Ch. 12 KEYTERMS

Air Exchanges

Refers to the process of replacing stale air within a controlled environment with fresh, filtered air to maintain optimal air quality and reduce the risk of contamination in sterile compounding areas.

Anteroom

An ISO Class 8 controlled room situated immediately outside the buffer room, designed for critical activities such as hand washing, maintaining hygiene, and garbing personnel. It serves as a transition space for gathering supplies and ingredients before entering the buffer or cleanroom area.

Asepsis

The condition of being free from pathogenic microorganisms, essential for preventing infection and contamination during medical and pharmaceutical procedures.

Aseptic hand washing

A rigorous hand hygiene practice that involves a thorough washing with soap and water, followed by the application of an antiseptic agent. This procedure is critical before donning sterile attire to ensure maximum microbial cleanliness.

Aseptic technique

A set of practices designed to prevent contamination when manipulating sterile products and devices. It includes stringent cleanroom protocols, proper hand-washing, and gowning procedures to maintain sterility and prevent the introduction of pathogens.

Autoclave

A sterilization device that uses high-pressure steam and heat to effectively kill all microorganisms, including spores, on tools and equipment, ensuring they are safe for use in sterile environments.

Auxiliary Clamp

A type of slide clamp utilized in intravenous (IV) therapy to completely halt the flow of IV solution, allowing for safe handling and maintenance of the IV line.

Bactrium

A small, single-celled microorganism characterized by its ability to exist in three predominant forms: spherical (cocci), rod-shaped (bacilli), and spiral (spirilla), which can be significant in various clinical contexts.

Buffer room

An ISO Class 7 or cleaner environment where primary engineering controls (PECs) are placed; it is also referred to as the IV room or cleanroom, providing a controlled space for the preparation of compounded sterile preparations (CSPs).

Clean room

An ISO-classified area specifically designed to control the concentration of airborne particles, ensuring a specific level of cleanliness required to minimize the risk of contamination in compounded sterile preparations; also known as the IV room or buffer room.

Compounded Sterile Preparation (CSP)

A medication prepared using aseptic technique within a sterile, controlled environment, ensuring it is free from contaminants before administration.

Critical Site

The specific areas on syringes and needles that are susceptible to contamination through touch or disruption of airflow, underscoring the importance of keeping these areas sterile.

Disinfectant

A chemical agent, such as sterile 70% isopropyl alcohol (IPA), used on inanimate surfaces to eliminate a wide range of microorganisms, including bacteria and viruses, although not necessarily their spores.

Distillation

A purification process that involves boiling a liquid to produce vapor and then condensing that vapor back into liquid form, effectively removing impurities and producing purified liquid.

Drip chamber

A small, open compartment located just below the spike adaptor of an IV set that collects drops of fluid, allowing healthcare providers to monitor and adjust the IV flow rate.

Drop factor

The specific number of drops that an IV tubing delivers per milliliter, a variable that aids nurses in calculating the IV flow rate for different types of infusion therapy; also referred to as drop set or drip set.

Epidemic

A widespread occurrence of an infectious disease within a specific geographical area, significantly impacting a larger population over a short period.

Filtration

The process of passing liquids or gases through barriers, known as filters or mesh screens, designed to trap particles, including biological and chemical contaminants, ensuring the safety and purity of the substance.

HEPA (High-Efficiency Particulate Air filter)

A specialized air filter capable of trapping over 99% of particulate matter, helping to create an aseptic environment for the preparation and handling of compounded sterile preparations (CSPs).

Horizontal Laminar Air Flow Workbench

CommOnly referred to as a laminar hood, a primary engineering control (PEC) that provides an ISO Class 5 air quality environment for the aseptic preparation of IV drug admixtures and other sterile products.

Injection Port

A connector integrated into IV tubing that allows healthcare professionals to introduce additional fluids or medications, other than those contained in the primary IV bag, directly into the patient's bloodstream.

In-Line Filter

A safety device incorporated into the IV line designed to remove contaminants such as glass shards, fibers, and various particles from IV fluids before they reach the patient.

ISO (International Organization for Standardization)

A classification system that measures the quantity of particulate matter in the air within a specific environment. The lower the ISO number, the fewer airborne particles are present, crucial for maintaining sterile conditions.

IV administration set

A sterile, disposable system composed of various components, including tubing and ports, utilized to deliver intravenous fluids to patients in a controlled manner.

IVPB (Intravenous Piggyback)

A small-volume parenteral (SVP) infusion, typically ranging from 50 mL to 250 mL, containing medication that is administered alongside a primary large-volume parenteral (LVP) IV solution.

LVP (Large Volume Parenteral)

Intravenous solutions that have a volume exceeding 250 mL and may contain essential medications, nutrients, or electrolytes for patient care.

Macrodrip IV Tubing

IV tubing designed with a larger diameter that delivers a greater volume of fluid, typically 10, 15, or 20 drops per milliliter, commonly used for treating adult patients.

Microdrip IV Tubing

IV tubing characterized by a smaller diameter that allows for the delivery of smaller drops, typically 60 drops per milliliter, suitable for pediatric patients and cases where gradual dosing is necessary.

Phlebitis

An inflammatory condition of the vein, often resulting from the administration of intravenous medications, which can lead to discomfort, swelling, and potentially serious complications.

Positive Pressure

A situation in which air is intentionally forced into a room, resulting in higher pressure within the space compared to adjacent areas; this prevents the entry of contaminants from outside.

Primary Tubing

The IV tubing connected directly to the primary IV solution bag, facilitating the delivery of fluids and medications to the patient.

Protozoan

A single-celled organism commonly found in water and soil, which can have significant implications for human health and disease.

Secondary Tubing

IV tubing specifically designated for a secondary medication, which attaches to the primary tubing via a Y-site injection port, allowing for the simultaneous administration of multiple therapies.

Sepsis

A serious medical condition resulting from a severe infection where the body's immune response causes systemic inflammation, potentially leading to organ failure and life-threatening complications.

SVP (Small Volume Parenteral)

Generally defined as IV solutions that range in volume from 25 to 250 mL, commonly administered via piggyback infusion into a larger volume parenteral (LVP) solution.

Sterilization

The complete elimination or destruction of all microorganisms, including spores, using various methods such as heat, chemicals, or radiation, ensuring that instruments and surfaces are safe for use in sterile environments.

Superbugs

Strains of bacteria that have developed resistance to multiple antibiotic treatments, posing significant challenges in treating infections effectively.

Zone of turbulence

The area where filtered air encounters obstacles or blockages, particularly between the direct compounding area (DCA) and the compounding personnel; this zone is critical as it can promote contamination risks.

What is the reason for using glass syringes instead of plastic syringes in sterile compounding?

Glass syringes are used when certain chemotherapy products are prepared.

What parts of a syringe must not be touched?

inner plunger shaft and syringe tip

Which of the following regarding needles is true?

The higher the gauge number, the smaller the diameter of the needle is.

What happens if a sterile compounding technician inadvertently touches a sterile needle?

The needle should be disposed of into a sharps container.

The purpose of an IV administration set is to

deliver IV fluids to patients.

What component of an IV set pierces the port on the IV container?

spike

What is the drop factor of an IV administration set?

number of drops to make 1 mL

What happens when the roll clamp is moved up toward the universal spike adaptor?

The flow rate increases.

Where does the nurse directly inject medications into an IV administration set?

Y-site port

What is the purpose of a 0.45 micron in-line filter in an IV administration set?

provides optimal conditions for blocking particulate matter

How are the compounding aseptic isolator and horizontal laminar airflow workbench alike?

Both vent air through a high-efficiency particulate air (HEPA) filtered ventilation system.

What is a reason that compounded products in the hospital must be as germ-free as possible?

Most products are being administered directly into a vein.

Which microorganism reproduces slowly by means of spores?

fungi

Amoebic dysentery, malaria, and sleeping sickness are all illnesses caused by

protozoa

What preventative measure has had some of the greatest widespread regional and worldwide success in stemming harm from microorganisms?

immunizations

When patients stop their antibiotics or antivirals because they feel better, what may happen?

antimicrobial resistance

What is the life threatening reaction that happens when a patient has a healthcare associated infection that is so threatening that the body’s immune system goes into overdrive?

sepsis

Inhaling, ingesting, touching mucosal linings, contact with piercings or open sores, and injections are all_______________for microbes to cause infection.

modes of transmission

Sneezing and coughing are sources of ___________contamination.

water

Universal precautions work to protect healthcare workers and patients from

All of the choices are correct.

Which of the following should NOT be placed in a red plastic biohazardous container?

blood-soaked bandages

A nosocomial infection outbreak in the hospital would be investigated by the _____

ICC.

Which one of these employees in the pharmacy cannot receive a seasonal influenza vaccination?

someone allergic to eggs

When an object, such as a medical instrument, is sterilized, the microbial life forms on it are

destroyed.

What is the advantage of heat sterilization?

economical

Large volume parenterals, small volume parenterals, sterile hazardous drugs, and intrathecal medications are all examples of

compounded sterile products

Which of the following does USP <797> NOT cover in its compounding standards?

antimicrobial stewardship

What document should you use to make sure you are following the most current standards for compounding sterile products?

USP Chapter <797>

By not following the policy and procedures for compounding sterile products, the pharmacy technician is at risk for causing

CSP contamination.

The lower the fractional number of particles, the lower the ISO Class number and

the better the air quality.

Which item should NOT be in the anteroom of the sterile compounding area?

direct compounding area

Who may be in the buffer room?

trained and garbed cleanroom personnel

Which of the following is a primary engineering control?

horizontal laminar airflow workbench

In the sterile cleanroom facility layout, the airflow is always

out of the high positive pressure buffer room.

What is the disadvantage of the segregated compounding area (SCA) used by smaller hospitals?

There is no wall between ante and buffer rooms.

What is the correct position for your hands during hand and forearm washing?

Hands pointed up

When do you have to repeat the hand washing process during your shift in the sterile compounding area?

every 30 minutes during batch CSP procedures & after any touch contamination

When do you don the sterile gloves?

in the buffer room after applying antimicrobial alcohol based rub.

What do you call it when a sample of the CSP is sent to a laboratory for detection of viable microbial contamination?

sterility testing

How often do the sterile compounding techniques of the IV pharmacy technician need to re-evaluated?

semi-annually

What is the smallest size contaminant that the HEPA filter traps to provide a sterile compounding work surface?

0.3 micrometers

In the act of compounding, what is created between the DCA and the compounding technician?

zone of turbulence

How do you avoid shadowing in the direct compounding area?

Lay supplies on the outer edge of the counter in the order they will be used.

In the compounding aseptic isolator, what direction is the airflow?

from top to bottom

What is used to clean the PECs?

All of the choices are correct.

You need to document the replacement of all PEC pre-filters every

30 days.

Who is responsible for doing the release testing?

IV-room pharmacist

What is a glove box used for in the pharmacy?

to compound sterile products in a isolator PEC

What is the piece of equipment that uses heat and pressure to sterilize medical instruments and supplies?

autoclave