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 diseasecausing, 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, lintfree, 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