Use of Aseptic technique Seoul National University Bundang Hospital Hyung Uk Namgung, Rph ,

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.

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.

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.

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.

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

Hand washing  Before aseptic manipulations are performed, the hands, nails, wrists, and forearms should be scrubbed vigorously for at least 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

Steps of handwashing

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

Steps of putting on sterile gloves

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

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

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

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.

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

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

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

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

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.

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

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.