CNOR
CNOR 2024 Zander Notes Study Guide
Graded A+ UPDATED 2025
Name the 3 Spaulding Classification Systems -Correct Answer ✔Critical
Semi-Critical
Non-Critical
Meaning of Critical Spaulding Classification System -Correct Answer ✔Items MUST be
sterile.
Items will enter -sterile tissue- or -vascular system-
Examples of items in Critical Spaulding Classification System -Correct Answer ✔-
Instruments-
-Laparoscopes- -Arthroscopes-
-*Cutting endoscope accessories for biopsy*-
-Cardiac Caths-
-IV caths- - Needles-
-*Urinary Caths-
Meaning of Semi-Critical Spaulding Classification System -Correct Answer ✔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 Answer ✔-
Bronchoscopes
-GI Scopes/GI endoscopes
-RT equipment (laryngoscope blades)
-Anesthesia equipment
Meaning of Non Critical Spaulding Classification System -Correct Answer ✔-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 Answer ✔-
Furniture
-Laundry/Linens
-OR bed
-BP Cuff/Leads/Monitors/Stethoscopes
CNOR
,CNOR
-Tourniquets
Requirement for decontamination area: -Correct Answer ✔-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 Answer ✔Decontamination (always 1st) -->
Prep&Pack -->Sterilization
-->Distribute/Store
Most important step to prevent infection: -Correct Answer ✔Cleaning and Pre-treating
with a non-drying enzymatic solution in order to avoid biofilm, which encapsulates
spores.
Decontamination processes -Correct Answer ✔-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 Answer ✔-Pre-Vac Autoclave/Dynamic Air
Removal
-Gravity Displacement
PreVac settings -Correct Answer ✔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 Answer ✔270-276 for 4 min
PreVac/Dynamic Air Removal setting for Non Porous instruments -Correct Answer
✔270-276 for 3 min
How does PreVac/Dynamic Air Removal autoclave work? -Correct Answer ✔-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 Answer ✔270-276
CNOR
,CNOR
3 min: NonPorous/reg instruments
10 min: Porous/Lumens
Gravity Displacement autoclave settings for porous/lumens -Correct Answer ✔270-276
10 min
Gravity Displacement autoclave settings for NonPorous/reg inst -Correct Answer ✔270-
276 3 min
How does Gravity Displacement autoclave work? -Correct Answer ✔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 Answer ✔I will follow the manufacturers instructions!
3 ways to avoid condensation with steam sterilization items: -Correct Answer ✔- 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 Answer ✔6
What kind of chemical integrators react to heat? -Correct Answer ✔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 Answer ✔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
Answer ✔-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
CNOR
, CNOR
-Single Parameter?
-Multi Parameter? -Correct Answer ✔-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
Answer ✔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 Answer ✔Class 5 Integrator
Which class of chemical indicator is used for a particular tray/cycle? -Correct Answer
✔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 Answer ✔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 Answer ✔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
Answer ✔-Daily QCs with BIOLOGICALS to check for spores.
-Keep a sterilization log.
What happens if a steam sterilizer QC Bio fails? -Correct Answer ✔- Resterilize the
instruments
CNOR
CNOR 2024 Zander Notes Study Guide
Graded A+ UPDATED 2025
Name the 3 Spaulding Classification Systems -Correct Answer ✔Critical
Semi-Critical
Non-Critical
Meaning of Critical Spaulding Classification System -Correct Answer ✔Items MUST be
sterile.
Items will enter -sterile tissue- or -vascular system-
Examples of items in Critical Spaulding Classification System -Correct Answer ✔-
Instruments-
-Laparoscopes- -Arthroscopes-
-*Cutting endoscope accessories for biopsy*-
-Cardiac Caths-
-IV caths- - Needles-
-*Urinary Caths-
Meaning of Semi-Critical Spaulding Classification System -Correct Answer ✔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 Answer ✔-
Bronchoscopes
-GI Scopes/GI endoscopes
-RT equipment (laryngoscope blades)
-Anesthesia equipment
Meaning of Non Critical Spaulding Classification System -Correct Answer ✔-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 Answer ✔-
Furniture
-Laundry/Linens
-OR bed
-BP Cuff/Leads/Monitors/Stethoscopes
CNOR
,CNOR
-Tourniquets
Requirement for decontamination area: -Correct Answer ✔-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 Answer ✔Decontamination (always 1st) -->
Prep&Pack -->Sterilization
-->Distribute/Store
Most important step to prevent infection: -Correct Answer ✔Cleaning and Pre-treating
with a non-drying enzymatic solution in order to avoid biofilm, which encapsulates
spores.
Decontamination processes -Correct Answer ✔-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 Answer ✔-Pre-Vac Autoclave/Dynamic Air
Removal
-Gravity Displacement
PreVac settings -Correct Answer ✔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 Answer ✔270-276 for 4 min
PreVac/Dynamic Air Removal setting for Non Porous instruments -Correct Answer
✔270-276 for 3 min
How does PreVac/Dynamic Air Removal autoclave work? -Correct Answer ✔-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 Answer ✔270-276
CNOR
,CNOR
3 min: NonPorous/reg instruments
10 min: Porous/Lumens
Gravity Displacement autoclave settings for porous/lumens -Correct Answer ✔270-276
10 min
Gravity Displacement autoclave settings for NonPorous/reg inst -Correct Answer ✔270-
276 3 min
How does Gravity Displacement autoclave work? -Correct Answer ✔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 Answer ✔I will follow the manufacturers instructions!
3 ways to avoid condensation with steam sterilization items: -Correct Answer ✔- 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 Answer ✔6
What kind of chemical integrators react to heat? -Correct Answer ✔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 Answer ✔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
Answer ✔-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
CNOR
, CNOR
-Single Parameter?
-Multi Parameter? -Correct Answer ✔-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
Answer ✔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 Answer ✔Class 5 Integrator
Which class of chemical indicator is used for a particular tray/cycle? -Correct Answer
✔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 Answer ✔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 Answer ✔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
Answer ✔-Daily QCs with BIOLOGICALS to check for spores.
-Keep a sterilization log.
What happens if a steam sterilizer QC Bio fails? -Correct Answer ✔- Resterilize the
instruments
CNOR
