Term
| What does the MSDS identify? |
|
Definition
| Physical properties, any known hazards, required controls, emergency procedures, health hazard information, any specific precautions (e.g., the necessity for PPE when handling and storing chemicals), and procedures to follow in case of a fire, spill, or leak. |
|
|
Term
| Who maintains the AF IMT 55? Where is it located? |
|
Definition
| The supervisor for every worker; in his or her particular section/department. |
|
|
Term
| What is the AF IMT 55 used for? |
|
Definition
| To document all required, mandatory safety training employees have received, and any other special safety training attended. |
|
|
Term
| Why do accidents need to be reported in detail? |
|
Definition
| To determine what incidents led to the accident, and what steps can be taken to prevent future occurrence. |
|
|
Term
| Identify the form used to report accidents and injuries in the MTF. |
|
Definition
| AF IMT 765, Medical Treatment Facility Incident Statement. |
|
|
Term
| What form is used to report a hazardous condition? |
|
Definition
| AF IMT 457, USAF Hazard Report. |
|
|
Term
| When should you fight a fire? |
|
Definition
| When it is small and confined to one local area. |
|
|
Term
| When fighting a fire, what should be your plan when considering an escape route? |
|
Definition
| Keep your escape route clear and behind you in case you lose the fight. |
|
|
Term
| What is the most common cause of death in a fire? |
|
Definition
|
|
Term
| When should you check electrical equipment in the OR? Why? |
|
Definition
| Equipment must be inspected by OR personal before each use; to ensure proper working condition. |
|
|
Term
| Who should be aware of fire evacuation plans? |
|
Definition
|
|
Term
| State the primary purpose of the AFOSH program. |
|
Definition
| Protect all AF personnel from work-related deaths, injuries, and occupational illnesses. |
|
|
Term
| List eight of the supervisory responsibilities outlined in the AFOSH program. |
|
Definition
Any eight of the following:
(1) Ensure all OSH guidelines and standards applying to their workplace are available to personnel.
(2) Ensure compliance with OSH, fire prevention, and health programs applying to their workplace.
(3) Ensure the AFOSH program requirements are part of the measurement of commanders and military and civilian supervisory personnel’s performance.
(4) Provide safe and healthful workplaces and conduct periodic self-inspections for hazards or
deficiencies; conduct job safety analyses for each work task and anytime a new work task or process is introduced to the workplace to determine potential hazards; and consult the installation ground safety staff or the bio-environmental engineer when assistance is required.
(5) Establish and implement a hazard reporting and abatement program.
(6) Notify the installation ground safety personnel of mishaps and accidental occurrences as soon as possible after the accidental event.
(7) Establish procedures for employees to follow in situations of imminent danger.
(8) Provide training for employees in job safety, fire prevention and protection, and health as required by OSH guidelines.
(9) Notify the installation ground safety staff when a military or civilian becomes a supervisor for scheduling of required supervisor safety training.
(10) Enforce compliance with OSH guidelines.
(11) Ensure areas and operations requiring PPE or other special precautions are identified and posted as necessary.
(12) Ensure compliance with PPE program requirements.
(13) Post AFOSH program visual aids conspicuously so personnel have reasonable access to it.
(14) Ensure compliance with the AFHCP as outlined in AFI 90–821, Hazard Communication.
(15) Maintain BEE, safety, and fire prevention periodic reports until superseded.
(16) Brief all personnel on the findings and recommendations contained in annual and baseline BEE (industrial hygiene) surveys and reports. |
|
|
Term
| What are two responsibilities all AF personnel have under the AFOSH program? |
|
Definition
Any two of the following:
(1) Comply with OSH guidance.
(2) Promptly report safety, fire, and health hazards and deficiencies.
(3) Promptly report injuries and illnesses to the supervisor.
(4) Comply with PPE requirements, including its use, inspection, and care, applying to the work situation.
(5) Give due consideration to personal safety and the safety of fellow workers while performing assigned tasks. |
|
|
Term
| What are two opportunities all AF personnel have under the AFOSH program? |
|
Definition
Any two of the following:
(1) Take part in the AFOSH program without fear of coercion, discrimination, or reprisal.
(2) Request inspections of unsafe or unhealthy working conditions, or report those conditions to the supervisor, safety manager, fire protection specialist, or BEE, including OSHA officials.
(3) Have access to applicable OSHA and AFOSH standards; installation injury and illness statistics; safety, fire protection, and health program procedures; and personal exposure and medical records.
(4) Decline to perform an assigned task because of a reasonable belief the task poses an imminent risk of death or serious bodily harm.
(5) Use official on-duty time to take part in AFOSH program activities. |
|
|
Term
| What AF publication establishes specific safety guidelines for medical facilities? |
|
Definition
| AFOSH Standard 91–8, Medical Facilities. |
|
|
Term
| In the OR, at what level must you maintain the relative humidity? |
|
Definition
|
|
Term
| What are the most hazardous instruments you routinely handle? |
|
Definition
| Scalpels and dermatome blades. |
|
|
Term
| What instrument of choice is used to safely arm and disarm a scalpel blade? Why? |
|
Definition
| A needle holder; allows a firm grip on the blade without damaging the jaws of the instrument. |
|
|
Term
| If a scalpel blade falls on the floor, how is it picked up? |
|
Definition
| A piece of wide adhesive tape. |
|
|
Term
| Whose responsibility is it to remove and properly dispose of scalpel blades following a surgical procedure? |
|
Definition
|
|
Term
| List three safety rules to be followed when handling sharp instruments. |
|
Definition
(1) Avoid grabbing or handling the functional end of the instrument.
(2) Always keep sharp instruments separated from other instruments.
(3) Always inspect all sharp instruments before they are used on a patient. |
|
|
Term
| Why are glass items (e.g., syringes and medicine glasses) inspected before use? |
|
Definition
| A chipped syringe barrel or cracked medicine glass can result in minute glass fragments being introduced into a patient. |
|
|
Term
| What do you look for when inspecting needles? |
|
Definition
| Burrs, bent tips, and defective cutting edges. |
|
|
Term
| Why are needles separated from other instruments? |
|
Definition
| To prevent damage or loss. |
|
|
Term
| Cite three safety practices you follow when passing and handling sharp items on the sterile field. |
|
Definition
(1) When possible, use the hands-free technique for passing sharp items.
(2) When you must pass instruments to the surgeon, pass them in the position of use.
(3) Any needles, scissors, or scalpels left lying on the sterile field should be retrieved by the scrub technician immediately and placed back in their proper place on the setup. |
|
|
Term
|
Definition
| A form of energy produced when negatively charged atomic particles flow from one point in a material to another. |
|
|
Term
| What is required for an electrical current to flow? |
|
Definition
| Resistance must be kept to a minimum and the current path must be continuous (unbroken). |
|
|
Term
| Name two variables that determine how the human body responds to electrical shock. |
|
Definition
(1) The amount of current flow (amperage).
(2) The route the current takes through the body. |
|
|
Term
| What causes electrical burns? |
|
Definition
| When current flow is concentrated in a small area of tissue. |
|
|
Term
| What three conditions must exist for a fire or explosion to occur? |
|
Definition
(1) There must be combustible material.
(2) There must be a source of ignition.
(3) There must be oxygen or oxygen-supplying substance to support combustion. |
|
|
Term
| List three measures you can take to eliminate ignition sources from the OR. |
|
Definition
(1) Avoid storing supplies within 18″ of a light fixture.
(2) Do not allow portable personal electronic devices in the surgical suite unless they meet electrical safety standards and have been approved by biomedical equipment repair personnel.
(3) Keep the OR clean. |
|
|
Term
| What should you do with an electrical device that has a dent in the external cabinet? |
|
Definition
| Have it removed from service and checked by qualified maintenance personnel. |
|
|
Term
| What may happen if you wrap a power cord tightly around a piece of equipment? |
|
Definition
| This may damage the cord insulation and internal wire. |
|
|
Term
| Describe the guidelines or rules for using extension cords in the OR. |
|
Definition
| Avoid the use of extension cords (if they must be used, they should be constructed of heavy-duty, three conductor wires with a UL-approved, “Hospital Grade” plug); two-wire household-type extension cords are strictly prohibited. |
|
|
Term
What might happen to electrical current flow if the ground pathway from an electrical device
back to the wall outlet is broken or interrupted? |
|
Definition
| The current seeks “ground” through other conductive pathways, and you or your patient could become a part of one of these alternate pathways, resulting in an electric shock; the possibility of creating sparks, leading to a fire or explosion. |
|
|
Term
| Briefly describe an isolated power system. |
|
Definition
| The electrical circuits in the designated area are isolated from the grounded main power circuits. |
|
|
Term
| What is the purpose of a line isolation monitor? |
|
Definition
| Monitor the circuit for grounding faults or power overloads within the systems. |
|
|
Term
If the line isolation monitor alarm stays on after you have unplugged the last piece of electrical
equipment plugged in immediately before the alarm went off, what do you do next? |
|
Definition
| Unplug each nonessential device until the alarm goes off. |
|
|
Term
| What is the purpose of a cut-off valve for piped-in gas outlets? |
|
Definition
| Allows piped-in gas to be shut off in the event of an emergency. |
|
|
Term
| Why should you not use a flame or boiling water to thaw out a frozen cylinder valve? |
|
Definition
| Never use boiling water or and open flames because the heat can ignite leaking vapors. |
|
|
Term
| Identify three safety requirements pertaining to storage of large compressed gas cylinders. |
|
Definition
Any three of the following:
(1) Gas cylinder storage area should be well ventilated, cool, and isolated from main hospital traffic areas.
(2) Large cylinders should always be stored upright with the protective valve caps in place and the tanks must be secured with a strap or chain.
(3) Anesthetic gases should not be stored with oxygen cylinders.
(4) Empty cylinders should always be plainly marked and stored in a different area than full cylinders. |
|
|
Term
| What is the purpose of the pin-index safety (coupling) system? |
|
Definition
| This system prevents one type of gas cylinder from being accidentally connected to the regulator for another type of gas. |
|
|
Term
| List five safety considerations relating to handling and using compressed oxygen. |
|
Definition
(1) Never handle oxygen tanks with greasy or oily hands.
(2) Never drape an oxygen cylinder with a gown, cap, mask, sheet, or other material.
(3) Post no smoking signs when oxygen is in use.
(4) Never use oxygen fittings, valves, regulators, or gauges for any other service except oxygen.
(5) Never use oxygen from a cylinder except through a pressure-reducing regulator. |
|
|
Term
| What is the purpose for wearing protective gloves when handling chemical agents? |
|
Definition
| To protect hands from the effects of direct chemical contact and long-term effects of constant absorption. |
|
|
Term
| What is the most important rule to follow when handling any hazardous chemicals? |
|
Definition
| Always read and follow the manufacturer’s directions. |
|
|
Term
| Describe the role of the surgeon as a member of the surgical team? |
|
Definition
| Is always the leader of the surgical team. |
|
|
Term
| The surgeon is responsible for what three aspects of surgical patient care? |
|
Definition
(1) Making the preoperative diagnosis.
(2) Performing the operation.
(3) Managing the patient’s postoperative care. |
|
|
Term
| Define the term “qualified assistant.” |
|
Definition
| Someone who is recognized by the hospital credential committee as having the knowledge, experience, and skill to effectively assist the surgeon without risk to the patient. |
|
|
Term
| What is the main difference between an anesthesiologist and an anesthetist? |
|
Definition
| Anesthesiologists are MDs; anesthetists are professional RNs who are qualified to administer anesthesia. |
|
|
Term
| Describe the main roles of the operating nurse. |
|
Definition
| They are qualified to perform all sterile and non-sterile duties required in the OR. They may act as a scrub nurse, but more commonly perform the role of circulator. In addition to the technical duties they perform in surgery, OR nurses are responsible for developing surgical nursing care plans, conducting preoperative patient interviews, performing postoperative assessments of care provided, helping develop OR policies and procedures, and conducting in-service training. |
|
|
Term
| Besides AF training, how can ophthalmology technicians enhance their job qualifications? |
|
Definition
|
|
Term
|
Definition
| A person who defends, intercedes on behalf of, or pleads the cause of a patient. |
|
|
Term
| What provides the moral guidelines for carrying out your duties as a surgical technician? |
|
Definition
| Ethics and good surgical conscience. |
|
|
Term
| Define respectful treatment. |
|
Definition
| All patients have the right to considerate and respectful care, with recognition of their personal dignity. |
|
|
Term
| What is the military exception to the patient’s right to privacy and confidentially? |
|
Definition
| Physicians and other healthcare providers have a duty to disclose a patient’s UCMJ violation. |
|
|
Term
|
Definition
| Each patient has the right to be advised in laymen’s terms on information needed to make knowledgeable decisions on consent or refusal for treatments. |
|
|
Term
What responsibility has a patient failed when he or she does not divulge a history of drug abuse,
is smoking in the lavatory, and does not keep appointments on time? |
|
Definition
| Providing information; respect and consideration; and compliance with medical care. |
|
|
Term
| Briefly define patient sensitivity. |
|
Definition
| Being aware of how your actions, words, and appearance may be perceived by a patient, and modifying these actions to ensure you do nothing to detract from the image of a competent and caring professional. |
|
|
Term
| What is the key to patient sensitivity? |
|
Definition
| Acting and living professionally at all times. |
|
|
Term
| Define surgical conscience. |
|
Definition
| The application of ethical standards to surgical patient care. |
|
|
Term
| What two qualities are needed to develop a sound surgical conscience? |
|
Definition
(1) Self-discipline.
(2) Dedication to a high level of moral conduct. |
|
|
Term
| What factors can degrade surgical conscience? |
|
Definition
| Apathy, surgical team relationships, personal problems, and poor health. |
|
|
Term
| List the five emotional stages a person goes through when facing death. |
|
Definition
(1) Denial.
(2) Anger.
(3) Bargaining.
(4) Depression.
(5) Acceptance. |
|
|
Term
| During which emotional stage does the patient realize death is inevitable? |
|
Definition
|
|
Term
| Briefly describe the acceptance emotional stage of dying. |
|
Definition
| The patient no longer feels angry or depressed about the situation; often wants to be left alone, may take naps more frequently, and usually prefers more nonverbal than verbal support from family members; and begins to prepare for the “final” journey. |
|
|
Term
| Briefly explain what a “tort” is. |
|
Definition
| An intentional or unintentional wrongful act committed against a person or property. |
|
|
Term
|
Definition
| The failure to do something that a reasonable individual with the same training and experience and in similar circumstances would do; or, when someone performs an act that a reasonable individual with the same training and experience in similar circumstances would not do. |
|
|
Term
| What is the difference between assault and battery? |
|
Definition
| Assault is the act of threatening or attempting to touch a person without the person’s consent; battery is the actual touching of a person without the person’s consent. |
|
|
Term
| What is the term used to describe defamatory written statements? |
|
Definition
|
|
Term
| What is a nuncupative will? |
|
Definition
|
|
Term
| If a dying patient makes a statement pertaining to a criminal act, what action should be taken? |
|
Definition
| Notify your supervisor and the security forces as soon as possible. |
|
|
Term
| What law prevents active duty military from suing the Federal Government? |
|
Definition
|
|
Term
| For a lawsuit against the Federal Government to be justified, what conditions must be met? |
|
Definition
| A Federal employee committed a negligent act while on duty and acting in the scope of his or her employment. |
|
|
Term
| List three negligent acts that could occur in surgery and lead to a lawsuit against the Federal Government. |
|
Definition
Any three of the following:
(1) Improper identification of the patient and failing to confirm the exact area to be operated on.
(2) Losing an item in a surgical wound due to improper counting procedures.
(3) Improper identification and use of medications and solutions.
(4) Explosion or fire resulting in patient injury caused by improper handling of oxygen tanks, valves, or supply lines.
(5) Abandoning patients, particularly pediatric patients and those under the influence of drugs.
(6) Failure to properly identify and preserve surgical specimens.
(7) Failure to obtain legal consent for surgery, anesthesia administration, or other procedures.
(8) Failure to properly inspect equipment for defects prior to use, resulting in equipment malfunction and injury to a patient.
(9) Failure to use proper aseptic technique, resulting in a postoperative wound infection or other
complication. |
|
|
Term
| Where are your liabilities as an ophthalmology technician outlined? |
|
Definition
|
|
Term
| Cite three consequences you could suffer for committing a negligent act. |
|
Definition
(1) You may pay for the judgment.
(2) You may be reprimanded.
(3) You may serve time in a Federal prison if found guilty of dereliction of duty as a result of gross negligence. |
|
|
Term
| What is the primary purpose of CSS? |
|
Definition
|
|
Term
| List some of the common services provided by CSS personnel. |
|
Definition
(1) Maintaining an adequate stock of sterile and non-sterile supplies.
(2) Providing a distribution and collection service.
(3) Developing, maintaining, and updating a list of sterile and non-sterile supplies.
(4) Maintaining a current list of the contents of sets.
(5) Providing a continuous service on a 24-hour basis. |
|
|
Term
| What kind of ventilation system is recommended for sterile storage rooms? |
|
Definition
| A positive-pressure ventilation system with at least 10 air exchanges per hour. |
|
|
Term
| What temperature and humidity ranges are recommended for a sterile storage area? |
|
Definition
| The temperature should be kept between 64°F and 72°F (18°C –22°C), and the humidity between 35% and 70%. |
|
|
Term
| Why are shipping cartons never allowed into a sterile storage area? |
|
Definition
| They harbor dust, micro-organisms, molds, fungi, and insects. |
|
|
Term
| How far away from floors, ceilings, and outer walls should sterile supplies be stored? |
|
Definition
| 8″ above the floor, 18″ below the ceiling, and 2″ from outside walls. |
|
|
Term
| What is the most important rule you follow when utilizing closed cabinets for supply storage? |
|
Definition
|
|
Term
| How often are sterile supply storage areas usually cleaned? |
|
Definition
|
|
Term
| Identify three ways sterile package contents can become contaminated. |
|
Definition
(1) Moisture strike-through.
(2) Dirt or dust forced through package pores.
(3) Package damage. |
|
|
Term
| What basic rule do you follow when handling sterile supply items? |
|
Definition
| Handle them as little as possible between sterilization and use. |
|
|
Term
| When do you check the integrity of a sterile package? |
|
Definition
| Immediately after sterilization, when putting the item in storage, when removing the item from storage, and just before use. |
|
|
Term
| What do you do with a sterile item that falls on the floor? Why? |
|
Definition
| It is discarded if disposable and reprocessed if reusable; the item is considered contaminated by dirt and microbes forced into the package by the impact of the fall. |
|
|
Term
| When is a dust cover placed on a steam sterilized item? Why? |
|
Definition
| After the item has cooled to room temperature; to prevent moisture condensation inside the sealed dust cover because, since the dust cover is not sterile, condensation results in strike-through contamination. |
|
|
Term
| Why are sterile supplies stored in a limited-access, enclosed area? |
|
Definition
| To minimize traffic through the area, and help reduce the number of potentially contaminating incidents and excessive air movement that transports airborne contaminants from other areas. |
|
|
Term
| How often do you check outdates on all sterile supplies? |
|
Definition
|
|
Term
| What actions can be taken to help correct the problem of excessive outdates? |
|
Definition
| The packaging method, stock level, or stock rotation may need adjusting; the item(s) in question may not even require sterile storage. |
|
|
Term
| What does the acronym FIFO mean? |
|
Definition
| First in, first out (the items placed in storage first should be used first). |
|
|
Term
| Define the term “shelf life.” |
|
Definition
| The length of time a sterile item is assumed to remain sterile while in storage. |
|
|
Term
| List three packaging characteristics affecting shelf life. |
|
Definition
(1) How permeable or porous the package is.
(2) How long (under various conditions) the packaging retains its barrier capability.
(3) What length of time the manufacturer states the items packaged in their product can be considered sterile. |
|
|
Term
| How does repeated handling of supplies affect the shelf life? Why? |
|
Definition
| The more times an item is handled, or the greater the number of people handling it, the greater the risk of contamination of the contents; handling of sterile items may force unsterile air into a package, or it may result in “strike-through” from moisture on the hands, enabling airborne contaminants to enter the pack and compromise sterility. |
|
|
Term
| What type of packaging is less affected by repeated handling? |
|
Definition
| Packages wrapped in impervious materials (e.g., plastic). |
|
|
Term
| What is the difference between organisms that are parasites and those that are saprophytes? |
|
Definition
| Parasites rely on living hosts to sustain their existence; saprophytes live off dead or decaying organic matter. |
|
|
Term
| What is the general classification term used to describe micro-organisms causing tissue damage or disease? |
|
Definition
|
|
Term
What might happen if a normally harmless, nonpathogenic micro-organism is introduced into an
environment different from its normal habitat? |
|
Definition
| The micro-organism can become pathogenic and cause an infection. |
|
|
Term
| What is a transient micro-organism? |
|
Definition
| A micro-organism that has a very short life span and resides on the external surfaces of an object or live organism. |
|
|
Term
| What is a resident micro-organism? |
|
Definition
| Any micro-organism that normally lives in the deep cracks and folds of the skin, or commonly resides in body orifices. |
|
|
Term
| What are the two types of pathogenic micro-organisms of most concern in hospitals? |
|
Definition
(1) Bacteria.
(2) Viruses. |
|
|
Term
| In what temperature range does most bacteria thrive? |
|
Definition
| Between 68°F and 104°F (20°C and 40°C). |
|
|
Term
| Do most bacteria prefer a moist or dry environment? |
|
Definition
|
|
Term
| What acid-base range does most bacteria grow best in? |
|
Definition
| A neutral or slightly alkaline environment (pH 7.0 or slightly above). |
|
|
Term
| Describe the size of viruses relative to bacteria. |
|
Definition
| Viruses are much smaller than bacteria (so small that they pass through bacterial filters and can only be seen with an electron microscope). |
|
|
Term
|
Definition
| Bacteria that cause wound infections. |
|
|
Term
| What group of bacteria causes the most common type of postoperative wound infection? |
|
Definition
|
|
Term
| List some of the diseases caused by streptococci. |
|
Definition
| Septic sore throat (“strep” throat), scarlet fever, impetigo, bacterial endocarditis, rheumatic fever, neonatal meningitis, and pulmonary infections (e.g., lobar pneumonia). |
|
|
Term
| What diseases and infections are caused by Gonococci? |
|
Definition
| Gonorrhea and conjunctivitis. |
|
|
Term
| How is meningitis primarily transmitted? |
|
Definition
| Through droplet inhalation or from direct contact with the source. |
|
|
Term
| What makes the tubercle bacilli nearly as difficult to destroy as spore-forming bacteria? |
|
Definition
| A wax-like protective coating surrounding the cell. |
|
|
Term
| Which viruses are responsible for causing the “common cold?” |
|
Definition
|
|
Term
| What should you do if you think you have a cold or the flu? Why is this action necessary? |
|
Definition
| Tell your supervisor so you can go to sick call and be kept away from direct patient care. |
|
|
Term
| What highly contagious virus causes cold sores and fever blisters? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| How is AIDS spread from person-to-person? What effect does the disease have on the body? |
|
Definition
| Via contact with infected blood, blood components, or other body fluids; it virtually destroys the body’s immune system. |
|
|
Term
| List the “links” in the infection chain. |
|
Definition
| An infectious agent (pathologic micro-organism); a reservoir or place the infectious agent can multiply or grow; a portal of exit from the reservoir; a mode of infectious agent transmission; a portal of entry into the body; and a host or person susceptible to the pathogenic organism. |
|
|
Term
| Define the term normal flora. |
|
Definition
| Refers to micro-organisms that normally reside on or in a certain body area. |
|
|
Term
| List the four major delivery methods of disease transmission. |
|
Definition
(1) Contact.
(2) Vehicle (common source).
(3) Airborne.
(4) Vector. |
|
|
Term
|
Definition
| Any live carrier, especially a rodent or insect, that transfers an infectious agent from one host to another. |
|
|
Term
| List some common entry points for pathogenic micro-organisms. |
|
Definition
| The mouth and nose (most common), eyes, and breaks in the skin from incisions or other invasive procedures. |
|
|
Term
| What is the body’s best natural barrier to infection? |
|
Definition
|
|
Term
| How do mucus membranes defend against infection? |
|
Definition
| The moist surfaces of the membranes trap micro-organisms, which is enhanced in some areas by cilia or hairs growing out of the membranes; the mucous membranes are highly vascular enabling white blood cells to be rapidly supplied to the area of pathogen invasion; and may also harbor normal flora that combat pathogens. |
|
|
Term
|
Definition
| Substances created in the body to attack specific foreign substances called antigens. |
|
|
Term
| What is a regional infection? |
|
Definition
| An infection that has spread to the lymph nodes. |
|
|
Term
| In relation to standard precautions, describe prevention and control of infections. |
|
Definition
| Prevention refers to the measures we take to keep patients and personnel from acquiring infections; control refers to the measures we take to keep infections from spreading. |
|
|
Term
| Standard precautions combined what two components? |
|
Definition
(1) Universal precautions.
(2) Body substance isolation precautions. |
|
|
Term
| Using standard precautions as a reference, when should hand washing be done? |
|
Definition
| After touching blood, body fluids, secretions, excretions, and contaminated items, even if you were wearing gloves; after removing gloves; between all patient contacts; and whenever you may potentially transfer microbes to other patients or areas. |
|
|
Term
| According to standard precautions, when is mask and eye protection worn? |
|
Definition
| During patient care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, and excretions. |
|
|
Term
| What should be used for performing mouth-to-mouth resuscitation according to standard precautions? |
|
Definition
| Mouthpieces, resuscitation bags, or other ventilation devices as an alternative to mouth-to-mouth resuscitation in areas where the need for resuscitation is predictable. |
|
|
Term
| What is meant by “a drape must serve as a barrier?” |
|
Definition
| It must prevent the microbes from the non-sterile areas beneath the drapes from migrating or passing through to the sterile areas above. |
|
|
Term
When draping, what should you do to reduce causing air currents that disturb dust, lint, and
microbes, possibly allowing them to migrate to the field? |
|
Definition
| Handle drapes as little as possible. |
|
|
Term
| Once placed, what levels of a drape are considered sterile? |
|
Definition
|
|
Term
| When draping the patient, where should draping start? |
|
Definition
|
|
Term
| Why is an unguarded or unwatched sterile field considered contaminated? |
|
Definition
| Contamination may occur during the time it is unobserved. |
|
|
Term
| When opening a wrapped item, why should you open the flap closest to you last? |
|
Definition
| To prevent contaminating the item by passing your unsterile arm over the sterile wrapped item. |
|
|
Term
| How should you open sharp or heavy objects? |
|
Definition
| Present sharp or heavy objects to the scrub tech, or open them on a separate sterile field. |
|
|
Term
| What areas of a sterile gown are considered sterile? |
|
Definition
| The front of the gown from the chest to the level of the sterile field (usually the back table); the sleeves from about 3″ above the elbows to the cuffs. |
|
|
Term
| What areas of a sterile gown are considered non-sterile? |
|
Definition
| The neckline, shoulders, under-the-arms, back, and any area that falls below table level; the cuffs after the gloves are donned. |
|
|
Term
| When scrubbed personnel must move or change positions, how should they do so? |
|
Definition
| They should move face-to-face or back-to back, keeping a safe distance between them. |
|
|
Term
| List some of the personal hygiene recommendations for fingernails. |
|
Definition
| Nails should be relatively short, nail polish is prohibited, and artificial nails are forbidden. |
|
|
Term
| List some of the restrictions for wearing jewelry in the OR. |
|
Definition
| If permitted, it must be contained inside (under) normal surgical attire; circulators may be allowed to wear a watch and a ring, but they must be removed for hand washing; hand and wrist jewelry must also be removed anytime gloves are donned; and scrub personnel may not wear any jewelry on the hands and arms. |
|
|
Term
| What is the mode of transmission for most preventable nosocomial infections? |
|
Definition
|
|
Term
| Contrast the purpose of routine hand-washing with that of the surgical scrub. |
|
Definition
| Hand washing is done to remove the contaminants your hands pick up from various sources to keep them from contaminating the rest of your body or other things you touch; surgical scrub is done to remove transient and resident bacteria from your hands and arms to minimize the chances that you will infect a patient. |
|
|
Term
| What agent is recommended by the CDC for routine hand washing? |
|
Definition
| Plain soap (no antiseptic required). |
|
|
Term
| When should you don your surgical cap or hood? |
|
Definition
| Before the scrub suit and other attire. |
|
|
Term
| List two reasons surgical attire should not be laundered at home. |
|
Definition
(1) It may lead to the spread of micro-organisms in the home.
(2) Its care cannot be adequately controlled to protect the surgical environment. |
|
|
Term
| What type of top or jacket should non-scrubbed personnel wear? Why? |
|
Definition
| Long-sleeved, elastic cuffed jackets that are snapped or buttoned during use; long sleeves reduce microbial shedding from bare arms, and also meet the OSHA requirements for PPE from light to moderate exposure to pathogen-containing fluids. |
|
|
Term
| List some of the criteria for surgical footwear. |
|
Definition
| Should be dedicated solely for the OR; be washable, comfortable, and protective; and provide good support. |
|
|
Term
| When should you wear shoe covers? |
|
Definition
| When dedicated shoes are not available, when exposure to blood or body fluids may be expected, and to cover your dedicated shoes when you leave the OR. |
|
|
Term
| Why should you not “double mask”? |
|
Definition
| It acts as a barrier rather than a filter. |
|
|
Term
| Describe the proper way to remove a surgical mask. |
|
Definition
| Untie and handle the mask only by the strings; never touch the mask body; discard the mask immediately; and wash your hands after discarding the mask. |
|
|
Term
| For what type of surgical procedures is protective eyewear or a face shield required? |
|
Definition
|
|
Term
| What is the purpose of wearing a non-sterile gown? |
|
Definition
| To protect you from pathogenic contaminants. |
|
|
Term
| What is the definition of sterilization? |
|
Definition
| The process that destroys all living micro-organisms, including bacterial spores and viruses. |
|
|
Term
| When are items considered sterile? |
|
Definition
| When exposed to a sterilization process and all mechanical parameters are met, and all external and internal sterilization cycle indicators are acceptable. |
|
|
Term
| List and define the three levels of disinfection. |
|
Definition
(1) High-level disinfection kills all micro-organisms, except spore-forming bacteria; the process may also kill spores if the exposure time is long enough and certain other conditions are met.
(2) Intermediate-level disinfection kills most micro-organisms, including bacteria, viruses, and fungi, but spores are not affected.
(3) Low-level disinfection attacks vegetative bacteria, fungi, and the least-resistant viruses. |
|
|
Term
| State two reasons why we sterilize patient care items. |
|
Definition
(1) Destroying micro-organisms on or within surgical care items prevents these microbes from being introduced into the patient where they can cause a surgical wound infection.
(2) By disinfection and sterilization we can achieve decontamination; by killing as many microbes as possible that our instruments and supplies collected during the procedure, we render the items safe for handling by hospital personnel. This helps prevent the spread of potentially pathogenic micro-organisms to other patients, surgical personnel, and environmental surfaces. |
|
|
Term
| What is the main hazard associated with steam sterilization? |
|
Definition
| The chance of getting burned. |
|
|
Term
| To prevent being burned by steam, what can you do before opening the sterilizer door? |
|
Definition
| Ensure the chamber pressure is zero. |
|
|
Term
| What safety measures can you take to prevent contact burns when unloading a steam sterilizer and handling recently sterilized items? |
|
Definition
| Wear special insulated gloves to protect your hands and forearms. |
|
|
Term
| What acts as the sterilant in a steam sterilizer? |
|
Definition
| Moist heat, in the form of steam under pressure. |
|
|
Term
| Why aren’t anhydrous oils, greases, ointments, or powders steam sterilized? |
|
Definition
| The steam (sterilant) is unable to penetrate them and contact all areas; this is essential to ensure sterility. |
|
|
Term
| What is the method of choice for sterilizing items that are not heat or moisture sensitive? |
|
Definition
|
|
Term
| In dry-heat sterilization, how is heat transferred from items being sterilized to microbial cells? |
|
Definition
| The cells absorb the heat directly through conduction. |
|
|
Term
| List some disadvantages of dry-heat sterilization. |
|
Definition
| Requires very high temperatures and a long exposure period; deteriorates fabrics and rubber; and completely destroys other items (e.g., most plastics). |
|
|
Term
| What types of items are commonly sterilized by ionizing radiation? |
|
Definition
| Large, bulk loads of prepackaged, disposable supply items produced by commercial medical supply manufacturers. |
|
|
Term
| What is one of the first symptoms of EtO exposure? |
|
Definition
| Irritation of the eyes and nose. |
|
|
Term
| Why is EtO gas combined with an inert gas? |
|
Definition
| To stabilize it, reducing its volatility and making it safer to use and handle. |
|
|
Term
| What is the purpose of aerating EtO-sterilized items? |
|
Definition
| It allows residual EtO absorbed by certain materials to escape into the atmosphere, rendering the items safe to handle and use on patients. |
|
|
Term
| What types of items are sterilized using EtO gases? |
|
Definition
| Heat- and moisture-sensitive items. |
|
|
Term
| What are the disadvantages of using ozone as a sterilant? |
|
Definition
| It oxidizes and corrodes iron, copper, brass, and aluminum, and destroys natural rubber, as well as some types of plastics; it is also considered a toxic gas. |
|
|
Term
| List the advantages of hydrogen peroxide sterilization. |
|
Definition
| The process is non-toxic and it sterilizes at cool temperatures; it also leaves no toxic residue, is dry, and the sterilizer is self sufficient. |
|
|
Term
| List the disadvantages of hydrogen peroxide sterilization. |
|
Definition
| Many items cannot be sterilized by this method, and special containers must be used. |
|
|
Term
| List some advantages of peracetic acid as a sterilant. |
|
Definition
| It is relatively fast when compared to most other cold-sterilization methods; almost any type of immersible surgical instrument can be processed; the cycle is almost entirely automatic, minimizing the chances of human error; the sterilant is single-use, so there is no possibility of cross-contamination; and the solution discharged at cycle completion is not considered hazardous even by the strictest current laws. |
|
|
Term
| How long must an item be immersed in most glutaraldehyde solutions before it may be considered sterile? |
|
Definition
|
|
Term
What three micro-organisms must a chemical agent be proven effective against to be classified as
a disinfectant by the EPA? |
|
Definition
(1) Staphylococcus aureus.
(2) Salmonella choleraesuis.
(3) Pseudomonas aeruginosa. |
|
|
Term
| Why should items exposed to the HBV be sterilized instead of disinfected? |
|
Definition
| Because HBV survives exposures to many disinfectants. |
|
|
Term
| What makes an agent broad spectrum? |
|
Definition
| Is effective against a wide variety of micro-organisms; kills or irreversibly inactivates all vegetative bacteria, fungi, and viruses. |
|
|
Term
| How long does it take alcohol to kill vegetative bacteria, pseudomonas, and fungi? |
|
Definition
|
|
Term
| How long does it take alcohol to kill tubercle bacillus and most viruses? |
|
Definition
|
|
Term
| Why should you not use alcohol on lensed instruments? |
|
Definition
| It dissolves the cement holding the lens in place. |
|
|
Term
| What is a solution of iodine and detergent called? |
|
Definition
|
|
Term
| What disinfecting agents leave a residue that is reactivated when the treated surface becomes moist? |
|
Definition
|
|
Term
In the context of instrument and supply processing, define:
Cleaning.
Decontamination.
Terminal sterilization.
Disinfection. |
|
Definition
Cleaning- Physical removal of organic material or soil from an object.
Decontamination- The use of physical or chemical means to remove, inactivate, or destroy blood-borne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles, and the surface or item is rendered safe for handling, use, or disposal.
Terminal sterilization- A sterilization process used to decontaminate patient care items to render them biologically safe for handling and processing.
Disinfection- The process of destroying or inhibiting the growth of micro-organisms. |
|
|
Term
| Where and when does the cleaning process begin? |
|
Definition
| In the OR during the surgical procedure. |
|
|
Term
| Who should remove gross contaminants from all instruments and supplies? List some ways this is done. |
|
Definition
| The scrub technician; by wiping instruments with a wet sponge or towel, or by soaking the instruments in a basin of sterile water or other locally approved solution before the scrub removes his or her gown, gloves, and other protective attire. |
|
|
Term
How should sharp instruments and all instruments that may puncture, lacerate, or otherwise injure
somebody be placed in a container for transport to the decontamination area? |
|
Definition
| In a manner ensuring the person in the decontamination area does not need to reach into the container to retrieve them. |
|
|
Term
| What is the purpose of pre-soaking or pre-rinsing? |
|
Definition
| To help loosen dried blood and organic matter the scrub technician missed; the presoak also helps prevent these organic substances from drying on the instruments. |
|
|
Term
| When should you use the manual cleaning method? |
|
Definition
| Only when no other method is available. |
|
|
Term
| List the PPE required by OSHA and the CDC for manual cleaning. |
|
Definition
| Eye and face protection (a full-face shield is recommended); a surgical face mask (a high filtration mask is recommended); a surgical cap or other permitted hair cover; a scrub suit, covered with a liquid-proof gown or apron with long, impervious sleeves (if spills or splashing are likely, a moisture-resistant coverall or similar item is also recommended); rubber or latex gloves (should be high enough and strong enough to prevent contact with the solution); and, if splashing or fluid pooling on the floor is likely, water-proof boots or shoe covers. |
|
|
Term
| Why should you keep items immersed and avoid splashing as you manually clean them? |
|
Definition
| To prevent microbes from being transmitted via airborne droplets (aerosolization). |
|
|
Term
| Briefly describe the difference between a washer-sterilizer and a washer-decontaminator. |
|
Definition
| The washer-sterilizer washes its contents by filling the chamber with solution and agitating it, and then sterilizes the contents; the washer-decontaminator usually uses a forceful jet or spray to wash the contents, and then relies on a germicidal detergent for decontamination (they do not terminally sterilize the contents). |
|
|
Term
| What term describes removing soil from instruments by using of high-frequency sound waves generated by an ultrasonic cleaner? |
|
Definition
|
|
Term
|
Definition
| A water-soluble instrument lubricant. |
|
|
Term
| What type of lubricants is not used on surgical instruments? Why? |
|
Definition
| Mineral oil, silicones, or machine oils; they interfere with steam, EtO, and chemical sterilization techniques. |
|
|
Term
| How do you organize and keep ring-handled instruments together during the sorting process? |
|
Definition
| Put them side-by-side on a rolled towel. |
|
|
Term
| List some ways you protect delicate or sharp instruments from being damaged during instrument sorting. |
|
Definition
| Handle them by the handles; lay them on a towel to prevent contact with hard table surfaces. |
|
|
Term
| How do you sort reusable suture needles and specialty needles? |
|
Definition
| According to size, type, or, for specialty needles, gauge. |
|
|
Term
| Where may you find pictures and information that help you identify, sort, and assemble instruments? |
|
Definition
| A locally developed photographic instrument identification book, or instrument manufacturer’s catalogs or brochures. |
|
|
Term
| What are the two main reasons for routinely inspecting all instruments? |
|
Definition
(1) Prevent patient injury.
(2) Avoid delays during surgical procedures. |
|
|
Term
| When are all instruments inspected thoroughly? |
|
Definition
| After cleaning and decontamination, and before storage or sterilization; also by the scrub technician while preparing the sterile field before surgery, and during the breakdown of the setup at the end of the operation. |
|
|
Term
| Why is it important to inspect new instruments? |
|
Definition
| To identify defective or low-quality instruments and reject them from service. |
|
|
Term
| Identify six things you check during a routine instrument inspection. |
|
Definition
Any six of the following:
(1) Check hinges and box locks for cracks and loose pivot pins or screws.
(2) Check all jaws for proper alignment.
(3) Check the ratchet closing mechanism for signs of wear and proper function.
(4) Check for bent shanks.
(5) Check for proper jaw tension.
(6) Check needle holder jaws for worn serrations and their ability to firmly hold needles.
(7) Check scissors for bent or broken tips, burrs or nicks on cutting surfaces; loose or damaged pivot screws or pins; and sharpness. |
|
|
Term
| What simple test can you perform to test for instrument corrosion? |
|
Definition
| Try to erase it with a pencil eraser; if the “rust” comes off, then the residue is a stain, not corrosion. |
|
|
Term
| List four causes of spotting on surgical instruments. |
|
Definition
(1) High mineral content in the cleaning water or steam.
(2) Removing the instruments too soon, allowing cold air to condense inside the sets.
(3) A faulty sterilizer drying cycle leaving excess moisture.
(4) Using too much of or improper types of cleaning agents. |
|
|
Term
List the common causes for the following instrument problems:
Black or purple stains.
Corrosion.
Pitting.
Rusting. |
|
Definition
Black or purple stains- Cleaning instruments with ammonia-based detergents or by exposure to steam contaminated by the chemicals facility maintenance personnel use to clean the lime deposits from the steam lines.
Corrosion- Dried blood or organic material left on the instruments (particularly in hard-to-clean areas), excessive moisture left on instruments due to condensation following steam sterilization, or transfer of deposits and scale from improperly cleaned sterilizer chambers or racks to the instrument surfaces.
Pitting- Prolonged soaking of instruments in saline; prolonged exposure to blood or corrosive chemical disinfectants; use of excessively alkaline (high pH) or acidic (low pH) detergents for instrument cleaning; and mixing dissimilar metals during ultrasonic cleaning and steam sterilization processes.
Rusting- Rinsing instruments with mineral-containing tap water and mixing instruments made from different metals in ultrasonic cleaning or steam sterilization loads. |
|
|
Term
| What is the first thing you do with a damaged instrument? |
|
Definition
| Remove the instrument from service. |
|
|
Term
How do you store clean, unsterile instruments that have ratchet mechanisms? Why is this storage
method necessary? |
|
Definition
| Close them to the first ratchet tooth, not the last; to prevent tension and strain on the lock and tips. |
|
|
Term
| Name some of the methods commonly used to determine what items need to go into a set or pack. |
|
Definition
| Count sheet method and cardex system. |
|
|
Term
| What do you do with all hinged instruments placed in a set? Why? |
|
Definition
| Open the jaws and ratchets; to allow steam to contact all surfaces of the instrument. |
|
|
Term
| Why is it necessary to put instruments in a pan in an orderly, standardized sequence? |
|
Definition
| To facilitate sterile field setup and instrument counting. |
|
|
Term
| What are the reasons for individually wrapping all glass items placed in an instrument set? |
|
Definition
| To prevent breakage and contain glass fragments if an item does break. |
|
|
Term
| What should be done with all items having hollow channels or lumens? Why? |
|
Definition
| Flush them with distilled water; to ensure steam is formed inside the lumen (this theoretically eliminates cool air pockets and sterilizes the lumen). |
|
|
Term
| Why are linen items placed in a pack usually fan-folded? |
|
Definition
| To allow adequate steam circulation between fabric layers and facilitate handling and use during surgery. |
|
|
Term
| Where should chemical indicators be placed inside each pack, set, or individually wrapped item? |
|
Definition
| As close to the geometric center of the pack as possible. |
|
|
Term
| What is the primary purpose of packaging patient care items? |
|
Definition
| To maintain their sterility up to the point of use. |
|
|
Term
| What does the term “permeability” mean in the context of being a desirable characteristic of a package? |
|
Definition
| Permits the sterilization agent to penetrate the package and fully contact the surfaces of the items being sterilized; allows non-sterile air to escape from the package during the sterilization cycle; allows the sterilant to escape at the end of the cycle; and doesn’t hinder drying of steam-sterilized or EtO-sterilized loads. |
|
|
Term
| To obtain a true picture of total packaging costs, what factors do you consider? |
|
Definition
| The original cost; number of times of reuse; efficiency of use; labor costs; and collecting, moving, storing, laundering and repairing (if non-disposable), inspecting, and using the materiel being considered. |
|
|
Term
| What is the traditional and most commonly used fabric for non-disposable wrapping materials? |
|
Definition
| 140-thread count, unbleached cotton muslin. |
|
|
Term
| What is the cause of linen superheating? |
|
Definition
| Lack of moisture (dehydration) in the fibers of the linen caused by a failure to re-launder them after each sterilization process. |
|
|
Term
| What does the term “memory” mean when talking about paper wrapping materials? |
|
Definition
| It refers to a paper wrapper’s tendency to return back to its original unfolded state each time it is folded or held. |
|
|
Term
| List some advantages of disposable, non-woven fabric wrappers. |
|
Definition
| Available in different weights, or thicknesses, for various applications; nearly as flexible (memory-free) as cloth wrappers; nearly lint-free; disposable; excellent barriers to microbes and moisture after sterilization; and stronger and more tear resistant than paper. |
|
|
Term
| What is the primary disadvantage of non-woven fabric disposable wrappers? |
|
Definition
|
|
Term
| Describe a peel-pack pouch. |
|
Definition
| Made with a layer of paper on one side, and plastic on the other; come in various sizes; and are sealed on three sides, with the fourth side left open until the desired item is inserted into the package, and then the open end is sealed with a fold-down adhesive flap or by using a heat sealer. |
|
|
Term
| What type of rigid container cannot be used in gravity displacement sterilizers? |
|
Definition
| Those without perforated bottoms. |
|
|
Term
| Why is it important to form a wide cuff or flap fold in a wrapper used to package a surgical patient care item? |
|
Definition
| To allow personnel to open the wrapper without contaminating the inner, sterile contents of a package. |
|
|
Term
| What should you look for when performing the final “quality check” before wrapping any item? |
|
Definition
| Ensure an internal chemical sterilization indicator is included in the package; look at how the items are arranged; look for any missed stains or rust; and be alert for any other discrepancies. |
|
|
Term
| When wrapping an item using the diagonal method, which corner of the wrapper should be folded first? |
|
Definition
| The wrapper corner closest to the person doing the wrapping. |
|
|
Term
| How much “safety margin” should you leave around an item being placed in a peel-pack? |
|
Definition
| One inch from the edges of the package all around the item contained. |
|
|
Term
| How do you place an item in a peel-pack? |
|
Definition
| With the handle or part to be grasped first facing towards the end of the pack designed to be opened. |
|
|
Term
| What restriction is placed on instruments in the internal basket or pan of a rigid container? |
|
Definition
| The instruments cannot extend above the pan or basket because they cannot contact the lid. |
|
|
Term
| How does moist heat provided by steam-under-pressure destroy micro-organisms? |
|
Definition
| By denaturation, a process whereby heat energy disrupts the structure of the cell and coagulates its protein, destroying the reproducing and life-sustaining activities of the cell. |
|
|
Term
| Define “saturated steam.” |
|
Definition
| Steam that contains a maximum amount of water vapor; it condenses into water when it contacts a cool object, releasing a large amount of heat. |
|
|
Term
| Which factor is of greater concern in steam sterilization––temperature or pressure? Why? |
|
Definition
| Temperature; the high temperature of the steam kills all microbes. |
|
|
Term
| What is meant by the term “pure steam?” |
|
Definition
| Contains no excess air, liquid water drops, or solid particle contaminants. |
|
|
Term
| What type of rigid containers should not be used in a gravity displacement sterilizer? Why? |
|
Definition
| Containers with non-perforated bottoms; air cannot escape downward through the container and air pockets result; non-perforated bottoms also collect and allow the water in the steam to pool. |
|
|
Term
| Why must all dirt, organic material, and oil be removed from the surfaces of items to be sterilized? |
|
Definition
| Because steam must contact all surfaces of the items, and it cannot penetrate dirt, organic material, or oil. |
|
|
Term
| Why do exposure times vary during steam sterilization? |
|
Definition
| The exposure time must allow complete steam penetration to all parts of the load, and some materials are penetrated more easily than others. |
|
|
Term
| Why do you load all packages with loose contact between individual items in a sterilizer load? |
|
Definition
| To ensure the passage of steam meets minimal resistance from the top to the bottom of the chamber and throughout the load; reduce the tendency for air pockets to form in the load; and shorten the drying time. |
|
|
Term
| Describe how you position packages, trays, and sets on the sterilizer rack shelves. |
|
Definition
| Place all packages, trays, and sets (except rigid containers) on edge with the longest side of the pack on the rack shelf; place receptacles (e.g., basins and bowls) on their sides; tip wrapped packages slightly forward; and place rigid containers flat on the shelf. |
|
|
Term
| Why are wrapped packages tipped forward when loaded into the sterilizer? |
|
Definition
| To prevent condensation from being trapped in the containers during load cool down. |
|
|
Term
| What is the minimum distance allowed between the top of the sterilizer chamber and the topmost packages of the load? |
|
Definition
|
|
Term
| Why are fluids never sterilized with non-fluids? |
|
Definition
| May result in the non-fluids being contaminated or damaged if the fluid is expelled into the chamber. |
|
|
Term
| What is the first thing you do after the cycle completion alarm sounds? |
|
Definition
| Check the chamber pressure gauge or digital readout to ensure it reads “zero.” |
|
|
Term
| Where should you stand when opening a sterilizer door? Why? |
|
Definition
| Behind the door, slightly towards the hinged side, but never in front of the opening chamber; to greatly reduce the likelihood of a steam burn or other injury as you open the sterilizer door. |
|
|
Term
Why do you “crack” the sterilizer door open a few inches and leave it this way for 15 – 30
minutes following the sterilization cycle? |
|
Definition
| It helps any remaining moisture to evaporate, and makes the load slightly cooler and safer to transport to the sterile supply cooling area. It also reduces the likelihood of condensation occurring within the packs, which results if the hot items are exposed to cool room air too quickly. |
|
|
Term
| What is the number one cause of sterilization errors? |
|
Definition
|
|
Term
| Name one factor causing steam sterilizer malfunction despite the best maintenance efforts. |
|
Definition
| Changes in the water and steam quality supplying the sterilizer. |
|
|
Term
| What is the primary purpose of all OR sanitation activities? |
|
Definition
| To reduce and control the possibility of cross-contamination between patients and surgical staff members by significantly reducing the number of micro-organisms in these environments. |
|
|
Term
| Describe the steps to initial cleaning activities. |
|
Definition
| Remove unnecessary furniture and equipment; damp-dust all horizontal surfaces in the OR, starting with the highest, most central point in the room, and working downward and outward in a spiral pattern; move all mobile furniture to one side of the room; apply detergent germicide solution to the bare floor; roll all movable furniture onto the now wet floor; apply the solution to the other side; and use a wet-vacuum to pick up the solution. |
|
|
Term
| What is the goal of sanitation activities performed during a surgical procedure? |
|
Definition
| To confine and contain contamination to as limited an area as possible. |
|
|
Term
| List three measures a circulator should take during a case to limit the spread of infectious agents. |
|
Definition
(1) Use a detergent-germicide solution to immediately “spot-clean” any area contaminated with blood, body fluids, or other organic matter.
(2) Keep all soiled surgical sponges contained and sealed in impervious containers (e.g., plastic bags).
(3) Avoid contaminating the outside of specimen containers, X-rays, lab slips, and patient documentation. |
|
|
Term
| How can the scrub best help contain contamination during the surgical procedure? |
|
Definition
| By exercising caution when handling and disposing of contaminated items. |
|
|
Term
| What is the ultimate goal of between-case cleaning? |
|
Definition
| To contain, confine, and destroy potentially infectious micro-organisms to prevent cross contamination of patients and personnel. |
|
|
Term
| Which surgical team members routinely handle all contaminated items after a procedure? Why? |
|
Definition
| Scrub technicians; they are protected by the gown, gloves, and other attire. |
|
|
Term
| Where are most of the between-case cleaning efforts concentrated? |
|
Definition
|
|
Term
| Generally, what items and areas in the surgical suite are cleaned periodically? |
|
Definition
| Items and areas in the surgical suite that are not normally cleaned at the end of each day. |
|
|
Term
| Name three categories of human needs. |
|
Definition
(1) Physical.
(2) Psychological.
(3) Spiritual. |
|
|
Term
|
Definition
| Those necessary to sustain life. |
|
|
Term
| Identify six physical needs. |
|
Definition
(1) Food.
(2) Water.
(3) Oxygen.
(4) Sleep.
(5) Waste elimination.
(6) Control over body functions. |
|
|
Term
| What category of needs is most patient care and treatment directed at satisfying? |
|
Definition
|
|
Term
| Where do psychological needs come from? What are they responsible for? |
|
Definition
| Life experiences; controlling the greater part of human behavior. |
|
|
Term
| List four classifications of psychological needs. |
|
Definition
(1) Safety.
(2) Belonging.
(3) Self-esteem.
(4) Self-actualization. |
|
|
Term
| Identify three consequences that may result from hospital personnel failing to recognize and satisfy a patient’s need for security. |
|
Definition
(1) The patient may be afraid to be alone.
(2) The patient may feel helpless and worried about his or her safety.
(3) The patient may feel abandoned by friends and families. |
|
|
Term
| Specify two needs that originate from a person’s need to belong. |
|
Definition
(1) To love and be loved.
(2) To establish stable, accepted relationships with other people as a functioning member of a group. |
|
|
Term
| Describe the need for self-esteem. |
|
Definition
We all need to feel worthy and respected; it is the need implied when we talk about dignity, self-respect,
honor, and self-worth. |
|
|
Term
| Describe what may happen if patients have a lowered sense of self-worth? |
|
Definition
They may feel they are of little value to themselves and others; as a result, their will to live and to get well
may decrease. |
|
|
Term
| Describe the human need for self-actualization. |
|
Definition
A person’s desire for self-fulfillment, or the tendency for people to strive to reach their full potential, to
develop their abilities, and express their personalities. |
|
|
Term
| How may an injury or illness affect a patient’s need for self-actualization? |
|
Definition
| It may interfere with the patient’s ability and opportunity to develop and use personal talents. |
|
|
Term
| How can a chaplain or spiritual adviser help a patient satisfy their spiritual needs? |
|
Definition
By comforting the patient, and providing the patient with the warmth, strength, courage, and support to get
through difficult times. |
|
|
Term
| List five common fears of the surgical patient. |
|
Definition
Any five of the following:
(1) Fear of the unknown.
(2) Fear of death, disability, or disfigurement.
(3) Fear of poor prognosis.
(4) Fear of pain.
(5) Fear of anesthesia.
(6) Fear of loss of privacy. |
|
|
Term
| What causes a surgical patient to fear the unknown? |
|
Definition
| The patient’s ignorance or misunderstanding of surgical procedures and anesthesia. |
|
|
Term
| What type of fear is common in patients who have cancer? |
|
Definition
| The fear of death, disability, or disfigurement. |
|
|
Term
| What action should you take if a patient tells you he or she is afraid of dying during surgery? |
|
Definition
| Immediately report the incident to a licensed practitioner. |
|
|
Term
| What does “fear of poor prognosis” mean? |
|
Definition
| A fear of the outcome of a disease or treatment. |
|
|
Term
| What type of surgical patients may be particularly affected by a fear of pain? |
|
Definition
| Patients who will be operated on under local and know they will be conscious during surgery. |
|
|
Term
| Why is a patient who will be administered a general anesthetic more susceptible to a fear of anesthesia? |
|
Definition
| They realize they will be totally dependent on the surgical team for their survival. |
|
|
Term
|
Definition
| A persistent feeling of uneasiness or uncertainty that comes from anticipation of real or imagined threats. |
|
|
Term
| Identify eight physiological changes that may occur in an overly anxious, highly stressed patient. |
|
Definition
Any eight of the following:
(1) Rapid pulse and heart palpitations.
(2) Alteration of time perception.
(3) Faster breathing.
(4) Increased sweating.
(5) Dilated pupils.
(6) Dry mouth.
(7) Clammy skin.
(8) Stuttering.
(9) Confusion.
(10) Memory lapses.
(11) Distorted perception events.
(12) Involuntary twitching of muscles.
(13) Paralysis. |
|
|
Term
| Name three ways patients’ fears can be reduced. |
|
Definition
(1) Keep patients informed.
(2) Treat patients with respect.
(3) Look and act professionally. |
|
|
Term
| What “tool” used by surgical nursing personnel is designed to identify and satisfy each patient’s needs? |
|
Definition
| A comprehensive plan of care (perioperative care plan). |
|
|
Term
| What is the main purpose of the perioperative nursing care plan? |
|
Definition
| To establish goals for surgical care, which will become the guide for specific actions. |
|
|
Term
| Name two sources of data the OR nurse uses in developing the perioperative nursing care plan. |
|
Definition
(1) The patient’s medical record.
(2) A preoperative patient interview. |
|
|
Term
| Identify three purposes of the nurse’s preoperative patient interview. |
|
Definition
(1) Evaluate the patient’s physical status.
(2) Evaluate the patient’s need.
(3) Validate information in the history and physical reports. |
|
|
Term
During preoperative interviews, a nurse will ask questions to psychologically evaluate patients.
What does this questioning include? |
|
Definition
Questions regarding fears and anxieties, how they are coping with preoperative stress, and what their
understanding of the operation and care required. |
|
|
Term
| List three benefits derived from having a patient’s family present during a preoperative interview. |
|
Definition
(1) The nurse can establish a better rapport with the patient.
(2) The nurse can dispel some of the family’s fears and apprehensions.
(3) The nurse can achieve a better understanding of the patient’s lifestyle. |
|
|
Term
| What form is used in AF medical facilities to document perioperative nursing care? |
|
Definition
| AF Form 1864, Perioperative Nursing Record. |
|
|
Term
Where is the perioperative nursing record maintained after the surgical nurse documents the
patient assessment and nursing care plan? |
|
Definition
|
|
Term
| Name two laboratory tests that are routinely ordered for surgical patients. |
|
Definition
(1) Urinalysis.
(2) Hematology. |
|
|
Term
| What is the normal range and average pH of urine? |
|
Definition
|
|
Term
| If the urinalysis shows the presence of RBCs, what could this mean? |
|
Definition
| Bleeding, which may be caused by inflammation, a stone in the kidney, or other conditions. |
|
|
Term
| What is the most common routine hematology study? What does it include? |
|
Definition
| A CBC; WBC count, RBC count, platelet count, Hct, Hgb, and WBC – Diff count. |
|
|
Term
| What does a WBC count over 11,000 usually indicate? |
|
Definition
| The patient has an infection. |
|
|
Term
| What does the Hct measure? |
|
Definition
| The volume of packed RBCs in 100 ml of blood. |
|
|
Term
| What is crossmatching of blood? |
|
Definition
| To the procedures used to determine compatibility of the patient’s blood and the donor blood unit. |
|
|
Term
|
Definition
| Preoperative pathology studies. |
|
|
Term
| Cite the four types of patients who normally require a preoperative chest X-ray. |
|
Definition
(1) Patients who will be given a general anesthetic
(2) Elderly patients.
(3) Smokers.
(4) Patients with chronic lung disease or pulmonary problems. |
|
|
Term
| What patients are routinely required to have an ECG before surgery? |
|
Definition
| Patients 35 years old and over. |
|
|
Term
| What is the purpose of the Surgical Checklist? |
|
Definition
| It serves to remind personnel of, and document completion of, the routine procedures involved in preoperative patient preparation. |
|
|
Term
| Where is the Surgical Checklist located? |
|
Definition
| On the front of the patient’s chart. |
|
|
Term
| Into what two categories can items on the Surgical Checklist be grouped? |
|
Definition
(1) Clinical records.
(2) Patient-care procedures. |
|
|
Term
| Where can you find the surgeon’s orders for patient skin preparation and preoperative medication? |
|
Definition
| AF Form 3066, Doctor’s Orders, or AF IMT 3066–1, Doctor’s Orders. |
|
|
Term
| Why must makeup and nail polish be removed before surgery? |
|
Definition
Makeup so the patient’s color can be monitored to assess circulation; makeup and nail polish to prevent
flakes or chips that may contaminate the field. |
|
|
Term
| Give two reasons why dentures, false teeth, and partial plates are removed preoperatively. |
|
Definition
(1) They might interfere with maintaining a patient’s airway.
(2) They are very expensive pieces of the patient’s personal property, so you don’t want to risk losing or
damaging them. |
|
|
Term
| When are the vital signs noted on the Surgical Checklist usually taken? |
|
Definition
| Just before the preoperative medication is given. |
|
|
Term
| What is informed consent? |
|
Definition
The patient fully understands and voluntarily gives the health-care provider permission, in writing, to
perform the treatment specified. |
|
|
Term
| What are the five reasons for informed consent? |
|
Definition
(1) To ensure the patient understands the nature and purpose of the treatment, including complications
and alternatives.
(2) To protect the patient from non-approved or experimental surgery and unnecessary surgery.
(3) To ensure nursing and surgical personnel know exactly what procedures the patient has agreed to have
done.
(4) To protect the patient’s right to self-determination and participation in decisions involving his or her
care.
(5) To protect the medical staff (surgeons, anesthesiologists, etc.), nursing staff (including surgery
personnel), and the hospital from legal claims of unauthorized operations and other procedures. It also prevents patient claims filed for invasion of privacy, assault, and battery. |
|
|
Term
| Who is primarily responsible for obtaining a patient’s written consent? |
|
Definition
| The surgeon and anesthesia staff. |
|
|
Term
What are the four things the provider’s handwritten informed consent entry in the Progress Notes
indicate? |
|
Definition
(1) The patient and surgeon have discussed the disease process.
(2) The surgeon has explained the nature and purpose of the proposed procedures, its anticipated risks and
benefits, and alternative treatments with their risks and benefits.
(3) The patient has indicated he or she understands the matters discussed and consents to the
procedures.
(4) All procedures the surgeon anticipates performing during the course of an operation. |
|
|
Term
| What are the legal requirements for informed consent? |
|
Definition
The patient must be mentally competent, of legal age, and physically able to understand the consent and to
sign the consent forms; if the patient is a minor, unconscious, sedated, physically unable to sign, or declared
mentally incompetent or insane, a parent, legal guardian, or court-appointed representative may sign the
forms. |
|
|
Term
What type of terminology must be used on all consent forms to ensure a patient understands
exactly what he or she is consenting to have done? |
|
Definition
|
|
Term
| What signatures are required on a legal operation permit? |
|
Definition
| The attending physician’s (usually the operating surgeon’s), patient’s, and a witness’s signature. |
|
|
Term
| Describe implied consent. |
|
Definition
If the patient is incapable of consenting, and if no legal representative can be found, an emergency
procedure required to save a person’s life or limb may be performed without consent. It applies to situations
where a reasonable adult would normally give his or her consent for an emergency procedure, but is
incapable of doing so. This rule applies to minors and incompetent patients as well. |
|
|
Term
What can the provider do if a military member refuses to submit to medical, surgical, or dental
treatment? What are the potential consequences? |
|
Definition
The provider may refer him or her to an MEB. This board decides if the procedure is required for the
member to perform his or her military duties and if he or she meets the established medical qualifications
for continued military service. The board also determines if the procedure would probably produce the
desired results. If the board decides the procedure is required and would be effective, the member is
notified of the decision. If he or she still refuses treatment, the MEB may recommend administrative
discharge. |
|
|
Term
| Specify two reasons why patients are brought to the OR approximately 45 minutes before their scheduled surgery. |
|
Definition
(1) Allows enough time for preoperative medications to take effect.
(2) Allows the time to do the last minute things necessary to get the patient ready for anesthesia
administration and surgery. |
|
|
Term
What basic information about the patient should the transport specialist or technician be provided
with before going to pick up a patient? |
|
Definition
The patient’s full name, rank (if applicable) or status, age, sex, hospital register or social security number,
type of surgery, surgeon’s name, type of anesthesia projected, patient-care unit designation, and any special
transport considerations. |
|
|
Term
| As a minimum, how many sheets are required for patient transport? |
|
Definition
|
|
Term
| What do you inspect on the gurney? |
|
Definition
Ensure you have an IV pole that attaches to the gurney. Check all safety devices and restraints. There must
be at least one safety strap to secure the patient above the knees. Both side rails must raise and lock into
position, and the gurney’s floor or wheel locking device(s) must firmly anchor the gurney when engaged.
The head and foot of the gurney should be able to be raised independently. The litter’s raising or lowering
mechanism should operate smoothly and slowly, moving the mattress up or down evenly. Check the “ride”
of the gurney. |
|
|
Term
| What is the first thing you check on the patient’s chart? |
|
Definition
| Ensure the chart’s identification information matches the pickup slip. |
|
|
Term
| Why should nursing personnel accompany you to the patient’s room? |
|
Definition
| To help you identify and transfer the patient from the bed to the gurney. |
|
|
Term
| What is the first thing you should do when you approach the patient? |
|
Definition
Tell the patient who you are and why you are there; tell him or her exactly what you are going to do before
you do it, and explain the why, to avoid startles or surprises. |
|
|
Term
| List five methods used to positively identify a patient before transport to surgery. |
|
Definition
(1) Compare the pickup slip with the chart identification.
(2) Ask nursing unit personnel to identify the patient.
(3) Check the chart against the name on the patient’s bed.
(4) Ask the patient to say his or her full name.
(5) Check the patient’s ID band against the chart. |
|
|
Term
| Where should IV containers be placed on the gurney? Why? |
|
Definition
Suspended from a pole at the side or foot of the litter away from the patient’s head to prevent the patient
from being hit in the head should the bag or bottle fall. |
|
|
Term
| How many people are required to safely transfer a conscious patient from a bed to a gurney? How many for an unconscious patient? |
|
Definition
| At least two; at least four. |
|
|
Term
| Why should you not allow patients to place their hands under their head while being transported to the OR? |
|
Definition
It makes their elbows stick out beyond the side rails, and a corner cut a bit too sharp or a bump against the
wall could result in a broken arm or a mashed elbow. |
|
|
Term
| In which direction is the gurney normally pushed? What is the usual exception to this rule? |
|
Definition
| Feet first; when entering an elevator, push the head end of the gurney into the elevator first. |
|
|
Term
| When reverifying the identity of the patient, why does the nurse usually ask the patient about the operation he or she is going to have? |
|
Definition
This ensures the patient understands exactly what is going to be done and it matches what he or she has
agreed to have done. |
|
|
Term
| Why is a surgical cap placed on the patient’s head? |
|
Definition
This covers the hair to reduce chances of shed hair contaminating the field and prevents the hair from
getting soiled by blood or emesis. |
|
|
Term
| Why is the IV started as soon as possible after the patient arrives in the surgical suite? |
|
Definition
| To allow the patient to relax and adapt to the surgical environment after this relatively traumatic procedure is completed. |
|
|
Term
| When attending a drowsy patient awaiting surgery, what rule should you follow? |
|
Definition
| Avoid unnecessary conversation and let the patient sleep. |
|
|
Term
| Why is the patient not moved into the OR until the last minute before surgery is scheduled to start? |
|
Definition
| To avoid a prolonged, uncomfortable wait on the OR bed and to prevent patient anxiety from increasing. |
|
|
