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CIS SELF-STUDY LESSON PLANLesson No. CIS 279 (Instrument Continuing Education - ICE)Sponsored by:Environmental Responsibility:Keeping Sterile ProcessingDepartments Clean and FunctionalBY SUSAN KLACIK, BS, CRCST, CIS, CHL, ACE, FCS, IAHCSMM CLINICAL EDUCATORCertified Instrument Specialist (CIS) lessonsprovide members with ongoing education inthe complex and ever-changing area of surgicalinstrument care and handling. These lessons aredesigned for CIS technicians, but can be of valueto any CRCST technician who works with surgicalinstrumentation.Earn Continuing Education Credits:Online: Visit for onlinegrading.By mail: For written grading of individual lessons,send completed quiz and 15 to:Purdue University - Online LearningYoung Hall, Room 527155 S. Grant StreetWest Lafayette, IN 47907Subscription Series: Purdue Extended Campusoffers an annual mail-in or online self-study lessonsubscription for 75 (six specific lessons worth 2points each toward CIS recertification of 6hours). Call 800.830.0269 for details.Scoring: Each online quiz with a passingscore is worth 2 contact hours toward your CISrecertification (6 hours) or CRCST recertification(12 hours).More information: IAHCSMM provides onlinegrading service for any of the Lesson Planvarieties. Purdue University provides gradingservices solely for CRCST and CIS lessons. Directany questions about online grading to IAHCSMMat 312.440.0078. Questions about writtengrading are answered by Purdue University at800.830.0269.LEARNING OBJECTIVES1. Discuss the importance of routine environmental cleaning and disinfection of a SterileProcessing department2. Discuss the responsibilities of the environmental interdisciplinary team3. List critical equipment and surfaces in Sterile Processing that require routine careand maintenanceNote: This lesson plan is based on standards and regulations as of 1/2/2020.Often, a Sterile Processingdepartment (SPD) is sobusy processing medicaldevices that some of theenvironmental cleaning and routinemaintenance tasks are left undone. Theenvironment in which medical devicesare processed is very important. Forexample, if the processing area hasdust and lint contamination, thoseparticles could be deposited onto theinstrumentation. This lesson will addressthe importance of environmentalcleaning and the guidelines andregulations that guide this process.Objective 1: Discuss the importanceof routine environmental cleaning anddisinfection of a Sterile ProcessingdepartmentEnvironmental cleaning is every SterileProcessing (SP) technician’s responsibility.The SP environment is comprised notonly of the air, walls and floors but alsoall work surfaces and equipment.The decontamination area has a highrisk of pathogen transmission due tomultiple contacts between staff andcontaminated medical devices. It iscritical to thoroughly clean and disinfectthis room, as it is a basic infectionprevention principle used to reduce thelikelihood that the exogenous sources inthat room will contaminate other areasand surfaces of the SPD.The clean areas of the departmentalso must be cleaned and disinfectedon a regularly scheduled basis to helpkeep the microbial and dust levels down.Dust and lint can enter an unpackagedtray and transfer onto/into a patientduring a procedure. An uncleanedsterilization or storage area cancontaminate a sterilized tray.It is important that most areas ofthe SPD are properly cleaned at leastdaily. Work surfaces and sinks shouldbe cleaned at least each shift and morefrequently, as needed. Cleaning in theSPD is a shared responsibility with

CIS SELF-STUDY LESSON PLANdepartments such as EnvironmentalServices (EVS), Facilities Maintenanceand Biomedical Engineering(Biomed), to name a few. Developingan interdisciplinary team to developand monitor environmental cleaningand equipment maintenance cleaningroutines is an effective way to keep thedepartment properly maintained.Objective 2: Discuss the responsibilities ofthe environmental interdisciplinary teamThe interdisciplinary team shoulddetermine the cleaning routinesand schedules for each area of thedepartment. For example, floors shouldbe wet mopped and disinfected atleast daily and vents and walls shouldbe cleaned on a regular basis, basedon the activity and dust levels of thedepartment. The team should alsomonitor established procedures toensure they are consistently followed.For example, environmental cleaningequipment and supplies used in thedecontamination room should only beused in the decontamination room toprevent the spread of contamination.The SPD should have policies andprocedures developed that specifythe cleaning, disinfection and routinemaintenance procedures for each areaof the department and for each piece ofequipment. This is best accomplishedusing the interdisciplinary team thatincludes SP, EVS, perioperative nursing,and Infection Prevention to ensurecleaning procedures and frequencies arebased on manufacturers’ instructionsfor use (IFU), best practices, standardsand regulations. Facilities Maintenanceand Biomed professionals will helpensure the area and equipment aremaintained properly.Failure to perform routinemaintenance tasks can result inequipment becoming contaminated ornot functioning properly. Equipmentmanufacturers’ IFU should specify thecleaning, disinfection and/or sterilization,inspection and routine maintenancerequirements. The recommendationsfor cleaning and disinfection of surfacesshould originate from either themanufacturer, government regulations,or standards and guidelines.The interdisciplinary team shouldidentify high-touch areas to be cleanedand disinfected. Evidence has shownthat high-touch areas such as controlpanels, switches, knobs and handles canharbor contamination and should becleaned and disinfected on a routinebasis to prevent the cross-contamination.Note: It is important to understandwho is responsible for keeping surfacesclean. Typically, EVS maintains floors,walls, ceilings and vents. The rest of thearea is typically the responsibility of SPtechnicians. While this is the typical lineof responsibility, it is important to have awritten plan to specify who is responsiblefor each surface and piece of equipment toprevent an item from being missed.The equipment and work surfaces usedin medical device processing should becleaned on a routine basis, as prescribedin the policies and procedures. To ensureall areas are cleaned, a checklist should bedeveloped that specifies the equipmentor surface to be cleaned, and the cleaningschedule. The same can be done forroutine equipment maintenance.Checklists are a means of standardizingprocedures, preventing missing surfacesor equipment and demonstratingcompliance with policies and bestpractices. The checklist may be designedto each area of SP or different typesof equipment.There also should be a method ofevaluating the effectiveness of thecleaning process. This measurementcan be either using a qualitative method[such as visual inspection and/orfluorescent marking, or quantitativemethods using cultures or adenosinetriphosphate (ATP) monitoring].The testing time intervals should bebased on recommendations from theinterdisciplinary team. Results fromquantitative methods should be recordedand used to provide measurable objectivedata. This information can then be usedto drive process improvement, promotecompliance, educate personnel and verifypersonnel competency.Objective 3: List critical equipment andsurfaces in Sterile Processing that requireroutine care and maintenanceThere are equipment and surfacesthroughout an SPD that require routinecleaning and disinfection to maintaina clean environment for processingmedical devices. The following areasshould be considered for routine cleaningand/or disinfection: Ventilation ducts, including air ventsand grilles, and the filter should becleaned and changed on a routinebasis. The manufacturers’ IFU shouldprovide this information. Walls, floors and ceilings shouldbe routinely inspected for debris andstaining. These areas should beroutinely cleaned and should alsobe cleaned whenever debris ispresent/noted. High-touch areas/surfaces thatcannot withstand disinfection shouldbe protected with a barrier coveringto prevent the surfaces from becominga reservoir for microorganisms. Anexample is a computer keyboard. Theprotective covering should be removedor disinfected in accordance withthe IFU. High-touch areas such as doorknobs,control panels, cart handles andswitches should be routinely cleaned. All floors should be cleaned anddisinfected each day with a damp mop.

CIS SELF-STUDY LESSON PLAN Sinks should be cleaned anddisinfected at least daily and morefrequently, as necessary. Emergency eye wash/shower stationsshould be cleaned and disinfectedon a routine basis. This equipmentrequires weekly testing to ensureits safe operation, according tothe Occupational Safety and HealthAdministration’s (OSHA’s) Eyeand Face Protection Standard (29CFR 1910.133). Both the shower (ifavailable) and eye wash station shouldbe activated for a period long enoughto verify its operation and ensure thatthe flushing solution is available. Thewater temperature should bemonitored to ensure it is a tepidtemperature, (between 60 and 100 F).A record of this weekly test shouldbe maintained. Countertops should be cleaned anddisinfected at least daily. Workstations should be cleaned anddisinfected at the end of each shift andwhenever soiled. The service area behind the sterilizersshould be routinely cleaned, withspecific areas in need of cleaningclearly defined. The cleaning scheduleshould be based on recommendationsfrom the interdisciplinary team. Employee changing areas should becleaned daily and employees shouldbe encouraged to clean their lockers ona routine basis.Sterile Processing equipmentIt is imperative to follow the IFU of theequipment used in the SPD. The IFUshould be used to select the types ofcleaning and disinfectant chemicals foruse. The IFU should also provideinformation regarding routine maintenancerequirements, replacement parts (includingtubing and filters), inspection and othermaintenance necessities. The requirementsshould be included in a checklist andverification testing should be recorded.While the IFU provides informationregarding the types of cleaning solutionsto use, they may not provide informationregarding the frequency of use. Whatfollows are some frequency of userecommendations, based on standards,guidelines and regulations: Ultrasonic cleaners This equipmentshould be cleaned at least dailywhenever the equipment is in use,in accordance with the equipmentmanufacturer’s IFU. The basin mayrequire daily cleaning. In addition,the equipment should undergo dailyperformance verification andcavitation testing. If a manifoldsystem with tubing is used forirrigating cannulated instrumentation,the tubing should be tested for fluidflow. The strainer should be cleanedeach day. Washer-decontaminator Spray armsshould be checked at least dailyto ensure they are completely freeturning and that the spray nozzlesare not clogged. The strainer shouldbe cleaned at least daily and whenevervisible debris is observed; the eternalsurface should be cleaned at leastdaily and whenever visibly soiled.Cleaning verification testing shouldbe performed and documented eachday the equipment is used. Equipmentsettings should be checked to ensurethey are correct, and the printoutshould be examined to ensure it isfunctioning properly. Equipmentloading carts and trolleys should beinspected and cleaned on aroutine basis, in accordancewith recommendations from theinterdisciplinary team. Cart washer The chamber should becleaned according to the IFU. Cleaningverification testing should beperformed and documented each day the cart washer is used. The settingsshould be checked to ensure theyare correct, and the printout shouldbe examined to ensure it is functioningproperly. The strainer should becleaned at least daily and wheneverthere is visible debris. Spray armsshould be checked at least daily toensure the arms are completelyfree-turning.Leak tester Each day, pressureverification should be performed foreach type of leak tester; the resultsshould be recorded.Borescopes These devices should becleaned and disinfected after each use.Automatic flushers Check with themanufacturer for specific informationon filter changes, cleaning anddisinfecting tubing, and calibration.Detergent doser Clean and disinfect inaccordance with the IFU, and routinelyverify for correct dose. Ensurecalibration is verified, per the IFU.Pass-through window The windowshould be checked periodically toensure it completely closes and seals,thereby, creating an effective physicalbarrier. Instrument preparation and packagingworkstations These areas should becleaned and disinfected after each shift. Heat sealer This piece of equipmentshould be cleaned at least daily toremove packaging debris. Temperaturecalibration should be checked, perthe IFU. Biological incubators Refer to themanufacturer’s IFU for propercleaning and other maintenancerequirements. Storage areas/storage equipment Sterilestorage area equipment such as theshelves or cabinets should be cleanedand documented on a routine basis. Automatic endoscope reprocessor (AER)The AER should undergo automatedcleaning efficacy

CIS SELF-STUDY LESSON PLANverification testing, in accordance withthe equipment manufacturer’s IFU. Sterilizers Routine inspection andcleaning of sterilizers reduces the riskof accidental contamination of sterileitems. Sterilizers should beinspected and cleaned according tothe manufacturer’s written IFU. Dailysterilizer evaluation requiresassessment of recording charts;printers; printer ribbons; marking pensand ink; door gaskets (look for nicksand stains); inspection and cleaningthe chamber drain screen to removelint tape and other small objects fromentering the exhaust line; and externalsurfaces. The sterilizer chamber shouldbe cleaned weekly.Routine sterilizer efficacy monitoringSteam sterilizers should be tested at leastdaily using biological indicator processchallenge devices (BIPCDs) validatedfor the sterilization cycle being tested.Some steam sterilizers have more thanone cycle (such as gravity displacementand dynamic air removal); if both cyclesare used, both cycles must be tested. Thistesting demonstrates that all sensors,controls, indicators and charts arefunctioning properly.SP technicians can assemble theirown BIPCD for steam sterilization.Information for the assembly of thistest can be found in ANSI/AAMI ST79,Comprehensive guide to steam sterilizationand sterility assurance in health carefacilities. If a steam sterilizer is used forextended cycles, only the shortest cycleneeds to be tested. The shorter cycle canbe considered representative of the otherlonger cycles.Dynamic-air-removal sterilizersrequire daily testing with a Bowie-Dicktest. This test should be conducted everyday the sterilizer is used, before the firstprocessed load or at the same time eachday. It is a sensitive and rapid meansof detecting air leaks, inadequate airremoval, inadequate steam penetration,and noncondensable gases. Insufficientair removal in a dynamic-air-removalsterilizer, particularly a prevacuum cycle,can result in a failed sterilization cycle.An improperly heated sterilizer couldcause false Bowie-Dick test failures.This steam sterilization cycle utilizespreconditioning techniques to removeair from both the sterilizer chamberand the load before pressurizationwith steam to a sterilization exposuretemperature. Effective air removal iscritical for predictable steam penetrationand subsequent sterilization. A shortenedcycle (i.e., a cycle omitting the dryingphase) should be run first to heat thesterilizer. If the sterilizer is usedcontinuously, the test may be performedat any time; however, it should beperformed at the same time every day.For steam-flush pressure-pulse cycles,the manufacturer’s recommendations forBowie-Dick testing should be followed.Biological indicators (BIs) should berun in every cycle for ethylene oxidesterilization and at least daily (preferably,every load) for all other low-temperaturemodalities.What follows are cleaningrecommendations for low-temperaturesterilizers, sterilizer carts/trolleys, andendoscope drying/storage cabinets: Low-temperature sterilizers Some low-temperature sterilizers require routinefilter changes. As always, it is importantto review the IFU and include theseimportant maintenance functions on achecklist. Chambers should be cleanedin accordance with the IFU. Sterilizer carts and trolleys Theseshould be routinely cleaned, and theroutine cleaning schedule should bebased the recommendations from theinterdisciplinary team. If sterilizer cartsand trolleys are not routinely cleaned,dust and lint may accumulate. Endocope drying/storage cabinets Aroutine cleaning schedule forendoscope drying/storage cabinetsshould be developed by theinterdisciplinary team. A cleaning logshould be maintained for the cleaningof the endoscope storage cabinet.Cabinets with filtered air require filterchanges on a routine basis; be sureto consult the IFU for specifications.If the cabinet has tubing and adaptors,the IFU should be consulted forspecific maintenance.ConclusionIt is essential that the environmentin which medical devices areprocessed is routinely cleaned andproperly maintained to prevent dust,lint and microbial contamination.Environmental cleaning is a sharedresponsibility between the SPD, EVSand, perhaps, even other departmentssuch as Facilities Maintenance andBiomedical Engineering. Developingan interdisciplinary team to developand monitor environmental cleaningand equipment maintenance cleaningroutines is an effective way to keep thedepartment properly maintained.RESOURCESAssociation for the Advancement of MedicalInstrumentation. ANSI/AAMI ST79:2017,Comprehensive guide to steam sterilization andsterility assurance in health care facilities.Association for the Advancement of MedicalInstrumentation. ANSI/AAMI ST91:2015,Flexible and semi-rigid endoscope processing inhealth care facilities.Association of periOperative Registered Nurses.AORN 2020 Guideline for EnvironmentalCleaning.

CIS Self-Study Lesson Plan Quiz - Environmental Responsibility:Keeping Sterile Processing Departments Clean and FunctionalLesson No. CIS 279 (Instrument Continuing Education - ICE) Lesson expires May 20231. Why does the Sterile Processingdepartment require daily cleaning?a. Routine cleaning prevents aerosolsb. Routine cleaning helps preventdust and lint from being depositedonto instrumentationc. Routine cleaning reduces lint on theventilation systemd. Routine cleaning prevents debris fromentering sterile water2. Which room in Sterile Processing has ahigh risk of pathogen transmission?a. The preparation and packaging areab. The sterile storage areac. The decontamination aread. The area behind the sterilizer3. Where can a Sterile Processingtechnician access requirements forcleaning, disinfection and/or sterilization,inspection, and routine maintenance ofequipment?a. In the equipment manufacturers’instructions for useb. The US Environmental ProtectionAgencyc. The US Food and Drug Administrationd. The Joint Commission4. Why should environmental cleaningequipment and supplies used in thedecontamination area only be used inthat area?a. Doing so prevents the equipment andsupplies from becoming lostb. The equipment and supplies arecomprised of a different type of materialc. The decontamination area is exposedto more wetnessd. Doing so helps prevent thecontamination of other areas5. A qualitative method of evaluating theeffectiveness of cleaning is:a. Adenosine triphosphate monitoringb. Visual inspectionc. Culturesd. Biological monitoring6. A quantitative method of evaluating theeffectiveness of the cleaning is:a. Adenosine triphosphate monitoringb. Visual inspectionc. Biological monitoringd. Lighted magnification7. Which should be established to ensure allareas of Sterile Processing are cleaned?a. The use of a buddy systemb. Assigning a mentor to a new SterileProcessing technician to ensure theyknow how to clean the areasc. A checklist to specify the equipmentor surface to be cleaned and thecleaning frequencyd. A detailed listing of all high-touch areasin the department8. What is the minimum frequency thatsinks should be cleaned and disinfected?a. Weeklyb. Dailyc. After each cased. After every orthopedic case9. How often should instrument preparationand packaging workstations be cleanedand disinfected?a. Weekendsb. Weeklyc. Whenever dustyd. After each shift12. How often should borescopes becleaned and disinfected?a. Monthlyb. Weeklyc. Dailyd. After each use13. What should be checked on a heat sealer?a. Temperature and leakageb. Temperature calibrationc. Pressure validationd. None of the above14. The automatic flusher’s instructionsfor use should be checked for informationabout which of the following tasks:a. Filter changes, cleaning anddisinfecting tubing, and calibrationb. Adenosine triphosphate testing, filterchanges and disinfectionc. Adenosine triphosphate testing, tubingchanges and disinfectiond. Leak tests, adenosine triphosphatetesting and calibration15. How often do endoscope cabinets withfiltered air require filter changes?a. Semi-annuallyb. Monthlyc. Weeklyd. According to the instructions for use10. What is the recommended watertemperature for eye wash stations?a. Cold (between 34 and 50 F)b. Cool (between 40 and 60 F)c. Tepid (between 60 and 100 F)d. Warm (between 80 and 120 F)Request for paper/pencil scoring (please print or type information below)m I have enclosed the scoring fee of 15. (please make checks payable toPurdue University. We regret that no refunds can be given)m Check here if you have a change of addressm Check here if you wish to have your results emailed to youDetach quiz, fold, and return to:Purdue University - Online LearningYoung Hall, Room 527155 S. Grant StreetWest Lafayette, IN 47907800.830.026911. Which of the following should beperformed for pass-through windows?a. Inspection to ensuring that the windowcompletely closes and sealsb. Inspection to ensure that noticesposted on the window are currentc. Adenosine triphosphate testingd. WaterproofingNameMailing Address (be sure to include apartment numbers or post office boxes)CityState/Province Zip Code/Postal Code()Daytime telephoneIAHCSMM Membership NumberEmail AddressIf your name has changed in the last 12 months, please provide your former namePurdue University is an equal access/equal opportunity institution

CIS SELFSTUDY LESSON LAN Lesson No. CIS 279 (Instrument Continuing Education - ICE) BY SUSAN KLACIK, BS, CRCST, CIS, CHL, ACE, FCS, IAHCSMM CLINICAL EDUCATOR Environmental Responsibility: Keeping Sterile Processing Departments Clean and Functional Certified Instrument Specialist (CIS) lessons provide members with ongoing education in

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