CNOR 2025 Zander Notes
Name the 3 Spaulding Classification Systems ✅Critical
Semi-Critical
Non-Critical
Meaning of Critical Spaulding Classification System ✅Items MUST be sterile.
Items will enter -sterile tissue- or -vascular system-
Examples of items in Critical Spaulding Classification System ✅-Instruments-
-Laparoscopes- -Arthroscopes-
-*Cutting endoscope accessories for biopsy*-
-Cardiac Caths-
-IV caths- - Needles-
-*Urinary Caths-
Meaning of Semi-Critical Spaulding Classification System ✅Items SHOULD be sterile.
Items will contact -broken skin- or -MM-
If the manufacturers instructions say it WON'T tolerate sterilization, they CAN be HLD (but only IF MF
SAYS).
-Spores survive HLD-
Examples of items in Semi-Critical Spaulding Classification System ✅-Bronchoscopes
-GI Scopes/GI endoscopes
-RT equipment (laryngoscope blades)
-Anesthesia equipment
,Meaning of Non Critical Spaulding Classification System ✅-Will be in contact with INTACT SKIN
-Intermediate or Low Level Disinfection or Cleaning.
-Disinfect with an FDA approved disinfectant that's effective against HEP B.
Examples of items in Non Critical Spaulding Classification System ✅-Furniture
-Laundry/Linens
-OR bed
-BP Cuff/Leads/Monitors/Stethoscopes
-Tourniquets
Requirement for decontamination area: ✅-Must have a physical WALL or SEPARATION between
decontam and processing areas.
-This includes Immediate Use Areas.
-Why: Because decontam requires NEGATIVE PRESSURE
Sterile Processing Workflow ✅Decontamination (always 1st) --> Prep&Pack -->Sterilization
-->Distribute/Store
Most important step to prevent infection: ✅Cleaning and Pre-treating with a non-drying enzymatic
solution in order to avoid biofilm, which encapsulates spores.
Decontamination processes ✅-Disassemble everything
-Brush lumens/channels using a brush based on mfr instruction for correct diameter and length of
lumen
-Brush lumens/channels/crevices/joints UNDER WATER
-Automated (washers/ultrasonic) more effective than manual cleaning.
Two Types of Steam Sterilization ✅-Pre-Vac Autoclave/Dynamic Air Removal
-Gravity Displacement
,PreVac settings ✅270-276
3 min (NON porous instruments/regular instruments)
4 min (POROUS or LUMEN instruments, heavy plastic, rubber, wooden handles, poole suction)
PreVac/Dynamic Air Removal setting for porous (heavy plastic, rubber, wood handels) or lumen
instruments (poole suction/channels) ✅270-276 for 4 min
PreVac/Dynamic Air Removal setting for Non Porous instruments ✅270-276 for 3 min
How does PreVac/Dynamic Air Removal autoclave work? ✅-Sucks air out of chamber with a VACCUM
then steam is released and snaps down onto inst/trays.
-DRAINS MUST BE CLEAN
-Most common. Most effective.
Gravity Displacement Autoclave settings ✅270-276
3 min: NonPorous/reg instruments
10 min: Porous/Lumens
Gravity Displacement autoclave settings for porous/lumens ✅270-276 10 min
Gravity Displacement autoclave settings for NonPorous/reg inst ✅270-276 3 min
How does Gravity Displacement autoclave work? ✅Steam pushes air down to a thermometer in the
drain, the air exits the chamber, drain closes, cycle starts.
, -Not great for trays or packages.
-Rarely used.
Both PreVac/Dynamic Air Removal and Gravity time and temperature requirements are for the
instrument and autoclave only.
For certain containers/systems such as One Tray system or containers with lids: ✅I will follow the
manufacturers instructions!
3 ways to avoid condensation with steam sterilization items: ✅- Allow airflow between trays and pkgs
and all the way around.
-Remove loads immediately (don't crack the door to cool).
-Don't place items on cooling racks or solid surfaces (can place on lined surfaces).
How many classes of Chemical Integrators? ✅6
What kind of chemical integrators react to heat? ✅Class 1 Chemical Indicator
-Reacts to HEAT only. Verifies exposure only.
-Tape-Locks-Filter dots
What kind of chemical integrator is an External Indicator? ✅Class 1 Chemical Indicator
External Indicator that reacts to Heat only
-Tape-Locks-Filter dots
What class of Chemical Indicator is the Bowie Dick, and what does it react to? ✅-Class 2 Chemical
Indicator
-Reacts to PRESSURE and ONLY indicates a VACUUM was created.
-Used only with PreVac/Dynamic Air Removal cycles
Name the 3 Spaulding Classification Systems ✅Critical
Semi-Critical
Non-Critical
Meaning of Critical Spaulding Classification System ✅Items MUST be sterile.
Items will enter -sterile tissue- or -vascular system-
Examples of items in Critical Spaulding Classification System ✅-Instruments-
-Laparoscopes- -Arthroscopes-
-*Cutting endoscope accessories for biopsy*-
-Cardiac Caths-
-IV caths- - Needles-
-*Urinary Caths-
Meaning of Semi-Critical Spaulding Classification System ✅Items SHOULD be sterile.
Items will contact -broken skin- or -MM-
If the manufacturers instructions say it WON'T tolerate sterilization, they CAN be HLD (but only IF MF
SAYS).
-Spores survive HLD-
Examples of items in Semi-Critical Spaulding Classification System ✅-Bronchoscopes
-GI Scopes/GI endoscopes
-RT equipment (laryngoscope blades)
-Anesthesia equipment
,Meaning of Non Critical Spaulding Classification System ✅-Will be in contact with INTACT SKIN
-Intermediate or Low Level Disinfection or Cleaning.
-Disinfect with an FDA approved disinfectant that's effective against HEP B.
Examples of items in Non Critical Spaulding Classification System ✅-Furniture
-Laundry/Linens
-OR bed
-BP Cuff/Leads/Monitors/Stethoscopes
-Tourniquets
Requirement for decontamination area: ✅-Must have a physical WALL or SEPARATION between
decontam and processing areas.
-This includes Immediate Use Areas.
-Why: Because decontam requires NEGATIVE PRESSURE
Sterile Processing Workflow ✅Decontamination (always 1st) --> Prep&Pack -->Sterilization
-->Distribute/Store
Most important step to prevent infection: ✅Cleaning and Pre-treating with a non-drying enzymatic
solution in order to avoid biofilm, which encapsulates spores.
Decontamination processes ✅-Disassemble everything
-Brush lumens/channels using a brush based on mfr instruction for correct diameter and length of
lumen
-Brush lumens/channels/crevices/joints UNDER WATER
-Automated (washers/ultrasonic) more effective than manual cleaning.
Two Types of Steam Sterilization ✅-Pre-Vac Autoclave/Dynamic Air Removal
-Gravity Displacement
,PreVac settings ✅270-276
3 min (NON porous instruments/regular instruments)
4 min (POROUS or LUMEN instruments, heavy plastic, rubber, wooden handles, poole suction)
PreVac/Dynamic Air Removal setting for porous (heavy plastic, rubber, wood handels) or lumen
instruments (poole suction/channels) ✅270-276 for 4 min
PreVac/Dynamic Air Removal setting for Non Porous instruments ✅270-276 for 3 min
How does PreVac/Dynamic Air Removal autoclave work? ✅-Sucks air out of chamber with a VACCUM
then steam is released and snaps down onto inst/trays.
-DRAINS MUST BE CLEAN
-Most common. Most effective.
Gravity Displacement Autoclave settings ✅270-276
3 min: NonPorous/reg instruments
10 min: Porous/Lumens
Gravity Displacement autoclave settings for porous/lumens ✅270-276 10 min
Gravity Displacement autoclave settings for NonPorous/reg inst ✅270-276 3 min
How does Gravity Displacement autoclave work? ✅Steam pushes air down to a thermometer in the
drain, the air exits the chamber, drain closes, cycle starts.
, -Not great for trays or packages.
-Rarely used.
Both PreVac/Dynamic Air Removal and Gravity time and temperature requirements are for the
instrument and autoclave only.
For certain containers/systems such as One Tray system or containers with lids: ✅I will follow the
manufacturers instructions!
3 ways to avoid condensation with steam sterilization items: ✅- Allow airflow between trays and pkgs
and all the way around.
-Remove loads immediately (don't crack the door to cool).
-Don't place items on cooling racks or solid surfaces (can place on lined surfaces).
How many classes of Chemical Integrators? ✅6
What kind of chemical integrators react to heat? ✅Class 1 Chemical Indicator
-Reacts to HEAT only. Verifies exposure only.
-Tape-Locks-Filter dots
What kind of chemical integrator is an External Indicator? ✅Class 1 Chemical Indicator
External Indicator that reacts to Heat only
-Tape-Locks-Filter dots
What class of Chemical Indicator is the Bowie Dick, and what does it react to? ✅-Class 2 Chemical
Indicator
-Reacts to PRESSURE and ONLY indicates a VACUUM was created.
-Used only with PreVac/Dynamic Air Removal cycles
