APIC DFW PROFESSIONAL ADVANCEMENT CHAPTER 10 REVIEW: CLEANING, STERILIZATION, DISINFECTION & ASEPSIS

Transcription

1 APIC DFW PROFESSIONAL ADVANCEMENT CHAPTER 10 REVIEW: CLEANING, STERILIZATION, DISINFECTION & ASEPSIS

2 Test Your Knowledge 1. Type of germicidal action required for semi-critical items: a) Kills all microorganisms except high numbers of bacterial spores b) Kills all vegetative bacteria, fungi & lipid viruses c) Kills all microorganisms, including bacterial spores d) Kills all visible contamination

3 Test Your Knowledge 2. The first step in the sterilization process is: a) Wrapping of the equipment prior to placing in autoclave b) Pre-cleaning by applying enzymatic cleaner or detergent to the used equipment c) Taking the equipment to the Sterile Processing Dept. via biohazard container d) Cleaning the equipment via manual or mechanical means

4 Test your knowledge 3. Types of antiseptics include all of the following except: a) Iodophors b) Chlorhexidine, 2 & 4% aqeuous c) Glutaraldehyde, 2.0% d) Alcohols, 60-95% e) PCMX f) Triclosan

5 Cleaning, Sterilization, Disinfection & Asepsis CIC exam contains 15 questions on these topics, covering: 1. Identification & evaluation of appropriate cleaning, sterilization & disinfection practices 2. Collaboration with others to assess products under evaluation of their ability to be reprocessed 3. Identification & evaluation of critical steps in cleaning, high-level disinfection & sterilization

6 Resources for Study APIC Test of Infection Control & Epidemiology, 4 th edition; focus on chapters 7, 30, 31, 32 & 106 Ready Reference for Microbes Control of Communicable Diseases Manual The Infection Preventionist s Guide to the Lab (all authors/references listed in the study guide) Supplemental reference: William Dr. Rutala s website: disinfectionandsterilization.org

7 Key Concepts 1. Disinfection & sterilization are essential to reduce the risk of transmitting infections pathogen to patients. 2. Failure to comply with scientifically based guidelines has led to numerous outbreaks 3. Adherence to evidence-based recommendations on the preferential methods for cleaning, disinfection & sterilization of patient care medical devices & for cleaning & disinfecting the HC environment are critical components of IP & C programs.

8 Definitions EH Spaulding developed the concept that how an object would be disinfected depended on the object s intended use. 1. CRITICAL - objects which enter normally sterile tissue or the vascular system or through which blood flows should be sterile 2. SEMICRITICAL - objects that touch mucous membranes or skin that is not intact require a disinfection process (high-level disinfection[hld]) that kills all microorganisms except for high numbers of bacterial spores 3. NONCRITICAL - objects that touch only intact skin require low-level disinfection

9 Table 31-1 Methods for Disinfection and Sterilization of Patient-Care Items and Environmental Surfaces Process Level of Microbial Method Examples Inactivation (with processing times) Sterilization Destroys all High temperature Steam (~40 min), dry heat (1-6 hr microorganisms, depending on temperature) including bacterial spores High-level disinfection (HLD) Destroys all microorganisms except high numbers of bacterial spores Low temperature Ethylene oxide gas (~15 hr), hydrogen peroxide gas plasma (28-52 min), ozone (~4 hr), hydrogen peroxide vapor (55 min) Liquid immersion Chemical sterilants include*: >2% glut (~10 hr); 1.12% glut with 1.93% phenol (12 hr); 7.35% HP with 0.23% PA (3 hr); 8.3% HP with 7.0% PA (5 hr); 7.5% HP (6 hr); 1.0% HP with 0.08% PA (8 hr); >0.2% PA (12 min at C) Heat-automated Liquid immersion Pasteurization (65-77 C, 30 min) Chemical sterilants/hlds include*: >2% glut (10-90 min); 0.55% OPA (12 min); 1.12% glut with 1.93% phenol (20 min); 7.35% HP with 0.23% PA (15 min); 7.5% HP (30 min); 1.0% HP with 0.08% PA (25 min); ppm chlorine (10 min); 2.0% HP (8 min); 3.4% glut with 26% isopropanol (10 min) Healthcare Application Heat-tolerant critical (surgical instruments) and semicritical patient-care items Heat-sensitive critical and semicritical patient-care items Heat-sensitive critical and semicritical patient-care items that can be immersed Heat-sensitive semicritical items (e.g., respiratory therapy equipment) Heat-sensitive semicritical items (e.g., GI scopes, bronchoscopes, endocavitary probes)

10 Intermediate-level disinfection Destroys all microorganisms except high numbers of bacterial spores Heatautomated Liquid immersion Pasteurization (65-77 C, 30 min) Chemical sterilants/hlds include*: >2% glut (10-90 min); 0.55% OPA (12 min); 1.12% glut with 1.93% phenol (20 min); 7.35% HP with 0.23% PA (15 min); 7.5% HP (30 min); 1.0% HP with 0.08% PA (25 min); ppm chlorine (10 min); 2.0% HP (8 min); 3.4% glut with 26% isopropanol (10 min) Heat-sensitive semicritical items (e.g., respiratory therapy equipment) Heat-sensitive semicritical items (e.g., GI endoscopes, bronchoscopes, endocavitary probes) Low-level disinfection Destroys vegetative bacteria, mycobacteria, most viruses, most fungi but not bacterial spores Liquid contact EPA-registered hospital disinfectant with label claim regarding tuberculocidal activity (e.g., chlorinebased products, phenolics, improved hydrogen peroxide-exposure times at least 1 min) Noncritical patient care item (blood pressure cuff) or surface with visible blood

11 CRITICAL/STERILIZATION Anything entering sterile body tissue Surgical instruments Foley Catheters All central & venous lines Implantable devices Hands via gloves which are entering sterile body sites or handling sterile instruments

12 Sterilization Killing of all microorganisms, including bacterial spores. Examples: Surgical instruments and devices; cardiac catheters; implants; etc. Methods: Steam, gas, hydrogen peroxide gas plasma, vaporized hydrogen peroxide, ozone or chemical sterilization.

13 Steps in Sterilization Immediate application of detergent/enzymatic to all surfaces of used instruments Items then cleaned using water with detergents or enzymatic cleaners Cleaning reduces the bioburden and removes foreign material (organic residue and inorganic salts) that interferes with the sterilization process. Cleaning and decontamination should be done as soon as possible after the items have been used as soiled materials become dried onto the instruments Basic principle: it it s not clean, it can t be sterilized or disinfected!!

14 Washer-Disinfector

15 Ready to package for sterilizer?? No because it s not!

16 Steam Sterilization Most commonly used type of sterilization Six parameters that must be met for sterilization to occur 1. Time 2. Temperature 3. Moisture 4. Direct steam contact 5. Air removal 6. Drying

17 QA Measures to Assure Sterilization 1. Biological Indicators: considered the only true indicators of sterilization because show proof that sterilization cycle actually killed a very hard-to-kill organism (see below) 2. Both control & the biological in sterilizer (which should be placed deep in pack) are incubated; if cycle successful, the organism will not grow in sterilized BI (but control will grow) 3. If failure (sterilized BI grows), none of equipment since last successful cycle should be used. Sterilizer is taken out of use & vendor notified for repairs. If any equipment since last successful load has been used, IP & surgeon are notified. 4. Types of Biological Indicators Bacillus stearothermophilis Moist-heat systems Geobacillus stearothermophilis Bacillus subtilis EO, dry heat systems Bacillus atropheus Bacillus pumilus Radiation-based systems 5. BIs should be run at least weekly, but most facilities run daily; they should also be used after servicing prior to use

18 Sterilization QA, cont. Chemical Indicators: usually tape or strip with print that changes color when temp parameter is met; placed in every load. Sterilizer print-outs: show that machine completed all cycles the details of the process Bowie-Dick: also sometimes placed in packs to ensure that sufficient vacuum condition established; must have adequate vacuum to assure adequate steam penetration Logs are kept of all sterilizer testing; surveyors will usually ask to see the last years worth of data; most facilities keep 3 years of data on file.

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20 Immediate Use Steam Sterilization (IUSS) In 1969, Perkins redefined flash sterilization as an unwrapped item exposed to 270 F for 3 minutes in a gravity sterilizer. Only used for items that must be used immediately Acceptable for processing items that cannot be packaged, sterilized and stored before use but items should be placed in rigid containers prior to IUS to help maintain sterility Because of the potential for serious infections, implanted surgical devices should not be flash sterilized Do not use flash sterilization for reasons of convenience, as an alternative to purchasing additional instrument sets, or to save time Tracking & trending of IUS recommended to identify areas for improvement.

21 Semi-critical/High Level Disinfection For items with mucous membrane or non-intact skin contact, such as: Endoscopes Laryngoscopes, Endocavitary probes Prostate biopsy probes Tonometers

22 Semi-critical/High Level Disinfection Issues with Reprocessing of Semi-critical Equipment Reprocessing semi-critical items has been shown to have a narrow margin of safety Generally, the narrow margin of safety attributed to high microbial load and complex instruments with lumens Any deviation from the recommended reprocessing protocol can lead to the survival of microorganisms and an increased risk of infection Problems encountered with reprocessing semi-critical equipment often related to improper cleaning

23 Transmission of Infection by Endoscopy Kovaleva et al. Clin Microbiol Rev : Scope Outbreaks Micro (primary) Pts Contaminated Pts Infected Cause (primary) Upper GI 19 Pa, H. pylori, Salmonella Cleaning/Disinfection (C/D) Sigmoid/ Colonoscopy 5 Salmonella, HCV 14 6 Cleaning/Disinfection ERCP 23 Pa C/D, water bottle, AER Bronchoscopy 51 Pa, Mtb, Mycobacteria C/D, AER, water Totals Based on outbreak data, if eliminated deficiencies associated with cleaning, disinfection, AER, contaminated water and drying would eliminate about 85% of the outbreaks.

24 FEATURES OF ENDOSCOPES THAT PREDISPOSE TO DISINFECTION FAILURES Require low temperature disinfection Long narrow lumens Right angle turns Blind lumens May be heavily contaminated with pathogens (9-10 logs inside) Cleaning (4-6 log 10 reduction) and HLD (4-6 log 10 reduction) essential for patient safe instrument

25 ENDOSCOPE REPROCESSING 1) PRECLEAN: point-of-use (bedside) remove debris by wiping exterior and aspiration of detergent through air/water and biopsy channels-transport to scope cleaning area in safe manner 2) CLEAN: mechanically cleaned with water and enzymatic cleaner 3) HLD/STERILIZE: immerse scope and perfuse HLD/sterilant through all channels for exposure time (>2% glut at 20m at 20 o C). If AER used, review modelspecific reprocessing protocols from both the endoscope and AER manufacturer 4) RINSE: scope and channels rinsed with sterile water, filtered water, or tap water. Flush channels with alcohol and dry 5) DRY: use forced air to dry insertion tube and channels 6) STORE: hang in vertical position to facilitate drying; stored in a manner to protect from contamination A. CMS & TJC getting more strict on scope storage; should not touch floor or walls of cabinet, or each other, & should be in closed closet/cabinet. 7) Sterilization of scopes with elevators now being recommended (or HLD X 2). 8) Outcome monitoring of scope reprocessing is under consideration; currently process monitoring is all that is required; performance of outcome testing via scope culturing/atp testing under consideration.

26 Germicide High-Level Disinfectants for Semicritical Objects Exposure Time > 8m-45m (US), 20 o C Concentration Glutaraldehyde > 2.0% Ortho-phthalaldehyde 0.55% Hydrogen peroxide* 7.5% Hydrogen peroxide and peracetic acid* 1.0%/0.08% Hydrogen peroxide and peracetic acid* 7.5%/0.23% Hypochlorite (free chlorine)* Accelerated hydrogen peroxide 2.0% Peracetic acid 0.2% ppm Glut and isopropanol 3.4%/26% Glut and phenol/phenate** 1.21%/1.93% *May cause cosmetic and functional damage; **efficacy not verified

27 Workflow, QA and Other Considerations Workflow must be from dirty to clean with no opportunity for cross-contamination Monitoring of HLD chemical: chemical test strips are tested X 3 when opening new bottle, solution is tested with strip before use to make sure it has sufficient concentration remaining; temp. of solution also monitored when using solution Solution much be changed out as recommended by manufacturer (even if concentration still adequate) All of this monitoring info. must be recorded without failsurveyors will ask to see 1 year of records; most facilities keep 3 years of records on file.

28 Workflow, QA and Other Considerations Scopes which have not been used/disinfected must be disinfected on regular basis (most using 7 days) Adequate PPE must be available for staff disinfecting scopes (all HCWs must receive education on PPE use) Appropriate spill kits must be available in proximity of chemical; make sure staff knows where it is, how to use it, etc. Also, the spill kits generally outdate educate staff to monitor expiration dates (& check for yourself when in dept. Round frequently, ask lots of questions. A VERY hot topic for TJC & CMS (which is definitely warranted)

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30 ENDOSCOPE REPROCESSING: CHALLENGES: NDM-Producing E. coli -associated ERCP Epstein et al. JAMA 2014;312: March-July 2013, 9 patients with cultures for New Delhi Metallo-ß-Lactamase producing E. coli associated with ERCP History of undergoing ERCP strongly associated with cases NDM-producing E.coli recovered from elevator channel No lapses in endoscope reprocessing identified Hospital changed from automated HLD to ETO sterilization Due to either 1)failure of personnel to complete required process every time or 2)intrinsic problems with these scopes (not altered reprocessing)

31 ENDOSCOPE REPROCESSING: CHALLENGES Complex [elevator channel]-10 9 bacteria Surgical instruments-<10 2 bacteria

32 Reprocessing of Rigid Laryngoscopes JHI 2008, 68:101; ICHE 2007, 28:504; AJIC 2007, 35: 536 Limited guidelines for reprocessing laryngoscope s blades and handles Many hospitals consider blade as semicritical (HLD) and handle as noncritical (LLD) Blades linked to HAIs; handles not directly linked to HAIs but contamination with blood/opim suggest its potential and blade and handle function together Ideally, clean then HLD/sterilize blades and handles (UNCHCblades wrapped in a tray-sterrad; handle wrapped in tray [without batteries]-steam); the blades and handles placed together in a Ziploc bag. Blades and handles checked for function prior to packaging.

33 Laryngoscopes Blades The Joint Commission, FAQ, October 24, 2011 How should we process and store laryngoscope blades? Processed via sterilization or HLD Packaged in some way to prevent from contamination Also stored in a way that prevents recontamination. Examples of compliant storage include, but are not limited to, a peel pack post steam sterilization (long-term) or wrapping in a sterile towel (short term) Should not place unwrapped blades in an anesthesia drawer (or anywhere, for that manner)

34 ENVIRONMENTAL CONTAMINATION LEADS TO HAIs There is increasing evidence to support the contribution of the environment to disease transmission prevent with cleaning & low level disinfection of non-critical items & surfaces. This supports comprehensive disinfecting regimens (goal is not sterilization) to reduce the risk of acquiring a pathogen from the healthcare environment/equipment

35 KEY PATHOGENS WHERE ENVIRONMENTIAL SURFACES PLAY A ROLE IN TRANSMISSION MRSA VRE Acinetobacter spp. Clostridium difficile Norovirus Rotavirus SARS

36 ENVIRONMENTAL SURVIVAL OF KEY PATHOGENS ON HOSPITAL SURFACES Pathogen Survival Time S. aureus (including MRSA) 7 days to >12 months Enterococcus spp. (including VRE) Acinetobacter spp. Clostridium difficile (spores) Norovirus (and feline calicivirus) Pseudomonas aeruginosa Klebsiella spp. 5 days to >46 months 3 days to 11 months >5 months 8 hours to >2 weeks 6 hours to 16 months 2 hours to >30 months Adapted from Hota B, et al. Clin Infect Dis 2004;39: and Kramer A, et al. BMC Infectious Diseases 2006;6:130

37 Environmental Disinfection Interventions Donskey CJ. Am J Infect Control 2013;41:S12 Cleaning product changes Improvements in the effectiveness of cleaning and disinfection practices Education Audit and feedback Addition of housekeeping personnel or specialized cleaning staff Automated technologies Conclusion: Improvements in environmental disinfection may prevent transmission of pathogens and reduce HAIs

38 LOW-LEVEL DISINFECTION FOR NONCRITICAL EQUIPMENT AND SURFACES Exposure time per manufacturer recommendations Germicide Use Concentration Ethyl or isopropyl alcohol 70-90% Chlorine 100ppm (1:500 dilution) Phenolic UD Iodophor UD Quaternary ammonium UD Improved hydrogen peroxide (HP) 0.5%, 1.4% UD=Manufacturer s recommended use dilution

39 REVIEW THE BEST PRACTICES FOR CLEANING AND DISINFECTING SURFACES Cleaning and disinfecting is one-step with use of disinfectant-detergent (EPA claim in presence of soil). No pre-cleaning necessary unless spill or gross contamination.

40 ALL TOUCHABLE (HAND CONTACT) SURFACES SHOULD BE WIPED WITH DISINFECTANT High touch objects only recently defined (no significant differences in microbial contamination of different surfaces) and high risk objects not epidemiologically defined.

41 PROPERTIES OF AN IDEAL DISINFECTANT Rutala, Weber. Infect Control Hosp Epidemiol. 2014;35: Broad spectrum: wide antimicrobial spectrum Fast acting: should produce a rapid kill Remains Wet: meets listed kill/contact times with a single application Not affected by environmental factors: active in the presence of organic matter Nontoxic: not irritating to users Surface compatibility: should not corrode instruments and metallic surfaces Persistence: should have sustained antimicrobial activity Easy to use Acceptable odor Economical: cost should not be prohibitively high Soluble (in water) and stable (in concentrate and use dilution) Cleaner (good cleaning properties) and nonflammable

42 Scoring Considerations for Selecting the Ideal Disinfectant for Your Facility Rutala, Weber. Infect Control Hosp Epidemiol. 2014;35: Consideration Question to Ask Score (1-10) Kill Claims Kill Times and Wet-Contact Times Safety Ease-of-Use Other factors Does the product kill the most prevalent healthcare pathogens How quickly does the product kill the prevalent healthcare pathogens. Ideally, contact time greater than or equal to the kill claim. Does the product have an acceptable toxicity rating, flammability rating Odor acceptable, shelf-life, in convenient forms (wipes, spray), water soluble, works in organic matter, one-step (cleans/disinfects) Supplier offer comprehensive training/education, 24-7 customer support, overall cost acceptable (product capabilities, cost per compliant use, help standardize disinfectants in facility) Note: Consider the 5 components shown, give each product a score (1 is worst and 10 is best) in each of the 5 categories, and select the product with the highest score as the optimal choice (maximum score is 50).

43 Surface Disinfection Noncritical Patient Care Rutala, Weber. Disinfecting Noncritical Patient-Care Items Process noncritical patient-care equipment with a EPA-registered disinfectant at the proper use dilution and a contact time of at least 1 min. Category IB Ensure that the frequency for disinfecting noncritical patient-care surfaces be done minimally when visibly soiled and on a regular basis (such as after each patient use or once daily or once weekly). Category IB

44 Surface Disinfection Environmental Surfaces Rutala, Weber. Disinfecting Environmental Surfaces in HCF Disinfect (or clean) housekeeping surfaces (e.g., floors, tabletops) on a regular basis (e.g., daily, three times per week), when spills occur, and when these surfaces are visibly soiled. Category IB Use disinfectant for housekeeping purposes where: uncertainty exists as to the nature of the soil on the surfaces (blood vs dirt); or where uncertainty exists regarding the presence of multi-drug resistant organisms on such surfaces. Category II

45 CLEANING WIPES Wipes: may be cotton, disposable, microfiber Wipe should have sufficient wetness to achieve the disinfectant contact time. Discontinue use of the wipe if no longer leaves the surface visibly wet for manufacturer s recommended wet contact time. When the wipe is visibly soiled, flip to a clean/unused side and continue until all sides of the wipe have been used (or get another wipe) Dispose of the wipe/cloth wipe appropriately Do not re-dip a used wipe into the clean container of pre-saturated wipes

46 DISPOSABLE WIPES Wetness-ideally, stays wet long enough to meet EPAregistered contact times (e.g., bacteria-1 minute). Surface Coverage-premoistened wipe keeps surface area wet for 1-2 minutes (e.g., 12 x12 wipes keep 55.5 sq ft wet for 2m; 6 x5 equipment wipe keeps 6.7 sq ft wet for 2m). Wipe size based on use from small surfaces to large surfaces like mattress covers Durable substrate-will not easily tear or fall apart Top-keep closed or wipes dry out

47 OPTIONS FOR EVALUATING ENVIRONMENTAL CLEANING PROCESS Guh, Carling. December CDC Joint effort of EVS and IP Responsibilities of EVS staff and other staff for cleaning surfaces clearly defined Education of EVS staff to define expectations Development of measures for monitoring Interventions to optimize cleaning Report results to IPC and facility leadership

48 MONITORING THE EFFECTIVENESS OF CLEANING Cooper et al. AJIC 2007;35:338 Visual assessment-not a reliable indicator of surface cleanliness ATP bioluminescence-measures organic debris (each unit has own reading scale, < RLU) Microbiological methods-<2.5cfus/cm 2 -pass; can be costly and pathogen specific; ENVIRONMENTAL CULTURING NOT ROUTINELY RECOMMENDED Fluorescent marker- is transparent & easily cleaned, environmentally stable marking solution that fluoresces when exposed to an ultraviolet light (applied by IP/EVS manager unbeknownst to EVS worker; after EVS cleaning, markings are reassessed) GREAT TEACHING TOOL!

49 METHODS TO IMPROVE DISINFECTION OF ENVIRONMENTAL SURFACES Follow best practices for room cleaning and disinfection Follow CDC guideline for choosing disinfectant and best practices Improve training/education of environmental service workers Use of checklists to ensure all room surfaces are cleaned/disinfected Assure nursing and EVS agreed what items disinfected by nursing vs EVS Use of method (fluorescent dye, ATP) to ensure proper cleaning No touch terminal disinfection UV light Hydrogen peroxide Self disinfecting surfaces New disinfection technology

50 Decreasing Order of Resistance of Microorganisms to Disinfectants/Sterilants Most Resistant Prions Bacterial spores (C. difficile) Mycobacteria Small, non-enveloped viruses (HPV, polio, EV-D68) Fungal spores Gram-negative bacilli (Acinetobacter) Vegetative fungi and algae Large, non-enveloped viruses Gram-positive bacteria (MRSA, VRE) Enveloped viruses (Ebola, MERS-CoV) Most Susceptible

51 Best Practices in Disinfection and Sterilization Disinfection and sterilization technologies and practices reduce risk of infection associated with medical devices and surfaces. Endoscopes represent a nosocomial hazard. Urgent need to understand the gaps in endoscope reprocessing. Reprocessing guidelines must be followed to prevent exposure to pathogens that may lead to infection. Endoscopes have narrow margin of safety and manufacturers should be encouraged to develop practical sterilization technology. The contaminated surface environment in hospital rooms is important in the transmission of healthcare-associated pathogens (MRSA, VRE, C. difficile, Acinetobacter). Thoroughness of cleaning should be monitored (e.g., fluorescence). Emerging pathogens, such as Ebola, are susceptible to currently available disinfectants.

52 Antisepsis: the removal of pathogens from living tissue The goal of preoperative patient skin antisepsis is to reduce the risk of the patient developing a surgical site infection (SSI) by removing soil and transient microorganisms at the surgical site. 1 Reducing the amount of bacteria on the skin near the surgical incision lowers the risk of contaminating the surgical incision site. 1 As part of preparing the skin for antisepsis, preoperative bathing and hair management at the surgical site contribute to a reduction of microorganisms on the skin. 2 4 Effective skin antiseptics rapidly and persistently remove transient microorganisms and reduce resident microorganisms to subpathogenic levels with minimal skin and tissue irritation AORN GUIDELINE

53 Pre-op Skin Antisepsis: The Basics Preoperative bathing and hair removal Patients should bathe or shower with either soap or skin antiseptic at the least the night before or day of surgery (2% CHG-impregnated cloths are becoming used more frequently due to ease of use vs. specific guideline) Hair at surgical site should be left in place, & only when necessary, removed via a method that minimizes trauma to skin (clipping or depilatory) OUTSIDE of the OR Selecting skin antiseptics No one skin antiseptic has been proven to be more effective in preventing SSIs; a facility multidisciplinary team should select safe, effective antiseptics for pre op antisepsis based on each patient s need. Current choices are: Iodophors, Chlorhexidine, 2 & 4% aqeuous, Alcohols, 60-95%, PCMX & Triclosan.

54 Pre-op Skin Antisepsis: The Basics Applying, handling, and storing skin antiseptics Skin should be free of dirt, debris, creams, cosmetics & alcohol-based products prior to application Antiseptics should be applied per manufacturer recommendations vis aseptic technique; sterile gloves are worn if the caregiver s hands could touch the patient s skin during prep Antiseptic dry times should be followed without fail FDA rules recommend single-use applicators/bottles (one time/one patient) Antiseptic solutions should not be diluted Antiseptic solutions should be stored/disposed of per local, state & federal regulations in a manner that decreases fire risk.

55 Test Your Knowledge 1. Type of germicidal action required for semi-critical items: a) Kills all microorganisms except high numbers of bacterial spores b) Kills all vegetative bacteria, fungi & lipid viruses c) Kills all microorganisms, including bacterial spores d) Kills all visible contamination

56 Test Your Knowledge 1. Type of germicidal action required for semi-critical items: a) Kills all microorganisms except high numbers of bacterial spores b) Kills all vegetative bacteria, fungi & lipid viruses c) Kills all microorganisms, including bacterial spores d) Kills all visible contamination

57 Test Your Knowledge 2. The first step in the sterilization process is: a) Wrapping of the equipment prior to placing in autoclave b) Pre-cleaning by applying enzymatic cleaner or detergent to the used equipment c) Taking the equipment to the Sterile Processing Dept. via biohazard container d) Cleaning the equipment via manual or mechanical means

58 Test Your Knowledge 2. The first step in the sterilization process is: a) Wrapping of the equipment prior to placing in autoclave b) Pre-cleaning by applying enzymatic cleaner or detergent to the used equipment c) Taking the equipment to the Sterile Processing Dept. via biohazard container d) Cleaning the equipment via manual or mechanical means

59 Test your knowledge 3. Types of antiseptics include all of the following except: a) Iodophors b) Chlorhexidine, 2 & 4% aqeuous c) Glutaraldehyde, 2.0% d) Alcohols, 60-95% e) PCMX f) Triclosan

60 Test your knowledge 3. Types of antiseptics include all of the following except: a) Iodophors b) Chlorhexidine, 2 & 4% aqeuous c) Glutaraldehyde, 2.0% d) Alcohols, 60-95% e) PCMX f) Triclosan

61 Dr. William Rutala Mr. Clean & one of the nicest guys you will ever meet!! Much of the material for this presentation prepared from his website: disinfectionandsterilization