CMDRT - Certified Medical Device Reprocessing Technician Infection Prevention and Control Questions and Answers 2 — Questions and Answers

Question 1: What is the chain of infection, and why is it important in medical device reprocessing?

A method for storing instruments in sequence
A model describing the six links required for infection transmission: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host (Correct answer)
A chain used to secure biohazard containers
A ranking system for infection severity

Correct answer: A model describing the six links required for infection transmission: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host

The chain of infection describes the six elements needed for disease transmission. Medical device reprocessing breaks this chain by eliminating the infectious agent on devices (reservoir) and preventing contaminated instruments from becoming a mode of transmission.

The chain of infection is a foundational epidemiological model consisting of six interconnected links: (1) Infectious agent — the pathogen (bacteria, virus, fungus, parasite); (2) Reservoir — where the pathogen lives and multiplies (e.g., a contaminated instrument); (3) Portal of exit — how the pathogen leaves the reservoir; (4) Mode of transmission — how it travels to a new host (contact, droplet, airborne, vehicle); (5) Portal of entry — how it enters the new host (mucous membranes, broken skin, surgical site); (6) Susceptible host — a person vulnerable to infection. Medical device reprocessing primarily targets the reservoir and mode of transmission links. By properly cleaning, disinfecting, or sterilizing reusable devices, reprocessing technicians eliminate pathogens from the instrument (removing the reservoir) and prevent contaminated devices from serving as vehicles of transmission. Understanding this model helps CMDRT professionals appreciate why every reprocessing step matters.

Question 2: What are routine practices (formerly universal precautions) in the context of infection prevention?

Special precautions used only during outbreaks
A set of infection prevention measures applied to ALL patients and situations regardless of known infection status (Correct answer)
Precautions taken only when handling sharps
Practices limited to operating room staff only

Correct answer: A set of infection prevention measures applied to ALL patients and situations regardless of known infection status

Routine practices are applied universally because any patient may carry undiagnosed infections. In reprocessing, this means treating all instruments as potentially contaminated and following full decontamination protocols regardless of the patient's known infection status.

Routine practices, as defined by the Public Health Agency of Canada (PHAC), are a comprehensive set of infection prevention and control measures applied to the care of all patients at all times, regardless of their diagnosis or presumed infection status. This approach recognizes that many infections are asymptomatic or undiagnosed, and that healthcare workers cannot reliably identify all infectious patients. For medical device reprocessing technicians, routine practices mean: all instruments are treated as contaminated; full PPE is worn in the decontamination area; hand hygiene is performed at appropriate moments; sharps are handled safely; and all reprocessing protocols are followed consistently. Routine practices replaced the older concept of 'universal precautions' and are supplemented by additional precautions (contact, droplet, airborne) when specific transmissible infections are identified.

Question 3: What role does hand hygiene play in infection prevention for reprocessing technicians?

It is only necessary before eating
It is the single most effective measure for preventing the transmission of healthcare-associated infections (Correct answer)
It replaces the need for gloves in the decontamination area
It is only required at the beginning of a shift

Correct answer: It is the single most effective measure for preventing the transmission of healthcare-associated infections

Hand hygiene — through handwashing with soap and water or using alcohol-based hand rub — is recognized worldwide as the most effective single measure to prevent healthcare-associated infection transmission, including in reprocessing departments.

Hand hygiene is universally recognized as the single most effective measure for preventing healthcare-associated infections (HAIs). The World Health Organization, PHAC, and Infection Prevention and Control Canada (IPAC) all emphasize its critical importance. For CMDRT professionals, hand hygiene must be performed: before and after donning/removing PPE, after handling contaminated items even while wearing gloves, before handling clean or sterile items, after touching potentially contaminated surfaces, and whenever gloves are changed. While gloves provide a barrier, they are not infallible — studies show that microorganisms can penetrate glove material through microperforations and can contaminate hands during glove removal. Alcohol-based hand rub (ABHR) with 60-90% alcohol is the preferred method for most situations, while soap and water is required when hands are visibly soiled or after exposure to spore-forming organisms like Clostridioides difficile.

Question 4: What are healthcare-associated infections (HAIs) and how does reprocessing help prevent them?

Infections that patients had before admission
Infections acquired during or as a result of healthcare delivery that were not present at the time of admission (Correct answer)
Infections that only affect healthcare workers
Infections caused by allergic reactions to medications

Correct answer: Infections acquired during or as a result of healthcare delivery that were not present at the time of admission

HAIs are infections that patients acquire during their healthcare experience. Improperly reprocessed medical devices are a recognized source of HAIs, making effective reprocessing a critical infection prevention strategy.

Healthcare-associated infections (HAIs) are infections that patients acquire during or as a result of receiving healthcare, which were not present or incubating at the time of admission. In Canada, HAIs affect approximately 1 in 9 hospitalized patients, resulting in significant morbidity, mortality, extended hospital stays, and increased costs. Contaminated medical devices are a recognized vehicle for HAI transmission — outbreaks have been traced to inadequately reprocessed endoscopes, surgical instruments, and other reusable devices. Organisms commonly implicated include Pseudomonas aeruginosa, Klebsiella pneumoniae (including carbapenem-resistant strains), methicillin-resistant Staphylococcus aureus (MRSA), and Clostridioides difficile. Medical device reprocessing technicians serve as a critical line of defence against HAIs by ensuring that every reusable device is properly cleaned, disinfected, or sterilized according to CSA Z314.8 standards.

Question 5: What are additional precautions, and when are they implemented in the reprocessing department?

They are the same as routine practices
Infection-specific measures (contact, droplet, airborne) added on top of routine practices when a patient is known or suspected to have a transmissible infection (Correct answer)
Extra cleaning steps performed only on Mondays
Precautions used only during construction in the hospital

Correct answer: Infection-specific measures (contact, droplet, airborne) added on top of routine practices when a patient is known or suspected to have a transmissible infection

Additional precautions supplement routine practices when a specific transmissible infection is identified. In reprocessing, this may mean enhanced PPE, dedicated reprocessing equipment, or specific handling protocols for instruments used on patients under additional precautions.

Additional precautions are infection prevention measures implemented in addition to routine practices when a patient is known or suspected to have a specific transmissible infection. PHAC defines three categories: Contact precautions (for organisms spread by direct or indirect contact, e.g., MRSA, VRE, C. difficile), Droplet precautions (for organisms in large respiratory droplets, e.g., influenza, pertussis), and Airborne precautions (for organisms in small airborne particles, e.g., tuberculosis, measles, varicella). For reprocessing departments, instruments from patients under additional precautions should be clearly labelled and may require specific handling. For example, instruments from C. difficile patients should be cleaned with chlorine-based solutions when possible, as spores are resistant to many standard cleaning agents. However, standard validated reprocessing protocols (proper cleaning followed by appropriate disinfection/sterilization) are generally effective regardless of the infecting organism.

Question 6: What is the significance of prion diseases (such as CJD) for medical device reprocessing?

Prions are easily destroyed by routine sterilization
Prions are abnormal proteins that are extremely resistant to standard disinfection and sterilization methods, requiring special reprocessing protocols (Correct answer)
Prion diseases are not transmissible through medical devices
Standard HLD is sufficient for prion decontamination

Correct answer: Prions are abnormal proteins that are extremely resistant to standard disinfection and sterilization methods, requiring special reprocessing protocols

Prions are misfolded proteins that cause fatal neurological diseases and are extraordinarily resistant to conventional disinfection and sterilization methods. Instruments potentially contaminated with prions require special reprocessing protocols or may need to be destroyed.

Prion diseases, including Creutzfeldt-Jakob disease (CJD) and variant CJD (vCJD), present unique challenges for medical device reprocessing because prions are not living organisms but rather misfolded proteins (PrPSc) that are extraordinarily resistant to conventional decontamination methods. Standard steam sterilization (121°C for 15 minutes), chemical disinfection (including glutaraldehyde and OPA), ethylene oxide, and radiation are all inadequate for prion inactivation. Health Canada and CSA Z314.3 provide specific guidance: for high-risk tissues (brain, spinal cord, eye) in known or suspected CJD cases, instruments should ideally be destroyed by incineration. If instruments must be reprocessed, extended steam sterilization at 134°C for 18 minutes in a prevacuum sterilizer combined with sodium hydroxide (1N NaOH) or sodium hypochlorite (20,000 ppm) treatment may be used. Facilities must have a prion reprocessing policy as part of their infection prevention program.

CMDRT - Certified Medical Device Reprocessing Technician Infection Prevention and Control Questions and Answers 2

What is the chain of infection, and why is it important in medical device reprocessing?