- Steam BI organism?
- Geobacillus stearothermophilus — used for steam, ozone, and hydrogen peroxide gas plasma sterilization.
- EO and dry-heat BI organism?
- Bacillus atrophaeus — used for ethylene oxide and dry heat.
- Spaulding: critical items?
- Enter sterile tissue or the vascular system — must be STERILIZED (surgical instruments, implants).
- Spaulding: semicritical items?
- Contact mucous membranes or non-intact skin — high-level disinfection minimum (flexible endoscopes).
- Spaulding: noncritical items?
- Contact intact skin only — low/intermediate-level disinfection (BP cuffs, stethoscopes).
- Prevacuum steam cycle?
- About 4 minutes at 132–135°C (270–275°F); a vacuum pump removes air before steam.
- Gravity steam cycle (wrapped)?
- About 30 min at 121°C (250°F) or 15 min at 132°C (270°F); steam pushes air out the drain.
- What does a biological indicator prove?
- Actual kill of resistant spores — the only DIRECT proof of sterilization.
- What does a chemical indicator prove?
- The sterilant contacted the item (a PROCESS check) — not that the item is sterile.
- Cleaning vs sterilization order?
- Clean FIRST — soil shields microbes. 'If it is not clean, it cannot be sterilized.'
- What is the Spaulding classification?
- A system that ranks devices by infection risk (critical, semicritical, noncritical) to set the reprocessing level.
- High-level disinfection (HLD)?
- Destroys all microbes EXCEPT small numbers of bacterial spores (glutaraldehyde, OPA, peracetic acid).
- Intermediate-level disinfection?
- Kills mycobacteria, most viruses and bacteria — but NOT spores (alcohols, chlorine, iodophors).
- Low-level disinfection?
- Kills most bacteria, some viruses and fungi — not mycobacteria or spores (quats).
- What is sterilization?
- A process that destroys ALL microbial life, including bacterial spores.
- How does an ultrasonic cleaner work?
- Cavitation — imploding microscopic bubbles dislodge fine soil from hinges, box locks, and lumens.
- When is the ultrasonic used?
- AFTER gross soil is removed — never as the first or only cleaning step.
- What does a washer-disinfector do?
- Automated wash plus thermal or chemical disinfection of instruments (thermal rinse often ≥ 90°C).
- Utility water vs critical water?
- Utility = tap water for flushing/early cleaning. Critical = purified (RO/DI) for the final rinse.
- What is biofilm?
- A protective layer of microbes and soil that forms when soil dries on instruments; resists cleaning.
- How is biofilm prevented?
- Point-of-use treatment and prompt cleaning — keep instruments moist so soil never dries.
- Purpose of point-of-use treatment?
- Keep soil moist and start removing it right after use, so it cannot dry into biofilm.
- Enzymatic cleaner purpose?
- Breaks down organic matter — blood, protein, fat — in the pre-cleaning phase.
- Why submerge instruments during manual cleaning?
- To prevent aerosols (splash/spray) that could spread contamination.
- Manual cleaning water temperature?
- Controlled per IFU — typically warm, not hot, so protein soil does not coagulate onto the instrument.
- What is the chain of infection?
- The linked conditions (agent, reservoir, exit, transmission, entry, host) that let infection spread.
- What is cross-contamination?
- Transfer of microbes from a contaminated item or surface to a clean one.
- What is CJD and why is it special?
- Creutzfeldt-Jakob Disease — prion disease; prions resist normal sterilization and need enhanced processing.
- CJD/prion processing?
- Special enhanced steam exposure (e.g., prevacuum 134°C extended); prions resist routine cycles.
- What is TASS?
- Toxic Anterior Segment Syndrome — sterile eye inflammation from residues; prevented by thorough rinsing.
- MEC of a disinfectant?
- Minimum Effective Concentration — the lowest concentration that still works; checked with test strips.
- What are quats?
- Quaternary ammonium compounds — low-level disinfectants for noncritical surfaces.
- Glutaraldehyde and OPA are what level?
- High-level disinfectants (aldehydes) used for semicritical items like endoscopes.
- PPE for the decontamination area?
- Fluid-resistant gown, gloves, mask, and face/eye protection (full barrier in the dirty area).
- What is an AER?
- Automated Endoscope Reprocessor — cleans and high-level-disinfects flexible endoscopes.
- Why brushes sized to the lumen?
- A correctly sized brush contacts the inner walls to remove soil; a loose one misses it.
- Cart washer purpose?
- Automated cleaning of carts, large containers, and bulky items.
- Leak testing flexible scopes?
- Detects holes/tears in the scope before immersion; a leaking scope is removed from service.
- Detergent pH types?
- Enzymatic, neutral, and alkaline — matched to the soil and the IFU.
- What governs water quality for processing?
- ANSI/AAMI ST108 — defines utility and critical water categories.
- Why disinfectant exposure time matters?
- The agent must stay wet on the surface for the full labeled contact time to work.
- What is a chemical spill kit for?
- Safely containing and neutralizing a hazardous-chemical spill per the SDS.
- Decontamination area air pressure?
- Negative relative to clean areas, so contaminated air does not flow toward sterile items.
- Steam mode of action?
- Moist heat denatures and coagulates microbial proteins and enzymes.
- Dry-heat mode of action?
- Oxidation of cell constituents; slow to penetrate, so longer times are needed.
- Gravity-displacement steam cycle?
- Steam pushes air out by gravity through a drain; slower air removal, longer exposure.
- Prevacuum (dynamic-air-removal) cycle?
- A vacuum pump removes air BEFORE steam, giving fast, reliable penetration and shorter cycles.
- What is the Bowie-Dick (DART) test?
- A daily air-removal test for prevacuum sterilizers; uniform color = pass, a spot = trapped air = fail.
- When is the Bowie-Dick run?
- Daily, before the first processed load, in an otherwise empty chamber.
- Steam sterilization temperatures?
- 121°C (250°F) and 132°C (270°F) are the two common temperatures.
- Three phases of a steam cycle?
- Conditioning (air removal/heat-up), exposure (sterilize at temp/time), and exhaust/drying.
- Leading cause of a steam failure?
- Trapped air — it blocks steam contact, so air removal is closely monitored.
- Ethylene oxide (EO) used for?
- Heat- and moisture-sensitive devices and lumened items, at low temperature.
- Four critical EO parameters?
- Gas concentration, temperature, humidity, and exposure time.
- Why does EO need aeration?
- EO residual is toxic and carcinogenic; aeration (8–12 hr at 50–60°C) drives off the gas.
- EO hazards?
- Toxic, flammable, explosive, and a known human carcinogen.
- OSHA EO exposure limit?
- 1.0 ppm as an 8-hour time-weighted average (TWA).
- Hydrogen peroxide gas plasma temperature?
- Low temperature, about 37–44°C — for heat-sensitive devices.
- Does H₂O₂ gas plasma need aeration?
- No — by-products are water vapor and oxygen, so items are safe to handle immediately.
- H₂O₂ gas plasma restrictions?
- No moisture (wet items abort the cycle); cellulose/linen and long narrow lumens are restricted.
- Ozone sterilization basics?
- Low temperature (30–35°C); made in-machine from oxygen and water; reverts to oxygen and water.
- Dry-heat parameters?
- About 170°C for 60 min, 160°C for 120 min, or 150°C for 150 min.
- Dry heat is used for?
- Powders, oils, and anhydrous items that steam cannot penetrate or that moisture would damage.
- What is IUSS (flash)?
- Immediate Use Steam Sterilization — for items needed right away; e.g., 132°C, 3 min, gravity, unwrapped.
- Are implants sterilized by IUSS?
- Not routinely — only in a documented emergency, with a Class 5 integrator.
- Chemical indicator (CI)?
- A device that changes color when a sterilization condition is met — a process check, not sterility.
- External vs internal chemical indicator?
- External = on the outside (processed vs not). Internal = inside the pack at the hardest-to-reach spot.
- CI Class 1?
- Process indicator (e.g., autoclave tape) — shows the pack was exposed, not that it is sterile.
- CI Class 2?
- A specific-use test, such as the Bowie-Dick air-removal test.
- CI Class 5?
- Integrating indicator — reacts to all critical parameters and correlates to BI performance.
- CI Class 6?
- Emulating indicator — cycle-verification, tied to a specific cycle's parameters.
- Biological indicator (BI)?
- Contains resistant spores; after incubation it proves whether the cycle killed them.
- What is a PCD?
- Process Challenge Device — a hard-to-sterilize challenge pack holding the BI/CI to test the cycle.
- Action on a positive BI?
- Recall loads back to the last negative BI, quarantine them, remove the sterilizer, document, investigate.
- Why quarantine implants?
- Hold implants until the BI result is read; release early only in a documented emergency.
- What is a load-control (lot) number?
- An identifier linking every item to a specific sterilizer, load, and date — enables recall and traceability.
- Physical/mechanical monitor confirms?
- That the cycle reached and held time, temperature, and pressure (printout/gauge).
- Who initials the sterilizer printout?
- The operator — accountability that the cycle parameters were verified.
- What is a wet pack?
- Moisture inside or on a package after the cycle; it can wick microbes in — the load is not sterile.
- Cooling sterile items — why?
- Hot packs must cool on a rack/cart before handling; handling warm packs can cause condensation and wet packs.
- High-temp vs low-temp methods?
- High-temp = steam and dry heat. Low-temp = EO, H₂O₂ gas plasma, ozone, liquid chemical.
- Liquid chemical sterilant example?
- Peracetic acid systems — low-temperature sterilization of immersible instruments and endoscopes.
- Sterilizer parts to check?
- Jacket, door gasket, and drain/strainer — inspected and maintained per IFU.
- Why inspect instruments before packaging?
- To verify cleanliness and function — a soiled or broken instrument cannot be sterilized or used safely.
- Correct instrument lubricant?
- Water-soluble, steam-penetrable instrument 'milk' per IFU — never petroleum/oil-based.
- Why not oil-based lubricant?
- Oil coats the surface and blocks the sterilant from contacting the metal.
- What is insulation testing?
- Checking electrosurgical instrument coatings for breaks that could burn tissue; defects are removed.
- What is a count sheet?
- A list of every item in a tray, used to assemble and verify the set correctly.
- Tray weight limit benchmark?
- AAMI recommends about 25 lb (≈11.3 kg) per tray, with even weight distribution.
- Why open/unlock hinged instruments?
- So the sterilant reaches all surfaces, including the box lock and jaws.
- Where does the internal CI go?
- In the area of the pack most challenging for the sterilant to reach.
- Three main packaging methods?
- Sterilization wrap, peel pouches, and rigid containers.
- Two sterilization-wrap fold techniques?
- Square fold and envelope fold.
- Which side of a peel pouch to write on?
- The clear plastic side — never the paper (Tyvek), which the sterilant passes through.
- Where to write a tray label?
- On the indicator tape or label — never on the sterilization wrapper itself.
- Rigid container checks?
- Intact filters, gaskets, valves, and latches before each use.
- What goes on a package label?
- Contents, load/lot number, sterilizer, date, and the technician's initials.
- Tip protectors are for?
- Protecting delicate or sharp instrument tips and must be steam/sterilant-permeable.
- Functionality testing checks?
- Sharpness, alignment, ratchets, box locks, hinges, and signs of staining or corrosion.
- Handling a broken/dull instrument?
- Document it and remove it for repair — do not assemble it into a set.
- Why magnification/good lighting in prep?
- To detect residual soil, cracks, pitting, and damage during inspection.
- Match packaging to what?
- The sterilization method — high-temp packaging vs low-temp-compatible packaging.
- What is a peel pouch used for?
- Small, lightweight single items; the clear side lets you see the contents.
- Why not overload a set/tray?
- Excess weight and density block sterilant penetration and cause wet packs.
- What is an integrator?
- A Class 5 chemical indicator that reacts to all critical parameters; placed inside the pack.
- Why a one-way workflow in the SPD?
- Items move dirty → clean → sterile and never back, preventing contamination of clean instruments.
- What separates decon from the clean side?
- A physical barrier (wall/partition) with separate ventilation and pressure.
- Who sets SPD temperature/humidity/airflow?
- ASHRAE (and AAMI ST79) define the environmental requirements per area.
- What is an SDS?
- Safety Data Sheet — OSHA-required document of a chemical's hazards, handling, PPE, first aid, and disposal.
- What is an IFU?
- Instructions For Use — the manufacturer's validated, FDA-cleared method for reprocessing a device.
- Why is the IFU legally binding?
- It is the validated, FDA-cleared method; following it is how a device is ensured safe and sterile.
- SPD dress code basics?
- Surgical attire, hand hygiene, hair covered, no artificial nails or jewelry.
- What is QA in the SPD?
- Quality assurance — monitoring processes (tray audits, turnaround, case-cart accuracy) to ensure quality.
- Quality improvement methods?
- TQI/CQI, Six Sigma, and LEAN.
- Record retention — why?
- Sterilization records are legal documents and enable recall and traceability.
- What is an eyewash station for?
- Immediate flushing of the eyes after a chemical splash; required where chemicals are used.
- Which agencies regulate/standardize SPD?
- FDA, CMS, CDC, OSHA, EPA, The Joint Commission, plus AAMI/ANSI and AORN standards.
- What is AAMI ST79?
- The comprehensive guide to steam sterilization and sterility assurance — the primary SPD standard.
- What is ergonomics in the SPD?
- Designing tasks and workstations to reduce strain and injury (lifting, repetitive motion).
- What is IUSS tracked under QA?
- Immediate-use steam sterilization is monitored and minimized because it has higher risk.
- Role of The Joint Commission?
- Accredits hospitals and surveys SPD practices, IFU adherence, and the environment.
- Role of the FDA in the SPD?
- Regulates medical devices, sterilizers, and sterilants; device IFUs are legally binding.
- What does CMS oversee?
- Conditions of Participation tied to Medicare/Medicaid reimbursement.
- What is event-related sterility?
- A package stays sterile until an EVENT compromises it (tear, wet, dropped) — not until a date.
- Time-related vs event-related sterility?
- Time-related used expiration dates; event-related (current standard) uses package integrity.
- What is FIFO?
- First In, First Out — use the oldest stock first to rotate inventory and avoid expiration.
- Sterile storage floor/ceiling distances?
- About 8–10 in. off the floor and 18 in. below the ceiling/sprinklers, away from outside walls.
- Sterile storage environment?
- Clean, dry, controlled temperature/humidity, restricted access, with covered or solid shelving.
- Transporting sterile items?
- In closed/covered carts with dust covers to maintain sterility during distribution.
- Inspect a package before use — what?
- Integrity (no tears/holes), dryness, intact seal, and the chemical indicator.
- What is PAR level?
- Periodic Automated Replenishment — the set stock level that triggers reordering.
- What is a case cart system?
- A cart assembled with all instruments and supplies for a specific surgical case.
- What is a UDI?
- Unique Device Identifier — used to identify and track a specific device.
- What is RFID used for in inventory?
- Radio-frequency tracking of instruments, trays, and equipment location and status.
- Handling a manufacturer recall?
- Identify affected lots via load-control records, remove items from use, and document/notify.
- Just-in-time vs exchange cart?
- Just-in-time delivers supplies as needed; exchange carts swap a full cart for a used one.
- Loaner/consignment instruments?
- Vendor-owned trays that must be cleaned, inspected, and sterilized per IFU before use.
- How does HIPAA apply to an SPD tech?
- Protect patient information on case carts, count sheets, and implant records; share only on need-to-know.
- What is service recovery?
- Resolving a complaint or error to restore a customer's (OR/unit) confidence.
- Why learn medical/instrument terminology?
- To communicate accurately about cases, sets, and instruments with the OR and other staff.
- What is continuing education for?
- Maintaining certification and staying current with standards and technology.
- What is a cross-functional team?
- A group from different roles/departments working together on a shared goal (e.g., OR and SPD).
- Professional communication etiquette?
- Courteous, clear telephone and in-person communication, including service recovery and respect (DEI).
- Why is anatomy/physiology useful to a tech?
- It helps a technician understand how instruments are used and assemble sets correctly.
- What is in-servicing?
- On-the-job training on new equipment, instruments, or procedures.
- What is preventive maintenance (PM)?
- Scheduled inspection, testing, and servicing of patient care equipment to keep it safe and working.
- Expired or missing PM tag — action?
- Remove the equipment from service and send it to Biomedical Engineering before issuing it.
- Inspect patient care equipment for?
- Frayed cords, cracks, damage, and proper function per the IFU before distribution.
- Who repairs patient care equipment?
- Biomedical Engineering (Clinical Engineering).
- Examples of patient care equipment?
- SCD pumps/sleeves, suction units, feeding pumps, and IV poles handled by the SPD.
- How is equipment location tracked?
- Manual logs, computerized systems, or RFID record where each item is and its status.
- Where is equipment distributed?
- To the OR, ED, L&D, and patient units after testing, cleaning, and inspection per IFU.
- What is decontamination?
- The process that removes or reduces contamination so an item is safe to handle (cleaning + disinfection).
- Cleaning vs decontamination?
- Cleaning removes soil; decontamination makes the item safe to handle by cleaning plus disinfection.
- What is bioburden?
- The number of microorganisms on a contaminated item before reprocessing.
- Why control detergent dilution?
- Too little is ineffective; too much wastes product and can leave residue — follow the IFU exactly.
- What is a high-pressure water gun for?
- Flushing soil from lumens and channels that brushes cannot fully reach.
- Manual vs mechanical cleaning?
- Manual = hand cleaning at the sink; mechanical = automated (ultrasonic, washer-disinfector, cart washer).
- Why visual inspection after cleaning?
- To confirm no visible soil remains before the item moves to the clean side.
- Sharps handling in decon?
- Keep point-down, never recap by hand, and dispose in a puncture-resistant sharps container.
- EPA's disinfection role?
- Registers surface disinfectants and their tuberculocidal and other label claims.
- Peracetic acid is used for?
- A high-level disinfectant/sterilant for immersible instruments and endoscopes (e.g., automated systems).
- Why rinse after disinfection?
- To remove chemical residue that could harm patients or instruments (e.g., TASS prevention).
- Closed container for transport — why?
- To contain soiled items and prevent exposure and spills during transport to decontamination.
- Why not mix dissimilar metals in the ultrasonic?
- Galvanic action can pit or corrode the instruments.
- Standard precautions mean?
- Treat all blood and body fluids as potentially infectious — full PPE in decontamination.
- What is the dirty side?
- The decontamination area where contaminated items are received and cleaned.
- What is SAL?
- Sterility Assurance Level — the probability of a surviving microbe, target 10⁻⁶ (one in a million).
- What is conditioning in a steam cycle?
- The first phase — air removal and heat-up before exposure.
- What is the exposure phase?
- The time the load is held at the set temperature to sterilize.
- Why drying after a steam cycle?
- To remove condensate and prevent wet packs that could wick microbes in.
- Steam-flush pressure-pulse (SFPP)?
- A steam cycle that alternates flush and pressure pulses to remove air; air leaks do not affect it.
- Where is the BI/PCD placed in the load?
- In the area hardest for the sterilant to reach, per IFU and AAMI guidance.
- Run a BI how often for steam?
- At least daily, and with every load containing an implant.
- What is a control BI?
- An unprocessed BI from the same lot, incubated to confirm the spores were viable.
- Why test a sterilizer after repair?
- To verify it works before clinical use — run BI/PCD and qualification cycles after major repair.
- EO 5-stage cycle?
- Preconditioning/humidification, gas introduction, exposure, evacuation, and air washes.
- Why humidity in an EO cycle?
- Moisture carries EO to reactive sites and is required for the gas to be effective.
- STERRAD uses what agent?
- Vaporized hydrogen peroxide, energized into a plasma of microbicidal free radicals.
- Ozone reverts to what?
- Oxygen and water vapor at the end of the cycle — no toxic residue.
- Static-air vs forced-air dry heat?
- Static-air (gravity convection) is slower; forced-air (mechanical convection) heats faster.
- Why is dry heat slow?
- Air is a poor conductor, so heat penetrates slowly — long times at high temperatures are needed.
- Steam quality requirement?
- Saturated steam (about 97–100% dryness) with minimal non-condensable gases.
- What aborts an H₂O₂ plasma cycle?
- Moisture or cellulose in the load — both are not permitted.
- Implant load release rule?
- Hold the load until the BI is read; early release only in a documented emergency with a Class 5 integrator.
- Recall back to when?
- Back to the last NEGATIVE biological indicator result for that sterilizer.
- Process failure follow-up steps?
- Identify, recall, quarantine, document, notify, investigate, and retest before returning to service.
- Why even weight distribution in a tray?
- To prevent wet packs and ensure the sterilant penetrates the whole set.
- Stringers and racks are for?
- Holding hinged instruments open and organized so the sterilant reaches all surfaces.
- Self-seal vs heat-seal pouch?
- Self-seal has an adhesive strip; heat-seal is closed with a heat sealer — both must seal fully.
- Why test the heat sealer?
- A weak or incomplete seal can fail and compromise sterility; seals are checked routinely.
- Inspecting a wrapper before use?
- Check for holes, tears, and stains; a compromised wrapper cannot maintain sterility.
- Loaner tray handling?
- Obtain the IFU and count sheet, then clean, inspect, assemble, and sterilize per the manufacturer.
- Why catalogs/product numbers in prep?
- To correctly identify instruments and assemble sets accurately.
- Special label identifiers?
- Implant, loaned, and the sterilization method/cycle used.
- Foam, mats, and tray liners are for?
- Protecting instruments and absorbing moisture while allowing sterilant penetration.
- Why a clean, well-lit prep area?
- Soil and defects must be visible; the clean side is kept separate from decontamination.
- Air exchanges in decontamination?
- Per AAMI/ASHRAE, frequent air exchanges with negative pressure relative to clean areas.
- Out-of-parameter temp/humidity — action?
- Document it and take corrective action; sterility and package integrity can be affected.
- What are accident/incident reports?
- Documentation of injuries or events, retained as legal records and for QA review.
- AORN's role?
- Sets perioperative nursing standards that overlap with the sterile field and instrument handling.
- What is tray-audit benchmarking?
- Tracking tray accuracy and errors as a quality metric.
- Why retain QA test results?
- They are legal records and support recall, traceability, and process improvement.
- Hand hygiene in the SPD?
- Performed on entry, between tasks, and when changing areas; part of the dress code.
- What is LEAN?
- A quality method that reduces waste and improves workflow efficiency.
- Break-out area purpose?
- Where external shipping cartons are removed before supplies enter the clean storage area.
- Why no shipping boxes in sterile storage?
- Cartons carry dust and pests; they are broken down in a separate break-out area.
- Dust covers are used when?
- Over sterile packs in storage/transport to protect them from contamination.
- Unit of measure in ordering?
- Each, box, or case — must match so quantities are ordered correctly.
- Exchange cart system?
- A par-stocked cart swapped on a schedule to replenish a unit's supplies.
- Specialty/emergency carts examples?
- Code carts, C-section carts, and procedure-specific carts kept ready.
- Consignment inventory?
- Vendor-owned stock kept on site and paid for only when used (e.g., implants).
- Why FIFO with manufacturer dates?
- So items with printed expiration dates are used before they expire.
- DEI in the workplace?
- Diversity, equity, and inclusion — respectful, fair treatment of all coworkers and customers.
- Role accountability on a team?
- Each member understands their responsibilities and is accountable for their part of the workflow.
- Why telephone etiquette matters?
- Clear, courteous communication with the OR/units prevents errors and delays.
- Resume and interview prep belong to?
- Personal and professional development within the human-relations content area.
- SCD device purpose?
- Sequential compression device — pumps that help prevent blood clots in the legs.
- Why test equipment per IFU before issue?
- To confirm it functions safely for patient use.
- Rental/loaned equipment tracking?
- Documented in manual, computer, RFID, or hybrid systems for location and return.
- Corrective action for damaged equipment?
- Tag it out of service and route it to Biomedical Engineering for repair.
