks  Each workstation will have three sink bays for washing, rinsing and final rinsing.  A three sink arrgangement used for manual cleaning should consist of: o A wash sinks with water and detergent or enzymatic solution. Fill water should have a temperature range of 80–110-degree Fahrenheit. o Pg 112

Sterile Processing Study Guide

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