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CSMLS GUIDELINES
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Hazardous material on skin
 CLICK THE CARD TO FLIP IT
shower, remove contaminated clothing, rinse for 15 minutes
 CLICK THE ARROWS BELOW TO ADVANCE
Hazardous material to the eyes
eye wash station, rinse with lids held open for 15 minutes, if
contact lens are in remove after rinsing for 1 min and
continue rinsing
1/100
Terms in this set (100)

Hazardous material on skin

shower, remove contaminated clothing, rinse for 15 minutes
Hazardous material to the eyes
eye wash station, rinse with lids held open for 15 minutes, if
contact lens are in remove after rinsing for 1 min and continue
rinsing
burns
remove clothing from around the burn ( not from on burn)
immerse in cold water for 10 mins, never burst blister, no oily
substances keep burn moist
clothing on fire
stop, drop and roll .. cool burned area with water
chemical poisoning
ensure the location is safe for rescue, move victim outside, place
on back, head to side, keep warm, do not induce vomitting, attempt
to find out poison, contact pcc, provide MSDS
Electrical shock
Ascertain that electrical current causing shock is disconnected
before touching victim, seek medical assistance regardless of
external damage.
Cuts
Apply pressure to cut with sterile dressing( if object is protruding
from wound apply pressure around the wound and try to elevated it
above the heart.
Needle sticks
Encourage bleeding, clean puncture site , apply dressing, seek
medical attention, make incident report
material safety data sheet
is a technical summary of the chemical, physical and
toicoxcological properties of a subtance, along with recommended
procedures.
routes of entry
inhalation, ingestion, absorption, injection
three components necessary for fire
heat, fuel, oxygen ( aka fire triangle)
Flash point
minimum temperature at which a liquid gives off enough vapor 
to ignite in the presence of a source of ignition. The lower the flash
point the GREATER is the risk of fire
Fire classes
Class A , Class B , Class C, Class D
Class A Fire extinguishers
(green ) Combustibles- wood, paper,cloth
Class B Fire extinguishers
( red) Liquid Fuels - Solvents, oil, gasoline
Class C Fire extinguishers
( Blue) Electrical- switch boxes , motors
Class D Fire extinguishers
(Yellow) Combustible Materials- Sodium, Potassium , phosphorus
proper order of PPE
grown, mask, gloves
protective isoaltion
reverse isolation - protecting the patient from the worker
nosocomial infection
hospital -acquired infection or injury
formites
are in animate object capable of transmitting pathogens
droplet
Transmission via airborne droplets
PPE
Personal Protective Equipment i.e. gloves, mask, safety glasses
and clinical attire
biological hazards
any materials that are dangerous to ones health any items
contaminated by blood or body fluids go in the container marked
BIOHAZARD WASTE
Chemical hazards
chemicals that are flammable, caustic, poisonous and carcinogenic,
include cleaners, sanitizers, polishes machine lubricants, and toxic
metals.
Physical hazards
CATEGORY OF HAZARDS THAT INCLUDE: NOISE,
IONIZING RADIATION, ELECTRICITY, INJURY TO THE
BODY, FIRE, AND EXPLOSION

biohazard sharps
container, ALL needles with or without syringes should go into
this container, color coded yellow, labeled with bioharzard
symbol, lids that can be tightly secured
balance centrifuge
same size tubes, volume, opposite one another, same stopper
Insidious hazards
aerosols, ionizing radiation, carcinogen/ mutagen clastogen
centrifuge
machine that works on the principal of gravity
common disinfectants
cidex & 2% guteraldehyde
4 types of bioharzards
chemical, physical, insidious, biological
water sensitive substances
substances that will react with water , steam and moisture to
evolve heat or gases... e.g. strong acids and bases , alkali metals
chemical with colour in their name
carogentic & mutogens
4 forms of radiation
microwave, ionizing, lazer, ultra violet, xray
flammable chemical flash-point
below 37'C
Explosive chemical flashpoint
above 37'C
Storing acid
in glass, on a drip tray in a cool well ventilation area, separated
from alkali other reactive chemicals at floor level or below eye
level
storing alkalis
Stored in plastic containers, with air tight cap to protect, from
moisture
five major departments of lab
Histology, microbiology, Blood bank, hematology, chemistry
microtomes
used to cut tissue samples into one cell thick slices or sections,
used in histology
how is acids are mixed
you must pour the acids and bases INTO water.
scald
caused by vapour, steam or hot liquids
burns
caused by hot, dry objects, chemicals, electricity or radiation
toxic substances
interfere with normal cell function, interact chemically with cells,
may cause death
reactive substances
may explode, ignite or burn,gives off poisonous fumes, cause
serious burns
flammable substances
ignite at below 37c,stored in safety cabinet, identified as
flammable
Combustible substances
flash point at above 37c,stored in safety cabinet,
Antiseptic
substance that kills disease producing microorganisms but not their
spores (applied to living tissues)
Contaminate
to soil, stain or pollute to make impure
Critical item
an item that comes in contact with sterile tissue or the vascular
system
decontamination
use of physical or chemical means to remove or destroy pathogens
on an item so that it is no linger capable of transmitting disease,
making it safe to handle.
detergent
an agent that cleanses by emulsifying dirt and oil
disinfectant
an agent used to destroy pathogenic microorganisms but not their
spores ( usually applied to inanimate objects)
load
articles being sterilized
Noncritical item
item that comes in contact with intact skin but not mucous
membranes
Sanitization
process to remove organic matter from an articles and to lower the
number of microorganisms to a safe level as determined by Public
Health requirements
semicritical item
item that comes in contact with contact skin or intact mucous
membranes `
Sterilization
process of destroying all forms of microbial life, including
bacterial spores
major principles of self protection of radiation exposure
Shielding, time and distance
RACE
resuce, alert, confine, extinguish
PASS
pull, aim, squeeze , sweep side to side
OSHA
Occupational Safety and Health Administration, a government
agency ( in US ) the Department of Labor to maintain a safe and
healthy work environment
BBP
Blood Borne Pathogens
Chain of infection
1)Source, 2)mode of transmission, 3)susceptible host
standard precautions
used for all persons, — PPE use, hands washed, gloves worn,
masks, gowns, goggles, face sheilds, equipment properly cleaned,
discard sharp instruments,
universal precautions
are safety procedures to be followed in the handling of human
remains, blood, and body fluids. These procedures are based on the
required assumption that all human remains may be infected with
HIV or HBV virus or other bloodborne pathogens.
protective isolation
for patients who must be in completely sterile environment, gowns
gloves and masks, hands must be washed upon entering and
leaving room
strict isolation
practiced with highly contagious diseases or viruses that may be
spread by air and/or contact. must wear gowns gloves and masks
Enteric isolation
Prevents the transmission of contagious diseases that are spread
through direct contact, gowns and gloves are needed
Geiger- mueller counter
which instrument detects the presence of radiation rather than
measuring it
communicable disease
infection that may spread from person to person
corrosive
are strong acids and strong bases. these chemicals will injure body
tissue by contact or corrode metal.
caustic
by contact, these chemicals can burn, eat away , or destroy tissue
( acetic acid)
Carcinogenic
chemicals known to cause cancer to humans or laboratory animals
mutagenic
cause genetic mutations, many mutations cause cancer, mutagens
are typically also carcinogens
Reactive and volatile
when mixed with other chemicals can cause undesirable reactions
and explosions
flammable storage cabinets
used to store flammable or combustible chemicals safely
whats on suppliers label?
product name, supplier name, ref.2 MSDS , Hazard symbol, risk
phrases,precautionary measures, first aid
Whats on a workplace label ?
the identity of product, info for safe handling,say if a MSDS is
available
storage of Ether
in full, air tight ,amber glass bottle or safety cans in the dark.
fumes are flammable
Storage of Picric acid
under water, in glass bottle with moistened with water before
removing or replacing, in drip tray, at floor level if over 500ml and
below eye level if not.
zenkers fluid
used in histology contains mercury
Drabkins reagent
toxic, contains cyanide
Laminar flow hood
Class II biological -safety cabinet used for airborne containment
( e.g. carcinogens ) in the cabinet are prevented from escaping both
user and specimen are protected.
Class 1- ventilated
biological safety cabinet user is protected the test or specimen is
not
Class III
biological safety cabinet totally enclosed - highest level of
personal and environmental protection
Storing of bases ( alkalis)
Store in plastic NOT glass, not with acids or reactive chemicals
THE ACID RULE
pour acid into water NOT water into acid
glacial acetic acid
smells like vinegar , do not put in refrigerator it will freeze
WHMIS
Workplace Hazardous Materials Information System
WHMIS Class A
compressed gas
WHMIS Class B
Flammable, Combustible material
WHMIS Class C
oxidizing material
WHMIS Class D1
Poisonous and Infectious materials - immeadiate
WHMIS Class D2
Material causing other TOXIC effects
WHMIS Class D3
Bio-hazardous infectious material
WHMIS Class E
Corrosive materials
WHMIS Class F
Dangerously Reactive Materials
2% Glutaraldehyde
disinfectant used to clean centrifuge & to clean metal
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Sarah_Agas…
42 terms
kdawgie17
Chemical Safety
STUDY
FLASHCARDS
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SPELL
TEST
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 GRAVITY
What the chemical label should have...
 CLICK THE CARD TO FLIP IT
1. Name and concentration of chemical (recognizable name)
2. Date of receipt or date made
3. Date of expiration
4. Initials of person who made or received it
5. Hazards present
6. Special Instructions
CLICK THE ARROWS BELOW TO ADVANCE
NFPA Diamond
0 represents no hazard, 4 greatest hazard
Red= flammability hazard
Yellow= stability hazard
Blue= health hazard
White= specific hazard
1/42
Terms in this set (42)

What the chemical label should have...

1. Name and concentration of chemical (recognizable name)
2. Date of receipt or date made
3. Date of expiration
4. Initials of person who made or received it
5. Hazards present
6. Special Instructions
NFPA Diamond
0 represents no hazard, 4 greatest hazard
Red= flammability hazard
Yellow= stability hazard
Blue= health hazard
White= specific hazard
HMIS stands for
Hazardous materials information system from the national
United Nations Globally Harmonized System of Labeling
Voluntary for all countries 
US, Canada, Europe currently phasing in
Also applied to infectious substances
Chemical storage locations
in lab-minimize amounts
under hood-minimize "
under sink-usually not-due to water reactivity
Best place: designated storage cabinet, designated storage
refrigerator, designated storage room-separate prep room
Basic Requirements for Chemical Storage
Spacious, organized, well-vented, cool
Directional air flow- keep fumes out of public spaces
Heating/Cooling systems 6-12 air exchanges/hr
Ceiling and floor vents-chemicals both lighter and heavier than air
Large containers should be stored in groups of similar reactivites
and compatibilities
Nothing should be stored close to heat or electrical surfaces
Chemical fume hoods
velocity sensor
raised edge or "lipped" shelves
-proper shelving material
-do not line with paper towels
-no deep shelves or deep storage
Inventory Management for Chemical Storage
"First in, First out"- oldest stock in front
Minimize inventory
"Good Housekeeping"
Large containers/dangerous chemicals stored close to floor
Raised edge or "lipped" shelves
Safe containers
Fume Hoods
Small amount of storage
Hood must be left on, sash down
May need back-draft hood for chemicals heavier than air
Security in Chemical storage rooms
self-locking/self-closing doors
secured and locked
(because of possible terrorism)
Department of Homeland security (DHS)
posts "chemical facility anti-terrorism standards" and list of
"chemicals of interest"
Contents of MSDS
Chemical identity
Manufacturer's contact info
Physical and Chemical characteristics
Fire, Reactivity, health hazards
Handling, use and control measures
Chemical Hazard Classes
Corrosives- strong acids and bases
Ignitibles- flammable and combustibles
Health Hazards
Oxidizers
Explosive and stability hazards
Corrosives
substances that cause visible destruction and/or irreversible
alterations on metals/metallic compound or human tissue
"caustics": acids-low pH <2.1, bases-high pH, >12.5
causes severe internal and external injury
best treatment: flush exposed area for 15 mins, do not use a strong
neutralizer, weak buffers is ok
Safety rules for corrosives
Lab coat, goggles, gloves
use in or near sink
use inside hood-many acids fume
no mouth pipetting
"acid to water, not water to acid"
Ignitibles
Flammables (flash point <100 F) 
Combustibles (flash point > 100 F)
Pyrophorics
Pyrophorics
substances that oxidize in air and ignite spontaneously at
temperature < 130 F
water reactive
Ignitibles' storage
store and use in ventilated space
minimize amount in lab
avoid sources of heat and electricity
Health Hazards
Poisons and toxins, irritants (think rashes), sensitizers (allergies),
carcinogen (cancer), mutagens (think genes), teratogens
(pregnancy), hepatoxin (liver)
Acute exposure
single, large dose
symptoms immediate and evident
Chronic exposure
low doses over long period of time
symptoms vague and insidious
OSHA permissible exposure limits are applied to this (think
sample device for formaldehyde)
Hydrogen Cyanide
used in "gas chambers"- most people can not detect odor
smells like "bitter almonds"
made when cyanide + acids
never put down sink because both toxic and reactive as a waster
use gloves to prevent absorption and segregate cyanide compounds
for disposal
Nitrogen
"asphyxiating gas" -creates an anaerobic environment
use in well vented area & be alert for leaks
if leak occurs IMMEDIATELY evacuate
Dry Ice
frozen CO2
Extremely cold-causes frostbite -'burns'- treat w/ tepid wtr
use gloves 
CO2 gas given off can reduce O2 levels- need to ventilate
(CO2 is heavier than air)
can "explode" in sealed containers- think lab!!
Mercury (Hg)
very toxic with low vapor pressure-easily inhaled
because of vapor, IMMEDIATE evacuation if spill occurs
can be absorbed through skin, ingested, or inhaled
How to clean Hg spills...
Suction pump or special vacuum cleaner NOT reg vacuum
Special spill kits that neutralize mercury- commercial kits; contain
absorbent powder
remove with licensed handler
substitute with non-Hg thermometers
Formaldehyde
in preservatives including formalin
strong irritant, sensitizer, possible carcinogen
Need to monitor to prevent exceeding PEL
good ventilation
crude rule- if you can smell it, PEL may be exceeded
sampling device should be worn
Glutaraldehyde
One of few high level chemical disinfectants approved by EPA
used to sterilize medical instruments
irritant and sensitizer (can cause occupational asthma)
needs ventilation and environmental monitoring
minimize or substitute another disinfectant when possible
if smelled, limit is exceeded
Oxidizers
react with reducing materials and release energy
Contain oxygen or oxidizing species Ex: Halogen, peroxides
React with reducing chemicals; hydrocarbons (oil, grease) and
some metals
Reactions release energy
must be stored separate from reducers
do not freeze-it will explode
use wood, plastic,glass-NO METAL
use under hood
Ethers
an oxidizer
form very explosive peroxides with oxygen over time
MUST DATE when opened
discard no later than a yr
do not open if white crystals are on cap
Explosives
Unstable chemicals, temperature, mechanical shock, chemical
reaction
dangerous/violent reactions
Ex: flammables, crystalline picric acid and dry perichloric acid
both reducer and oxidizer
very exothermic
heat+gas=expansion and shock wave
common groups: Azides and Nitro groups (nitroglycerine)
Crystalline picric acid
VERY explosive
should be prevented from drying out
Dry perichoric acid
extremely explosive, if crystals form it can create a bomb (caused
by condensed vapors)
when heating, need specialized fume hood w/ wash down system
Incompatible chemicals
Always store separate
group and segregate chemicals by reactivity, ideally in different
rooms
closed storage cabinets
different shelf areas is NOT ideal- store least used chemicals over
MOST used
Examples of Incompatibles
1. Bleach and ammonia-toxic gas
2. Bleach/hydrochloric acid/chlorine compounds + formaldehyde-
carcinogen
3. Chloroform and cigarettes-mustard gas
4. Cyanides and acid- cyanide gas
5. Oxygen and flammables, grease, metals, hydrogen-violent
reaction
6. Strong acids and bases- violent heat
7. Strong acids or bases with water- violent heat
8. Na azide and metals- explosive
Transporting chemicals
Cart for multiple bottles, plastic bucket bottle carriers
hold from bottom NOT "neck"
Ship chemicals with cushioning and absorbent packing
Fume hood requirements
2.5 linear ft per worker
~100 linear ft per minute to insure air flow
Keep sash down while working to insure air flow
Chemical disposal
must check EPA, state and local regulations
Waste-reduce, reuse, recycle
segregate hazardous and non-hazardous
methods of disposal: Landfill, licensed waste handler, incineration,
sanitary sewer (nothing toxic, gaseous, malodorous, irritating,
corrosive, and be aware of piping (metal or plastic?)
flush chemicals with LOTS of cold water and run cold water
between chemicals
triple-rinse empty containers before disposal
General plan for Chemical spill
Evacuate and quarantine
First aid
Notify authorities
Put on protective equipment
Stop spill or leak
Turn off heat and electricity. Turn on vents
Contain and clean spill
Document incident
Technique for chemical spill
use sand, kitty litter, vermiculite
can "dike" around spill- build a barrier
use baking soda for acids
citric acid for bases
Treatment for chemical spills
Remove contaminated clothing
Flush area with water for at least 15 min
remove contacts from eyes to flush
seek medical attention
"CLEAN"
C-Contain spill
L-Leave area
E- Emergency equipment
A- Access MSDS
N- Notify a supervisors/emergency personnel
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Decontamination study set
STUDY
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What is the purpose of thorough cleaning of a resuable
medical device?
 CLICK THE CARD TO FLIP IT
To remove soil, including organic matter (blood, protein,
feces, mucus and tissue) and other material, prior to
submitting the device toa disinfection or sterilization process.
CLICK THE ARROWS BELOW TO ADVANCE
What may the failure to remove organic matter and residue
prior to disinfection or sterilization impair?
the efficacy of disinfection and sterilization process
1/417
Terms in this set (417)

What is the purpose of thorough cleaning of a resuable

medical device?
To remove soil, including organic matter (blood, protein,
feces, mucus and tissue) and other material, prior to
submitting the device toa disinfection or sterilization process.
What may the failure to remove organic matter and residue
prior to disinfection or sterilization impair?
the efficacy of disinfection and sterilization process
Will the extension or repetition of the disinfection or
sterilization process remove the microbial load on
inadequately cleaned devices?
Not necessarilly
Define decontamination
The process of reducing the number of microorganisms on a
soiled item to a low level making the item safe to handle and
controls the spread of pathogens in the department
What is the most important step in decontamination?
thorough cleaning
Will cleaning adequately decontaminate an item?
Maybe not. DIsinfecting further reduces the number of
microorganisms
What are the activities in decontamination directed towards?
Keeping staff and patients safe, and controlling the spread of
pathogens. This is done through dress code and principles
of medical asepsis.
What must procedures for disinfection and sterilization
include>
Statements and information regarding the type,
concentration and testing of chemical products; duration and
temperature of exposure; and physical and chemical
properties that might have an impact on the efficacy of the
process.
what is the goal of a quality system?
to provide assurance that the facility's policies, processes
and procedures are in compliance with CSA Z314.8 and the
department's products and services provide the highest
possible degree of safety and quality
does the level of responsibility of each individual staff
membner or group need to be defined?
yes
how often must the operating procedures be reviewed and
updated?
at specific intervals stated in the facility's policies
who must complete the reviews and updates or operating
procedures?
A knowledgeable individual who has the authority to make
necessary changes to ensure conformance wqith current or
new requirements and/or changes in the practice.
what must an operating procedure be reviewed in response
to (in addition to the set-intervals for reviewing and updating
operating procedures)?
-any accident, error or adverse event that is related to a
function goverened by the procedure;
-changes in applicable laws or regulatory requirements;
-results obtained from internal or external audits;
-other conditions or situations as defined in the facility's
policies
what are accidents or errors?
occurences that could adversely effect the safety, efficacy or
quality of the reprocessing system, or the safety of patients
or facility personnel.
who must complete audits, how often and according to
what?
must be completed according to an established program by
trained personnel with well-defined responsibilities and
authority who do not have direct responsibility for the
procedures being audited. (yearly or more often)
procedures for process control must contain, but not be
limited to, the following elements:
change control
proficiency testing program
quality control
true/false: all reusable medical devices should be
decontaminated before they are used on a patient
true
what are critical devices and do they need to be sterilized in
addition to decontamination?
devices that will invade the blood stream, such as biopsy
forceps and cautery devices, and yes they do.
what must the decision to sterlize semi-critical and non-
critical devices be based on?
the intended use of the device and associated risks.
true/false: all manufacturer information and manufacturer's
instructions must be device specific.
true.
what must manufacturer information and instructions
contain?
-cleaning and reprocessing instructions;
-schematic drawings;
-assembly and disassembly instructions;
-information to provide staff in-service on reprocessing the
medical device. This in-service must be performed prior to
the device being used on a patient.
-routine maintenance schedulres
what is the purpose of all required information in the
manufacturer's instructions?
to prevent risk to patients and ensure that staff performing
the reprocessing of medical devices are properly trained
When purchasing a reusable medical device, what must the
health care facility confirm?
That it is properly licensed and meets applicable standards.
Can devices that are not manufacturered for medical use be
used on patients?
NO
What must the reprocessing committee consist of at
minimum?
Risk manager
reprocessing manager
infection prevention and control
user department
finance and purchasing
true/false. Anti-corrrosive and anti-rusting agents (i.e. oils,
greases or waxes) may be applied to the device by the
manufacturer and may applied to the device by the
manufacturer in order to protect it during shipping. Such
agents will not interfere with sterlization if not removed.
False. they must be removed because they may be
removed.
all personnel working in the decontamination area must: (2)
1) be made aware of the associated hazards;
2) wear appropriate atire, including PPE
When working in the decontamination area, workers must:
(4)
1) wear the appropriate PPE to prevent being exposed to
blood, or body fluids or contaminated devices;
2) wash their hands immediately if they have been expoed to
potentially infectious material;
3) not eat, drink, smoke, apply cosmetics or lip balm or
handle contact lenses
4) not store food, drink or personal belongings in the area
What must all personnel working in the reprocessing area be
immunized against?
Heptitis B
true or false, used needles or other sharps must be
recapped,
false. They must not be recapped except with a recapping
device or technique
workers exposed to contaminated medical devices must
wear the following PPE when working in the
decontamination work area: (3)
1) gloves appropriate for the task
2) a liquid-resistant garment with long sleeves (eg. a
backless gown, jumpsuit or surgical gown)
3) either a full-face shield or a high-filtration, fluid-impervious
face mask and protective eyewear
what are major spills or accidents usually caused by?
container rupture, caused either by equipment malfunction
or by careless handling.
how often must work areas be cleaned and disinfected and
what do these areas include?
at least daily, including floors, stands, tables, countertops,
sinks and equipment surfaces.
how often must sinks be cleaned
each shift at minimum and more frequently as necessary
how often must sinks used for cleaning endoscopes and
respiratory equipment be cleaned?
In between each use.
the decontamination work area must be designed such that
there is: (4)
1) physical separation from clean MDRD areas, with a
separate receiving area
2) restriced access
3) one-way workflow
4) negative air pressure, thereby keeping any contaminants
within the decontamination area.
true/false. If containers contining soiled items are
transported directly from point of use to point of
decontamination by means of a dedicated soiled elevator,
the elevator may be considered equivalent to a closed cart.
true
if external surfaces of containers are contaminated, what
should be done to them before being placed on an elevator?
placed in plastic bags or bins
how often should an elevator be decontaminated?
daily
can clean or sterile items be transported on a soiled
elevator?
no
What must the room temperature of all decontamination
work areas be?
WIthin the range of 18-20 degrees Celsius
What must the relative humidity the decontamination work
area be maintained at?
In the range of 30 to 60% and prefereably in the range of 40
to 50%
can portable fans be operated in the MDRD?
no, not in any area.
Why must portable fans not be operated in any area of the
MDRD?
creates a highly turbulent airflow that re-circulates dust and
miocroorganisms from the floor and work surfaces, thus
increasing the risk or airborne transmission of
microorganiosms and interference with designed airflow
characteristics.
how many total air changes are required per hour?
10
What are the minimum outdoor air changes per hour?
2
What should the relative pressurization of soil areas be?
negative to surrounding areas
What should the relative pressurization of clean areas be?
positive to surrounding areas
what is the required filter efficiency (%ASHRAE)
80%
what should the speed of air movement be? (m/s)
0.2
when must personnell complete hand hygiene?
After handling devices contaminated or likely to be
contaminated with blood, body fluids, excretions or
secretions
After removing gloves
After touching face
Before leaving decontamination area
After using the toilet
Before leaving clean area or entering sterile area
In other cases in accordance with facility policies
What is the single most important procedure for preventing
Nosocomial infections in patients and staff?
hand hygiene
What are Nosocomial infections?
Hospital aquired infections
True/false. Medical devices that have not been used but are
from open packages must be treated in the same way as
used devices.
True
what must contaminated items be transported in?
covered, fully-enclosed containters designed to prevent the
spill of liquids, and must be designed to allow
decontamination after each use.
true/false. contaminated items may be transported with
clean items together if there is adquate containers involved
False. Clean and soiled items must not be transported
together because of the risk of cross-contamination.
True/false organic matter/other residue that has dried are
significantly more difficult to remove during cleaning.
True.
Why must on-site transport for contaminated devices follow
designated routes?
To avoid high traffic and patient-care areas
Transport equipment (eg. carts or driver-operated vehicles)
that are used to convey contaminated devices on site must:
(3)
1) provide effective containment of blood and body fluids to
prevent spillage;
2) prevent damage to devices;
3) facilitate safe loading and unloading of the medical
devices
what does transport equipment include
hand-propelled carts, motorized carts and driver-operated
vehicles
during off-site transport a vehicle's compartment for holding
contaminated devices during transportation should be
environmentaly controlled at what temperature and relative
humidity?
20-23 degrees Celsius and 30-60% RH
Why must pneumatic suspension of the off-site trnaport
vehicle be considered?
to minimize damage to devices
how must cleaned, disinfected or sterlized devices be
transported during off-site transportation?
in containers that protect devices from moisture and covered
with dust-impervious covers during transport
true/false potable tap water is adequate for initial cleaning of
mmedical devices and the final rinse after HLD?
False. It is okay for initial cleaning of medical devices but
rinsing after HLD must be with water of appropriate quality to
ensure that neither inorganic residues nor bioburden will
remain on the device after it has been rinsed (type of rinse
water must be dependent upon the manner in which the
device will be used)
What kind of water should be used to rince critical devices
that have received liquid chemical streatment as part of the
sterilization process?
de-mineralized water to reduce precipitates and corrosion.
For devices that will be exposed to the bloodstream, the final
rinse water should not have excess endotoxin levels.
What kind of water should be used to rince semi-critical
devices that have received HLD using liquid chemical
treatment?
reverse osmosis (RO) and uv treatment water (treated water
that is bacteria-free, submicron filtration using 0.2 um
filtration. Note: hospital grade RO system should also be
treated with uv light as RO water may contain more bacteria
than standard water)
tap water that has been filtered using submicron filtration is
acceptable but submicron filters may clog quickly and
consideration should be given to pre-filters to protect the lif-
span of sub-micron filters. Ideally use demineralized water
that has been passed through sub-micron filters
what kind of water should be used as a final rinse for non-
critical medical devices?
potable tap water, however impurities in the water may result
in precipitate formation or pitting and water may need to be
softened or treated to ensure it is of adequate quality to use
for medical device reprocessing.
true/false. Devices that have been treateed with liquid
chemicals to providde sterlization and rinsed with sterile
water should be used immediatelyu and not dried.
true. However if drying is performed, it should be with
medical grade air that is filtered to ensure no particulates or
organisms re-contaminate the device during drying.
How should drying of semi-critical devices that have been
disinfected using HLD and rinsed with bacteria-free water be
dried?
using medical grade air that is filtered or by placing the
medical device ina drying cabinet that circulates heated
HEPA filtered air for drying. Drying of non-critical devices
may be done by air-drying or other methods.
Why are contaminated devices sorted before reprocessing?
so that devices requiring similar deconamination procedures
or the same cleaning agents can be separated from the
devices that require a different decontamination procedure
or different cleaning agents. Sorting is also important to keep
medicalo devices that belong to a set together
true/false saline should be used as a soaking solution?
False it will damage medical devices
true/false prolonged soaking will help to process medical
devices
False. This may cause damage
What are the two steps of decontamination?
step one: cleaning--thorough removal of soil. Soil can trap
and protect pathogens and cause the failure of either
disinfection or sterlization
step two: deisinfection. Process that removes/reduces
pathogenic microorganisms to a safe level.
are all microorganisms removed in decontamination?
no, but enough are removed to ensure that items are safe
for patient or staff contact.
How is disinfection carried out
with chemicals or heat
Why is using cleaning machines when possible preferred to
hand washing?
Staff safety and efficiency
Once a medical device has been thoroughly cleaned, the
need for further reprocessing will depend on what?
the risk of infection that the intended use of the device poses
to a patient
What criteria is used to determine the reprocessing level
required?
Spaulding's criteria
What type of contact is associated with a critical device
sterile body tissue
what is the risk of infection of critical devices?
high
what reprocessing agents are currently available in canada
for reprocessing critical devices
steam
ethylene oxide
vaporized hydrogen peroxide
plasma
liquid paracetic acid
ozone
what type of contact is associated with a semi-critical device
mucous membrane
what is the risk of infection of semi-critical devices?
moderate
what reprocessing level is required for critical devices
sterilization
what reprocessing level is required for semi-critical devices
high-level disinfection (HLD)
what reprocessing agnets are currently available in Canada
for reprocessing semi-critical medical devices?
Gluteraldehyde >2 %
Ortho-Phthalaldehyde 0.55%
Hydrogen Peroxide > 2%
Hot water pasteurization
Peracetic Acid
Thermal Disinfection
what type of contact is associated with non-critical medical
devices?
contact skin or no direct contact
what is the risk of infection with non-critical devices?
low
What reprocessing level is required for non-critical devices?
intermediate or low-level disinfection
What reprocessing agents currently available in Canada for
reprocessing non-critical medical devices?
Alcohol >70%
Halogens
Phenolics
Hydrogen Peroxide ~3%
Quaternary Ammonium
Thermal Disinfection
What four steps are associated with the cleaning process?
1) Sorting (disassembly)
2) Soaking or rinsins
3) Cleaning (mechanical or manual)
4) rinsing
What are the four categories that items are sorted into at
point of use?
1) Soiled linen
2) Sharps
3) Disposable items
4) Reusable items
true/fals: soaking, rinsing and washing is best done in warm
water during the cleaning process?
True
What is the risk of using water that is too hot (over 60
degrees Celsius) for soaking, rinsing and washing during the
cleaning process?
protein will coagulate.
what is the risk of using water that is too cold for soaking,
rinsing and washing during the cleaning process?
fats, oils and greases will be congealed or hardened
How often should a soaking solution be changed?
ideally after each batch, certainly after soaking an extremely
soil item and at least three times per shift
True or false? Soaking solutions should stand overnight
false
what is cleaning defined as?
the mechanical or manual removal of visable soil from an
item
what is the mechanical action created by hand or machine
during cleaning?
friction
how is hand washing done?
rubbing, scrubbing, brushing or wiping (running water also
creates friction_)
how is friction created during machine washing?
spray, vibrate and agitate water over instruments and
equipment
what agents aid in the mechanical cleaning process?
detergents, solvents/enzymatics and, occasionally abrasives
true/false: detergents, solvents/enzymatics and, occasionally
abrasives can replace friction in the cleaning process
false
true/false meticulous cleaning of patient care items must
take place using a detergent or enzyme cleaner with water
before high level disinfection or sterilization
true
what are the most common classes of cleaning agents (4)
1) Solvents and enzymatics
2) Detergents
3) Soaps
4) Abrasives
What do solvents do to act as a cleaning agent?
Break soil down into small particles
What is the most common solvent in the cleaning process?
water
what is the most effective solvent?
soft, tepid water
water is an effective solvent for many soils but not for what?
proteins, greases and oils
why is water not an effective solvent for proteins, greases
and oils?
they are not water soluble so they will not dissolve and must
be removed by a different process
how does an enzymatic or presoak agent work as a cleaning
agent?
it is a chemical cleaner that effectively breaks down dried
blood, tissue, mucous and others making them more soluble
in water.
What are Klenzyme, Medzyme, Reneuzyme and Protozyme
examples of?
enzymatic or presoak solutions
If an enzymatic agent is very sudsy, it may be used in an
ultrasonic cleaner for even greater cleaning?
false. Low-sudsing enzymatic angents may be used in an
ultrasonic cleaner for even greater cleaning
What are detergents?
chemical compounds which do not have animal fats as a
base
What is the base of detergents?
alcohols
what is the benefit of not having a fatty base for detergents?
they are less likely to grow microorganisms than are soaps
how do detergents work as a cleaning agent?
dissolves dirt and grease and break down (or emulsify) oils
better than soaps.
Why are wetting agents added to detergents?
to decrease the surface tension of water to overcome the
tendency of water to bead up, give detergents a more
slippery feeling and allow them to more easily penetrate soil
and joints and crevices of instruments and equipment. Help
to allow water to run more freely off of water. Speeds
drainage and drying and decreases water spotting following
cleaning.
What do "bacterialstatic" detergents do?
prevent the growth of bacteria.
a chemical with a pH of 1 is
a) extremely acidic
b) extermely alkaline
c) neutral
a) extremely acidic
A chemical with a pH of 14 is 
a) extermely acidic
b) extremely alkaline
c) neutral
b) extremely alkaline
What is the disadvantage of using chemicals with either the
extreme pH of 1 or 14?
will burn flesh and corrode metals
What is the pH of highly alkaline detergents and what do
they do?
12-13, rapidly dissolve blood and other proteins and
emulsifty fats and oils. They do not harm rubber but can
corrode aluminum. Rarely used in the mDRD
What is the pH of moderately alkaline detergents and what
do they do?
10-11, readily disolve blood and protein and are often used
in MDRD mechanical washers. Less corrosive than highly
alkaline detergents but cand still corrode aluminum and
glass to some degree
What is the pH of so-called neutral detergents and when are
they used?
7.5 (still slightly alkaline), often used for manual washing.
Less effective on blood and protein
What is the pH of acidic detergents used in the MDRD and
why are they used?
6.5, usually produce low-sudsing with wetting agents added.
They are used mainly to prevent mineral deposit build-up
from hard water or urine
True/false: most detergents are interchangeable?
false
what are soaps, what are they made of and when are they
used?
organic chemical compounds made from animal fat and
alkali (lye). They are added to water and assist in cleaning
by dissolving (loosening and breaking up) soil. They work
best in warm, soft water. Mainly used for hand hygiene and
not for cleaning equipment.
What is water 'hardness"
a measure of the amount of minerals such as calcium
dissolved in water
what units is water hardness measured in?
milligrams of calcium carbonate per liter of water (mg/l)
What unit amount is considered soft water?
0 to 50 mg/l
what unit amount is considered very hard water?
150 mg/l
what are soaps incompatiple with?
Quaternary Ammonium Compounds (QUATS) and rapidly
deplete halogens
why do soaps encourage a good base for the growth of
microorganisms?
organic base (animal fat)
how are abrasives used as a cleaning agent?
using grit or a rough surface to wear away soil.
what forms can abrasives be found in?
powder (i.e. Ajax, Comet), paste (Pry, Kleen-Glo or Bon
Ami), tools such as brushes, pipe cleaners and steel wool.
What two ways do abrasives create problems?
1) they can scratch the surface of the item being cleaned
which can trap and harbor pathogens and may allow rust to
form.
2) the residue left by abrasives is very difficult to completely
rinse away.
True/false. Powdered cleaners should never be used to
clean equpiment or instruments
true
true/false steel brushes may be used to clean equipment or
instruments
false
what kind of grit should be used to clean equipment of
instruments if abrasives must be used?
the finest grit possible and ensure it has been manufacturerd
for the uses and is recommended by the medical device
manufacturers
should water be used when using abrasives to clean
equipment/instrument?
yes
what will the choice and effectiveness of any cleaning agent
depend on?
-the type and amount of soil to be removed
-the hardness and temperature of the water supply
-the composition of the surface to be cleaned
-the method of cleaning to be used
true/false: soil must be literally rubbed and scrubbed away,
either by water in a machine or with good, old-fashioned
elbow grease
true
true or false: instruments must be rinsed after cleaning prior
to disinfection?
true
What two reasons are items rinsed after cleaning before
disinfection?
1) cleaning and disinfecting agents may be incompatible. If a
film of detergent or soap is left ono an item, it may decrease
the effectiveness of any disinfectant to be used.
2) rinsing will help to flush away soil and pathogens
loosened by the cleaning process.
what kind of pH should be used to clean aluminum?
7
what motion should be used to clean aluminum?
"to and from" motion following grain. Circular motion causes
scratches that might trap microorganisms
why is the use of aluminum discouraged in the MDRD?
it is soft and eaily scratched.
what kind of detergent should be used to clean glassware?
neutral fo slightly acidic detergent (6.5-7.5) with a low
surface tension (wetting agent added).
true/false. When glassware is clean, water will bead up on
the surface rather than sheet.
false. It will sheet rather than bead up