CRCST cheat sheet

Decontamination is the first step of reprocessing: it removes bioburden and soil so later cleaning, inspection, and sterilization can work; it does not sterilize instruments.

Standard PPE for the decontamination area includes fluid-resistant gown, gloves, mask, eye protection, and shoe covers; sharps handling requires puncture-resistant utility gloves.

Traffic flow is one-way: dirty-to-clean. Soiled items enter at the decontamination side; clean items exit on the clean side; doors between areas stay closed.

Manual cleaning steps in order: presoak or pretreat, then wash with detergent at correct dilution and temperature, then rinse, then dry.

Enzymatic detergent breaks down protein, fat, and carbohydrate soil; it is single-use in most facilities and loses activity if reused or left standing.

Water quality matters: final rinse water should be treated (deionized or reverse osmosis) to prevent mineral and pyrogen deposits that interfere with sterilization.

Lumened instruments need brushing with a lumen brush sized to the channel, flushing with detergent, rinsing, and drying with forced air before assembly.

Powered equipment must be disassembled per manufacturer instructions before cleaning; batteries are removed and contacts cleaned separately.

Mechanical washer-disinfectors are monitored with wash-cycle verification: check detergent dose, water temperature, spray-arm rotation, and final rinse; log each cycle.

Inspection checks function, cleanliness, and integrity: hinges move freely, ratchets hold, jaws align, insulation is unbroken, and no corrosion, cracks, or retained soil remain.

A lumen is inspected by looking through it against a light source; a borescope is used for long or narrow channels where direct vision is impossible.

Instrument sets are assembled against a count sheet or pick list; each tray is verified item by item, and missing or extra items are resolved before packaging.

Packaging must be compatible with the chosen sterilization method: steam needs steam-permeable wrap; low-temperature methods require materials validated for that process.

Sterile barrier systems must allow air removal and sterilant penetration, provide a sterile barrier to microorganisms, and resist tears and punctures during handling.

Chemical indicators are placed inside every package; an external indicator is used on packages going into steam so processed and unprocessed items can be distinguished.

Package labeling includes contents, sterilizer ID, cycle or load number, date of sterilization, and expiration or event-related date; labeling happens before sterilization.

Package weight and density limits follow the sterilizer manufacturer's written instructions; overloading blocks steam penetration and causes wet packs.

Tamper-evident seals must be continuous; a package with a broken seal, tear, or visible moisture is considered non-sterile and is reprocessed.

Steam sterilization parameters: 250°F (121°C) for 30 minutes or 270°F (132°C) for 4 minutes in a gravity displacement cycle; prevacuum cycles are shorter.

Steam quality matters: saturated steam with less than 3% moisture is required; superheated or wet steam causes failed cycles and wet packs.

Biological indicators for steam use Geobacillus stearothermophilus spores; they are incubated and read per manufacturer instructions after the cycle.

Ethylene oxide (EO) is a low-temperature method for heat- and moisture-sensitive items; it requires aeration to remove residual gas before items are released.

Hydrogen peroxide gas plasma is a low-temperature, non-toxic-residue method; it requires items and packaging validated for that specific system.

Monitoring has three levels: physical (gauges, printouts), chemical (indicators), and biological (spore tests); all three must pass for release of an implant load.

Implant loads are held until a biological indicator is negative; if the BI is positive, the load is recalled and the sterilizer is taken out of service.

Sterilizer loading: place items so steam can circulate, do not stack trays tightly, and place rigid containers flat with lids per manufacturer instructions; never overload.

Each sterilizer is tested at least weekly with a biological indicator and daily with a Bowie-Dick test for prevacuum sterilizers, per facility policy and standards.

Sterile storage areas are clean, dry, temperature-controlled, and separated from the decontamination area; relative humidity and temperature are monitored and logged.

Sterile items are stored at least 8 to 10 inches above the floor, 2 inches from walls, and 18 inches below the ceiling to allow cleaning and air circulation.

Event-related shelf life uses package integrity and storage conditions rather than a fixed date; a package remains sterile until an event compromises it.

A package is considered compromised by tears, holes, water stains, crushed corners, broken seals, or being dropped; it is reprocessed, not used.

Distribution uses first-in, first-out (FIFO) rotation to prevent expired or deteriorated products from reaching the point of use.

Inventory is tracked by par levels and minimum/maximum quantities; stockouts are prevented by reorder points tied to usage data.

Transport of sterile items uses closed carts or covered containers; soiled and clean items never share the same cart or route.

Case carts are assembled from physician preference cards; missing items are documented and communicated to the OR before the case starts.

Sterile storage requires that shelving be smooth and cleanable; cardboard boxes are not used because they harbor dust and moisture.

Regulatory roles: FDA clears sterilizers and biological indicators; OSHA enforces bloodborne pathogen and PPE rules; AAMI publishes technical standards; Joint Commission surveys compliance.

Standard Precautions treat all blood and body fluids as infectious; hand hygiene is performed before and after glove use and after contact with contaminated items.

Sharps injuries are managed by washing the site with soap and water, reporting immediately, and following the facility exposure control plan for evaluation and prophylaxis.

Quality assurance uses process monitors, audits, and documentation; every cycle is recorded with load contents, parameters, operator, and results.

Recall procedure: identify the affected load, quarantine it, notify users, document the event, and perform root cause analysis before resuming.

Chemical and biological indicator results are documented and retained per facility policy and accreditation requirements; records must be traceable to the load.

Inventory management uses par levels, usage reports, and periodic cycle counts; expired or recalled products are removed and documented.

Staff competency is verified at hire and annually; training records for sterilization, decontamination, and packaging are maintained.

Safety data sheets (SDS) are available for every chemical used; staff are trained on hazards, spill response, and waste handling.