Surgical Technology Principles And Practice 5th Edition By Joanna Kotcher – Test Bank

Surgical Technology Principles And Practice 5th Edition By Joanna Kotcher – Test Bank

Fuller: Surgical Technology, 5^th Edition

Chapter 8: Decontamination, Sterilization, and Disinfection

Test Bank

TRUE/FALSE

1. An antiseptic is a chemical used to remove microorganisms on tissue.

ANS: T

An antiseptic is a chemical used to remove microorganisms on tissue. Surgical hand rubs and soaps contain antiseptic.

DIF: 1 REF: p. 119

2. The central issue with reprocessing single-use items is not the patient and personal safety of the user but the cost of reprocessing.

ANS: F

Single-use items manufactured under FDA approval have a high level of safety. However, many items opened for surgery are never used and eventually are discarded as waste. To cut costs and retrieve the expense of these items, some institutions reprocess the items. Commercial reprocessing services are available for instruments and equipment approved for reprocessing by the manufacturer. However, unless the manufacturer sanctions reprocessing, the safety of any device intended for single use may be compromised.

DIF: 2 REF: p. 122

3. Event-related sterility or terminal sterilization is based on the principle that sterilized items are assumed sterile between uses, unless environmental conditions or events interfere with the integrity of the package.

ANS: T

After an item is processed and sterilized, consideration must be given to how the item can be kept sterile. Time-related sterility measures (based on the amount of time since sterilization) is not considered valid. Event-related sterility or terminal sterilization is the accepted standard.

DIF: 2 REF: p. 139

4. If sterile items are stored in open bins, the bins or drawers should be shallow to prevent excess handling of the items.

ANS: T

This is one of the guidelines for storing items.

DIF: 1 REF: p. 139

5. Sterile items should be stored in areas that are separate from those used to store clean, nonsterile items.

ANS: T

This is one of the guidelines for storing items.

DIF: 1 REF: p. 139

6. Growth of bacteria in a test monitor culture indicates that the sterilization process was ineffective.

ANS: T

Growth of bacteria in the test monitor culture indicates that the sterilization process was probably ineffective. If no bacteria grow, it is presumed that sterility of all items within the load was achieved.

DIF: 1 REF: p. 132

7. A chemical monitor may be placed on the outside or the inside of a package, but never both.

ANS: F

A chemical monitor should be placed inside and outside all packs to be sterilized.

DIF: 1 REF: p. 131-132

8. Flash sterilization should be used to sterilize instruments whenever possible.

ANS: F

A flash sterilizer is used in the operating room and in other areas of the hospital to sterilize unwrapped items quickly. A flasher sterilizer usually is located just outside the operating suite, in the substerile area. This type of sterilizer is used onlywhen no alternative is available

DIF: 1 REF: p. 134

9. The purpose of wrapping an item prior to sterilization is to protect it from contamination following the sterilization process.

ANS: T

All items to be sterilized by pressurized steam, ethylene oxide, or plasma methods must be wrapped according to approved methods. The purpose of wrapping an item prior to sterilization is to protect it from contamination following the sterilization process.

DIF: 1 REF: p. 127

10. All items to be gas sterilized may be wet or dry.

ANS: F

All items to be gas sterilized must be clean and dry. Any water left on equipment will bond with ethylene oxide (EO) gas and produce a toxic residue. This residue can cause burns or toxic reaction to those who contact it. Any organic material or soil that is exposed to ethylene oxide may also produce toxic residues; therefore, all items processed for EO gas must be completely clean.

DIF: 1 REF: p. 137

MULTIPLE CHOICE

1. ________ is/are used in the operating room and elsewhere in the hospital to render objects nearly free, but not completely free, of microorganisms.

a.

Sporicidals

b.

Disinfection

c.

Antisepsis

d.

Cobalt 60 radiation

ANS: B

Disinfection is the destruction of some but not all types of microorganisms. Common terms used to describe chemicals and the process of disinfection help distinguish chemicals and clarify their action.

DIF: 2 REF: p. 141

2. Many surgical departments use a ___________ system to collect and transport instruments and equipment for a surgical procedure.

a.

case cart

b.

elevator

c.

personnel

d.

conveyer

ANS: A

Many surgical departments use a case cart system to collect and transport instruments and equipment for a surgical procedure. Sterile instruments and supplies are loaded onto the cart before surgery and transported to the surgical suite. After surgery, instrument trays, basins, and any other soiled equipment are placed on the cart, which has closed shelving units.

DIF: 1 REF: p. 123

3. ________ items are items that must be sterile. These items enter sterile tissue or the vascular system.

a.

Semicritical

b.

Noncritical

c.

Critical

d.

Low critical

ANS: C

Critical risk is assigned to sterile body tissues including the vascular system. Nearly all body tissues are sterile. Exceptions are the external orifices (openings) of the body such as the urethra, anus, vagina, ear, nose, and mouth, which are covered by mucous membranes. All other tissue is considered critical because contamination, even by microbes with relatively low or no pathogenity, can lead to serious infection.

DIF: 2 REF: p. 120

4. During surgical procedures, small-bore cannulas and suction tip lumens should be flushed frequently with ________.

a.

germicidal solution

b.

antibiotics

c.

saline

d.

water

ANS: D

Small-bore cannulas and suction-tip lumens should be flushed frequently to prevent interior build-up of debris. If a suction tip becomes completely occluded, use a metal stylet to remove the debris before flushing. When blood and tissue are allowed to dry on an instrument, they stick to the surface and may pass intact through subsequent phases of processing, including vigorous mechanical washing.

DIF: 2 REF: p. 144

5. Because paper products are difficult or impossible to decontaminate, patient’s charts, x-rays, and lab documentation should be ________.

a.

left outside of the surgical suite

b.

kept free from contamination

c.

flash sterilized

d.

immediately placed in plastic bags

ANS: B

Because paper products are difficult or impossible to decontaminate, all attempts should be made to keep patient charts, laboratory slips, x-ray reports or radiographs, and other paper documentation free from contamination.

DIF: 1 REF: p. 144

6. The process of sterilizing a surgical instrument with a flash sterilizer is called ___________ processing.

a.

just-in-time

b.

quick

c.

fast

d.

right-on-time

ANS: A

A flash sterilizer is used in the operating room and in other areas of the hospital to sterilize unwrapped items quickly. A flasher sterilizer usually is located just outside the operating suite, in the substerile area. Items are sterilized just before use; this is called just in time processing.

DIF: 1 REF: p. 134

7. Regardless of the job description of the personnel participating in the clean-up following a surgical procedure, all personnel must ________.

a.

change scrub attire after clean-up is completed

b.

be attired in personal protective equipment

c.

remember that room turnover time is more important than following standard precautions

d.

make sure that only OR furniture that was used for the case is wiped with a hospital-grade disinfectant

ANS: B

The goal of terminal decontamination is to prevent disease transmission. A systemic routine is followed to ensure that no step in decontamination is missed. Regardless of the type of personnel participating in the clean-up, all must be attired in personal protective equipment.

DIF: 1 REF: p. 145

8. ___________________is a highly flammable liquid that, when blended with inert gas, produces effective sterilization by destroying the DNA and protein structure of microorganisms.

a.

Glutaraldehyde solution

b.

Peracetic acid

c.

Gas plasma

d.

Ethylene oxide

ANS: D

Ethylene oxide (EO) is a highly flammable liquid that, when blended with inert gas, produces effective sterilization by destroying the DNA and protein structure of microorganisms. EO is used in 100% pure form, blended with carbon dioxide gas, or mixed with hydrochlorofluorocarbons.

DIF: 1 REF: p. 137

9. The pads of the operating table are removed to expose the undersurface of the table. All surfaces of the table and pads are cleaned, with particular attention to hinges, pivotal points, and castors. It is ________ to move the table to mop and clean under the supporting post and castors.

a.

always necessary

b.

optional

c.

up to the circulator to decide whether

d.

up to the anesthesia provider to decide whether

ANS: A

In addition to the pads of the operating table being removed to expose the undersurface of the table so that all surfaces of the table and pads can be cleaned with particular attention to hinges, pivotal points, and castors, floors are cleaned with disinfectant and may be wet vacuumed.

DIF: 1 REF: p. 145

10. The recommended practice to damp dust the surgical lights, furniture, and fixed equipment in the operating suite is ___________.

a.

at the end of the day

b.

prior to the beginning of each shift

c.

prior to each case of the day

d.

prior to the first case of the day

ANS: D

The recommended practice prior to the first case of the day is damp dusting of surgical lights, furniture, and fixed equipment in the operating suite. A clean, lint-free cloth and a hospital-grade chemical disinfectant are used.

DIF: 1 REF: p. 144

11. The process of ________________ of the operating suite follows every surgical case.

a.

terminal sterilization

b.

terminal decontamination

c.

chemical sterilization

d.

steam decontamination

ANS: B

The process of terminal decontamination follows every surgical case. This is the thorough cleaning and disinfection of all equipment and soiled surfaces in the operating room. It follows the removal of instruments and contaminated disposable items used during surgery.

DIF: 1 REF: p. 145

12. When instruments are received in the processing area, they are sorted and the instruments with detachable parts are disassembled. Instruments are disassembled because ________.

a.

this exposes all areas so they can be properly cleaned

b.

the instruments are too large to fit into the decontaminator

c.

OSHA requires it

d.

of counting purposes on the next case

ANS: A

Instruments that have movable parts intended for disassembly must be disassembled before sterilization. Any instrument that was not disassembled before disinfection may not be clean and should be returned for disinfection.

DIF: 2 REF: p. 126

13. Following processing in the washer-sterilizer, all instruments should be placed in the ultrasonic cleaner. This process further removes particles and debris through a process called “cavitation.” Because cavitation is not ________, all instruments subjected to it must first be processed in the washer-sterilizer.

a.

clearly understood

b.

always reliable

c.

a disinfecting or sterilizing process

d.

able to meet the criteria associated with the Bowie-Dick tests

ANS: C

The ultrasonic cleaner removes debris from instruments by a process called cavitation. High-frequency sound waves are generated through the water bath. Cavitation causes tiny air spaces trapped within debris to explode inwardly (implode), and this releases them from the surface of the instrument.

DIF: 2 REF: p. 125

14. A _________________ is a paper strip or specially treated tape that changes color when exposed to a specific temperature.

a.

wrapping paper

b.

litmus paper

c.

paper monitor

d.

chemical monitor

ANS: D

A chemical monitor is a paper strip or specially treated tape that changes color when exposed to a specific temperature.

DIF: 1 REF: p. 131

15. The purpose of wrapping an item prior to sterilization is to protect it from _____________ following the sterilization process.

a.

light

b.

damage

c.

infection

d.

contamination

ANS: D

All items to be sterilized by pressurized steam, ethylene oxide, or plasma methods must be wrapped according to approved methods. The purpose of wrapping an item prior to sterilization is to protect it from contamination following the sterilization process.

DIF: 1 REF: p. 127

16. The Spaulding Method of reprocessing instruments and patient materials assigns three risk levels based on the specific region of the body the device will be used. These levels are critical risk, semicritical risk, and ________.

a.

noncritical risk

b.

uncritical risk

c.

ultracritical risk

d.

lowcritical risk

ANS: A

The decision to sterilize, disinfect, or merely clean equipment used in the health care environment is based on categories established by the Spaulding system. The system assigns a risk category (i.e., critical risk, semicritical risk, and noncritical risk) that is specific to the regions of the body inwhich the device is to be used.

DIF: 1 REF: p. 120

17. The relationship between ________ is instrumental in the destruction of microbes with a steam sterilizer.

a.

water and microbe

b.

temperature, pressure, and exposure time

c.

heat and energy

d.

the normal atmospheric pressure and the exposure time

ANS: B

Steam sterilization is achieved at 250° F (121° C) or 270° F (132° C), depending on the items being sterilized (some items require a higher temperature than others). The laws of physics tell us that to raise the temperature of steam, we must also raise the pressure in the closed sterilization chamber:

• To achieve 250° F (121° C), the required pressure is 15 pounds per square inch (psi).
• To achieve 270° F (132° C), the required pressure is 27 psi.

The exposure time is actual amount of time the load is held at the designated temperature and pressure. This depends on the type of steam sterilizer, the size of the load, the temperature, and the type of materials or supplies being

processed.

DIF: 1 REF: p. 133

18. The primary advantage of ________ sterilization is its ability to penetrate wrappers and to disinfect objects that cannot tolerate heat, moisture, and the pressure of steam sterilization.

a.

ethylene oxide

b.

ionizing radiation

c.

DART

d.

cold chemical

ANS: A

The ethylene oxide sterilizer is loaded in such a way that gas can penetrate all surfaces of the packages. Packages must not touch the bottom or top of the chamber and must be placed loosely on their sides.

DIF: 1 REF: p. 137

19. The current emphasis on cost-cutting in the health care system had led many hospitals to ________ single-use items.

a.

discontinue the use of

b.

stock and use

c.

propose the reprocessing of

d.

charge the patient more for the use of

ANS: C

In order to cut costs and retrieve the expense of these items, some institutions reprocess the items. Commercial reprocessing services are available for instruments and equipment approved for reprocessing by the manufacturer.

DIF: 1 REF: p. 122

20. _______________ is the process by which any surfaces, materials, and equipment are cleaned with specific substances that render them safe for their intended use.

a.

Scrubbing

b.

Cleaning

c.

Sterilization

d.

Disinfection

ANS: D

Disinfection is the process by which any surfaces, materials, and equipment are cleaned with specific substances (disinfectants) that render them safe for their intended use. Therefore, any item that is soiled with organic matter such as blood, tissue, or any body fluids is considered contaminated.

DIF: 1 REF: p. 144

21. Unwrapped sterile supplies and instruments are prevented from touching ____________.

a.

contaminated surfaces or objects

b.

each other or other sterile instruments

ANS: A

Sterile supplies and instruments are prevented from touching contaminated surfaces or objects. If the sterile object touches a contaminated object, it must not be used in surgery.

DIF: 1 REF: p. 119-120

22. If other personnel are responsible for cleaning up the back table, the scrub people should _____________ on the table.

a.

verbally communicate the presence of sharps

b.

protect sharps under a towel to protect them

ANS: A

All disposable sharp instruments (e.g., knife blades, sutures, trocars) are placed in a designated sharps container in a manner that will not injure personnel handling the container next. If other personnel are responsible for cleaning up the back table, the scrub person should verbally communicate the presence of sharps on the table and visually identify them to the other personnel.

DIF: 1 REF: p. 145

23. A/an ___________system is the preferred method of transferring contaminated surgical instruments and supplies to the decontamination area. .

a.

open basket

b.

case cart

ANS: B

A case cart system is the preferred method of transferring contaminated surgical instruments and supplies to the decontamination area.

DIF: 1 REF: p. 146

24. Most equipment available prepackaged from a manufacturer has been sterilized by ionizing radiation (cobalt 60), which destroys _____ microorganisms.

a.

most

b.

all

ANS: B

Most equipment available prepackaged from a manufacturer has been sterilized by ionizing radiation (cobalt 60), which destroys all microorganisms. Items such as sharps, sutures, sponges, and disposable drapes are just a few of the many types of presterilized products available.

DIF: 1 REF: p. 139

25. All articles used and discarded in the course of surgery must be placed in ___________.

a.

leak-proof containers

b.

plastic bags

ANS: A

The principles of Standard Precautions apply to all surgical procedures, and all cases are considered contaminated and treated accordingly. During surgery, the circulator and his or her assistants are responsible for ensuring that the environment in the surgical suite is kept as disease free as possible. With this in mind, all articles used and discarded in the course of surgery must be placed in leak-proof containers. This prevents spilling of contaminated liquid onto other surfaces.

DIF: 1 REF: p. 144

26. At the close of surgery, sharp instruments are _________ larger instruments to prevent injury.

a.

placed under

b.

separated out from

ANS: B

At the close of surgery, sharp instruments are separated out to prevent injury. Other instruments are usually placed in a separate basin with the heaviest ones on the bottom and lighter ones placed on top.

DIF: 1 REF: p. 123

27. The washer sterilizer or washer disinfector is used to decontaminate all instruments that can tolerate water _______________________.

a.

submersion and high temperature

b.

turbulence and high-pressure steam

ANS: B

The washer sterilizer or washer disinfector is used to process all instruments that can tolerate water turbulence and high-pressure steam. Instruments are opened and hinges extended to their widest adjustment.

DIF: 1 REF: p. 125

28. To test and monitor the efficiency of the high-vacuum sterilizer, a test known as the ________ test is performed.

a.

external indicator monitor

b.

daily air removal

ANS: B

To test and monitor the efficiency of the high-vacuum sterilizer, a test called the daily air removal test (DART) is performed each day.

DIF: 1 REF: p. 132-133

29. The important factor to remember about ________ is that they do not indicate sterility, only that certain conditions for sterility have been met.

a.

indicators

b.

Bowie-Dick tests

ANS: A

Indicators are not used to verify that an item is sterile, only that a parameter has been achieved.

DIF: 2 REF: p. 118

30. An item is either considered sterile or ________ sterile.

a.

mostly

b.

not

ANS: B

An object is either sterile or not sterile. There are no “levels” of sterility.

DIF: 1 REF: p. 119

MATCHING

Choose from the terms listed and match them with their most correct description. You will use the same answer more than once.

a.

critical items

b.

semicritical items

c.

noncritical items

1. Stethoscopes, blood pressure, and tourniquet cuffs

2. Exposed to the skin but not mucous membranes

3. Objects that enter sterile tissue or the vascular system

4. Laryngoscopes, bronchoscopes, and endotracheal tubes

5. Must be sterile

6. Can include bed linens, crutches, tables

7. Come into contact with mucous membranes or intact skin

8. Include vascular and urinary catheters

9. Not required to be sterile because they do not penetrate intact tissues

10. In medicine, they must be sterilized before use on a patient

1. ANS: C DIF: 3 REF: p. 117-118

2. ANS: C DIF: 3 REF: p. 117-118

3. ANS: A DIF: 3 REF: p. 117-118

4. ANS: B DIF: 3 REF: p. 117-118

5. ANS: A DIF: 3 REF: p. 117-118

6. ANS: C DIF: 3 REF: p. 117-118

7. ANS: B DIF: 3 REF: p. 117-118

8. ANS: A DIF: 3 REF: p. 117-118

9. ANS: C DIF: 3 REF: p. 117-118

10. ANS: A DIF: 3 REF: p. 117-118

Choose from the terms listed and match them with their most correct description. You will use the same answer more than once.

a.

decontamination

b.

disinfection

c.

sterilization

11. Used for noncritical items

12. Destruction of microorganisms, except spores, by heat or chemical means

13. Performed in washer sterilizer

14. Uses steam, ethylene oxide, peracetic acid, or cobalt-60

15. Process by which all microorganisms, including spores, are destroyed

16. After this process, the instruments can be safely handled with bare hands

17. Used for anesthesia equipment, gastrointestinal endoscopes, bronchoscopes

18. Monitored by chemical and biological methods to ensure patient safety

19. Used for surgical instruments, implants, and needles

20. Uses isopropyl alcohol 70%-90%, glutaraldehyde, and iodophor solution

11. ANS: A DIF: 3 REF: p. 117-118

12. ANS: B DIF: 3 REF: p. 117-118

13. ANS: A DIF: 3 REF: p. 117-118

14. ANS: C DIF: 3 REF: p. 117-118

15. ANS: C DIF: 3 REF: p. 117-118

16. ANS: A DIF: 3 REF: p. 117-118

17. ANS: B DIF: 3 REF: p. 117-118

18. ANS: C DIF: 3 REF: p. 117-118

19. ANS: C DIF: 3 REF: p. 117-118

20. ANS: B DIF: 3 REF: p. 117-118