CNOR 2024 Zander Exam with Accurate
Solutions
Name the 3 Spaulding Classification Systems - Correct Answers-Critical
Semi-Critical
Non-Critical
Meaning of Critical Spaulding Classification System - Correct Answers-Items MUST be
sterile.
Items will enter -sterile tissue- or -vascular system-
Examples of items in Critical Spaulding Classification System - Correct Answers--
Instruments-
-Laparoscopes- -Arthroscopes-
-*Cutting endoscope accessories for biopsy*-
-Cardiac Caths-
-IV caths- - Needles-
-*Urinary Caths-
Meaning of Semi-Critical Spaulding Classification System - Correct Answers-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 - Correct Answers--
Bronchoscopes
-GI Scopes/GI endoscopes
-RT equipment (laryngoscope blades)
-Anesthesia equipment
Meaning of Non Critical Spaulding Classification System - Correct Answers--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 - Correct Answers--
Furniture
-Laundry/Linens
,-OR bed
-BP Cuff/Leads/Monitors/Stethoscopes
-Tourniquets
Requirement for decontamination area: - Correct Answers--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 - Correct Answers-Decontamination (always 1st) -->
Prep&Pack -->Sterilization
-->Distribute/Store
Most important step to prevent infection: - Correct Answers-Cleaning and Pre-treating
with a non-drying enzymatic solution in order to avoid biofilm, which encapsulates
spores.
Decontamination processes - Correct Answers--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 - Correct Answers--Pre-Vac Autoclave/Dynamic Air
Removal
-Gravity Displacement
PreVac settings - Correct Answers-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) - Correct Answers-270-276 for 4 min
PreVac/Dynamic Air Removal setting for Non Porous instruments - Correct Answers-
270-276 for 3 min
How does PreVac/Dynamic Air Removal autoclave work? - Correct Answers--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 - Correct Answers-270-276
,3 min: NonPorous/reg instruments
10 min: Porous/Lumens
Gravity Displacement autoclave settings for porous/lumens - Correct Answers-270-276
10 min
Gravity Displacement autoclave settings for NonPorous/reg inst - Correct Answers-270-
276 3 min
How does Gravity Displacement autoclave work? - Correct Answers-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: -
Correct Answers-I will follow the manufacturers instructions!
3 ways to avoid condensation with steam sterilization items: - Correct Answers-- 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? - Correct Answers-6
What kind of chemical integrators react to heat? - Correct Answers-Class 1 Chemical
Indicator
-Reacts to HEAT only. Verifies exposure only.
-Tape-Locks-Filter dots
What kind of chemical integrator is an External Indicator? - Correct Answers-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? - Correct
Answers--Class 2 Chemical Indicator
-Reacts to PRESSURE and ONLY indicates a VACUUM was created.
-Used only with PreVac/Dynamic Air Removal cycles
What class of chemical indicator measures
, -Single Parameter?
-Multi Parameter? - Correct Answers--Class 3 Single (Ex: quality of steam)
-Class 4 Multi (Ex: Time+Temp)
-Class 3&4 are usually made by the manufacturer.
Which class of chemical indicator is the most common all inclusive integrator? - Correct
Answers-Class 5 Chemical Integrator/Indicator is the
-most common
-covers ALL parameters (time/temp/pressure/steam quality)
-ALL INCLUSIVE
-internal
-placed on each layer and in corner (most challenging area)
-used for implants
Which chemical indicator is used for implants? - Correct Answers-Class 5 Integrator
Which class of chemical indicator is used for a particular tray/cycle? - Correct Answers-
Class 6 Emulating Integrator
-internal
-all inclusive for a SPECIFIC cycle
-made by mfr for a specific cycle OR tray
What does -integrator- mean? - Correct Answers-ALL inclusive. ALL parameters have
been met.
-Class 5 + Class 6
-No indicator or integrator promises sterility
Immediate Use settings:
What makes it different? - Correct Answers-270 10 min + BIO + Class 5 integrator
-Uses a rigid sterilization container with a lid.
-Must do same decontam process.
-Immediate Use has a shorter dry time.
-Items can be WET and it's OK
-NEVER use linens/wraps/packages in Immed Use
What has to be done for ALL steam sterilizers (PreVac/Dynamic, Gravity, IUS) - Correct
Answers--Daily QCs with BIOLOGICALS to check for spores.
-Keep a sterilization log.
What happens if a steam sterilizer QC Bio fails? - Correct Answers-- Resterilize the
instruments
- Do 3 Bios in a row. If 1 or more fails: shut it down, call bioengineering, and run 3 more
once it's fixed.
Solutions
Name the 3 Spaulding Classification Systems - Correct Answers-Critical
Semi-Critical
Non-Critical
Meaning of Critical Spaulding Classification System - Correct Answers-Items MUST be
sterile.
Items will enter -sterile tissue- or -vascular system-
Examples of items in Critical Spaulding Classification System - Correct Answers--
Instruments-
-Laparoscopes- -Arthroscopes-
-*Cutting endoscope accessories for biopsy*-
-Cardiac Caths-
-IV caths- - Needles-
-*Urinary Caths-
Meaning of Semi-Critical Spaulding Classification System - Correct Answers-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 - Correct Answers--
Bronchoscopes
-GI Scopes/GI endoscopes
-RT equipment (laryngoscope blades)
-Anesthesia equipment
Meaning of Non Critical Spaulding Classification System - Correct Answers--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 - Correct Answers--
Furniture
-Laundry/Linens
,-OR bed
-BP Cuff/Leads/Monitors/Stethoscopes
-Tourniquets
Requirement for decontamination area: - Correct Answers--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 - Correct Answers-Decontamination (always 1st) -->
Prep&Pack -->Sterilization
-->Distribute/Store
Most important step to prevent infection: - Correct Answers-Cleaning and Pre-treating
with a non-drying enzymatic solution in order to avoid biofilm, which encapsulates
spores.
Decontamination processes - Correct Answers--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 - Correct Answers--Pre-Vac Autoclave/Dynamic Air
Removal
-Gravity Displacement
PreVac settings - Correct Answers-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) - Correct Answers-270-276 for 4 min
PreVac/Dynamic Air Removal setting for Non Porous instruments - Correct Answers-
270-276 for 3 min
How does PreVac/Dynamic Air Removal autoclave work? - Correct Answers--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 - Correct Answers-270-276
,3 min: NonPorous/reg instruments
10 min: Porous/Lumens
Gravity Displacement autoclave settings for porous/lumens - Correct Answers-270-276
10 min
Gravity Displacement autoclave settings for NonPorous/reg inst - Correct Answers-270-
276 3 min
How does Gravity Displacement autoclave work? - Correct Answers-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: -
Correct Answers-I will follow the manufacturers instructions!
3 ways to avoid condensation with steam sterilization items: - Correct Answers-- 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? - Correct Answers-6
What kind of chemical integrators react to heat? - Correct Answers-Class 1 Chemical
Indicator
-Reacts to HEAT only. Verifies exposure only.
-Tape-Locks-Filter dots
What kind of chemical integrator is an External Indicator? - Correct Answers-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? - Correct
Answers--Class 2 Chemical Indicator
-Reacts to PRESSURE and ONLY indicates a VACUUM was created.
-Used only with PreVac/Dynamic Air Removal cycles
What class of chemical indicator measures
, -Single Parameter?
-Multi Parameter? - Correct Answers--Class 3 Single (Ex: quality of steam)
-Class 4 Multi (Ex: Time+Temp)
-Class 3&4 are usually made by the manufacturer.
Which class of chemical indicator is the most common all inclusive integrator? - Correct
Answers-Class 5 Chemical Integrator/Indicator is the
-most common
-covers ALL parameters (time/temp/pressure/steam quality)
-ALL INCLUSIVE
-internal
-placed on each layer and in corner (most challenging area)
-used for implants
Which chemical indicator is used for implants? - Correct Answers-Class 5 Integrator
Which class of chemical indicator is used for a particular tray/cycle? - Correct Answers-
Class 6 Emulating Integrator
-internal
-all inclusive for a SPECIFIC cycle
-made by mfr for a specific cycle OR tray
What does -integrator- mean? - Correct Answers-ALL inclusive. ALL parameters have
been met.
-Class 5 + Class 6
-No indicator or integrator promises sterility
Immediate Use settings:
What makes it different? - Correct Answers-270 10 min + BIO + Class 5 integrator
-Uses a rigid sterilization container with a lid.
-Must do same decontam process.
-Immediate Use has a shorter dry time.
-Items can be WET and it's OK
-NEVER use linens/wraps/packages in Immed Use
What has to be done for ALL steam sterilizers (PreVac/Dynamic, Gravity, IUS) - Correct
Answers--Daily QCs with BIOLOGICALS to check for spores.
-Keep a sterilization log.
What happens if a steam sterilizer QC Bio fails? - Correct Answers-- Resterilize the
instruments
- Do 3 Bios in a row. If 1 or more fails: shut it down, call bioengineering, and run 3 more
once it's fixed.
