High-level Disinfection, Sterilization, and Antisepsis: Current Issues in Reprocessing Medical and S

Technology is rapidly changing many aspects of health care. The intricate design of instruments, the configuration of instrument trays, and evidence-based practice have resulted in the need for complicated and specific reprocessing recommendations from instrument manufacturers.

Patient safety depends on instruments that are appropriately cared for and adequately reprocessed (ie, cleaned and disinfected and sterilized). This article covers some current issues that sterile processing and operating room professionals must deal with regarding reprocessing of medical and surgical instruments.

2 Comprehensive guide to steam sterilization and sterility assurance in health care facilities. ANSI/AAMI ST79:2006 and ANSI/AAMI ST79/A1:2008 (consolidated text). Accessed January 16, 2013. If packs are found to be wet after sterilization, they should not be released for use. ANSI and AAMI ST79 2 Comprehensive guide to steam sterilization and sterility assurance in health care facilities. ANSI/AAMI ST79:2006 and ANSI/AAMI ST79/A1:2008 (consolidated text). Accessed January 16, 2013. recommends any set containing moisture inside the container system should be considered contaminated because there are no scientific studies to prove otherwise. A package is considered a wet pack if moisture in the form of dampness, droplets, or puddles of water is found on or within a textile pack, instrument, basin set, or rigid container or containment devices after the sterilization and cool-down process.If packs are found to be wet after sterilization, they should not be released for use. ANSI and AAMI ST79recommends any set containing moisture inside the container system should be considered contaminated because there are no scientific studies to prove otherwise. Wet pack issues should be explored to resolve the problems. Internal or external moisture has the potential to provide pathways for microorganisms to go into the package, contaminating the contents. Moisture found on the outside of a package is usually caused by condensation dripping from above. This is sometimes the result of improper loading of the cart. Moisture found on the inside of a package can also be the result of a too-large metal mass that can trap water, an overloaded tray, or lack of absorbent material such as towels or textiles. 4 Recommended practices for selection and use of packaging systems. Association of periOperative Registered Nurses Web site. Accessed January 16, 2013. Precondition of the load is 1 method frequently used to minimize wet pack issues. To precondition a load, place the instruments inside the steam sterilizer with the door closed for 10-15 minutes before starting the cycle. This will heat the instruments, helping to resolve some wet pack problems not related to steam quality or inadequate packaging or loading configurations. All items removed from the sterilizer after sterilization processing, including items packaged in rigid sterilization container systems, should remain on the sterilizer cart until adequately cooled. They should not be touched during the cooling process. Rigid sterilization container systems should remain on the sterilizer cart until container surfaces are cool to the touch and can be handled safely by the operator with bare hands. The cool-down period begins within the sterilizer chamber. The door may be opened slightly at the end of the cycle and the items left inside for a period of time in order to reduce the potential for condensation formation. 2 Comprehensive guide to steam sterilization and sterility assurance in health care facilities. ANSI/AAMI ST79:2006 and ANSI/AAMI ST79/A1:2008 (consolidated text). Accessed January 16, 2013. The time allowed for cooling should take into account the type of sterilizer being used, the design of the device being sterilized, the temperature and humidity of the ambient environment, and the type of packaging used. A minimum cooling time of 30 minutes is recommended. During cooling, the sterilizer cart should be placed in a low-traffic area where there are no air-conditioning or other cold-air vents in close proximity. Warm items should never be transferred from the cart to cold metal racks or shelves for cooling or placed within dust covers before completion of the cooling process. 2 Comprehensive guide to steam sterilization and sterility assurance in health care facilities. ANSI/AAMI ST79:2006 and ANSI/AAMI ST79/A1:2008 (consolidated text). Accessed January 16, 2013. Sterilized packages should not be touched until after the cool-down period. Cooling packages is an important step in preventing wet packs. According to sterilizer unloading procedures in ANSI and AAMI ST79 section 8.8.1:

12 Loaner instrumentation: SPD and OR working together to manage loaner instrumentation. AORN recommended practices documents 4 Recommended practices for selection and use of packaging systems. Association of periOperative Registered Nurses Web site. Accessed January 16, 2013. state: "A formalized program between healthcare organizations and healthcare industry representatives should be established for the receipt and use of loaner instrumentation." Facilities frequently borrow surgical instruments or implants for specialty operative procedures. The management of loaner instrumentation and implants is recognized as a concern by many health care professionals.AORN recommended practices documentsstate: "A formalized program between healthcare organizations and healthcare industry representatives should be established for the receipt and use of loaner instrumentation." 12 Loaner instrumentation: SPD and OR working together to manage loaner instrumentation. The International Association of Healthcare Central Service Materiel Management (IAHCSMM) agrees 13 IAHCSMM position paper on the management of loaner instrumentation. Accessed January 17, 2013. that health care facilities that borrow surgical instruments should have a well-developed loaner program and written policy that establishes standardized receipt and use of all loaner instrumentation. Because of the need for consistent controls this policy should be established with input from sterile processing units, surgeons and operating room staff, and various departments such as infection prevention and control, administration, materials management, and risk management. The IAHCSMM sample policy 13 IAHCSMM position paper on the management of loaner instrumentation. Accessed January 17, 2013. states that health care facilities should have loaner trays at least 2 business days before the scheduled use and, if it is a first-time vendor, the loaned sets should be obtained 3 business days before the scheduled use for in-servicing, inspection, testing, and processing. The IAHCSMM position paper and the policy template can be downloaded from the association's Web site ( A collaborative, well-written policy with specific controls must be in place to ensure successful management of these instruments and implants.The International Association of Healthcare Central Service Materiel Management (IAHCSMM) agreesthat health care facilities that borrow surgical instruments should have a well-developed loaner program and written policy that establishes standardized receipt and use of all loaner instrumentation. Because of the need for consistent controls this policy should be established with input from sterile processing units, surgeons and operating room staff, and various departments such as infection prevention and control, administration, materials management, and risk management. The IAHCSMM sample policystates that health care facilities should have loaner trays at least 2 business days before the scheduled use and, if it is a first-time vendor, the loaned sets should be obtained 3 business days before the scheduled use for in-servicing, inspection, testing, and processing. The IAHCSMM position paper and the policy template can be downloaded from the association's Web site ( www.iahcsmm.org ). 12 Loaner instrumentation: SPD and OR working together to manage loaner instrumentation. Loaning and borrowing of surgical instruments and implants should be consistently managed according to the written policy of each facility. Tracking loaners, either manually or automatically, is necessary for quality controls as well as asset management of loaners.

14 Water for the reprocessing of medical devices. Accessed January 16, 2013. P. 37-46. Water quality is a vital concern in all steps of reprocessing surgical and medical instruments. The quality of water used is very important to prolong the life of the medical devices as well as minimizing the risk to patients. 15 Water quality and its impact on the decontamination process. There are 2 general methods used to deal with water impurities related to reprocessing of surgical and medical instruments. The first is the use of a water treatment system that reduces or removes impurities before use. The second method involves adding chemicals to address water impurities during the decontamination process. 14 Water for the reprocessing of medical devices. Accessed January 16, 2013. P. 37-46. Steam quality is affected by the quality of the water being used to generate the steam. Pretreatment of water may be required to eliminate the possibility of residuals or deposits when the steam is used for sterilization, especially in flash sterilization. 14 Water for the reprocessing of medical devices. Accessed January 16, 2013. P. 37-46. , 15 Water quality and its impact on the decontamination process. There are many different types of water purification systems. The most common water treatment is a water softener. A water softener purifies with a process of ion exchange. Other treatments commonly used to purify water are deionization system and reverse osmosis. Deionization removes ions to purify the water and requires tank exchanges. Reverse osmosis purifies by using a semipermable membrane to remove or reduce impurities. Reverse osmosis generally requires more space and has a higher start-up price; however, reverse osmosis systems do not require tank exchanges. 15 Water quality and its impact on the decontamination process. For devices that will come in contact with the bloodstream or sterile areas of the body, high purity water is recommended for the final rinse of the item. Health care facilities should evaluate the water used in the various steps of reprocessing. 15 Water quality and its impact on the decontamination process. Sterile processing staff members should work closely with water service maintenance personnel to establish and monitor the water treatment systems used for cleaning, disinfecting, and sterilizing all reusable devices. Water impurities can also affect the functionality, effectiveness, and life span of automated reprocessing equipment. There are several tools and test strips available to monitor the quality of water used in sterile processing.Sterile processing staff members should work closely with water service maintenance personnel to establish and monitor the water treatment systems used for cleaning, disinfecting, and sterilizing all reusable devices.

2 Comprehensive guide to steam sterilization and sterility assurance in health care facilities. ANSI/AAMI ST79:2006 and ANSI/AAMI ST79/A1:2008 (consolidated text). Accessed January 16, 2013. Toxic anterior segment syndrome (TASS) is an acute inflammatory response caused when foreign material is introduced into the anterior chamber of the eye. TASS may lead to severe visual impairment or blindness. Special processing considerations are necessary for eye instrumentation because of the nature of the instruments themselves and the sensitive nature of the eye. 2 Comprehensive guide to steam sterilization and sterility assurance in health care facilities. ANSI/AAMI ST79:2006 and ANSI/AAMI ST79/A1:2008 (consolidated text). Accessed January 16, 2013. addresses TASS and the processing of intraocular surgical instruments. According to AAMI, the introduction of TASS may be associated with specific products, such as contaminated balanced salt solution, detergent residues, endotoxins, preservatives, foreign matter, and residues from sterilization processing. Therefore, particular care must be taken in the processing of intraocular surgical instruments. Many eye instruments are complex and delicate and must be cleaned manually. Manual cleaning methods may be less controlled, so additional care must be taken during processing to ensure effective cleaning and rinsing. Annex N of the ANSI and AAMI ST79addresses TASS and the processing of intraocular surgical instruments. According to AAMI, the introduction of TASS may be associated with specific products, such as contaminated balanced salt solution, detergent residues, endotoxins, preservatives, foreign matter, and residues from sterilization processing. Therefore, particular care must be taken in the processing of intraocular surgical instruments. Many eye instruments are complex and delicate and must be cleaned manually. Manual cleaning methods may be less controlled, so additional care must be taken during processing to ensure effective cleaning and rinsing. 2 Comprehensive guide to steam sterilization and sterility assurance in health care facilities. ANSI/AAMI ST79:2006 and ANSI/AAMI ST79/A1:2008 (consolidated text). Accessed January 16, 2013. highlights those existing recommendations for reducing the risk of TASS. Important elements of a processing program for intraocular surgical instruments include, but are not limited to, maintaining an adequate inventory of eye instruments, allowing adequate time for processing instruments according to MDM instructions, processing intraocular surgical instruments separately from general surgical instruments in a designated cleaning area with dedicated equipment, and following manufacturers' current written instructions for the cleaning and sterilization of eye instruments. Auditing the cleaning process will ensure procedures comply with manufacturer instructions and that personnel performing cleaning procedures have received documented training and have demonstrated competency in the cleaning process. 2 Comprehensive guide to steam sterilization and sterility assurance in health care facilities. ANSI/AAMI ST79:2006 and ANSI/AAMI ST79/A1:2008 (consolidated text). Accessed January 16, 2013. Specific eye instrument cleaning and sterilization recommendations are published by the American Society of Cataract and Refractive Surgery and the American Society of Ophthalmic Registered Nurses. Annex N of AAMI ST79highlights those existing recommendations for reducing the risk of TASS. Important elements of a processing program for intraocular surgical instruments include, but are not limited to, maintaining an adequate inventory of eye instruments, allowing adequate time for processing instruments according to MDM instructions, processing intraocular surgical instruments separately from general surgical instruments in a designated cleaning area with dedicated equipment, and following manufacturers' current written instructions for the cleaning and sterilization of eye instruments. Auditing the cleaning process will ensure procedures comply with manufacturer instructions and that personnel performing cleaning procedures have received documented training and have demonstrated competency in the cleaning process. 2 Comprehensive guide to steam sterilization and sterility assurance in health care facilities. ANSI/AAMI ST79:2006 and ANSI/AAMI ST79/A1:2008 (consolidated text). Accessed January 16, 2013. Only cleaning agents that have been recommended by the specific eye instrument's manufacturer should be used on intraocular instruments. Particular attention should be directed toward ensuring that the specified concentration of the recommended cleaning agent and water quality are used. Final rinsing of instruments should be performed with the volume of sterile, distilled, or deionized water recommended by the manufacturer. Single-use brushes of the correct size should be used and then disposed of. 2 Comprehensive guide to steam sterilization and sterility assurance in health care facilities. ANSI/AAMI ST79:2006 and ANSI/AAMI ST79/A1:2008 (consolidated text). Accessed January 16, 2013. provides detailed recommendations for sterilization processing, including quality control and restrictions regarding the use of flash sterilization. Eye instruments should be sterilized using the methods and conditions recommended in the MDM IFU. The sterilization process should be effective, monitored, and documented. AAMI ST79provides detailed recommendations for sterilization processing, including quality control and restrictions regarding the use of flash sterilization. 2 Comprehensive guide to steam sterilization and sterility assurance in health care facilities. ANSI/AAMI ST79:2006 and ANSI/AAMI ST79/A1:2008 (consolidated text). Accessed January 16, 2013. Cleaning and sterilization equipment, boilers, and water filtration systems should be properly maintained. Otherwise, foreign materials such as endotoxins, heavy metals, or chemical contaminants or impurities may be deposited onto the instruments during processing and induce TASS. Because many different materials can elicit a TASS response if they are inadvertently introduced into the anterior chamber of the eye, the importance of following the proper intraocular surgical instrument processing procedures cannot be overemphasized.

Reprocessing plays a very important role in helping to prevent infections. Technology is changing how procedures are performed and requiring more complicated devices to be reprocessed. Published recommended practices are constantly being updated to reflect evidence-based practices and validated practices. Patient safety depends on instruments that are appropriately cared for and effectively reprocessed; therefore, the most current best practices should be identified and followed. Some of the most current issues relating to reprocessing surgical and medical devices are the importance of following the manufacturer's written IFUs, including cycle parameters; a pan weight not exceeding 25 lb; investigating the reason(s) for wet packs; being aware of updates in packaging; managing loaner instrumentation efficiently; monitoring water quality needs; and handling of intraocular instruments appropriately.

High-level Disinfection, Sterilization, and Antisepsis: Current Issues in Reprocessing Medical and S 1

home made cage disinfectant for rats?

I use a mixture of water and white vinegar. It takes away odour, gets rid of bacteria, and its completely safe for your rats. :)

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Citing Privacy Concerns, U.S. Panel Urges End to Secret DNA Testing
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A three-year-old federal law prohibits discrimination in employment or health insurance based on someone's genetic information but does not address other potential misuses of the data. Without such privacy protection, said Gutmann, people may be reluctant to participate in genetic studies that do whole genome sequencing, for fear their genetic data will not be secure and could be used against them. Recommendations from such panels are not binding but have been used as the basis for policy and legislation. One scenario the panel offers is a "contentious spouse" secretly having a DNA sample sequenced and using it in a custody battle "as evidence of unfitness to parent," perhaps because the DNA showed a genetic risk for mental illness or alcoholism. There are no federal laws against that. 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How to Cut Corn Off the Cob Easily, Quickly, & Safely
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How to Make Jewelry From Seeds
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Find the Right and Trustworthy Medical Equipment Suppliers in India
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What to Give Up for Lent? Smoking? Cursing? How About ...
What to Give Up for Lent? Smoking? Cursing? How About ...
LONDON - For Lent, many Christians give up indulgences like tobacco, alcohol or sweets, or transgressions like lying and swearing. And for Anglicans, don't forget synthetic fabrics, wet wipes, and those little boxes that hold dental floss.The Church of England has asked people to add a new culprit to the list of ills they forsake for the six weeks of penance that begin on Ash Wednesday: plastics. Specifically, the church wants people to avoid the plastic consumer products and packaging that have become a major environmental problem, polluting oceans and rivers, fouling beaches, killing wildlife and clogging landfills."I think it might well be a first for us, to have an entire Lent program on an environmental issue, but it is very much an integral part of what the church is about," said Ruth Knight, the Church of England's environmental policy officer. In fact, environmental stewardship "to safeguard the integrity of creation" is one of the five "marks of mission" the church lists in describing its purpose.The church's "Lent Plastic Challenge" arrives on a wave of anti-plastic sentiment and legislation in Britain and across Europe, as more people conclude that the first element of the motto "reduce, reuse, recycle" should take precedence. In December, the European Union announced binding waste-reduction targets for member nations, with particular emphasis on plastics.Last month, a ban on plastic microbeads in cosmetic products took effect in Britain, and Prime Minister Theresa May's government committed Britain to a 25-year environmental plan that includes eliminating most plastic waste. Several big cafe and restaurant chains have recently done away with plastic straws, or promised to do so, and the government of Scotland has said it will ban them by the end of next year.[Read how a 9-year-old boy's statistic shaped a debate on straws here.]In Wales, Scotland and Northern Ireland, stores must charge 5 pence for each single-use shopping bag, whether paper or plastic, and the same charge applies in England for plastic bags at larger retailers. The measure has sharply reduced plastic bag use, and lawmakers say they want to impose charging more widely in England.Last fall, a BBC documentary series on the oceans, Blue Planet II, which dealt extensively with environmental dangers, including from plastics, was the most-viewed program in Britain.The Church of England has created a calendar for a plastics-free Lent, each day bearing either an environmentally-themed Bible verse or a suggestion on how to avoid buying plastics.Along with some of the easier-to-follow suggestions, like buying clothes made of natural fibers or taking reusable bags to the grocery store, are others that might require more effort, like finding dental floss that does not come in a plastic box, or using "a bamboo toothbrush or a toothbrush with recyclable heads.""Yeah, some of them are more difficult than others," Ms. Knight said. "It's definitely not a commandment to do all of them, it's encouragement to do as much as you can."A large part of the world's plastic waste - estimates range from five million to 13 million tons per year - ends up in the oceans. Circulating currents have created immense rotating patches of waste, mostly plastic, in subtropical regions.Wave action and sunlight break floating plastics down in smaller pieces, but some of them are very slow to degrade chemically, and are toxic. Animals eat bits of plastic, with ill effects on them - and further up the food chain, all the way to humans - that are only beginning to be understood.
2021 07 28
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How to Mark Climbing Ropes
How to Mark Climbing Ropes
A climbing rope is literally a climber's lifeline, one of the few items of a gear system that usually isn't redundant. When you life depends on a single piece of nylon--and certain substances have been shown to degrade nylon--who can blame climbers for being nearly paranoid about what touches their ropes? There are two commonly accepted ways of marking the middle point on a climbing rope: using a specially designed rope marker or marking the middle with dental floss or thread.InstructionsDifficulty: Moderately EasyHold the two ends of the rope together in your right hand. Wrap your left hand around both strands of rope.Pull both strands of rope evenly through your left hand until you reach the middle of the rope.Pinch the rope in one hand, just below the middle of the rope, while you color in a 1- or 2-inch wide portion of the rope sheath, all the way around the circumference of the rope, centered on the middle of the rope. Make sure you use a marker specially designed for marking climbing ropes.Mark the middle with dental floss if you'd rather not use a marker on your rope. Thread a large sewing needle with dental floss. Work the dental floss around the middle of the rope, threading it through the rope's sheath, not directly through the core, until you've created a mark that's large enough to easily spot.Tips & WarningsResourcesArticle Written By Marie MulrooneyMarie Mulrooney has written professionally since 2001. Her diverse background includes numerous outdoor pursuits, personal training and linguistics. She studied mathematics and contributes regularly to various online publications. Mulrooney's print publication credits include national magazines, poetry awards and long-lived columns about local outdoor adventures.
2021 07 30
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