CNOR 2024 (2) Zander Exam Questions
and Answers
Where does a biological go in the sterilizer? - ANSWER-On the bottom rack, centered
and toward the front of the door (coolest spot).
What is the process of preparing the sterilizers for the day? - ANSWER-1st run of the
day: Warm up run with empty sterilizer
2nd run of the day: Bowie Dick
3rd run of the day: instruments load.
Necessary steps for autoclaves: - ANSWER--Run a daily biological (Gravity & PreVac)
-Run a daily Bowie Dick (shows vacuum cycle worked)
- After repair (change/moving), do 3 BDs in a row
-Biological with EVERY implant
Bio how often with EO? - ANSWER-Each load (loads take too long to aerate)
Packaging weight limit: - ANSWER-25 lbs --> BUT MFR INSTRUCTIONS ALWAYS
WIN!
Packaging basics: - ANSWER--Approved for use in specific sterilizer
-No textiles
-No sealed peel pouches inside trays
-No rubber mats unless comes like that from manufacturer
-Integrator in corner and top level
-Indicator on inside and outside (Class 1)
-Count sheets on outside or sealed envelope inside (scrub cant touch
How to store packages
Temp
Humidity - ANSWER-Temp: 78 degrees
Humidity: 60%
- 8-10 inches from floor, 18" from ceiling, bottom of shelf must be solid
Peel Pouch basics - ANSWER--Don't stack them, lay on their sides.
-Only write/label the plastic side. Sterilizing goes through paper side.
-No heavy items
,-Double pouch: Can't fold inner pouch, must fit sealed inside 2nd pouch. Follow
manufacturers instructions only.
Where does endoscope cleaning begin?
What if there's a delay? - ANSWER--Begins with manual cleaning at the field.
- clear the lumen with water
- wipe the exterior
-If Delay: Keep endoscope damp/wet but NOT submerged (incase of leaks or spills).
DO NOT allow to dry.
- Cover with damp sterile towel, and suction water into channels
What circumstances require extra cleaning of endoscopes? - ANSWER--Additional
cleaning needs to be done if ___ is used:
-Simethicone. (Gooey. Add low concentration to working channel NOT the water bottle)
-Radiographic medium
-Lube
-Tissue adhesives (Benzoin)
-Poop (poor preps or if was done emergently)
What's the endoscope Handover Process? - ANSWER-A scrub must tell the scope tech
a report of
- what was done
- if it is extra dirty/requires additional cleaning
- when the procedure was finished
How soon after using must endoscopes be cleaned?
What is the decontamination process? - ANSWER-Must be cleaned within 1 HOUR of
use
-If there's a delay, must follow delayed processing instructions ACCORDING TO
MANUFACTURER.
Decontamination:
- Leak test dirty scope (in case of holes)
- Visually inspect after manual cleaning
- Use 10x magnification
- Use Boroscope to look inside
What kind of testing is to be done on endoscopes to verify sterilization? - ANSWER-
ATP testing (swab for protein, hgb)
- ATP testing should be done daily on rigid scopes.
- ATP testing MUST be done EVERY USE on FLEX SCOPES
(duodenoscope, US endoscopes, bronchoscopes, ureteroscopes, cystoscopes)
How are endoscopes dried? - ANSWER-*Actively dried after processing with
, - Counter Top Dryer HOOKED UP or
- Drying Cabinet HOOKED UP
*Minimum 10 Minutes or until no visible moisture.
*Boroscope inspection or moisture detect test
What cycle doesn't count as a dry cycle for endoscopes UNLESS an extended time
feature is used? - ANSWER-Automated air purge cycle in the AER (Automated
Endoscope Reprocessor)
How must endoscopes be stored (2 options)? - ANSWER-- Dry Cabinet
- +Positive Pressure Cabinet with HEPA Filter
(in a clean work room separate from dirty area, or area NOT in procedure room)
Risk assessment determines storage times based on risks at the facility, and culture
results. Then write policy.
Maintain endoscope processing records for length of time by hospital policy.
Nail rules:
How long?
Scrub rules:
Circ rules: - ANSWER-Long: 2 mm
Scrubs: NO art nails/extenders, NO polish, NO jewelry hands/wrists .
Circs: Polish must be intact. No rings.
Hand sanitizer - ANSWER-Use PRIMARILY to avoid overdrying of hands with soap &
water.
Use alcohol based hand sani.
Rub hands until dry.
Washing hands:
Water Temp
Time - ANSWER-Temp: 70-80 degrees
Time: 15 seconds
When can't you use hand sanitizer? - ANSWER-Visibly soiled, blood/fluid exposure
Norovirus, C-Diff (need suds)
What kind of hand lotion? - ANSWER-Hospital approved lotion to avoid affecting the
glove barrier.
- Lotions cannot have petroleum
What's required of handwashing? - ANSWER-Handwash and Hand Scrub audits should
be done to evaluate and respond with opportunities for improvement.
, What properties should hand scrub products have? - ANSWER--Fast Acting
-Broad Spectrum
-Persistent
-Alcohol based
-Scrub for amount of time AS RECOMMENDED BY MFR
- Brush method: 3-5 minutes
- Brushless method: Can't do if: Visibly soiled or C-Diff
Where should you use the scrub brush side? - ANSWER-Subungual area (nailbeds).
-using the brush on skin will cause abrasions and increase bacteria levels.
What to use if hands are irritated: - ANSWER-Cotton glove liners
- disposable or laundered (new in 2023)
Scrub attire rules - ANSWER-- Best practice: hospital laundered
- Spun bound polypropylene (NOT cotton)
- Remove before leaving and earlier if soiled.
- Dress in locker room only (not offices, etc)
- Shirt tucked in unless snug at hips
- No bare legs/pantyhose. Must wear pants under skirts
- Clothing under attire (leggings/etc) per hospital policy
- Don't save scrubs in lockers, especially if worn.
- ID badge clipped (No lanyards). Clean with alcohol.
-Stethoscopes cleaned before and after each use, not worn around neck.
Scrub cover coats must be: - ANSWER-- Buttoned when skin prepping
- Worn when leaving surgical area (cafeteria)
- Can't wear scrubs outside or to walk to different buildings. Must change.
Head covering rules: - ANSWER-Per hospital policy
- Must completely cover hair and scalp
- Do not remove cap until jacket is on
- Head attire removed at end of shift or if contaminated.
- Beard covers in prep & pack SPD
- Paper hat over cloth hats are per policy: not EBP
Surgical masks: - ANSWER-On or Off.
- Don't wear as a necklace
- Change for each case
Eye Protection: - ANSWER-Goggles are okay.
Glasses are NOT okay because sides must be covered
Shoes in surgery: - ANSWER-- Wear shoe covers for unavoidable contamination
- Have dedicated shoes for periop area
- Open toes and Open heels NOT acceptable
and Answers
Where does a biological go in the sterilizer? - ANSWER-On the bottom rack, centered
and toward the front of the door (coolest spot).
What is the process of preparing the sterilizers for the day? - ANSWER-1st run of the
day: Warm up run with empty sterilizer
2nd run of the day: Bowie Dick
3rd run of the day: instruments load.
Necessary steps for autoclaves: - ANSWER--Run a daily biological (Gravity & PreVac)
-Run a daily Bowie Dick (shows vacuum cycle worked)
- After repair (change/moving), do 3 BDs in a row
-Biological with EVERY implant
Bio how often with EO? - ANSWER-Each load (loads take too long to aerate)
Packaging weight limit: - ANSWER-25 lbs --> BUT MFR INSTRUCTIONS ALWAYS
WIN!
Packaging basics: - ANSWER--Approved for use in specific sterilizer
-No textiles
-No sealed peel pouches inside trays
-No rubber mats unless comes like that from manufacturer
-Integrator in corner and top level
-Indicator on inside and outside (Class 1)
-Count sheets on outside or sealed envelope inside (scrub cant touch
How to store packages
Temp
Humidity - ANSWER-Temp: 78 degrees
Humidity: 60%
- 8-10 inches from floor, 18" from ceiling, bottom of shelf must be solid
Peel Pouch basics - ANSWER--Don't stack them, lay on their sides.
-Only write/label the plastic side. Sterilizing goes through paper side.
-No heavy items
,-Double pouch: Can't fold inner pouch, must fit sealed inside 2nd pouch. Follow
manufacturers instructions only.
Where does endoscope cleaning begin?
What if there's a delay? - ANSWER--Begins with manual cleaning at the field.
- clear the lumen with water
- wipe the exterior
-If Delay: Keep endoscope damp/wet but NOT submerged (incase of leaks or spills).
DO NOT allow to dry.
- Cover with damp sterile towel, and suction water into channels
What circumstances require extra cleaning of endoscopes? - ANSWER--Additional
cleaning needs to be done if ___ is used:
-Simethicone. (Gooey. Add low concentration to working channel NOT the water bottle)
-Radiographic medium
-Lube
-Tissue adhesives (Benzoin)
-Poop (poor preps or if was done emergently)
What's the endoscope Handover Process? - ANSWER-A scrub must tell the scope tech
a report of
- what was done
- if it is extra dirty/requires additional cleaning
- when the procedure was finished
How soon after using must endoscopes be cleaned?
What is the decontamination process? - ANSWER-Must be cleaned within 1 HOUR of
use
-If there's a delay, must follow delayed processing instructions ACCORDING TO
MANUFACTURER.
Decontamination:
- Leak test dirty scope (in case of holes)
- Visually inspect after manual cleaning
- Use 10x magnification
- Use Boroscope to look inside
What kind of testing is to be done on endoscopes to verify sterilization? - ANSWER-
ATP testing (swab for protein, hgb)
- ATP testing should be done daily on rigid scopes.
- ATP testing MUST be done EVERY USE on FLEX SCOPES
(duodenoscope, US endoscopes, bronchoscopes, ureteroscopes, cystoscopes)
How are endoscopes dried? - ANSWER-*Actively dried after processing with
, - Counter Top Dryer HOOKED UP or
- Drying Cabinet HOOKED UP
*Minimum 10 Minutes or until no visible moisture.
*Boroscope inspection or moisture detect test
What cycle doesn't count as a dry cycle for endoscopes UNLESS an extended time
feature is used? - ANSWER-Automated air purge cycle in the AER (Automated
Endoscope Reprocessor)
How must endoscopes be stored (2 options)? - ANSWER-- Dry Cabinet
- +Positive Pressure Cabinet with HEPA Filter
(in a clean work room separate from dirty area, or area NOT in procedure room)
Risk assessment determines storage times based on risks at the facility, and culture
results. Then write policy.
Maintain endoscope processing records for length of time by hospital policy.
Nail rules:
How long?
Scrub rules:
Circ rules: - ANSWER-Long: 2 mm
Scrubs: NO art nails/extenders, NO polish, NO jewelry hands/wrists .
Circs: Polish must be intact. No rings.
Hand sanitizer - ANSWER-Use PRIMARILY to avoid overdrying of hands with soap &
water.
Use alcohol based hand sani.
Rub hands until dry.
Washing hands:
Water Temp
Time - ANSWER-Temp: 70-80 degrees
Time: 15 seconds
When can't you use hand sanitizer? - ANSWER-Visibly soiled, blood/fluid exposure
Norovirus, C-Diff (need suds)
What kind of hand lotion? - ANSWER-Hospital approved lotion to avoid affecting the
glove barrier.
- Lotions cannot have petroleum
What's required of handwashing? - ANSWER-Handwash and Hand Scrub audits should
be done to evaluate and respond with opportunities for improvement.
, What properties should hand scrub products have? - ANSWER--Fast Acting
-Broad Spectrum
-Persistent
-Alcohol based
-Scrub for amount of time AS RECOMMENDED BY MFR
- Brush method: 3-5 minutes
- Brushless method: Can't do if: Visibly soiled or C-Diff
Where should you use the scrub brush side? - ANSWER-Subungual area (nailbeds).
-using the brush on skin will cause abrasions and increase bacteria levels.
What to use if hands are irritated: - ANSWER-Cotton glove liners
- disposable or laundered (new in 2023)
Scrub attire rules - ANSWER-- Best practice: hospital laundered
- Spun bound polypropylene (NOT cotton)
- Remove before leaving and earlier if soiled.
- Dress in locker room only (not offices, etc)
- Shirt tucked in unless snug at hips
- No bare legs/pantyhose. Must wear pants under skirts
- Clothing under attire (leggings/etc) per hospital policy
- Don't save scrubs in lockers, especially if worn.
- ID badge clipped (No lanyards). Clean with alcohol.
-Stethoscopes cleaned before and after each use, not worn around neck.
Scrub cover coats must be: - ANSWER-- Buttoned when skin prepping
- Worn when leaving surgical area (cafeteria)
- Can't wear scrubs outside or to walk to different buildings. Must change.
Head covering rules: - ANSWER-Per hospital policy
- Must completely cover hair and scalp
- Do not remove cap until jacket is on
- Head attire removed at end of shift or if contaminated.
- Beard covers in prep & pack SPD
- Paper hat over cloth hats are per policy: not EBP
Surgical masks: - ANSWER-On or Off.
- Don't wear as a necklace
- Change for each case
Eye Protection: - ANSWER-Goggles are okay.
Glasses are NOT okay because sides must be covered
Shoes in surgery: - ANSWER-- Wear shoe covers for unavoidable contamination
- Have dedicated shoes for periop area
- Open toes and Open heels NOT acceptable
