Wk 3: Cleaning

cleaning of sterile compounding environments

-logs are required for these cleanings to ensure compliance

-if items are in hazardous compounding area, the cleaning agent must also have deactivating activity

cleaning agent properties

-cleaning agents will be specific to the facility

-need to be approved by infection control

-products are selected based on:

->contact time

->spectrum of coverage

->active ingredient

->safety to personnel and equipment

->residue

->EPA registration

->available in sterile form: cleaning of PEC must be done w/ sterile items only

->trends of growth in environment

cleaning

-an agent, usually containing a surfactant used for the removal of substances (dirt, debris, microbes, residual drugs or chemicals) from surfaces

disinfectant

-chemical or physical agent used on inanimate surfaces and objects to destroy fungi, viruses, bacteria

sporicidal

-chemical or physical agent that destroys bacterial and fungal spores when used at a sufficient concentration for a specified contact time

-expected to kill all vegetative microorganisms

cleaning agents

-sterile water: breaks up contamination

-sterile 70% IPA: disinfects bacteria

->double bag packaging means bottle is sterile

->open first bag when bringing across line of demarcation and then second bag once in hood (stays in hood)

-germicidal agent: disinfects w/ wider coverage of bacteria

-sporicidal agent: mold and fungal converge

cleaning agent sterility

-cleaning, disinfecting, and sporicidal agents used within the PEC as well as supplies must be sterile

-cannot put body/exposed skin inside hood to reach far spaces: obtain a mop head/wand

->must be cleaned and disinfected before and after each use

->reusable cleaning tools must be dedicated for use in classified areas

-once opened, sterile cleaning and disinfecting agents and supplies and sterile 70% IPA may be reused for a time period specified by the manufacturer

-eliminate spray bottles as they are not permitted for use in the PEC

basic cleaning principles

-work from cleanest to dirtiest and top to bottom to prevent introduction of contamination during cleaning process

-turn lint-free wipe to clean surface frequently

->to reduce spread of contamination and inc effectiveness

->must be lint free

-work in one direction using linear overlapping strokes

->to ensure thorough and complete coverage

-entire surface must be wetted w/ cleaning agent

->to facilitate removal of dirt and particles and chemical contact w/ surface

-tools such as mops, wands, etc must be non-shedding, dedicated, and disposable

cleaning of controlled environment

-everything in controlled environment beyond line of demarcation must be cleaned

-use detailed cleaning logs: where to clean, what to use, contact time, when to clean

-particle generating items are not permitted in controlled environment

->brown cardboard is not only high particle generating, but carries bacteria and spores

->shelving prone to dust and external box of medications contaminate storage areas (anything w/ 90 degree angle)

-special attention to high touch areas, ex incl: handles of doors, cart hand rails, drawer hand grip, computer keyboards or touchscreens, refrigerator door handles, accessories for compounding/IV tech

cleaning of items for compounding

-wrappers of packing and boxes for med vials are very dirty

->cause of contamination and particle production

->cardboard boxes are not permitted anywhere in the clean room

-all items are wiped TWICE before item is used for aseptic technique

-1. all items must be wipes w/ sporicidal disinfectant, disinfectant, or sterile 70% IPA when being brough into the controlled environment for storage (all items must be wiped down when crossing the line of demarcation)

2. all items must be wiped w/ disinfectant agent (sterile IPA) when being brought into compounding hood

cleaning compounding hoods

-goal is to drag contamination out of hood

-all cleaning agents must be sterile and remain in the hood

-use sterile, lint-free or low lint cloths to clean the hood

-full compounding garb is required when performing cleaning activities

-be careful on the light and HEPA filter

-use of spray applicator is not permitted directly into hood: pre-saturated wipes or apply cleaning agent to wipe to apply the cleaning agent to the compounding hood

-you cannot have your body inside the hood -> no exposed skin can be present

-USP says to disinfect at least every 30 minutes

->best practice: disinfect work surface of the hood before and after each manipulation

-reminder: items that are 1) not sterile or 2) have not been sterilized cannot be placed inside the compounding hood

folding the lint free towel

-fold the lint free paper towel in half and then half again (fold twice)

-must use a clean part of the towel w/ each new surface or the hood

->minimizes contaminating other areas of the hood

cleaning Laminar (horizontal) flow hood

Cleaning the LAFW at the beginning of each shift:

1. collect lint/ free wipes and disinfectant

2. adequately saturate wipe w/ disinfectant and wipe all interior surfaces on LAFW

->order: ceiling ->back wall -> rod -> sides -> bottom

3. ceiling (be careful of light); direction left to right and back to front

4. back of hood/HEPA filter grate: direction left to right and top to bottom

5. bar and hooks (incl cups bar sits in)

6. side of hood: direction up and down, back to front

7. any items on the work surface area/deck (remove to clean work surface area/deck in step 8)

8. work surface area/deck: direction moving side to side, back to front

9. collect lint free wipes and sterile water for injection (SWFI)

10. adequately saturate the wipe w/ SWFI and wipe all interior surfaces on the LAFW in the order of steps 3 to 8

cleaning the hoods

1. ceiling

2. back wall (HEPA grate): top to bottom, side to side

3. rod and hooks

4. sides: back to front, up and down

5. bottom

cleaning compounding aseptic isolator

1. get wipe

2. saturate wipe and wipe in correct order

-ceiling -> back of hood -> bar and hooks -> sides of hood -> inside surface of glass view screen -> work surface area/deck -> gauntlet gloves (while arms inside, wipe out of gloves)

3. collect lint free wipes and sterile water for injections (SWFI)

4. adequately saturate the wipe w/ SWFI and wipe all interior surfaces on the CAI in teh order of steps 3-10

5. adequately saturate the wipe w/ disinfectant and wipe all interior surfaces of antechamber allowing rec contact time

6. adequately saturate wipe w/ IPA and wipe all surfaces

-do not forget to clean the pass through on each shift!!

additional requirements for compounding aseptic isolators

-each shift gloves and sleeves need to be inspected and cleaned

-when detailed cleaning w/ bleach/sporicidal agent is done, isolator must be turned off when opened

->must run for 30 min before resuming compounding activities

-an isolator mini mop can be used to each difficult places

-compounding garb must be worn when cleaning isolator

cleaning biological safety cabinet

1. get wipe and deactivating agent

2. saturate wipe and wipe in correct order

-ceiling/HEPA filter -> back of hood -> bar and hooks -> sides ->inside surface of glass view screen -> work surface area/deck

3. adequately wipe all interior surface in BSC w/ IPA in same order