CRCST Cheat Sheet.
The night-before summary, built like the exam.

Steam sterilization at a glance

• Rule: lower temperature needs longer time for equal lethality. Always run the parameters the device and sterilizer IFUs validate, including any extended cycles.
• Low-temperature methods: ethylene oxide penetrates lumens but needs long cycles, aeration, and exposure controls; vaporized hydrogen peroxide is fast with no aeration but cannot touch cellulose (paper, cotton, linen); dry heat handles powders and oils.

Indicators and monitors

• Type 1 external process indicator: processed vs unprocessed only.
• Type 2 specific test: Bowie-Dick air removal test, daily, empty chamber, before first processed load, dynamic air removal sterilizers only.
• Type 3 single variable; Type 4 multi-variable; Type 5 integrating, responds to all critical variables, the internal monitor of choice; Type 6 emulating, cycle-specific.
• Biological indicator: Geobacillus stearothermophilus spores for steam. Run with a positive control from the same lot. Failed BI: sterilizer out of service, recall to last negative BI, investigate, requalify.
• Implants: BI in a process challenge device, quarantine until negative, early release only for documented emergencies.
• Physical monitors: verify and initial the printout every cycle; a parameter excursion means the load is not released.

Workflow rules that answer many questions

• One-way flow, dirty to clean; never carry sterile items back through decontamination.
• Decontamination is negative pressure; prep and pack and sterile storage are positive.
• Keep soiled instruments moist at point of use; never saline (chlorides pit stainless steel).
• Clean before you disinfect or sterilize; no process works through soil or biofilm.
• Hinged instruments open and unlocked; disassemble per IFU; internal CI in the hardest-to-reach spot.
• Pouches: write on plastic side only, load on edge paper-to-plastic; no staples, pins, or rubber bands.
• Mixed loads: textiles above, metal below; cool on the cart before storage; a wet pack is contaminated.
• Event-related sterility: moisture, tears, crushing, dropping, or soiling ends sterility, not the calendar.

PPE by zone

• Decontamination: fluid-resistant gown, heavy-duty utility gloves, mask with eye protection or full face shield, hair cover; doff dirtiest first, hand hygiene last.
• Prep and pack / sterile storage: facility surgical attire, full hair covering, no artificial nails or loose jewelry; hand hygiene after glove removal.
• Chemical handling anywhere: check the SDS, know the eyewash location, use the spill kit.