1. Use of Aseptic technique Seoul National University Bundang Hospital Hyung Uk Namgung, Rph 031-787-3860, 016-281-2598 pinewind@snubh.org

2. Introduction  Aseptic : without microorganisms  Aseptic techniques −reduce the risk of postprocedure infections in patients −reduce service providers' risk of exposure to potentially infectious materials during clinical procedures.

3. Equipment  Laminar-airflow hood −Never interrupt the air-flow between the HEPA filter and the sterile objects. −Large materials placed within the laminar-airflow hood can disturb the patterned airflow from the HEPA filter. ; Zone of turbulence created −Foreign object can increase wind turbulence within critical area.

4. Proper operations of laminar-airflow hoods (I)  All aseptic manipulations should be performed at least 6 inch within the hood.  A laminar-airflow hood should operate continuously.  Before use, all interior working surfaces of the hood should be cleaned with 70% IPA or another disinfecting agent.  Nothing should touch the HEPA filter, including cleaning solution.  A laminar-airflow hood should be positioned away from excess traffic, doors, air vents, fans, and air currents capable of introducing contaminants.

5. Proper operations of laminar-airflow hoods (II)  Hand and wrist jewelry should not be worn.  Actions such as talking and coughing should be directed away from the critical area.  Only objects that are essential to product preparation should be placed in the hood.  Laminar-airflow hoods should be tested and certified by qualified personnel every 6 months.  Food and drink should not be permitted within the aseptic preparation area.

6. Proper operations of b iological safety cabinet  A plastic-backed liner is placed on the work surface  Sufficient materials should be assembled to avoid leaving and reentering of the work area  All aseptic manipulations should be performed at least 6 inch in away from each wall

7. Hand washing  Before aseptic manipulations are performed, the hands, nails, wrists, and forearms should be scrubbed vigorously for at least 10-15 sec.  Hand-washing agents should be selected based on their ability to kill microorganisms and also to provide a residual effect.  Hands should be washed frequently, especially when the compounding area is reentered, to reduce contamination.  Sterile gloves are recommended. ; Gloving dose not replace hand washing  Prewashing preparation is important

8. Steps of handwashing

9. Gloving  Controversy issues ; The gloves do not remain strerile during operation  Some should work with clean, scrubbed, and disinfected hands and develop manipulation techniques that keep the fingers and hands away from critical sites ; Sterile latex gloves are remcommended if handled drugs are allergenic or hazardous  Latex surgical gloves performed much better under normal use  All gloves should be rinsed thoroughly with a disinfectant and changed if punctured, torn, or contaminated

10. Steps of putting on sterile gloves

11. Syringes (I)  To maximize accuracy, the smallest syringe that can hold a desired amount of solution should be used  To maintain sterility, two parts of a syringe cannot be touched; the tip and plunger

12. Syringes (II)  These packages should be inspected for holes or teares and discarded if damaged  The syringe package should be opened within the laminar- airflow hood to maintain sterility  Luer-loc syringes are packaged with a protector over the tip. This protector should be left in place until needle attachment

13. Needles  These packages should be inspected for holes or teares and discarded if damaged  The hub of needle should not be touched when removing the overwrap  The needles should never be swabbed with alcohol or touched  The needles should be handled by their protective covers only, and these covers should be left in place until the needles or syringes are used

14. One-hand technique Step 1 Place the cap on a flat surface, then remove your hand from the cap. Step 2 With one hand, hold the syringe and use the needle to "scoop up" the cap. Step 3 When the cap covers the needle completely, use the other hand to secure the cap on the needle hub.

15. Vials  All vials should be swabbed with 70% IPA before entry and left to dry  The needles should be inserted so that the rubber closure is penetrated at the same point with both the tip and heel of the bevel ; noncoring technique  The volume of fluid to be removed from a vial should be replaced with an equal volume of air to minimize a vacuum  A slight negative pressure should be maintained in the vial

16. Ampuls  Before an ampul is opened, any solution visible in the top portion (head) should be moved to the bottom (body)  To open an ampul properly, its neck should be cleansed with an alcohol swab and the swab should be left in place  To withdraw from an ampul, it should be tilted and the bevel of the needle placed in the corner space (or shoulder) near the opening  The fluids should be drawn through the filter needle  After this needle exchanged, the drug may be transferred to an IV bag or bottle

17. Preparation of sterile products (I) Flexible plastic bags  The plastic overwraps is removed and the remaining solution should be entered within the laminar- airflow hood immediately  The injection port of bag should be positioned toward the HEPA filter when IV admixture is prepared  All injection surfaces should be disinfected

18. Preparation of sterile products (II) Glass container  Needles should be inserted through rubber stoppers using the noncoring technique  Following admixture, a protective seal is placed over the stopper of a glass container before it is removed from th laminar-airflow hood Syringe form  The syringe should be capped with a sterile tip  The syringe should be placed in a plastic bag or other container for transport

19. Antiseptics (I) reduce the number of microorganisms prevent the growth and development of some types of microorganisms  used for Skin, cervical, or vaginal preparation before a clinical procedure Surgical scrub Handwashing in high-risk situations  Antiseptics are for use on people. Disinfectants are for use on objects and surfaces.

20. Antiseptics (II) Iodophors (PVP, Betadine) Chlorhexidine (Hibitan) Iodine Tincture of iodine Alcohol (EtOH, IPA) SpectrumBroad Spores (-) Broad Tuberculosis, fungi, Spores (-) Broad Spores (-) 장점 Less irritable 점막에 사용가능 Persistent effectFast-actingRapid Effective 단점혈액이나 유기물질 에 의해 효과 감소 irritation 구강내, 점막, 손상 된 피부 사용 금기 용도손, 피부소독 기구, 환경소독 창상 소독 기구 침적 손, 피부소독 기구소독 기타 7.5% : 손소독제 10% : 피부소독제 4% : 손소독제 1-3% iodine, followed by 60-90% alcohol 60-70% : most effective 화재 주의

21. Antiseptics (III) To avoid contaminating solutions  Never leave cotton or gauze sponges soaking in solutions.  Never dip hands, items or used gauzes into the container repeatedly  Never dip cotton or gauze into the main container. Instead either: −Pour the amount of antiseptic needed into a small container and dip the cotton or gauze into it. Or −Pour the antiseptic from the container directly onto the cotton or gauze, making sure not to touch the lip of the container with the cotton or gauze.