Definition Contamination Laminar AirFlow Bench Aseptic technique Conclusion

Definitions
Enteral
Of or relating to the intestines (e.g. by mouth, orally) Introduced other than by way of the intestines (e.g. intravenous, intramuscular, subcutaneous) The technique for manipulations of compounded sterile products and parenteral preparations that prevents contamination

Parenteral

Aseptic Technique

Definitions (cont.)
Contamination any effect or action that has a negative impact on a product's integrity making it unfit for use
Chemical composition pH Sterility (e.g. microorganism contamination) Pyrogenicity Biological or therapeutic potency Physical appearance Particulate matter (e.g. dust, glass or precipitation)

Sources of product contamination

People (most common)
Touch contamination Generation of particulates from shedding cells or hair Breathing contamination In cloth dust may entangled in fibers of fabrics

Supply air
Containing microbes and dust

Infiltration
Particles from adjacent spaces (e.g. anteroom)

Internal generation
Walls, floors, ceilings, working surface and equipment

Prevention Of Contamination People

Gloves of hands Suitable caps should be worn in hair Over all coat should be worn To avoid breath contamination, shack type screens are used Protect the working area with screen Reduce air movements Protect with screen Working surface should be disinfected Equipment should be sterile Walls,floors,ceilings and working surface should be cleaned properly

Supply air

Infiltration

Internal generation

Importance of Aseptic Technique

Parenteral administration bypasses the skin and gastrointestinal tract, the bodies natural barriers to infection Giving a patient a contaminated product can cause serious adverse effects including DEATH Parenteral medications account for >40% of all medications administered in institutional practice

Laminar Air Flow Bench

The underlying principle of a laminar air flow bench is that a constant flow of HEPA filtered air at a rate of approximately 90 linear feet per minute physically sweeps the work area and prevents the entry of contaminated air The bench workspace is used to prevent the contamination of compounded sterile products and parenteral preparations

The space between the HEPA filter and sterile product being prepared is referred to as the critical work surface HEPA filter - High Efficiency Particulate Air filter removes 99.97% of all air particles 0.3mm or larger

Laminar Air Flow bench

HEPA Filter in Frame

Laminar Air Flow bench

Horizontal Flow (Laminar Flow bench)
Air blows towards worker Used for non-chemotherapy preparations

Vertical Flow (Biological Safety Cabinet or Chemotherapy Bench)

Air blows from top down to maintain sterility and protect the worker Used to make chemotherapy

Laminar Air Flow bench

Horizontal Laminar Air Flow bench
Hepa Filter

Filtered Air

Room Air

Prefilter

Laminar Air Flow bench

Vertical Laminar Flow bench

Correct placement of items in a laminar flow bench

Incorrect placement of items in a laminar flow bench

Laminar Air Flow bench

All aseptic manipulations should be performed at least SIX inches within the bench to prevent the possibility of contamination from room air entering the bench.

A laminar flow bench should be left operating continuously If bench is turned off it must run for 30 minutes to reestablish laminar air flow and then be cleaned prior to use Before use, all interior working surfaces of the laminar flow bench should be cleaned from back to front away from the HEPA filter

Laminar Air Flow bench

Cleaning process
Procedure for cleaning a bench should occur in the following order:
Obtain 4X4 gauze Clean the bench with sterile water for irrigation (bar, sides, base) Obtain new 4x4 gauze Clean the bench with 70% isopropyl alcohol (bar, sides, base) Hoods should be cleaned at the beginning of each shift and as needed throughout the shift

The HEPA filter is located in the fragile mesh between thin metal strips at the back of the bench behind the HEPA filter screen Nothing should be permitted to come in contact with the HEPA filter
NO cleaning solution NO aspirate from syringes NO glass from ampules NO fluids, even if sterile DO NOT touch HEPA filter

Only products essential to product preparation should be placed in the laminar flow bench to minimize the potential for contamination

Eating, drinking, and smoking is always prohibited Talking or coughing should be directed away from the bench to minimize air flow turbulence A mask covering mouth and nose must be worn while working in the bench The use of a laminar flow bench alone without the observance of aseptic technique, cannot insure product sterility

Aseptic Technique
Aseptic technique is the technique for manipulations of compounded sterile products and parenteral preparations that prevents contamination Aseptic technique requires specific manipulations for: Syringes Needles Vials Ampules Removal of packaging Assembling of sterile products Hand placement

Aseptic Technique - Needles

Hub
Where the needle attaches to the syringe tip and allows the fluid in the syringe barrel
The tip of needle is slanted to a point and the slanted part of the needle is the bevel. The bevel allows for smooth insertions through stoppers and ports with minimal coring

Bevel

Aseptic Technique - Needles

Coring
The development of a core or hole in the rubber of a vial To prevent coring insert needle as shown Insert the bevel tip first, then pressing downward and toward the bevel so the bevel tip and heel enter at the same point

Parts of Ampule

Vials

Ampules

Aseptic Technique - Vials and Ampules To prevent contamination

Swab rubber closure with 70% alcohol using firm strokes in the SAME direction

To prevent core formation

Insert needle to penetrate the rubber closure at same point with both tip and heel of bevel

To prevent vacuum formation Reconstituting drug powder

Inject an equal amount of air for the volume of fluid to be removed

Remove an equal amount of air for the volume of diluent added

To break ampule
Clean ampule neck with alcohol swab Leave swab in place Grasp ampule neck with thumb and index finger Use quick, firm, snapping motion away from body towards side wall of bench DO NOT BREAK TOWARD HEPA FILTER

Aseptic Technique - Removing Packaging Any sterile component or supply (e.g., syringes, needles, and ampules) should only be opened and/or removed from their packaging within the laminar-flow workspace. When opening the wrapper on a needle, it should be peeled open. Tearing paper introduces paper particles into the bench which could lead to product contamination.

Aseptic Technique - Assembling

Great care must be exercised to prevent any touch contamination of critical edges or component surfaces. The syringe tip and plunger and all parts of the needle are critical surfaces.

Aseptic Technique - Hand Placement

It is important that hand placement during any aseptic manipulation is such that laminar airflow is not interrupted around any of the critical sterile fluid pathways.

Great care should be taken to avoid contact with the syringe plunger, especially during multiple manipulations using the same syringe. Since the plunger enters the barrel of the syringe during repeated uses, contamination can be accidentally introduced into the barrel.

CONCLUSION
Aseptic technique is the manipulation of sterile products to prevent contamination Giving a patient a contaminated product can cause serious adverse effects including DEATH..!