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Infections > Aseptic techniques > Flashcards

Aseptic techniques Flashcards

1
Q

What is the crucial difference between disinfectant and asepsis?

A

Disinfectant is removing pathogens from the surface of objects found in a hospital (disinfecting syringes) whereas asepsis is destroying or inhibiting pathogens on living tissue which may cause a disease.

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2
Q

Define aseptic.

A

The procedure of preventing the transfer of micro-organisms from one location to another.

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3
Q

Give four examples of parenatal preparations.

A

Implants
Gel for injections
Infusions
Injections

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4
Q

Can you test for sterility?

A

No, it has to be assured by following a validated production process.

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5
Q

What process do you follow to ensure sterility?

A

Aseptic preparation (procedure of preventing the transfer of micro-organisms from the environment to the parental equipment).

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6
Q

Is it required to remove all micro-organisms in the disinfectant stage?

A

No, BP states it must be under a certain level, which can be achieved by using disinfectant which have different strengths (levels).

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7
Q

What can low level chemical disinfectants destroy?

A

Most vegetative bacteria and some fungi and viruses.

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8
Q

What can high level disinfectant destroy but medium level can’t?

A

They have sporicidal activity

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9
Q

What are the function of antiseptics?

A

They are bacteriostatic agents and by breaking down the word, prevent sepsis. They have anti-microbial activity and therefore are normally used to apply to skin before surgery to reduce microbial population.

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10
Q

Why is cleaning and disinfectant essential in clinical environments?

A

Patient may be at risk
No time to test the products
Products may be good for microbial growth

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11
Q

What are the extra risks of using parenatal preparations?

A

If the products are not sterile the bacterium will be injected straight into the bloodstream. There is no mucosal barrier to try and defend against the bacteria.

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12
Q

What results in the presence of particulates and presence of microbes?

A

Particulate presence: capillary granuloma,
phlebitis, pulmonary emboli

Presence of Microbes: infection, sepsis or death

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13
Q

What are the five sources of antimicrobial contamination?

A

Water
Raw material
Personnel
Equipment
Surfaces

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14
Q

What are the four methods of reducing the risk of bacteria and particulates?

A

Clean air technology/ laminar flow hood
Preventing contamination from operators (hand washing and sterile equipment)
Stopping contamination from products and surfaces
Categorizing bacterium and the corresponding safety cupboards

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15
Q

Which type of bacterium is kept only in a Class 3 safety cabinet?

A

Bacterium that poses a real danger to human life and no vaccine or antibiotics are available for it.

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16
Q

Typical organisms stored in a Class 1 or 3 safety cabinet?

A

HIV, rabies, typhoid, diptheria

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17
Q

When would bacteria be considered safe to store on an open bench?

A

If they pose no risk to human life or if it is unlikely to spread in the community.

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18
Q

Describe Class 1 safety cabinets.

A

They provide operator protection by means of a constant air inflow through the open front working aperture, which prevents escape of airborne particulate contamination from the cabinet. The cabinet itself is normally a steel structure with a front-visor with 5mm toughened glass panel.

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19
Q

Describe Class 2 safety cabinets.

A

Just like class 1 safety cabinets they also have an inward flow of air which prevents the escape of airborne particles. However it protects the person and product by a HEPA filter which draws the air onto the surface pushing air away.

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20
Q

Describe Class 2 safety cabinets.

A

Just like class 1 safety cabinets they also have an inward flow of air which prevents the escape of airborne particles. However it protects the person and product by a HEPA filter which draws the air onto the surface pushing air away.

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21
Q

Describe Class 3 safety cabinets.

A

Same as Class 2 mechanism but this time is double HEPA filtered.

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22
Q

What is the wet cleaning method?

A

Usually requires a sterile mop and use a three bucket system.
Bucket 1: water for rinsing dirty mop
Bucket 2: rinse water for second rinse
Bucket 3: disinfectant solution

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23
Q

Describe how you would clean inside a laminar hood.

A

Always start cleaning from back to front

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24
Q

List some antimicrobial agents.

A

Alcohol
Peroxygens
Aldehydes
Phenols
Halogens
Heavy metals

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25
Q

What properties of chemical disinfectants have to be considered?

A

The pH of the solution
Temperature at which it is stored
Formulation

Will it cause tissue toxicity?

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26
Q

What is bioburden?

A

The number of bacteria living on a surface that has not been sterilized

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27
Q

If a sample bacteria has a high bioburden how would this affect your choice of chemical agent?

A

You would need a reactant that has long exposure or high concentration

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28
Q

Is gram positive or gram negative bacterium more resistant to disinfectants?

A

Gram negative bacterium

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29
Q

What are types of resistant bacterium to disinfectants?

A

Pseudomonas aeruginosa is the most resistant type and types of mycobacterium

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30
Q

How does resistance to disinfectants occur?

A

Intrinsic due to reduced cellular permeability or acquired due to mutation or acquisition of plasmids.

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31
Q

Where does the greatest risk of bacteria spread come from?

A

Undiagnosed patients with an infection that could be carrying harmful bacterium, ensure equipment is sterilized after use.

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32
Q

Which antimicrobial agents are effective against bacteria spores?

A

Aldehydes, halides and peroxygens compounds

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33
Q

Is fungal or bacteria spores more resistant to disinfectants?

A

Bacteria spores

34
Q

Which type of viruses are most resistant to antimicrobial agents?

A

Non-enveloped viruses such as rotaviruses, picornaviruses and adenoviruses.

Hepatitis and HIV are quite resistant to antimicrobial agents, it is essential that any traces of the pathogen are removed to stop any potential spread.

35
Q

What level antimicrobial agent is used in patient settings?

A

Intermediate level

36
Q

What is Creutzfeldt Jakob disease?

A

A prion causing disease which results in infections in the eye, brain and spinal cord. It is caused by bovine spongiform encephalopathy (BSE) in cattle.

37
Q

Are prions resistant to disinfectants?

A

Most techniques yes however the WHO suggests a formula of 0.3% NaOH & 0.2% sodium dodecyl sulphate (SLS) in 20% npropanol showed potent effect

38
Q

What precautions should be taken when using glutaraldehyde as an antimicrobial agent and why?

A

It is quite a toxic substance and therefore should use face protection and gloves as it can cause irritation to the eyes and skin and induce respiratory distress.

39
Q

Why is considering the application of formulation important?

A

Preservative formulation may be antagonized by ingredients.

40
Q

How does organic matter affect antimicrobial activity?

A

It affects activity by reducing the concentration through adsorption or inactivation.

41
Q

Which common fluids affect the antimicrobial activity?

A

Pus, body fluids, milk, blood and food residues decrease the efficiency of antimicrobial activity.

42
Q

What are some examples of organisms specific to certain environments?

A

Legionella in cooling towers and non-potable water supply systems, Listeria in the dairy
and food industry and HBV in blood-contaminated articles

43
Q

What concentration of aliphatic alcohols must be used for disinfectant?

A

Above 50%

44
Q

Which types of bacterium is aliphatic alcohols effective against?

A

Vegetative bacteria and mycobacterium but it is not sporicidial

45
Q

What is required in alcohol preparations?

A

Water must be present

46
Q

What are the different concentrations of ethanol used for?

A

69-95% are bactericidal and 70% for disinfecting the skin. Higher concentration (e.g. 90%) virucidal including
HIV & fungi.

47
Q

How does isospropyl chloride compare to ethanol?

A

Less virucidial but more bactericidial activity

48
Q

What are some of the advantages and disadvantages of phenols?

A

Have good antimicrobial activity and are bactericidial

Not effective against spores.
Systemic toxicity
Caustic effect on the skin

49
Q

How can you tell by the structure if a phenol is less toxic?

A

More substituted = less toxic

50
Q

What activity does bisphenols have?

A

Effective against Gram positive and Gram negative but inactivate against Pseudomonas

51
Q

List four properties of Glutaraldehyde.

A

Wide range of activity
Not inactivated by organic matter
Used to clean instruments e.g. endoscopes
Should be in a closed system so not for benches etc, so not a first choice for pharmacies

52
Q

How do you prepare a formaldehyde preparation?

A

You either take a liquid formalin aqueous solution or a solid polymer paraformaldehyde. By heating the substance this liberates the gas.

53
Q

What are formaldehyde used for?

A

Decontamination of fume cabinets, isolators and rooms.

54
Q

What are some of the limitations of formaldehydes?

A

Irritant to the skin, vapours are highly toxic, the solution has poor penetration and tends to polymerize on the surface which limits their pharmaceutical use.

55
Q

Describe the activity of Biguanides.

A

Effective against gram positive bacterium but a higher concentration is needed against Gram negative. Not effective against spores or Mycobacteria.

56
Q

Where in industry is Polyhexamethylene biguanide used?

A

It is used in eye drops for eyes affected by Acanthamoeba keratitis.

57
Q

What bacterium does polyhexamethylene biguanide shown to have good activity aganist?

A

Gram positive and gram negative including Pseudomonas. Other specific bacterium includes E. coli, staphylococcus aureus and candida albicans.

58
Q

What are some of the uses of hydrogen peroxide?

A

Antiseptic for open wounds
Vapour-phase is used for decontamination of lab equipment

59
Q

What are some of the uses of peracetic acid?

A

It can be used in both the liquid and vapour phases and is active in the
presence of organic matter. At concentrations of 0.2-0.35% used as a
Chemosterilant of medical equipment (endoscopes).
Combination of hydrogen peroxide & peracetic acid is synergistic & is
marketed as cold sterilant for dialysis machine

60
Q

What is a disadvantage of peracetic acid?

A

Disadvantage: corrosive to some metals, highly irritant and must be used in
an enclosed system.

61
Q

How are micro-organisms in the atmosphere monitored?

A

Settle plates and air sampler

62
Q

What are the three broad types of environmental monitoring?

A

Physical (dust, fibres, light)
Chemical (vapor, fumes, smoke)
Biological (skin cells, fungi, bacterium)

63
Q

Define a Grade A manufacturing environment.

A

It is a local zone with high risk operations. For example if you were doing aspetic filling or product filling you would use this zone or handling sterile materials.

64
Q

Define a Grade B manufacturing environment.

A

Background environment for Grade A zone, e.g. cleanroom in which laminar
flow workstation is housed

65
Q

Define a Grade C manufacturing environment.

A

Clean area for carrying out less critical stages in manufacture of aseptically
prepared products e.g. preparation of solutions to be filter sterilised.

66
Q

Define a Grade D manufacturing environment.

A

Clean area for carrying out less critical stages in manufacture of aseptically
prepared products e.g. handling of components after washing.

67
Q

How are each of the four grades defined?

A

By their level of airborne contamination. Defined in the orange guide of the accepted level.

68
Q

What is a monitoring plan?

A

Check the orange guide, test at least 3 times monthly. Take counts in several areas.

69
Q

What is non-compliance to standards usually due to?

A

HEPA filter failure
§ Poor cleaning (dust swirling around)
§ Air flows failing to flush rooms effectively
§ Excessive activity when occupied

70
Q

How does terminally sterilised products differ from aseptically sterilised products?

A

Terminally sterilised products: product made completely backed into a container and then finally sterilised, prepared in Grades C-D.
Aseptic sterilised products are sterilised individually and then added together, grades C and then A

71
Q

What are HEPA filters tested for and how?

A

Using the generation upstream of dioctylphthalate and then detect dimensions of particles in the downstream filtered air. Retention efficiency is recorded as % of particles removed under defined
test conditions. Significant loss of particles indicate holes in the unit.

72
Q

What does positive pressure mean?

A

The area inside the critical zone is higher than that of the adjacent area or surrounding rooms. To prevent flow of particles into the critical zone.

73
Q

How are sterility tests taken?

A

Take swabs and place with a universal media that will support the growth of bacteria and incubate it and the bacteria will grow if present.

74
Q

What are examples of the microbiological monitoring programmes?

A

Finger Dabs.
ØSettle plates.
ØSurface samples – contact plates/swabs.
ØActive air samples.

75
Q

How does active air sampling work?

A

Air is sucked into machine forcing bacterium onto agar sheets

76
Q

How often should you do finger dabs on the critical zone or clean room suite?

A

Every session for finger dabs (after session before cleaning) for the critical zone, not applicable for clean room.

77
Q

How often should you do settle plates on the critical zone or clean room suite?

A

Every session for finger dabs (after session before cleaning) for the critical zone, weekly for clean room suite.

78
Q

How often should you do surface samples on the critical zone or clean room suite?

A

Weekly for both

79
Q

How often should you do active air samplers on the critical zone or clean room suite?

A

Three times a month for both

80
Q

Describe how to take finger swabs.

A

Fingers/thumbs of both hands can be gently pressed onto the surface of a
settle plate and then incubated in the normal way.
Standard TSA settle plates are used.
Operator lifts lid inside LAF cabinet or Isolator and gently touches all 10
fingers onto surface such that there is no overlap.
The most appropriate stage to sample is at the end of a session.
The plates are cultured as for settle plates, colonies should coincide with the
finger dab area

81
Q

How do you collect settle plates?

A

Leave them exposed for 4 hours then incubate and count colonies.

82
Q

How do you collect contact plates?

A

The plates used are Petri dishes brim full of TSA.
§ They are smaller than normal settle plates (55mm) diameter.
§ The surface agar is gently pressed onto the surface for typically 2-4 secs.
§ The plates are incubated as normal.
§ Calculate cfu/plate

Infections (16 decks)

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