RECALL REVIEW 1

sterilization DEFINITIONS

Cobalt 60 Radiation

A method of sterilizing pre-packaged equipment by ionizing radiation.

Ethylene Oxide Gas

Highly flammable, toxic gas that is capable of sterilizing an object.

Glutaraldehyde

Chemical capable of rendering objects sterile.

Gravity Displacement Sterilizer

Type of sterilizer that removes air by gravity.

High Vacuum Sterilizer

Type of steam sterilizer that removes air in the chamber by suction vacuum.

Shelf Life

The amount of time a wrapped object will remain sterile while stored on a shelf after it has been subjected to a sterilization process.

Steam Sterilizer

Sterilizer that exposes objects to high pressure steam.

Sterilization Control Monitor

Method of determining whether a sterilization process has been completed; does not indicate whether the items subjected to that method are sterile.

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INFECTIO CONTROL 18 Guidlines

PREVENTION GUIDELINES FOR OT TEAM

All members of the team should have vaccination for
Hepatitis B.

      There is as yet no vaccines for HIV and HCV. The sources for transmission from HBV, HCV and HIV can be the patient, his body fluids and sharps or other equipment. Therefore the following steps are suggested:

1.   Hand washing after removal of gloves with detergent even when gloves have been used in a procedure.

2.   Gloves, goggles and aprons worn in all procedures.

      •     Sharps-All suturing use forceps to hold skin edges

      •     Use needle holders

      •     Use instrument to hold needle to adjust needle holder.

3.   Discard all used needles into sharps containers.

4.   Spills of body fluids covered with absorbent material and kept in contact with 1 percent sodium hypochlorite for 30 minutes and then mopped dry.

5.   Specimens from patients infected with HIV or hepatitis should be placed in a sealed plastic bag and marked with warning tape.

6.   Contaminated dressings and waste material should be placed in a yellow plastic bag for incineration.

7.   Any linen contaminated with blood or body fluids should be handled with gloves, and washed in a washing machine separately at the highest temperature setting or act according to hospital policy. 

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INFECTION CONTROL17 Aids

HIV INFECTION

The acquired immune deficiency syndrome (AIDS) was first described in 1981 and the human immunodeficiency virus (HIV) was first identified in 1983.

•     In 1983 the receptor cell for the virus was identified as the CD-4 of T-helper cell

•     Antibody tests were developed which revealed the HIV status of the individual

•     In 1986 a second strain, HIV 2, was isolated

•     Like hepatitis B, the virus is present in blood and body fluids, but unlike hepatitis B is relatively easily destroyed outside the body, and is not as infectious as the hepatitis B virus

•     Infection of the surgeon can occur from contamination from infected blood or body fluids, either through an open wound, or from a puncture wound like a needle-stick injury

•     Following infection there is an asymptomatic period during which antibody to the virus is not yet present in the blood, and thus HIV tests will be negative

•     After approximately 6 months the infected individual may seroconvert, and the HIV antibody be detected

•     A high proportion will then progress to develop AIDS

•     A common presenting feature of AIDS sufferers is the Kaposi sarcoma, with an incidence of between 25 and  50 percent. Biopsy of such lesions may be the first contact the surgeon has with this disease

•     Kaposi sarcomas present as pink to purple blotches like a bruise or blood blister. They may be flat or raised. They are skin cancer arising from the endothelial cells such as those lining blood vessels. Histologically, malignant transformation causes the endothelial cells to become stippled with spindle-shaped tumor cells; lymphatic obstruction may occur, but they do not metastasize, and remain multifocal both on the skin and in the alimentary tract. Despite the worry of surgeons about risks of infection, these risks are small

•           The prevalance rate of HIV 0.3 to 7 percent in our country. Surgeons have been shown to contaminate themselves with blood in 8.7 percent cases, and sustain penetrating injuries in 1.7 percent cases the transmission rate is 0.3 to 0.4 percent, yet statistically the risk of seroconversion for a surgeon is one infection every 8 years in a high-risk area with a case-load of 15000 patients per year, and as small as one infection every 80 years in a low risk area. Thus the risk to surgeon is exceptionally low.

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INFECTION CONTROL 16

Disposal by Incineration

This is the preferred method of disposal for all combustible and other material of an infectious nature (e.g., contaminated needles, plastic syringes and clinical waste).

      Disposable linen and infected protective clothing and drapes should be incinerated
.

VIRUS INFECTIONS IN SURGERY 

HEPATITIS B (SERUM HEPATITIS)

This is one of the most infective viruses.

•     It may be transmitted from patient to patient by as little as 0.0001 ml of infected blood.

•     The virus remains active for up to 6 months in dried blood, consequently instruments which have been poorly cleaned or disinfected may be responsible for infecting other patients, whilst poor surgical technique may result in the doctor becoming infected from the patient, or vice versa

•     It has been estimated that there are possibly 200 million carriers of hepatitis in the world, representing up to 20 percent of the population in African, Pacific, and other Tropical countries, and 0.5 percent of the population in Northern Europe. The current prevlance in the population is from
1 to 15.8 percent

•     Thus, statistically the doctor has a 1 in 200 chance of treating a hepatitis B carrier

•           If the doctor becomes accidentally infected with the hepatitis B virus, not only may the disease develop but the doctor may become a hepatitis B carrier and be an unacceptable risk to patients and may have to give up surgery. The transmission role in case of needle stick is 6 to 37 percent.

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INFECTION CONTROL 15

Sterilization by Ionizing Radiation

Most equipment available prepackaged from the manufacturer has been sterilized by ionizing radiation. 

Items such as sutures, sponges and disposable drapes are just a few of the many types of presterilized products available. 

Also included are anhydrous materials such as powders and petroleum goods.

Sterilization by Low-Temperature Steam and Formaldehyde (LTSF)

This is a physicochemical method which uses a combination of dry saturated steam and formaldehyde to kill vegetative bacteria, bacterial spores and most viruses and the method is thus suitable for heat-sensitive materials and items of equipment with integral plastic components susceptible to damage by other processes.

            Prior to removal of sterilized objects all formaldehyde must be removed to provide a dry, sterile, formalin-free load.

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INFECTION CONTROL 14

Sterilization Control

•     A chemical monitor is an object that is treated with material that changes its characteristics when sterilized. This may be in the form of special ink that is impregnated into paper strips or tape and placed on the outside of the package, or it may be a substance that is incorporated into a pellet contained in a glass vial

•     The chemical responds to conditions such as extreme heat, pressure, or humidity but does not take into consideration the duration of exposure, which is critical to the sterilization process

•     Another monitoring method used to evaluate the steam sterilizer is the combined temperature time graphs that are installed within the control panel of the sterilizer. These graphs provide a permanent written record of all loads that have been processed

•     The surest way to determine the sterility of given items is with the use of biologic controls. A strain of a highly resistant, nonpathogenic, spore-forming bacteria contained in a glass vial or a strip of paper is placed in the load of goods to be sterilized. For steam sterilization, the dry spores of the bacteria Bacillus stearothermophilus are used. The gas sterilization process uses the bacterium Bacillus subtilis. The vial or strip is recovered at the end of the sterilization process and cultured. This process is time consuming and the results method of testing the efficacy of a sterilization process. Biologic controls should be administered at least once weekly. If feasible, they should also be used whenever an artificial implant or prosthesis is sterilized and the item withheld from use until the results are known to be negative.

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INFECION CONTROL 13

TYPES OF STERILIZERS

Gravity displacement sterilizer  The gravity (or “downward”) displacement sterilizer uses the principle that air is heavier than steam. Within the sterilizer there is an inner chamber where goods are loaded and an outer jacket type chamber that ejects steam forcefully into it. Any air in the inner chamber blocks the passage of pressurized steam to the surface of the goods and thus prevents sterilization. All the air must be removed because every surface of the supplies must be exposed to the pressurized steam to ensure sterilization. Therefore, the sterilizer is constructed in such a way that air is pushed downward by gravity (hence the name “gravity displacement sterilizer”).

Prevacuum sterilizer  The prevacuum sterilizer does not rely on gravity to remove air from the inner chamber. Instead, the air is pulled out of the chamber, which creates a vacuum in the chamber. Steam is injected into the chamber to replace the air. This type of sterilizer offers greater steam penetration in a shorter time than the gravity displacement sterilizer.

Flash sterilizer  The flash sterilizer has traditionally been used in the operating room and in other areas of the hospital to quickly sterilize items that are unwrapped. It has been common practice to flash sterilize any instrument that had become contaminated during surgery.

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All older posts are stored in archives fo access and review.
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To create consumer/provider engagement visit www.surgseminar.blogspot.com
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