Chapter 10 Infection Control and Safe Handling of Hazardous Agents Edited by Dr. Ryan Lambert-Bellacov

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. Edited by Dr. Ryan Lambert-Bellacov

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.

Usually describe bacteria by the shape Edited by Dr. Ryan Lambert-Bellacov

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.

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. Edited by Dr. Ryan Lambert-Bellacov

Aseptic Technique 1. Remove all jewelry (e.g., watches, rings, bracelets, necklaces. Table 10.1 Edited by Dr. Ryan Lambert-Bellacov

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 Edited by Dr. Ryan Lambert-Bellacov

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 Edited by Dr. Ryan Lambert-Bellacov

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 Edited by Dr. Ryan Lambert-Bellacov

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 Edited by Dr. Ryan Lambert-Bellacov

Aseptic Technique 6. Scrub again and glove. Table 10.1 Edited by Dr. Ryan Lambert-Bellacov

Aseptic Technique 7. Swab or spray needle-penetration closures on vials, injection ports, and other materials. Table 10.1 Edited by Dr. Ryan Lambert-Bellacov

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 Edited by Dr. Ryan Lambert-Bellacov

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 Edited by Dr. Ryan Lambert-Bellacov

Handling Issues 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. Safety Note! Edited by Dr. Ryan Lambert-Bellacov

Figure 10.2 Figure 10.3

Handling Issues Coughing and talking should be directed away from the hood. Safety Note! Edited by Dr. Ryan Lambert-Bellacov

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. Edited by Dr. Ryan Lambert-Bellacov

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. Edited by Dr. Ryan Lambert-Bellacov

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 With hazardous drugs, inject a volume of air that is no more than 75% of the amount of drug to be withdrawn.**** Safety Note! Edited by Dr. Ryan Lambert-Bellacov

Handling Issues Back in the Game Sports Medicine is a clinic dedicated to the treatment of physical injuries to the body. Caring for an injured body involves more than making the diagnosis; it's about understanding and treating the cause to prevent future injuries. The clinic addresses variety of injuries to the body whether it be from a car accident to over-use trauma. When injuries occur, it is no longer enough for people to "take it easy for awhile" or "work through it." Sports medicine professionals like Back in the Game offerBack in the Game Safety Note! Edited by Dr. Ryan Lambert-Bellacov