There's a lot of expertise required to sterilize instruments and equipment. Here's a quiz to test your knowledge of sterilization concepts.

1. How should you load peel packs in a steam sterilizer?
a. plastic to plastic.
b. paper to paper.
c. plastic to paper.

Correct answer: c. Load peel packs on their sides, plastic to paper, so that the right amount of steam penetrates the packs and sterilizes the items inside. Pack the sterilizer loosely; overloading it could keep the steam from circulating around the peel packs.

2. Chalky residue or pitting on instruments is caused by
a. improper soap.
b. low water temperature.
c. hard water.

Correct answers: a and c. Just like the dishwasher at home, hard water's high mineral content can cause a chalky residue to form on instruments when they dry. The residue can cause pitting and wear and tear. Ask your system's manufacturer if your water and detergent are compatible with your sterilizer. Many manufacturers recommend de-ionized water from which the mineral salts have been removed.

3. If the biological indicator test shows that sterilization failed, you should
a. begin the instrument recall process.
b. contact the manufacturer of the sterilizer.
c. run another cycle with a new biological indicator test.
d. all of the above.

Correct answer: d. When you have a positive biological indicator, first track down everything that was part of the load and bring it back for quarantine. That is why every item in each load should have a label recording the load number and date of sterilization. Next, determine the cause of the failure. Was the sterilizer set to the proper cycle? Did you use appropriate packaging? Then run another load and test it with another biological indicator. If you still get a positive, shut the sterilizer down, reprocess all of the items previously run in the sterilizer during the period in question and contact the manufacturer, service company or biomedical department for maintenance of the machine.

4. When opening the sterilizer door, you should
a. open it just a crack to let the load cool slowly.
b. open it completely.
c. open it a crack for 1 minute and then open it all the way.

Correct answer: b. Plenty of myths surround this issue. More important than how long the door is open is ensuring that the items inside have enough time to cool. So open the door completely, which will help everything cool more quickly.

5. Instruments that lock or have articulating joints should be sterilized in the open position.
a. true.
b. false.

Correct answer: a. Decontamination is the first step in the sterilization process. In order to properly clean instruments, they need to be fully opened so that debris can be removed. Likewise, instruments should be prepared for sterilization in the open position to ensure proper steam penetration.

6. Which material should not go in a hydrogen peroxide low-temperature gas plasma sterilizer?
a. paper.
b. plastic.
c. stainless steel.
d. Tyvek.

Correct answer: a. Paper absorbs hydrogen peroxide, which lessens the sterilant's efficacy. Use Tyvek in a hydrogen peroxide sterilizer. You can confuse Tyvek packs with paper packs, so mark each in storage.

7. The most effective way to sterilize colonoscopes is
a. steam.
b. hydrogen peroxide low-temperature gas plasma.
c. peracetic acid.

Correct answer: c. In theory, you could sterilize a colonoscope with steam, but it would ruin the scope. Hydrogen peroxide, which can damage the scope's surface and corrode metal, isn't recommended for instruments with small lumens and channels. Peracetic acid is effective, efficient and doesn't harm the scopes. Ask your sterilizer manufacturer for a list of products approved for use in a hydrogen peroxide system.

8. In a peracetic acid sterilizer, if the cycle aborts, it may be an indication that
a. the peracetic acid capsule was not punctured.
b. the water pressure is not correct.
c. the machine has too many items in it.

Correct answers: a and b. Several events may cause a peracetic acid sterilizer to abort a cycle, including a capsule that wasn't inserted and punctured properly, and incorrect water pressure, the result of low water pressure or a dirty filter.

9. Instrument sets with moisture inside (known as "wet packs" or "wet loads") are caused by
a. too short of a cycle.
b. improper cooling conditions.
c. using the wrong sterilizing products.

Correct answer: b. Wet packs are usually the result of moisture from the air inside the pack condensing on instruments that have been placed on a cold surface before they've cooled and dried sufficiently. The moisture will wick environmental organisms onto the sterile instruments and contaminate the set, which is why we must consider instruments that are wet inside contaminated. The best way to prevent wet packs? Give items in the sterilizer enough time to cool, 15 minutes to 1 hour, depending on the load size and the instruments processed.

10. The presence of biological matter on hemostats, rongeurs and other instruments with movable parts after sterilization may indicate that
a. the instruments weren't opened before sterilization.
b. the instruments weren't decontaminated properly and sterilization didn't occur.
c. the wrong sterilization system was used.

Correct answer: b. Biological matter on instruments before sterilization prevents proper sterilization from taking place. This is due to the inability of the sterilant to penetrate the instrument through the organic debris. This highlights the importance of thoroughly cleaning instrumentation before sterilization.