HOSA: Sterile and Non-Sterile Compounding

Given when a medication is rendered inactive in the gastrointestinal tract or when a patient can't take medication orally

Parenteral Preparations

Must be sterile

Must be free from contamination

Must be free from visible particles

Should be isotonic

Should be chemically, physically and microbiologically stable

Must be compatible with IV delivery systems, diluents, and other co-administered drugs

Parenteral Products

Is the most effective way to eliminate disease transmission, be completely sterile and be free from microorganisms

Asepsis

The removal of pathogens by cleaning surfaces exposed to microorganisms. Hand hygiene is the most important method of preventing the spread of infection. Cleaning and sanitizing equipment and instruments are very important. Removes debris and blood so when instruments are sterilized, steam and heat can penetrate all surfaces of the instrument. Disinfection is cleaning surfaces via boiling or chemical disinfectants.

Medical Asepsis

Destruction of all microorganisms (both pathogenic and non-pathogenic) on object or instrument. Equipment is sterilized to avoid microorganisms entering patient's wounds during surgery. In pharmacies, a laminary airflow hood is used to measure sterility

Surgical Asepsis

Applies steam under pressure to instruments to kill microorganisms within 20 minutes

Autoclave

Uses heated dry air for 90 minutes to 3 hours. Requires special equipment when handling after.

Dry Heat Sterilization

Ethylene oxide is used to heat sensitive items

Gas Sterilization

Disinfectants (iodine, bleach, alcohol) are applied to the surface of the instrument for sterilization.

Chemical Sterilization

Equipment for sterile compounding

Administration sets

Ambulatory pumps

Ampule breakers

Ampules

Catheters

Clamps

Drip Chambers

Filters

Filter Needles

Filter Straws

Flexible Bags

Heparin Locks

Infusion Pumps

Laminar Airflow Hoods

Large Volume Parenterals

Male/Female Adapters

Minibags

Needles

Piggybacks

Sharps Container

Small Volume Parenterals

Spikes

Syringes

Syringe Caps

Tubing

Vials

Supplies for sterile compounding

0.225% sodium chloride

5% dextrose and 0.45% sodium chloride

70% isopropyl alcohol

Alcohol pads

10% dextrose in water

5% dextrose in water

Lactated Ringer's solution with 5% dextrose

Normal Saline Solution

Sterile Water for injection

Designed for handling equipment when a sterile working environment is required. The device uses a system of circulating filtered air in parallel flow planes. Horizontal airflow hood is used for the preparation of parenteral medication and sterile product mixtures. Vertical airflow hood is used for chemotherapeutic agents.

Laminar Airflow Hood

must be applied when handling parenteral products to prevent contamination.

Aseptic Technique

Compounding of parenteral products

Products can be easily contaminated so the following factors should be considered: Route of administration, Pharmacokinetics (rate of absorption), Solubility of the drugs (concentration), Stability of the drug (degradation). Total Parenteral Nutrition (TPN) is designed to meet the nutritional needs of the patient

Used for patients with gastrointestinal distress, poor nutrient absorption, those who cannot eat.

Preparing IV Piggyback

A vial of medication is added to IV medication by using a syringe to remove and inject contents into the IV bag

Large Volume Parenteral

You're able to deliver large quantities of electrolytes, chemotherapy, and other fluids. It's important that a pharmacist ensure stability, compatibility and safety of mixture. Water is used in these mixtures: Bacteriostatic water (antimicrobial agents) and sterile water (no antimicrobial agents).

Preparation of IV Mixtures

Consists of several sterile products added into IV fluid for administration. Mixed using aseptic technique. Accomplished by mixing in a laminar airflow hood

What chapter of the U.S. Pharmacopeia has set the standards for compounding, preparing, and labelling of sterile drug preparations?

Chapter 797

How is the beyond-use date calculated?

Date compounded to date administered

How many levels of risk contamination are there?

3 levels

What is the level 1 risk? (Risk, time at room temp, refrigerate for)

High, 24h, 3d

What is the level 2 risk?

Medium, 30h, 7d

What is the level 3 risk?

Low, 48h, 14d

What do compounding records include?

expiry dates/lot numbers/stability information/specific instructions for mixture