Roles & Responsibilities
13%of exam
Life Science
9%of exam
MicrobiologyBioburdenChain of InfectionSpore Resistance
Decontamination & Disinfection
19%of exam
Preparation & Handling
16%of exam
Sterilization
18%of exam
Sterile Storage & Distribution
11%of exam
Sterile StorageEvent-Related SterilityLoaner TraysFIFO Rotation
Patient Care Equipment
6%of exam
Powered InstrumentsEndoscopesLeak TestWarming Cabinets
Ethics
8%of exam
Professional ConductDocumentationFollow IFUReport Defects
Quick Facts
- Exam
- CSPDT
- Body
- CBSPD
- Questions
- 150 (125 scored)
- Time
- 3 hours
- Pass
- Scaled score 70
- Fee
- $135
- Valid
- 5 years
- Provider
- PSI testing centers
- Pass rate
- 48.1% (2025)
One-Way Flow
Decontam then Prep then Sterilize then Store
Dirty to cleanNever backtrackNegative to positive pressure
Standards & Regulatory
- ANSI/AAMI ST79
- Steam sterilization
- ANSI/AAMI ST91
- Flexible endoscopes
- ANSI/AAMI ST41/ST58
- EO and low-temp
- ANSI/AAMI ST108
- Water quality
- OSHA
- Worker safety, bloodborne
- CDC
- Disinfection guideline
- FDA
- Clears devices, sterilants
- AORN
- Perioperative practices
Microbiology & Infection
- Bioburden
- Microbial load present
- Vegetative bacteria
- Easiest to kill
- Spores
- Hardest to kill
- Prions
- Extended special protocols
- Chain of infection
- Source to susceptible host
- SAL
- Sterility assurance 10⁻⁶
- Pathogen
- Disease-causing microbe
- Biofilm
- Shields attached microbes
Spaulding Levels
Critical sterilize, Semi HLD, Non low
Critical: sterilizeSemi-critical: HLDNon-critical: low-level
Disinfection vs Sterilization
Disinfection
- Reduces pathogens
- May spare spores
- HLD for semi-critical
Sterilization
- Destroys all microbes
- Includes spores
- SAL 10⁻⁶
Most vs all microbes
Spaulding to Reprocessing
- Enters sterile tissue→Sterilize(Critical)
- Enters vascular system→Sterilize(Critical)
- Surgical implant→Sterilize + BI(Critical)
- Touches mucous membrane→High-level disinfect(Semi-critical)
- Flexible endoscope→HLD or sterilize(Semi-critical)
- Contacts intact skin→Low-level disinfect(Non-critical)
- BP cuff, stethoscope→Intermediate/low(Non-critical)
- Heat-sensitive critical→Low-temp sterilize(EO/H2O2)
Decontam PPE & Area
- Fluid-resistant gown
- Protects torso and arms
- Gloves
- General-purpose utility gloves
- Face shield/mask
- Splash protection
- Hair + shoe covers
- Contain contaminants
- Decontam temp
- 60-65°F (16-18°C)
- Decontam humidity
- 30-60% RH
- Air exchanges
- ≥10 per hour
- Room pressure
- Negative pressure
Critical vs Semi-critical
Critical
- Sterile tissue/blood
- Must sterilize
- Implants, instruments
Semi-critical
- Mucous membranes
- HLD minimum
- Endoscopes, scopes
Sterilize vs HLD
Cleaning Chemistries
- Enzymatic detergent
- Breaks down bioburden
- Enzymes
- Protease, lipase, amylase
- Neutral pH
- ~7, protects instruments
- Keep instruments moist
- Prevent dried soil
- Point-of-use care
- Pre-clean at OR
- Utility water
- Wash and rinse
- Critical water
- Final rinse
- Rinse residue
- Removes detergent film
Cleaning vs Disinfection
Cleaning
- Removes soil
- Physical + detergent
- Must come first
Disinfection
- Kills microbes
- Chemical or thermal
- After cleaning
Remove vs kill
Cleaning Equipment
- Manual cleaning
- Scrub below water line
- Pre-clean first
- Before ultrasonic
- Ultrasonic
- Cavitation removes fine soil
- Cavitation
- Bubbles implode on soil
- Washer-disinfector
- Automated wash + thermal
- Thermal rinse
- ≈180°F (82°C)
- Cart washer
- Case carts, containers
- Lumen flushing
- Connect irrigation ports
Spaulding Classification
- Critical
- Enters sterile tissue/vascular
- Critical example
- Implants, surgical instruments
- Critical process
- Sterilization required
- Semi-critical
- Contacts mucous membranes
- Semi-critical example
- Endoscopes, laryngoscopes
- Semi-critical process
- High-level disinfection minimum
- Non-critical
- Contacts intact skin
- Non-critical process
- Low/intermediate disinfection
Disinfection Levels & Agents
- High-level (HLD)
- Kills all but spores
- OPA
- 0.55%, ~12 min
- Glutaraldehyde
- ≥2.4%, ≥20 min
- Peracetic acid
- Sporicidal liquid
- Hydrogen peroxide
- 7.5% HLD
- Intermediate-level
- Kills TB, not spores
- Low-level
- Vegetative bacteria only
- Alcohol
- 70-90%, not sporicidal
Packaging & Wrap
- Sequential wrap
- Two layers, two steps
- Simultaneous wrap
- Bonded double layer
- Envelope fold
- Diagonal technique
- Square fold
- Straight technique
- Peel pouch
- Single instrument, paper-plastic
- Pouch stacking
- Paper faces paper
- Rigid container
- Reusable, filters/valves
- Tamper seal
- Shows unopened
Inspection & Assembly
- Inspect cleanliness
- Under magnification/light
- Check function
- Sharpness, alignment
- Box locks open
- Allow sterilant contact
- Lubricate
- Instrument milk, water-soluble
- Tray weight
- ≤25 lbs total
- Count sheet
- Verify tray contents
- Tip guards
- Protect sharp tips
- Absorbent liner
- Wicks moisture
Steam Temps
Gravity 250, Prevac 270-275, BD 273
Gravity 121°C/250°FPrevac 132°C/270°F135°C/275°FBowie-Dick 134°C
CI vs BI
Chemical (CI)
- Chemical color change
- Confirms conditions
- Instant read
Biological (BI)
- Live spores
- Proves lethality
- Needs incubation
Conditions vs kill
Sterilization Method Picker
- Heat/moisture tolerant→Steam(Preferred)
- Dense metal, no lumen→Gravity steam(Longer cycle)
- Porous or lumened load→Prevacuum steam(Air removal)
- Heat-sensitive, no lumen→H2O2 gas plasma(Low-temp)
- Long lumens→EO(Aeration needed)
- Oils or powders→Dry heat(No moisture)
- Immersible, heat-sensitive→Liquid chemical(Peracetic acid)
- Need fast turnover→IUSS(Not for implants)
Steam Sterilization
- Gravity displacement
- Steam pushes air down
- Prevacuum
- Vacuum removes air first
- SFPP
- Steam-flush pressure-pulse
- Moist heat action
- Coagulates proteins
- Wrapped gravity
- 121°C, 30 min
- Prevacuum 132°C
- 4 minutes exposure
- Prevacuum 135°C
- 3 minutes exposure
- Drying phase
- Prevents wet packs
BI Organisms
Steam = Geo, EO = atrophaeus
Steam/H2O2/ozone: G. stearothermophilusEO/dry heat: B. atrophaeus
Gravity vs Prevacuum
Gravity
- Steam displaces air
- No vacuum
- 121°C 30 min
Prevacuum
- Vacuum removes air
- Faster penetration
- 132°C 4 min
Passive vs dynamic air
Indicator & Monitoring Picker
- New/repaired sterilizer→3 BI cycles(Qualification)
- Every prevacuum day→Bowie-Dick(Empty chamber)
- Confirm exposure outside→Type 1 CI(Process)
- Inside every package→Type 4-6 CI(Internal)
- Implant load→BI + Type 5(Quarantine result)
- Routine load monitor→BI, daily preferred(Weekly minimum)
- Positive BI→Recall load(Quarantine)
- Wet pack found→Do not use(Investigate)
Low-Temp Sterilization
- Ethylene oxide (EO)
- Heat/moisture-sensitive items
- EO parameters
- Gas, temp, humidity, time
- EO aeration
- Removes toxic residual
- H2O2 gas plasma
- ≈50°C, lumen limits
- Vaporized H2O2
- Oxidizes cell components
- Ozone
- Oxygen + water
- Liquid chemical
- Peracetic acid immersion
- Dry heat
- Oils, powders, 160-190°C
EO vs H2O2 Plasma
Ethylene oxide
- Penetrates long lumens
- Toxic residual
- Needs aeration
H2O2 plasma
- No toxic residue
- Lumen limits
- Fast cycle
Lumens vs no residue
Sterilization Monitoring
- Mechanical/physical
- Gauges, printouts, time/temp
- Chemical indicator
- Confirms conditions met
- Biological indicator
- Proves spore kill
- Bowie-Dick
- Daily air-removal test
- Every load
- External + internal CI
- Implant load
- BI + rapid readout
- Qualification
- 3 consecutive BI runs
- Positive BI
- Recall and quarantine
Chemical Indicator Types
- Type 1
- Process/exposure indicator
- Type 2
- Bowie-Dick test
- Type 3
- Single-variable indicator
- Type 4
- Multi-variable indicator
- Type 5
- Integrating indicator
- Type 6
- Emulating indicator
- Internal CI
- Inside every pack
- Type 5/6
- Track all parameters
Biological Indicators
- Steam BI
- G. stearothermophilus
- H2O2/plasma BI
- G. stearothermophilus
- Ozone BI
- G. stearothermophilus
- EO BI
- B. atrophaeus
- Dry heat BI
- B. atrophaeus
- Spore form
- Most resistant challenge
- PCD/challenge pack
- Holds the BI
- Control BI
- Confirms viable spores
Event vs Time Sterility
Event-related
- Sterile until compromised
- Integrity-based
- Current standard
Time-related
- Expires by date
- Older practice
- Not integrity-based
Integrity vs calendar
Sterile Storage Conditions
- Storage temp
- ≤75°F (24°C)
- Storage humidity
- ≤70% RH
- Air exchanges
- ≥4 per hour
- Room pressure
- Positive pressure
- From floor
- 8-10 inches
- From ceiling
- 18 inches
- From outside wall
- 2 inches
- Access control
- Limited traffic, closed
Distribution & Loaners
- Event-related sterility
- Integrity, not date
- FIFO
- First in, first out
- Handle minimally
- Prevent package damage
- Inspect before use
- No holes or moisture
- Loaner trays
- Arrive early, decontaminate
- Loaner IFU
- Vendor provides instructions
- Case cart
- Transport to OR
- Compromised package
- Considered unsterile
Patient Care Equipment
- Powered instruments
- Never immerse motors
- Air/battery lines
- Wipe, do not soak
- Endoscope channels
- Brush and flush all
- Leak test
- Before flexible reprocessing
- Warming cabinet
- Blankets ≤130°F
- Suction tubing
- Single-use preferred
Ethics & Conduct
- Never skip steps
- Patient safety first
- Follow IFU
- Manufacturer instructions
- Document loads
- Traceability and recall
- Report defects
- Remove from service
- Confidentiality
- Protect patient data
- Speak up
- Stop unsafe processing
Common Traps
Indicator vs kill
CI confirms conditions ≠ BI proves lethality
Cleaning vs sterilizing
Cleaning removes soil ≠ Sterilizing kills spores
HLD vs sterilization
HLD spares some spores ≠ Sterilization kills all
Gravity vs prevac time
Gravity 30 min ≠ Prevac 4 min
Steam vs EO spore
Steam: G. stearothermophilus ≠ EO: B. atrophaeus
Event vs date sterility
Event-related integrity ≠ Not calendar expiry
Bowie-Dick purpose
Tests air removal ≠ Not sterility or kill
Last Minute
- 1.Clean before disinfect or sterilize
- 2.Critical items must be sterilized
- 3.Semi-critical needs high-level disinfection
- 4.Gravity: 121°C for 30 min
- 5.Prevacuum: 132°C for 4 min
- 6.Prevacuum: 135°C for 3 min
- 7.Bowie-Dick tests air removal
- 8.CI confirms; BI proves kill
- 9.Steam BI: G. stearothermophilus
- 10.EO BI: B. atrophaeus
- 11.Implant loads: BI first
- 12.Storage ≤75°F, ≤70% humidity
- 13.Sterility is event-related
- 14.Decontam: negative pressure, 10 ACH
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