ROGO Flashcards
General considerations for a clean room
- Logical layout
-
Airflow + air supply
- Clean room tech. founded upon use of high efficiency particulate air (HEPA) filters
- HEPA filters remove 99.9997% of particles 0.3 micrometres or larger
- HEPA filtered provides products with protection from airborne contaminants by contnuously sweeping away ‘personnel derived’ particulates from the immediate work area using laminar airflow
-
Surfaces
- Smooth flat + impervious to minimise reservoirs/traps for particulates + microorganisms
- Junctions between walls + ceiling should be seamless + windowsills should be avoided
- Ease of cleaning + disinfection
Personnel Training
- Good personal hygiene
- Clothing
- Personal protective equipment
- Good aseptic technique + good manufacturing practice
- Movement within manufacturing area
Terminal Sterilisation
Sterilisation is the last step in the manufacturing process once the product is sealed within final container
Aseptic Processing
Procedure in which the medicine, container and closure are sterilised separately the combined together to give the final product
- Risk of microbial contamination > when products are terminally sterilised
- Aseptic technique used in manufacturing products which are terminally sterilised to maintain a low level of contamination in the beginning stages of production
What are the main sources of contamination?
- Personnel
- Air in surrounding environment
What are clean rooms?
Controlled environments where parameters (e.g. airflow, microbial + particculate quality of air, equipment surfaces, room surfaces, + personnel) are all monitored + must meet all specific requirements.
Why is it important to specify brand of Amphotericin B used?
Dosage recommendations differ between brands due to differences in their pharmacodynamics + pharmacokinetics
What is a common cause of morbidity + mortality in cancer patients?
Systemic fungal infections especially those with chemotherapy induced neutropenia
Molecular target of AmBisome
Ergosterol (a component of fungal membranes)
- Binding of amphotericin to ergosterol causes fungal cell death by induing pores to form, leading to increased membrane permeability
How can we prevent an allergic reaction prior to giving Amphotericin-containing products (including AmBisome)?
Administer a test dose of 1 mg over 10 minutes before treatment
How do we avoid dosage miscalculations for amphotericin B?
BNF states to state brand dispensed
AmBisome may not fully dissolve.
How do we prevent large particles entering IV bag?
Using a 5 micrometre needle to transfer contents
What is AmBisome composed of?
Each vial contains:
- 50 mg of amphotericin (50,000 units) encapsulated in liposomes
- 900 mg Sucrose
How sould AmBisome be administered?
IV infusion over 30-60 minute period
What is the recommended AmBisome IV concentration infusion?
0.20 mg/ml to 2.00 mg/ml
Daily dose of AmBisome
3.0 mg/kg of body weight + increased stepwise to 5.0 mg/kg
What is AmBisome compatible with?
- Water for Injections
- 5% Glucose
What is AmBisome incompatible with?
- Saline solutions
- Drugs
- Electrolytes
What is used to transfer AmBisome into a sterile container with Glucose?
5 micrometre filter needle
(to filter out particles not bacteria)
What can cause precipitation of AmBisome
- Other solutions
- Bacteriostatic agent
An in-line membrane filter is used for the IV infusion of AmBisome.
What should the mean pore diameter be?
The mean pore diameter of the filter should not be less than 1.0 micrometres
How do we flush the IV line?
An existing IV line is flushed with 5% Glucose prior to infusion of AmBisome
When is it good practice NOT to dispose needles + syringes together?
Where a syringe has to have needle removed when attaching a transfer device or a filter then needle has to be carefully re-sheathed
What is the shelf life of AmBisome after reconstitution?
Glass vials + propylene syringes up to 7 dyas at 2-8 degrees celsius
When is a hypodermic needle used?
A syringe to inject medication into the body or as part of a procedure for making meds in a SPU
Difference between Luer-slip + Luer lock?
Luer slip - needle slips on + off syringe
Luer-lock - needle = screwed + locked onto syringe to create a leak-free seal
What fitting do most SPUs have?
Luer-lock
How many times can you use mos needles?
Single use
How can you maintain needle sterility?
Protective packaging
Use-by dates
Batch/lot numbers
Aseptic technique
Safe use of needles to avoid accidents
Fit needle onto syringe whilst it is still in its sheath
Unsheath + resheath using NeedleSafe
Keep hand benhind needle tip @ all times
Minimise handling, do not pass needle from hand to hand
Used needles must be placed into sharps bin
What are Needle Stick injuries?
Skin punctures caused by hypodermic needles
What is the no touch technique?
Never to touch any critical site when making a sterile product
What is a critical site?
Any part of a sterile product/equipment used in its preparation that must remain sterile to prevent contamination of the final product
Quality control system for Aseptic Dispensing
Operator Training
Standard operating procedures
Environmental monitoring
Broth transfer tests
How many decimal places is it appropriate to work with?
3
No trailing zeros
Rate what movement has the highest no. of particles dispersed/min from lowest
- Sitting still (100k particles/min)
- Gentle movement of arms, hand + head (500k particles/min)
- Active movement of arms, hands + head (1 million/min)
- Change from sitting to standing/reverse (2.5 million/min)
- Walking (10 million/min)
When prepaing cytotoxic chemotherapy, which helps prevent operator exposure?
Negative pressure hoods
Full length suits when using open devices
Double gloving with nitrile rubber gloves
Chemotherapy never produced on an open bench
What is sterility?
Absence of viable microorganisms
Sterility of a product cannot be guaranteed by testing.
How can we be assured of sterility?
Application of a suitably validated production process
Principles of GMP
- Qualified personnel with appropriate training
- Adequate premises
- Suitable production equipment, designed for easy cleaning + sterilisation
- Adequate precautions to minimise the bioburden prior to sterilisation
- Validated procedures for all critical production steps
- Environmental monitoring + in-process testing procedures
Methods of terminal sterilisation
Steam
Dry heat
Ionising radiation
What is the nominal pore size of a bacteria-retentive membrane?
0.22 micrometres or less
How is solute loss during filtration?
Adsorption on to the filter
Why is sterilisation by filtration used?
For solutions/liquids not stable enough to withstand terminal sterilisation by autoclaving (e.g. products which are thermo-labile)
Not a terminal sterilisation method
Why is filtration not a terminal sterilisation method?
It is followed by aseptic transfer of the sterilised solution into the final container which is then sealed
Why is filtration different from other methods of sterilisation?
Process physically removes microorganisms
Major mechanisms of filtration
- Sieving particles out that are larger than the pore size
- Adsorption
- Deposition in the filter bed
- Retention in capillary films within the filter bed
Factors to consider when choosing a filter
- Pore size - a pore size of 0.2 micrometres or less
- Inertness - filter does not shed fibres into the product during filtration. Filter should not leach chemical substances into the product.
- Flow rate - adequate flow rate achieved
What are the 2 main types of filter types?
- Depth filters
- Membrane filters
What is the preferred type of filtration?
Membrane filters
Made from cellulose esters (or other polymers)
Membrane filters have a low dirt handling capacity. (e.g. easily clogged by particles just larger than their pore diameter)
How can we extend its working life?
Using a prefilter decreases blockage of final filter
How can we reduce particulate contamination?
Pre-filtered water is used
Polarised light viewer/strong light with the naked eye can check for particles in pre-filtered water
What is laminar airflow?
Movement of air within confined boundaries @ uniform velocity + along parallel flow lines
What do we use to filter air supply?
HEPA filters
Continuous unidirectional flow of filtered air sweeps away any airborne contaminants generated by operator during manipulations within cabinet
How can the air be displaced?
Horizontal
Vertical
What happens of airflow is physically obstructed?
Cause downstream turbulence
This increases risk of product contamination
Rate how much saliva travels when:
- talking
- coughing
- sneezing
Talking = 2-3 feet
Coughing = 4-6 feet
Sneezing = 10-15 feet
Assess operator’s aseptic technique
Universal operator broth transfer tests
Finger dabs