10 Decontamination, Sterilization, and Disinfection
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 10.1: Reprocessing and Decontamination
- 1. Correctly use terms related to disinfection and sterilization
- 2. Explain the Spaulding system of classification
- 3. Describe the steps of reprocessing surgical instruments from the point of use to sterilization
- 4. Discuss the principles and processes of decontamination
Lesson 10.2: Sterilization Methods
- 5. Explain the rationale for specific methods of wrapping of instruments and loading of the steam sterilizer
- 6. Explain the principles of gas sterilization
Lesson 10.3: Disinfection and Its Hazards
- 7. Describe special processing required for instruments exposed to Creutzfeldt–Jakob disease
- 8. Distinguish between disinfection and sterilization
- 9. Recognize the hazards associated with the use of chemical disinfectants
- 10. Describe terminal cleaning of the operating room environment
Classroom Preparation
Lesson 10.1: Reprocessing and Decontamination
INSTRUCTOR PREPARATION
Textbook Objectives Covered
- 1. Correctly use terms related to disinfection and sterilization
- 2. Explain the Spaulding system of classification
- 3. Describe the steps of reprocessing surgical instruments from the point of use to sterilization
- 4. Discuss the principles and processes of decontamination
National Standards Covered
- • See the Fuller 8e/AST Core Curriculum Mapping Guide on Evolve instructor resources.
Classroom Preparation
Lesson 10.1: Reprocessing and Decontamination
STUDENT PREPARATION (1 hr)
| 1 | READ – Chapter Heading(s) • Introduction • Standards in Surgical Decontamination, Disinfection, and Sterilization • Principles of Decontamination, Sterilization, and Disinfection Important Terms ANSWER – Textbook • Review Question 1 ANSWER – Workbook • Chapter 10 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
| 2 | READ – Chapter Heading(s) • Principles of Decontamination, Sterilization, and Disinfection Spaulding Classification System ANSWER – Textbook • Review Question 7 ANSWER – Workbook • Chapter 10 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
| 3 | READ – Chapter Heading(s) • Principles of Decontamination, Sterilization, and Disinfection Sterile Processing Department ANSWER – Workbook • Chapter 10 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
| 4 | READ – Chapter Heading(s) • Principles of Decontamination, Sterilization, and Disinfection Quality Control Monitoring Reprocessing Single-Use Devices Reposable Instruments Loaner Instruments • The Reprocessing Cycle • Cleaning at the Point of Use Close of Surgery Transport of Soiled Instruments to Decontamination Area • Instrument Cleaning and Decontamination Decontamination Attire Sorting Instruments Hand-Cleaning the Instruments Ultrasonic Cleaning Washer/Sterilizer/Disinfector Special Handling of Ophthalmic Instruments • Sorting and Inspection • Assembling Instrument Sets • Packaging Systems Used in Sterilization Qualities and Types of Wrapping Systems Wrapping Methods Using Textile Sheets Equipment Tracking ANSWER – Textbook • Review Questions 2, 10 • Case Study ANSWER – Workbook • Chapter 10 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
50-Minute Lesson Plan
Lesson 10.1: Reprocessing and Decontamination
LECTURE OUTLINE (50 min)
| POWERPOINT SLIDES | CHAPTER HEADING(S) | |
| 1 | TERMINOLOGY: SLIDES 4-5 | • Introduction • Standards in Surgical Decontamination, Disinfection, and Sterilization • Principles of Decontamination, Sterilization, and Disinfection Important Terms |
| 2 | SPAULDING SYSTEM: SLIDE 6 | • Principles of Decontamination, Sterilization, and Disinfection Spaulding Classification System |
| 3 | REPROCESSING: SLIDE 7 | • Principles of Decontamination, Sterilization, and Disinfection Sterile Processing Department |
| 4 | DECONTAMINATION: SLIDES 8-21 | • Principles of Decontamination, Sterilization, and Disinfection Quality Control Monitoring Reprocessing Single-Use Devices Reposable Instruments Loaner Instruments • The Reprocessing Cycle • Cleaning at the Point of Use Close of Surgery Transport of Soiled Instruments to Decontamination Area • Instrument Cleaning and Decontamination Decontamination Attire Sorting Instruments Hand-Cleaning the Instruments Ultrasonic Cleaning Washer/Sterilizer/Disinfector Special Handling of Ophthalmic Instruments • Sorting and Inspection • Assembling Instrument Sets • Packaging Systems Used in Sterilization Qualities and Types of Wrapping Systems Wrapping Methods Using Textile Sheets Equipment Tracking |
Learning Activities (choose one or more to equal 50 min)
| 1 | DISCUSS (50 min) • Discuss the standards and recommendations of aseptic technique. • Provide students with the list of basic terms for Chapter 10. Have them work in groups to provide the definitions. Ask students to share their lists with the class. Appropriate Settings: Traditional/online/flipped classroom |
| 2 | DISCUSS (20 min) • Ask students to work in small groups to make lists of examples of specific regions of the body that fall into each of the risk categories. Ask students to share their lists with the class. • Appropriate Settings: Traditional/online/flipped classroom |
| 3 | DISCUSS (30 min) • Have students refer to Figure 10.1 in the textbook. With that figure as a reference, have the class discuss each of the equipment processing steps, identifying the steps and explaining the reason(s) for each one. The instructor should encourage thorough discussion of such points as the need for disassembling multipart instruments, the need for using cleaning brushes below the liquid level, and the safety reasons behind placing sharps with points down. Appropriate Settings: Traditional/online/flipped classroom |
| 4 | DISCUSS (30 min) • Create a table with three columns with the following categories: Clean, Disinfect, Sterilize. Have students list items that belong to each category (e.g., instrument trays—sterilize). Appropriate Settings: Traditional/online/flipped classroom |
Critical Thinking Question
You are organizing the operating room suite when you notice a reprocessed single-use item that, by your standards, is not in usable condition. You have overheard nurses and doctors discussing the inadequacy of funding and the unstable financial situation of the hospital. The financial tensions are high, and you realize pointing out the condition of the single-use item will incite further debate at a time when a critical patient requires care and attention. What should you do?
Discussion Guidelines: The quality of patient care should always be of highest concern. Students should identify the necessity of pointing out the condition of the equipment and having it immediately replaced with an instrument in good condition. Time spent on financial debate should not interfere with patient care in a professional environment.
Classroom Preparation
Lesson 10.2: Sterilization Methods
INSTRUCTOR PREPARATION
Textbook Objectives Covered
- 5. Explain the rationale for specific methods of wrapping of instruments and loading of the steam sterilizer
- 6. Explain the principles of gas sterilization
National Standards Covered
- • See the Fuller 8e/AST Core Curriculum Mapping Guide on Evolve instructor resources.
Classroom Preparation
Lesson 10.2: Sterilization Methods
STUDENT PREPARATION (1 hr)
| 5 | READ – Chapter Heading(s) • Sterilization • Monitoring the Sterilization Process Mechanical Monitoring Chemical Indicators Biological Indicators Air Detection • Steam Sterilization Parameters for Steam Sterilization Water Quality Correct Loading of a Large-Capacity Steam Sterilizer Phases of Steam Sterilization • Immediate-Use (Flash) Steam Sterilizer AAMI Recommended Practices for Immediate-Use Steam Sterilization Removing Items from the Immediate-Use Sterilizer ANSWER – Textbook • Review Questions 3, 5, 6, 8 ANSWER – Workbook • Chapter 10 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
| 6 | READ – Chapter Heading(s) • Ethylene Oxide Sterilization EO Sterilization Safety Precautions Preparation of Items for Gas Sterilization EO Loading and Sterilization • Vaporized Hydrogen Peroxide Sterilization • Liquid Peracetic Acid Sterilization • Ozone Sterilization • Cobalt-60 Radiation ANSWER – Workbook • Chapter 10 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
50-Minute Lesson Plan
Lesson 10.2: Sterilization Methods
LECTURE OUTLINE (50 min)
| POWERPOINT SLIDES | CHAPTER HEADING(S) | |
| 5 | STEAM STERILIZATION: SLIDES 23-28 | • Sterilization • Monitoring the Sterilization Process Mechanical Monitoring Chemical Indicators Biological Indicators Air Detection • Steam Sterilization Parameters for Steam Sterilization Water Quality Correct Loading of a Large-Capacity Steam Sterilizer Phases of Steam Sterilization • Immediate-Use (Flash) Steam Sterilizer AAMI Recommended Practices for Immediate-Use Steam Sterilization Removing Items from the Immediate-Use Sterilizer |
| 6 | GAS STERILIZATION: SLIDES 29-31 | • Ethylene Oxide Sterilization EO Sterilization Safety Precautions Preparation of Items for Gas Sterilization EO Loading and Sterilization • Vaporized Hydrogen Peroxide Sterilization • Liquid Peracetic Acid Sterilization • Ozone Sterilization • Cobalt-60 Radiation |
Learning Activities (choose one or more to equal 50 min)
| 5 | ROLE PLAY (50 min) • Divide students into pairs, demonstrate the proper wrapping of instruments and loading of the steam sterilizer. Appropriate Settings: Traditional classroom |
| 6 | INVITE (50 min) • Invite a gas plasma sterilizer representative to bring in a sterilizer for demonstration. If possible, allow students to view the sterilizer and discuss its components. • Appropriate Settings: Traditional classroom |
Critical Thinking Question
What three elements are required for sterilization to be effective?
Discussion Guidelines: Any type of sterilization relies on particular concentrations, times, and temperatures to be effective.
You are sterilizing surgical instruments using a gravity displacement sterilizer. There are only a few items to be sterilized, so you are sure there is no possible way for the sterilizer to be overloaded. You are in a hurry, so you quickly drop the instruments in the sterilizer and attend to other business. What steps should you take to make certain that the instruments are loaded correctly?
Discussion Guidelines: Students should acknowledge the utmost importance of instrument placement in a gravity displacement sterilizer. Even if the sterilizer is not overloaded, the instruments might be placed in a position that allows air to get trapped in pockets. Instruments in air pockets would not be effectively sterilized. Carefully loading a sterilizer is an extremely important part of the process, particularly in the case of a gravity displacement sterilizer.
Classroom Preparation
Lesson 10.3: Disinfection and Its Hazards
INSTRUCTOR PREPARATION
Textbook Objectives Covered
- 7. Describe special processing required for instruments exposed to Creutzfeldt–Jakob disease
- 8. Distinguish between disinfection and sterilization
- 9. Recognize the hazards associated with the use of chemical disinfectants
- 10. Describe terminal cleaning of the operating room environment
National Standards Covered
- • See the Fuller 8e/AST Core Curriculum Mapping Guide on Evolve instructor resources.
Classroom Preparation
Lesson 10.3: Disinfection and Its Hazards
STUDENT PREPARATION (1 hr)
| 7 | READ – Chapter Heading(s) • Instrument Cleaning and Decontamination Instruments Exposed to Prion Disease ANSWER – Workbook • Chapter 10 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
| 8 | READ – Chapter Heading(s) • Storage of Wrapped Sterile Goods Guidelines for Storage • Disinfection ANSWER – Workbook • Chapter 10 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
| 9 | READ – Chapter Heading(s) • Environmental Disinfectants • Use of Chemical Disinfectants Disinfectant Safety • Chemical Disinfectants for Medical Devices Glutaraldehyde Orthophthalaldehyde Phenolics Quaternary Ammonium Compounds Hypochlorite Alcohol ANSWER – Textbook • Review Question 4 ANSWER – Workbook • Chapter 10 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
| 10 | READ – Chapter Heading(s) • Environmental Cleaning Routine Decontamination of the Surgical Suite ANSWER – Textbook • Review Question 9 ANSWER – Workbook • Chapter 10 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
50-Minute Lesson Plan
Lesson 10.3: Disinfection and Its Hazards
LECTURE OUTLINE (50 min)
| POWERPOINT SLIDES | CHAPTER HEADING(S) | |
| 7 | CREUTZFELDT–JAKOB DISEASE: SLIDE 33 | • Instrument Cleaning and Decontamination Instruments Exposed to Prion Disease |
| 8 | DISINFECTION VS. STERILIZATION: SLIDES 34-35 | • Storage of Wrapped Sterile Goods Guidelines for Storage • Disinfection |
| 9 | CHEMICAL DISINFECTANTS: SLIDES 36-37 | • Environmental Disinfectants • Use of Chemical Disinfectants Disinfectant Safety • Chemical Disinfectants for Medical Devices Glutaraldehyde Orthophthalaldehyde Phenolics Quaternary Ammonium Compounds Hypochlorite Alcohol |
| 10 | TERMINAL CLEANING: SLIDES 38-39 | • Environmental Cleaning Routine Decontamination of the Surgical Suite |
Learning Activities (choose one or more to equal 50 min)
| 7 | DISCUSS (20 min) • Discuss the special processing required for instruments exposed to CJD. Appropriate Settings: Traditional/online/flipped classroom |
| 8 | DISCUSS (20 min) • Ask students to work in small groups to make lists of examples of both disinfection and sterilization techniques used in the operating room. Ask students to share their lists with the whole class. • Appropriate Settings: Traditional/online/flipped classroom |
| 9 | PRACTICE (50 min) • Using the personal protective equipment for handling chemical disinfectants, ask students to identify the parts of the attire, and discuss the protective benefits of each part. Demonstrate proper use. If time permits, have students try wearing and moving in the equipment. • Appropriate Settings: Traditional classroom |
| 10 | DISCUSS (30 min) • Ask students to work in small groups to list the various steps in terminal decontamination. Ask students to share their lists with the class. • Appropriate Settings: Traditional/online/flipped classroom |
Critical Thinking Question
You and another team member are preparing a patient for surgery. When arranging the equipment, a surgical instrument briefly comes in contact with a nonsterile surface. The other team member suggests that you simply use the alcohol provided as a topical antiseptic in the operating room to disinfect the instrument. Should you follow this advice?
Discussion Guidelines: Contaminated surgical instruments must be replaced with sterile instruments, not simply disinfected. In addition, students should recognize that alcohol should never be used on surgical tools because it is not sporicidal. Alcohol is also very corrosive and may damage the instruments.
Assessments
Chapter 10: Decontamination, Sterilization, and Disinfection
ASSESSMENTS BY OBJECTIVE
| 1-10 | Workbook • Chapter 10 Evolve Instructor Resources • Test Bank Create a quiz using ExamView; sort by objective. Evolve Student Resources • Mock Certification Exam • Review Questions |
| All | Elsevier Adaptive Quizzing • Chapter 10 – Graded quizzes (Mastery Levels 1, 2, and 3) |
