Infection Control and Sterilization in the Anesthesia Setting Flashcards

At 7:15 AM a dental anesthesia assistant draws propofol from a single-dose vial into a labeled syringe for the first IV sedation case. That patient cancels. At 2:00 PM another patient is ready for sedation, and the syringe has stayed capped and refrigerated. What is the correct action?

Answer: Throw the syringe away, because propofol drawn into a syringe must be given within 6 hours of preparation

Propofol is a lipid emulsion that supports rapid microbial growth, and it has caused outbreaks of postoperative infection. The manufacturer's labeling requires syringes of propofol to be given within 6 hours of preparation. The 12-hour limit applies to infusion tubing and the reservoir in a running infusion, not to a prepared syringe. Refrigeration, capping and changing the needle do not extend the 6-hour limit or make the contents sterile again. Almost 7 hours have passed, so the syringe must be discarded.

A multi-dose vial of local anesthetic was opened and accessed on the treatment counter inside the operatory during a sedation case. According to CDC safe injection practices, how should the vial be handled after the case?

Answer: Treat it as dedicated to that one patient and do not use it for any other patient

CDC guidance says multi-dose vials should be kept in a centralized medication area, away from the immediate patient treatment area. If a multi-dose vial enters the immediate treatment area, it should be dedicated to that single patient and not used for anyone else, because contamination from splatter and aerosols cannot be ruled out. The 28-day beyond-use date only applies to vials that were properly accessed outside the treatment area. A new needle and syringe each time is required anyway, and it does not make up for a vial that was exposed in the treatment area.

The weekly biological indicator (spore test) for the office steam sterilizer comes back positive. The mechanical readouts and chemical indicators for that cycle were normal, and no implantable items were processed. What should be done first, according to CDC dental guidelines?

Answer: Remove the sterilizer from service, review loading, packaging and operating procedures, and retest it with a biological indicator right away

After a single positive spore test, CDC recommends taking the sterilizer out of service, reviewing procedures for operator error (overloading, wrong packaging, wrong cycle), and retesting with biological, mechanical and chemical indicators. If the repeat test is negative and procedures were correct, the sterilizer can go back into service. A full recall of items back to the last negative test is required if the repeat spore test is also positive. Normal mechanical or chemical results never override a positive biological indicator, and integrating indicators cannot replace biological monitoring.

Under the Spaulding classification, what is the minimum reprocessing required for a reusable laryngoscope blade used during airway management of a sedated dental patient?

Answer: Cleaning followed by at least high-level disinfection, with sterilization preferred

A laryngoscope blade touches mucous membranes but does not normally penetrate tissue, so it is a semicritical item. Semicritical items need, at minimum, cleaning followed by high-level disinfection, and heat sterilization is preferred when the device can tolerate it. Intermediate-level (tuberculocidal) disinfectants are for noncritical surfaces and do not meet the standard. The laryngoscope handle usually counts as noncritical, which is why people confuse the two parts.

After giving an IV medication to one patient, a provider removes the needle, attaches a new sterile needle to the same syringe, and plans to draw from a fresh vial for the next patient. Why is this practice unsafe?

Answer: The syringe itself can be contaminated by backflow from the IV line or patient, so both needle and syringe are contaminated after one use

CDC safe injection practices say a needle or syringe must never be used for more than one patient, even if the needle is changed. Pressure differences and backflow can push blood or IV fluid from the patient or catheter into the syringe barrel, so the syringe is contaminated once it has been used on a patient. Reusing syringes this way has caused hepatitis B and C outbreaks. A disinfected port, a patient with no known infection, or a new needle does not make the practice safe.

An office places a Class 5 integrating chemical indicator inside every instrument pouch in the steam sterilizer, and every one passes. Which statement about this practice is accurate?

Answer: Class 5 integrators react to multiple critical parameters, but they supplement weekly biological monitoring and do not replace it

Class 5 integrating indicators react to all critical parameters of steam sterilization (time, temperature and saturated steam). Placed inside each package, they are a useful check of conditions in that package. However, chemical indicators do not prove that microbes were killed. CDC still requires biological monitoring at least weekly, and with every load that contains an implantable device. Wet or damaged pouches must be reprocessed no matter what the indicator shows. External process indicators such as tape only show that the package was exposed to the process, which is a lower level of assurance than a Class 5 integrator.