Infection Control and Sterilization in the Anesthesia Setting Flashcards

During a long IV sedation case, the anesthesia assistant drew propofol from a single-dose vial into a syringe at 8:00 AM. At 2:30 PM the same patient needs an additional bolus. Under CDC/FDA guidance for propofol handling, what should the assistant do with the syringe?

Answer: Throw it away and draw a fresh dose from a newly opened vial, because the 6-hour limit has passed

Propofol is a lipid emulsion that supports fast bacterial growth, and it contains limited or no preservative. Propofol drawn into a syringe, or an opened vial, must be given or discarded within 6 hours. Propofol infusion tubing has a 12-hour limit. Staying with the same patient, refrigerating the syringe, or changing the needle does not extend this limit. Outbreaks of postoperative sepsis have been traced to propofol that was kept too long.

A reusable laryngoscope blade is kept on the emergency cart and used for airway management during an emergency in the dental office. Under the Spaulding classification, what is the MINIMUM reprocessing the blade needs before its next use?

Answer: High-level disinfection, because the blade contacts mucous membranes (sterilization is preferred)

Laryngoscope blades contact mucous membranes but do not normally enter sterile tissue, so they are semicritical devices. Semicritical items need at least high-level disinfection after thorough cleaning, and heat sterilization is preferred when the blade can tolerate it. Intermediate-level (tuberculocidal) and low-level disinfection are only for noncritical surfaces that touch intact skin. Wiping with alcohol is not acceptable for a blade.

A weekly spore test from the office steam autoclave comes back POSITIVE. The sterilizer is taken out of service, loading and operating procedures are reviewed, and the test is repeated with a correct load. The repeat spore test is ALSO positive. According to CDC dental infection-control guidelines, what is the required next step?

Answer: Keep the sterilizer out of service until it is inspected or repaired, and recall and reprocess, as far as possible, all items processed since the last negative spore test

A single positive spore test with correct procedures can be retested. If the retest is negative, the sterilizer can go back into service. A second positive result means the sterilizer has failed. It must stay out of service until it has been inspected, repaired, and given a negative retest. To the extent possible, every item processed since the last negative spore test must be recalled and reprocessed. Chemical indicators and mechanical readings cannot override a positive biological indicator.

A multidose vial of local anesthetic is opened and accessed inside the operatory where a sedated patient is being treated. The manufacturer's labeling gives no special in-use dating. How should this vial be handled from now on?

Answer: Dedicate it to that single patient, and discard it no later than 28 days after opening or at the manufacturer's expiration, whichever comes first

CDC Injection Safety guidance says that multidose vials should be kept in a central medication area, away from the immediate patient treatment area, if they will be used for more than one patient. A vial that is brought into or accessed in the immediate treatment area must be dedicated to that one patient, because it may have been contaminated in that environment. Once opened, it is dated and discarded within 28 days unless the manufacturer specifies a shorter or longer period. Wiping the septum with alcohol does not make it safe to use for other patients.

An unwrapped surgical instrument goes through an immediate-use ("flash") steam sterilization cycle because the only sterile one was dropped during a procedure. What is correct about how this instrument is handled afterward?

Answer: It must be moved aseptically and used right away; it cannot be stored for later use

Unwrapped items have no barrier against contamination once the chamber is opened. Immediate-use steam sterilization is only for items that will be used right away, and they must be carried to the point of use aseptically. They must never be stored. Putting a warm, wet item into a pouch afterward does not make it sterile and may wick in contaminants. Implantable devices should not be processed this way except in a documented emergency, and then with a biological indicator.

An office decides to validate a DRY HEAT sterilizer that is used for certain anesthesia-related metal instruments. Which biological indicator organism is appropriate for monitoring this sterilizer?

Answer: Bacillus atrophaeus spores

Bacillus atrophaeus (formerly B. subtilis var. niger) spores are the standard biological indicator for dry heat and ethylene oxide sterilization, because they are very resistant to those processes. Geobacillus stearothermophilus is used for steam autoclaves and unsaturated chemical vapor sterilizers. M. tuberculosis var. bovis is the benchmark for rating intermediate-level (tuberculocidal) disinfectants, not for monitoring sterilizers. C. difficile is not a sterilizer test organism.