Sterile Products and Aseptic Techniques for the Pharmacy

Sterile Products and Aseptic Techniques for the Pharmacy Technician CHAPTER 5 Aseptic Technique Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Preparation Personal Protective Equipment (PPE) • Must be worn when compounding • No jewelry, nail polish, artificial nails, makeup • Must be disposable, nonshedding, lowpermeable • Don all PPE in anteroom Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Preparation (cont’d) • Remove all PPE before leaving sterile area • Gown may be reused during shift • All other PPE must be disposed of Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Preparation (cont’d) Order of donning PPE (remove in reverse order) 1. Shoe covers 2. Head and facial hair covers 3. Face/eye masks 4. Eye shields (required for hazardous drugs) 5. Aseptically wash hands Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Preparation (cont’d) Order of donning PPE (remove in reverse order) (cont’d) 6. Nonshedding gown with snug fitting cuffs 7. Clean hands with waterless alcohol scrub 8. Sterile powder-free gloves Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Proper Dressing FIGURE 5 -1 Proper dressing Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Preparation (cont’d) Handwashing 1. Perform before entering direct compounding area 2. Run hands under warm water 3. Use nail cleaner & soap to clean under nails 4. Wash hands & forearms at least 30 sec with soap Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Preparation (cont’d) Handwashing (cont’d) 4. Wash around & between all fingers 5. Scrub up to elbow, covering entire area with soap 6. Rinse completely 7. Dry with lint-free paper towels or electric dryer Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Proper Handwashing FIGURE 5 -2 (A) Proper handwashing Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Proper Handwashing (cont’d) FIGURE 5 -2 (B) Proper handwashing (cont’d) Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Proper Handwashing (cont’d) FIGURE 5 -2 (C) Proper handwashing (cont’d) Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Proper Handwashing (cont’d) FIGURE 5 -2 (D) Proper handwashing (cont’d) Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Proper Handwashing (cont’d) FIGURE 5 -2 (E) Proper handwashing (cont’d) Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Proper Handwashing (cont’d) FIGURE 5 -2 (F) Proper handwashing (cont’d) Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Proper Handwashing (cont’d) FIGURE 5 -2 (G) Proper handwashing (cont’d) Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Proper Handwashing (cont’d) FIGURE 5 -2 (H) Proper handwashing (cont’d) Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Manipulation Avoid touching: • Swabbed area (vial top, bag port, ampule neck) • Uncapped needles • Hub of needle • Syringe tip • Syringe plunger • Open tip of filter or dispensing pin • Uncapped tip of any tubing Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Manipulation (cont’d) Swab with 70% isopropyl alcohol • Vial tops • Ampule necks • Tops of bottles • Ports of any IV or IVPB bags Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Manipulation (cont’d) Proper use of alcohol pad • Place pad on area to be swabbed • Allow alcohol to saturate surface • Make 1 gentle stroke across area toward side or front of hood • Use unused portion of swab with each pass • Allow alcohol to dry fully before each use Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Manipulation (cont’d) Proper use of alcohol pad (cont’d) • Swabbing – Removes physical contaminants such as dust – Disinfects as alcohol evaporates (desiccation) Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Manipulation (cont’d) Using syringes • Available in various volumes (0. 5 -60 m. L) • Use smallest syringe that will hold desired amount • 20% rule: total volume must be ≥ 20% of syringe volume • Don’t touch tip or plunger of syringe Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Manipulation (cont’d) Using syringes (cont’d) • Single-use only; dispose of in sharps container • Open syringe within clean air space in PEC • Be familiar with Luer-lock vs. slip tip Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Manipulation (cont’d) Using needles • Available in different sizes & lengths • Gauge: width of needle • Larger the gauge, smaller the bore • Standard gauge needle in pharmacy: 1821 G • Handle needle only by protective cover • Avoid touching hub Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Manipulation (cont’d) Using vials • Date all vials before bringing them into hood • Discard single-dose vials at end of shift • Multiple-dose vials – May be reused – Follow storage instructions on package insert – Note date & time opened & your initials on label Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Manipulation (cont’d) Using vials (cont’d) • To prevent coring – Insert needle into stopper with bevel tip up – Apply slight lateral & downward pressure to insert Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Manipulation (cont’d) Using vials (cont’d) • Pressure issues – Vials are closed-system containers – Positive pressure can cause spraying or leaking – Removing air can create vacuum – Replace volume of fluid to be removed with air Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Withdrawing From a Vial 1. Dress, wash hands, & gather all materials 2. Swab rubber top with alcohol & allow to dry 3. Make sure needle is firmly attached to syringe 4. Pull plunger back to slightly less than amount needed Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Withdrawing From a Vial (cont’d) 5. Remove cap, place needle, bevel end up, on center of stopper 6. Hold needle at 45º angle & insert 7. Gently push air from syringe into vial 8. Insert vial & release plunger 9. Remove any air bubbles by tapping on syringe 10. Withdraw needle & carefully recap Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Straight Draw FIGURE 5 -3 (A) Straight draw Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Straight Draw (cont’d) FIGURE 5 -3 (B) Straight draw (cont’d) Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Straight Draw (cont’d) FIGURE 5 -3 (C) Straight draw (cont’d) Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Straight Draw (cont’d) FIGURE 5 -3 (D) Straight draw (cont’d) Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Straight Draw (cont’d) FIGURE 5 -3 (E) Straight draw (cont’d) Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Straight Draw (cont’d) FIGURE 5 -3 (F) Straight draw (cont’d) Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Straight Draw (cont’d) FIGURE 5 -3 (G) Straight draw (cont’d) Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Straight Draw (cont’d) FIGURE 5 -3 (H) Straight draw (cont’d) Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Straight Draw (cont’d) FIGURE 5 -3 (I) Straight draw (cont’d) Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Straight Draw (cont’d) FIGURE 5 -3 (J) Straight draw (cont’d) Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Reconstituting a Powdered Vial 1. Dress, wash hands, & gather all materials 2. Swab all rubber tops with alcohol & allow to dry 3. Make sure needle is firmly attached to syringe 4. Draw up correct amount of diluent needed 5. Pull back plunger to clear neck; remove needle & replace with vented needle Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Reconstituting a Powdered Vial (cont’d) 6. Add diluent to powered vial 7. Gently shake or swirl to dissolve 8. Change back to regular needle & withdraw fluid 9. Remove any air bubbles 10. Withdraw needle & recap Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Removing Air Bubbles 1. Pull back plunger to allow more air in syringe 2. Rotate large air bubble around syringe to pick up small ones 3. Tap syringe to dislodge smaller air bubbles 4. Hold syringe upright; pull plunger back another 0. 2 m. L to clear hub Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Removing Air Bubbles (cont’d) 5. Push plunger up to remove air 6. Make sure desired amount is left in syringe Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Using Transfer Needles • Double-ended • Used to transfer entire contents of vial to an IVPB Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Using Transfer Needles (cont’d) • To use – Swab appropriate areas – Place longer of two ends in additive port of IVPB – Place shorter end in desired vial – Gently squeeze IV bag & IV fluid will fill vial – Hold IV bag so that air floats to top & squeeze – Air will move into vial & create pressure in vial Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Opening Ampules 1. Dress, wash hands, & gather all materials 2. Remove fluid from neck of ampule 3. Swab neck with alcohol 4. Hold ampule at 20º angle toward side of hood 5. Using thumbs, apply pressure toward neck Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Opening Ampules (cont’d) 6. Using filter needle, withdraw fluid 7. Remove any air bubbles 8. Change to regular needle before injecting in bag 9. Remove any air bubbles 10. Insert needle in additive port of IV bag & inject Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Opening an Ampule FIGURE 5 -7 (A) Opening an ampule Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Opening an Ampule (cont’d) FIGURE 5 -7 (B) Opening an ampule (cont’d) Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Opening an Ampule (cont’d) FIGURE 5 -7 (C) Opening an ampule (cont’d) Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Opening an Ampule (cont’d) FIGURE 5 -7 (D) Opening an ampule (cont’d) Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Opening an Ampule (cont’d) FIGURE 5 -7 (E) Opening an ampule (cont’d) Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Opening an Ampule (cont’d) FIGURE 5 -7 (F) Opening an ampule (cont’d) Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Opening an Ampule (cont’d) FIGURE 5 -7 (G) Opening an ampule (cont’d) Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Opening an Ampule (cont’d) FIGURE 5 -7 (H) Opening an ampule (cont’d) Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Preparing a Sterile Dosage Form 1. Assemble all materials within PEC 2. Clean injection surfaces with a 70% alcohol swab 3. Place syringes with needles capped on hood 4. Check base solution & place next to syringe Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Preparing a Sterile Dosage Form (cont’d) 5. Don’t puncture bag when inserting needle in port 6. Keep water & potassium chloride in hood 7. Position injection port of bag toward HEPA filter 8. Withdraw drug fluid with appropriate size syringe 9. Properly label & inspect CSP for cores & matter Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition Mike Johnston Copyright © 2011 by Pearson Education, Inc. All rights reserved.