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					  Chapter 10
Infection Control and
  Safe Handling of
  Hazardous Agents
         Learning Objectives
• Explain the germ theory of disease—the
  role of pathogenic organisms in causing
  disease.
• Distinguish among viruses, bacteria, fungi,
  and protozoa.
• Discuss the advantages and disadvantages
  of various forms of sterilization.
• Identify sources and prevention of common
  causes of contamination.
         Learning Objectives
• Describe proper aseptic technique,
  including the use of horizontal and vertical
  laminar airflow hoods and the new United
  States Pharmacopeia requirements.
• Discuss the importance of and techniques
  for handling and disposing of hazardous
  agents.
       INFECTION CONTROL
• Development of the Germ Theory of Disease:
  The identification of microorganisms as a cause
  of infectious disease is a surprisingly recent
  development. Pasteur was the originator of the
  theory. In one experiment, he successfully
  immunized chickens against chicken cholera.
       INFECTION CONTROL
• Micoorganisms and Disease: Since the days of
  Pasteur, thousands of pathogenic, or disease-
  causing, microorganisms have been identified.
  Bacteria, fungi, viruses, and protozoa are
  examples of microorganisms that can be
  harmful.
       INFECTION CONTROL
• Asepsis and Sterilization: The preparation of
  parenteral products, especially those for IV
  administration, requires special aseptic
  techniques, equipment, and procedures to
  minimize contamination. Various types of
  sterilization are available to kill
  microorganisms from medical instruments,
  devices, and surfaces.
Figure 10.1
       INFECTION CONTROL
• Contamination: Accidental exposures require
  immediate treatment, cleanup, reporting to the
  supervisor, and completion of an incident
  report. Contanination can occur in a pharmacy
  by three primary means: touch, air and water.
        Terms to Remember
•   spontaneous generation
•   germ theory of disease
•   viruses
•   bacteria
•   fungi
•   protozoa
•   asepsis
       Terms to Remember
• sterilization
• autoclave
   ASPTIC TECHNIQUE AND
      USP CHAPTER 797
Aseptic technique is used for the preparation
 of parenteral admixtures, combinations of
 fluids and/or medications or nutrients,
 which are administered using bolus (i.e.,
 push) or other intravenous (IV) methods.
 Table 10.1 summarizes the steps in detail.
             Aseptic Technique
     1. Remove all jewelry (e.g., watches,
     rings, bracelets, necklaces.




Table 10.1
             Aseptic Technique
   2. Put on non-shedding coats, gowns,
   or coveralls (hospital scrubs); head
   and facial hair covers; face masks; and
   shoe covers. Note that it is important
   to follow the sequence of items
   indicated in this step.

Table 10.1
             Aseptic Technique
   3. Scrub hands and arms to the elbows
   thoroughly with an antiseptic cleanser
   (e.g., povidone-iodine or chlorhexidine
   gluconate).




Table 10.1
             Aseptic Technique
   4. Clean the laminar flow hood with
   isopropyl alcohol. The alcohol must
   remain in contact with the surface for
   30 seconds prior to compounding any
   sterile product.


Table 10.1
             Aseptic Technique
    5. Place only essential materials under
    the airflow hood—no paper, pens, or
    labels. Remove the selected syringe(s)
    from its overwrap, attach a needle,
    then discard the waste.


Table 10.1
             Aseptic Technique
   6. Scrub again and glove.




Table 10.1
             Aseptic Technique
   7. Swab or spray needle-penetration
   closures on vials, injection ports, and
   other materials.




Table 10.1
             Aseptic Technique
   8. Prepare the sterile product by
   withdrawing the medication from vials
   or ampules and introducing it into the
   IV container.



Table 10.1
             Aseptic Technique
  9. Complete a quality check of the
  product for container integrity and
  leaks, solution cloudiness, particulates,
  color of solution, and proper
  preparation of product.


Table 10.1
             Aseptic Technique
  10. Present the product, the containers
  and devices used, and the label to a
  pharmacist for verification of the
  product preparation.



Table 10.1
           Handling Issues

Safety Note!
• When working in the pharmacy lab clean
  room, it is important to wear appropriate
  sterile gear, including face mask, full head
  covering, scrubs or gown with back closure,
  and gloves.
              Figure 10.2




Figure 10.3
           Handling Issues

Safety Note!
• Coughing and talking should be directed
  away from the hood.
       Terms to Remember
• aseptic technique
• horizontal laminar airflow hood
• high-efficiency particulate air (HEPA)
  filter
• vertical laminar airflow hood
• quality assurance (QA) program
• USP Chapter 797
      Terms to Remember
• compounded sterile products (CSPs)
• beyond-use dating
 HANDLING AND DISPOSAL
  OF HAZARDOUS AGENTS
• Receipt and Storage of Hazardous
  Agents: Hazardous drugs should be
  delivered directly to the storage area,
  inventoried, and, if necessary, refrigerated.
  Access to storage areas and work areas for
  hazardous materials should be limited to
  specified trained personnel.
 HANDLING AND DISPOSAL
  OF HAZARDOUS AGENTS
• Protective Clothing: A disposable, lint-
  free, nonabsorbent, closed-front gown with
  cuffed sleeves should be worn. Hair and
  shoe covers should be worn to reduce the
  potential for particulate contamination.
  Other protective clothing would include eye
  protection, mask, and use of latex gloves
  when disposing of damaged packages.
 HANDLING AND DISPOSAL
  OF HAZARDOUS AGENTS
• Technique for Handling Hazardous
  Agents: Hazardous drugs such as cancer
  chemotherapy require special techniques,
  equipment, and procedures to protect the
  health of the employee.
• Hazardous Agent Spills: Accidental
  exposures require immediate treatment,
  cleanup, reporting to the supervisor, and
  completion of an incident report.
 HANDLING AND DISPOSAL
  OF HAZARDOUS AGENTS
• Procedures in Case of Exposure: Any
  body area exposed should be flooded with
  water and thoroughly cleansed with soap
  and water. Dispose of contaminated
  garments appropriately in specially
  designated biohazard materials containers.
 HANDLING AND DISPOSAL
  OF HAZARDOUS AGENTS
• Hazardous Oral Dose Forms: The
  counting and pouring of these drugs should
  be done carefully, and contaminated
  equipment such as counting trays should be
  immediately cleaned with detergent and
  rinsed. Compounding with any of these
  drugs should be done in a protected area
  away from drafts and traffic.
           Handling Issues

Safety Note!
• With hazardous drugs, inject a volume of air
  that is no more than 75% of the amount of
  drug to be withdrawn.
       Terms to Remember
• cytotoxic materials
• antineoplastic drugs
            Discussion
Select and research a drug from the
hazardous drug list (Table 10.2) and
provide a written or verbal report on
its potential toxicity to a pharmacy
technician exposed to it. Is toxicity
the result of skin irritation, ingestion,
or inhalation?
             Discussion
The JCAHO is due to visit your hospital for
accreditation. Your hospital’s ICC is asking
your department of pharmacy to develop
quality assurance (QA) policy on your IV
admixture service. Your pharmacist supervisor
has designated you to write the first draft.
Check the following Web site for information:
www.ashp.org/bestpractices/drugdistribution/Pr
ep_Gdl_QualAssurSterile.pdf