Question 1

Within a steam sterilizer,at a temperature of 100° C (212° F),the water condensation and the steam are the same temperature.This scientific phenomenon is called ___________________ and will __________________.

Accepted Answer

When a cold item is introduced to steam,some of the steam releases its latent energy to the object and changes back to liquid water.This phenomenon allows items to be heated much more rapidly in steam than in dry heat.The phenomenon of steam changing to liquid water is called condensation,and the steam and the liquid water are at a temperature of 212° F (100° C)when this occurs.At this point,the steam is said to be saturated.This 212° F (100° C)temperature is insufficient to kill microorganisms,however.To kill microorganisms,a saturation temperature of 250° F (121° C)is necessary.

Question 2

A swab of a fluid collection from an edematous,red,and suppurative postoperative wound is sent to the microbiology lab for culture,sensitivity,and Gram stain.The surgeon expects that the result will show a gram-positive coccus.This Gram stain designation is based on the:

Accepted Answer

Gram staining is a procedure for staining bacteria; it is the first step in classifying and differentiating bacteria into two large groups (gram-positive and gram-negative)based on the chemical and physical properties of their cell walls.A gram-positive microorganism has a thicker cell wall than a gram-negative microorganism.

Question 3

The evening before the procedure was scheduled,the central sterile processing department received two complete sets of an orthopedic spine fusion system that contained titanium-implantable instrumentation,four flexible coated retractor blades,and an unsterilized internal paper inventory form.The sterilization instructions provided by the vendor representative recommended steam sterilization for the implants,but stated that the flexible coated blade retractors could not be exposed to temperatures higher than 220° F.The appropriate sterilization option for these instruments and devices would be:

Accepted Answer

Low-temperature hydrogen peroxide gas plasma sterilization should be used for moisture- and heat-sensitive items and when indicated by the device manufacturer.Cellulosic-based products,such as paper and linen,are not recommended for use with plasma systems,because they tend to absorb the vapor and cause the sterilization cycle to abort.

Question 4

The mechanism of lethality (microbial death)with steam sterilization is achieved with this event:

Accepted Answer

Microorganisms are believed to be destroyed by moist heat through a process of denaturation and coagulation of the enzyme-protein system when steam sterilized.This fact is based on the theory that all chemical reactions,including coagulation of proteins,are catalyzed by the presence of water.

Question 5

With the production of more steam in the sterilizer chamber,the pressure increases as well.The steam should contain little or no entrapped liquid water.Steam quality is the term that describes the amount of water mixed with the steam.The constitution of high-quality steam would be measured by:

Accepted Answer

Steam entering the sterilizer chamber should contain little or no trapped liquid water.The term steam quality describes the amount of steam vapor and liquid water in the mixture.A steam quality of 100% indicates that no liquid water is present in the steam.A steam quality of 97% or greater (i.e.,<3% of the mixture is liquid water)is recommended to achieve an efficient sterilization process.

Question 6

The Centers for Disease Control and Prevention (CDC)have identified pathogens that could pose a threat to national and world security and safety through bioterrorism.Select the four most probable agents that could be used to cause mass transmission,mortality,panic,and social disruption.

Accepted Answer

The potential for bioterrorism is a reality.The CDC has identified agents that may pose a risk to the national security because of their: (1)easy dissemination or transmission from person to person,(2)potential to cause high mortality and have a major public health impact,(3)potential to cause public panic and social disruption,and (4)necessity for special action for public health preparedness.

Question 7

Which glove lubricant,used to facilitate easy donning,is considered a best practice?

Accepted Answer

Using glove lubricants,particularly powder is not recommended because of three primary hazards: the potential for postoperative complication of powder granulomas; powder fallout from hands and gloves,which provides a convenient vehicle for dissemination of microorganisms throughout the OR; and the ability of powder to carry and disperse latex proteins,contributing to an increased latex sensitivity among healthcare workers and others.Because of the safety risks,the FDA published a final rule banning powdered gloves as of January 17,2017,stating they pose an unreasonable and substantial risk of injury,illness,or injury to individuals exposed to powered gloves.

Question 8

The skin preparation for a vaginal-assisted laparoscopic hysterectomy begins ______________ and _____________.

Accepted Answer

Factors to be considered in skin disinfection are as follows: condition of the involved area,number and kinds of contaminants,general physical condition of the patient,characteristics of the skin to be disinfected,and patient allergies.The surgical principle followed when preparing the patient's skin for surgery ("prepping")is to prepare ("prep")the cleanest area first and then move to the less clean areas (clean to dirty).The skin at the surgical site should be exposed and inspected before beginning the skin prep.

Question 9

To protect the forearms,hands,and clothing from contacting bacteria on the outside of the used gown and gloves,members of the scrubbed surgical team should use the following procedure to remove soiled gowns and gloves.Which choice lists the appropriate first three steps in the removal of the sterile gown?

Accepted Answer

Bring the neck and sleeve of the gown forward and off the gloved hand,turning the gown inside out and everting the cuff of the glove.Repeat the previous two steps for the other side.Keep arms and gown away from the body while turning the gown inside out and discarding carefully in the designated receptacle.

Question 10

Which of the following lists the correct order of the proper steps in the removal of soiled sterile attire when breaking scrub?

Accepted Answer

Members of the scrub surgical team should use the following procedure to remove soiled sterile scrub attire: gowns,gloves,and then masks.Hands must be washed after removing soiled sterile attire.

Question 11

A 47-year-old man was admitted to the emergency department (ED)with respiratory symptoms,facial and upper body abrasions,burns,and moist lesions after a small package,delivered to his office,exploded and sprayed him with dried powder and glass shards.In response to the reported mechanism of injury,the ED team sequestered him in a secluded area away from the rest of the patients.The team believed that this was highly suspicious of a bioterrorism event.The epidemiologist was called,and the patient was transferred to a negative-pressure isolation room and placed on standard,contact,airborne,and droplet precautions.Based on these actions,which microorganism agents might be suspected to be involved?

Accepted Answer

Anthrax: Cutaneous lesions can occur from direct contact and inhalation from droplet aerosolization.Use standard precautions with special attention to protection and containment of any draining wounds,inclusive of cutaneous lesions.Smallpox: Inhalation of droplets,droplet nuclei,aerosols,and direct or indirect contact; standard,droplet,airborne,and contact precautions for patients with vesicular rash pending diagnosis.Avoid contact with organism while handling contaminated bedding.Wear protective attire to include gloves,gown,and N95 respirator.

Question 12

The accumulation of dust,debris,and other microbial contaminants is a potential source of SSIs.Guidance for cleaning processes in the perioperative area states that perioperative staff should:

Accepted Answer

Wall and ceiling washing should be completed on a defined,regular basis and if the surfaces are soiled.Transmission-based precautions are designed for patients who have a documented infection or who are suspected to be infected with a highly transmissible pathogen for which additional precautions are necessary.Personnel should not use alcohol to disinfect large environmental surfaces because alcohol is not an EPA-registered disinfectant.Removal of trash and laundry should not begin until the patient has left the room.

Question 13

Both sterilization and disinfection describe the elimination of microbial contamination and the achievement of a state suitable for patient care in select situations.However,disinfection differs from sterilization in that the process for disinfection uses:

Accepted Answer

Disinfection is defined as the process of eliminating many or all pathogenic organisms,except bacterial spores,from inanimate objects.In healthcare facilities,equipment is usually soaked in liquid chemicals for a specified period to achieve disinfection of the equipment or item.The disinfection process may destroy tubercle bacilli and inactivate hepatitis viruses and enteroviruses but usually does not kill resistant bacterial spores.The term disinfection also may refer to treatment of body surfaces that have been contaminated with infectious material.Chemicals used to disinfect inanimate objects are referred to as disinfectants.Chemicals used for body surfaces are known as antiseptics.The term germicide refers to any solution that destroys microorganisms.

Question 14

Closed gloving is the technique of choice for the initial donning of sterile gloves by the scrubbed team member; however:

Accepted Answer

The closed method of gloving is the technique of choice when initially donning a sterile gown and gloves.Because the cuffs of a sterile gown collect moisture,become damp during wearing,and are considered unsterile,the closed-gloving technique can be used only for initial gloving.Cuffs may not be pulled down over the wearer's hand for subsequent gloving.For subsequent gloving,an alternative technique must be used,such as assisted gloving or open gloving.

Question 15

While antibiotics have been credited with saving lives,misuse of antibiotics has contributed to the evolution of multidrug-resistant organisms (MDROs).Select the antibiotic application that has evidence to support it as a best practice and not,potentially,a misuse of antibiotics.

Accepted Answer

Drug resistance from treatment-related causes is often the result of misuse (e.g.,incorrect use,overuse,or underuse)of antibiotics.It is believed that 50% of all antibiotic use in the United States can be characterized by misuse in one form or another,and efforts to reduce surgical site infections include appropriate prophylactic antibiotic use in surgical patients.It is estimated that half of all antibiotic prescriptions written are not warranted.Although some surgical complications are unavoidable,surgical care can be improved through decisions and subsequent care focusing on evidence-based practice recommendations.Research shows that delivering antibiotics to a patient within 1 hour of beginning surgery (or 2 hours for vancomycin or fluorquinolones which need to be administered over 1 to 2 hours)can dramatically decrease SSI rates,yet this practice is not followed in all situations.

Question 16

Qualities of an effective packaging material must include several key characteristics.Select the three most important qualities.

Accepted Answer

To be effective,packaging material should have the following characteristics: allows for adequate steam penetration and removal; provides an adequate microbial barrier; resists tearing or punctures; protects contents from damage; allows for aseptic delivery of package contents; is free of toxic ingredient; is low linting; has a favorable cost benefit ratio.

Question 17

The final step,after decontamination and before sterilization,is the prep,pack,and wrap process.The sterile processing technologist has taken the laparotomy set from the washer/decontaminator to prepare for sterilization.Select the most appropriate order that the instrument set must travel before reaching the steam sterilizer.

Accepted Answer

The final step before sterilization for reuse includes instrument preparation and packaging.These activities occur in a clean area,separate from the area where decontamination occurred.Instruments are inspected carefully for cleanliness and functionality.Soiled instruments are returned for further cleaning.Instruments with movable parts are treated with a water-soluble lubricant solution that contains an antimicrobial agent to retard growth in the lubricant solution.Broken or worn instruments are set aside for repair.Instruments are assembled into sets according to set content lists prepared by perioperative nursing staff.

Question 18

An integrator is a multiparameter indicator designed to measure:

Accepted Answer

Chemical integrators are so named for their ability to integrate time,temperature,and the presence of steam.Chemical integrators are placed inside every package.They indicate that one or more of the parameters necessary for sterilization have been achieved.

Question 19

Sterilization prepares instruments to be used within,and on,sterile tissues.It kills vegetative microorganisms and endospores within a probability of 10⁶.The process of decontamination prepares instruments to be:

Accepted Answer

The efficacy of the sterilization process depends in part on lowering or limiting the amount of bioburden present on the item to be sterilized.Items to be sterilized should be precleaned to lower the bioburden to the lowest possible level.Items that were soiled with blood or body fluids and that have only been cleaned may not have been sufficiently decontaminated to allow handling by workers not wearing protective attire.If such an item tolerates high-pressure water washing,it can be decontaminated further by processing through an unwrapped washer/disinfector cycle.It is then safe to handle.It is recommended that gloves be worn during preparation and wrapping until meticulous inspection has cleared the instruments to be handled without gloves.

Question 20

The scrub person is preparing to self-don a wraparound sterile gown before surgery.Select the best practice to follow for the self-gowning procedure:

Accepted Answer

The proper procedure for self-donning a wraparound sterile surgical gown includes the following best practices: allow the gown to unfold with the inside (not outside)toward the wearer.The hands should be kept on the inside (not outside)of the gown while it unfolds.Both hands should be slipped into the open armholes simultaneously (not while holding one shoulder in place with the other hand).

Quiz 4: Infection Prevention and Control

Within a steam sterilizer,at a temperature of 100° C (212° F) ,the water condensation and the steam are the same temperature.This scientific phenomenon is called _ and will .

A swab of a fluid collection from an edematous,red,and suppurative postoperative wound is sent to the microbiology lab for culture,sensitivity,and Gram stain.The surgeon expects that the result will show a gram-positive coccus.This Gram stain designation is based on the:

The mechanism of lethality (microbial death) with steam sterilization is achieved with this event:

With the production of more steam in the sterilizer chamber,the pressure increases as well.The steam should contain little or no entrapped liquid water.Steam quality is the term that describes the amount of water mixed with the steam.The constitution of high-quality steam would be measured by:

The Centers for Disease Control and Prevention (CDC) have identified pathogens that could pose a threat to national and world security and safety through bioterrorism.Select the four most probable agents that could be used to cause mass transmission,mortality,panic,and social disruption.

Which glove lubricant,used to facilitate easy donning,is considered a best practice?

The skin preparation for a vaginal-assisted laparoscopic hysterectomy begins __ and _.

Which of the following lists the correct order of the proper steps in the removal of soiled sterile attire when breaking scrub?

The accumulation of dust,debris,and other microbial contaminants is a potential source of SSIs.Guidance for cleaning processes in the perioperative area states that perioperative staff should:

Both sterilization and disinfection describe the elimination of microbial contamination and the achievement of a state suitable for patient care in select situations.However,disinfection differs from sterilization in that the process for disinfection uses:

Closed gloving is the technique of choice for the initial donning of sterile gloves by the scrubbed team member; however:

While antibiotics have been credited with saving lives,misuse of antibiotics has contributed to the evolution of multidrug-resistant organisms (MDROs) .Select the antibiotic application that has evidence to support it as a best practice and not,potentially,a misuse of antibiotics.

Qualities of an effective packaging material must include several key characteristics.Select the three most important qualities.

An integrator is a multiparameter indicator designed to measure:

Sterilization prepares instruments to be used within,and on,sterile tissues.It kills vegetative microorganisms and endospores within a probability of 10⁶.The process of decontamination prepares instruments to be:

The scrub person is preparing to self-don a wraparound sterile gown before surgery.Select the best practice to follow for the self-gowning procedure:

Quiz 4: Infection Prevention and Control

Within a steam sterilizer,at a temperature of 100° C (212° F) ,the water condensation and the steam are the same temperature.This scientific phenomenon is called ___________________ and will __________________.

A swab of a fluid collection from an edematous,red,and suppurative postoperative wound is sent to the microbiology lab for culture,sensitivity,and Gram stain.The surgeon expects that the result will show a gram-positive coccus.This Gram stain designation is based on the:

The mechanism of lethality (microbial death) with steam sterilization is achieved with this event:

With the production of more steam in the sterilizer chamber,the pressure increases as well.The steam should contain little or no entrapped liquid water.Steam quality is the term that describes the amount of water mixed with the steam.The constitution of high-quality steam would be measured by:

The Centers for Disease Control and Prevention (CDC) have identified pathogens that could pose a threat to national and world security and safety through bioterrorism.Select the four most probable agents that could be used to cause mass transmission,mortality,panic,and social disruption.

Which glove lubricant,used to facilitate easy donning,is considered a best practice?

The skin preparation for a vaginal-assisted laparoscopic hysterectomy begins ______________ and _____________.

Which of the following lists the correct order of the proper steps in the removal of soiled sterile attire when breaking scrub?

The accumulation of dust,debris,and other microbial contaminants is a potential source of SSIs.Guidance for cleaning processes in the perioperative area states that perioperative staff should:

Both sterilization and disinfection describe the elimination of microbial contamination and the achievement of a state suitable for patient care in select situations.However,disinfection differs from sterilization in that the process for disinfection uses:

Closed gloving is the technique of choice for the initial donning of sterile gloves by the scrubbed team member; however:

While antibiotics have been credited with saving lives,misuse of antibiotics has contributed to the evolution of multidrug-resistant organisms (MDROs) .Select the antibiotic application that has evidence to support it as a best practice and not,potentially,a misuse of antibiotics.

Qualities of an effective packaging material must include several key characteristics.Select the three most important qualities.

An integrator is a multiparameter indicator designed to measure:

Sterilization prepares instruments to be used within,and on,sterile tissues.It kills vegetative microorganisms and endospores within a probability of 10⁶.The process of decontamination prepares instruments to be:

The scrub person is preparing to self-don a wraparound sterile gown before surgery.Select the best practice to follow for the self-gowning procedure:

Within a steam sterilizer,at a temperature of 100° C (212° F) ,the water condensation and the steam are the same temperature.This scientific phenomenon is called _ and will .

The skin preparation for a vaginal-assisted laparoscopic hysterectomy begins __ and _.