Tech Lectures For the Pharmacy Technician

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1 Tech Lectures For the Pharmacy Technician P.O. Box Denver, CO Lecture 29 - Importance of Aseptic Technique It is respectfully requested by the Author that no part of this Tech Lecture be reproduced or transmitted in any form, by any means without express written consent. Joe Medina CPhT, B.S Pharmacy Tech Lectures Copyright 2014

2 The Importance of Aseptic Technique In the Pharmacy setting the importance of Aseptic Technique, which is defined as the preparation and administration of a product without contaminating, it is vital to ensure patient safety. This section is based on some basic knowledge concerning infections in general. Aseptic Technique is just as important as having the correct medication prepared in the correct IV solution. The introduction of a contaminated IV in someone veins will prolong the patient's hospital stay and in some cases kill them. Microorganisms Microorganisms live all around us. They are found in and around our bodies, in the air we breathe, in the water we drink, and on almost anything we touch. Microoganisms include: Goals and Objectives The Pharmacy Technician will have a basic understanding of the following: 1. Aseptic Technique defined 2. Microorganisms 3. Disease Process 4. Body s Defense 5. Human Immunity 6. Stages of Contamination 7. Cycle of Infection, etc. 8. Terms used in this CE offering Viruses: smallest of infectious agents Bacteria: single celled organisms that reproduce quickly and major causes of disease Protozoans - single celled organisms found in soil and water. Most do NOT cause Disease Fungi - small multicullar organisms with complex cell structure. Most do not cause disease example: candida albicans Parasitic - multicellular organisms that live on or in another organism and cause disease

3 Why do we not get infections all of the time? 1. Majority of microorganisms are harmless or even beneficial 2. Pathogens comprise only a small number of microorganisms Less than 5% 3. Human body has a number of defense mechanisms First line - skin 2 nd line - immune system 4. Conditions must be favorable for a pathogen to grow and transmitted Disease Process An infectious disease is one that is caused by the action of a microorganism Begins: When the microorganism finds a host or body in which it can survive, multiply and thrive a. needs specific conditions - proper temperature F or 37 C - proper ph - as neutral as possible - moisture level - dark and moist Some pathogens nearly always cause disease, while others cause less often or only under certain circumstances Virulence: A microorganisms disease producing power How do microorganisms damage the body? 1. by depleting nutrients or other substances needed by normal cells 2. by mass reproduction outside or inside normal cells 3. by making body cells the targets of the body s own defenses 4. by producing toxins, or poisons, that damage normal cells Daily life constantly exposes us to pathogens, but we do have built in defenses

4 Immunity: The condition of being resistant to pathogens and diseases they cause Why would we become susceptible to pathogens? others 1. poor health 2. inadequate nutrition 3. poor hygiene habits 4. break in skin 5. specific drugs such as chemo or even antibiotics 6. Disorders of the immune system Opportunistic Infection: Infections caused due to a compromised immune system Body s Defense Normal flora: beneficial bacteria found in the body that creates a barrier against pathogens use up resources pathogens need to live or secrete substance that destroy them Intact Skin: First line of defense Skin Secretions: Tears, saliva, internal secretions such as cervical mucous, etc. Respiratory Tract: lined with cilia to expel foreign substances trapped in mucous Urine: washes out pathogens from bladder and urinary tract Intestinal Tract: contractions of smooth muscles Immune System: immediately begins to neutralize and destroy pathogens Involves other organs such as spleen, lymph nodes, tonsils, thymus, lungs, liver and Kidneys (act as filters). All of which contains lymphatic tissue which contains lymphocytes. Cell mediated defense Lymphocytes: specialized white blood cells that combat infectious agents

5 Phagocytosis : A form of non-specific defense when special white blood cells called Phagocytes engulf and digest pathogens. Phagocytes are a form of pus that go to sites of infection and engulf the pathogen. Two types of Phagocytes Neutrophils - move on their own and can act quickly to destroy pathogens Macrophages - known as monocytes in bloodstream are phagocytes while found In the lymph nodes, spleen, liver, lungs, bone marrow and connective tissue. Larger and slower moving than Neutrophils, but live longer Humoral Immunity Deals with first exposure to an antigen or pathogen Antibodies - highly specific proteins that attach themselves to foreign proteins This type of defense involves two types of lymphocytes: B cells and T cells When body is invaded by a foreign substance (antigen), helper T cells activate B cells to produce antibodies which combine with the antigens and neutralize them. Memory B cells: are produced to for the appropriate antibody Specific antibodies are produced in response to specific antigens. The formation of antibodies gives the body immunity from a particular disease. Immunity can either be natural, artificial, active or passive.

6 Immunity Active Immunity - body produces its own antibodies; provides long term immunity Passive Immunity - Antibodies produced outside the body; limited immunity Normal Active Immunity - results from exposure to pathogen Natural Passive Immunity - when mother passes antibodies form self to fetus Artificial Active Immunity - results from vaccination with weak or killed organisms Artificial Passive Immunity - results from immunization with antibodies to a disease causing organism Stages where Contamination may Occur in IV products 1. Intrinsic Contamination - during commercial manufacturing 2. Extrinsic Contamination - during hospital preparation of IV solutions

7 Candida Albicans Candida is a yeast and the most common cause of opportunistic mycoses worldwide. It is also a frequent colonizer of human skin and mucous membranes. Candida is a member of normal flora of skin, mouth, vagina, and stool. As well as being a pathogen and a colonizer, it is found in the environment, particularly on leaves, flowers, water, and soil. While most of the Candida spp. are mitosporic, some have known teleomorphic state and produce sexual spores. See the page on individual species for more detailed information on teleomorphic genera. Species The genus Candida includes around 154 species. Among these, six are most frequently isolated in human infections. While Candida albicans is the most abundant and significant species, Candida tropicalis, Candida glabrata, Candida parapsilosis, Candida krusei, and Candida lusitaniae are also isolated as causative agents of Candida infections. Importantly, there has been a recent increase in infections due to non-albicans Candida spp., such as Candida glabrata and Candida krusei Patients receiving fluconazole prophylaxis are particularly at risk of developing infections due to fluconazole-resistant Candida krusei and Candida glabrata strains. Nevertheless, the diversity of Candida spp. that are encountered in infections is expanding and the emergence of other species that were rarely in play in the past is now likely Pathogenicity and Clinical Significance Infections caused by Candida spp. are in general referred to as candidiasis. The clinical spectrum of candidiasis is extremely diverse. Almost any organ or system in the body can be affected. Candidiasis may be superficial and local or deep-seated and disseminated. Disseminated infections arise from hematogenous spread from the primarily infected locus. Candida albicans is the most pathogenic and most commonly encountered species among all. Its ability to adhere to host tissues, produce secretory aspartyl proteases and phospholipase enzymes, and transform from yeast to hyphal phase are the major determinants of its pathogenicity. Several host factors predispose to candidiasis Candidiasis is mostly an endogenous infection, arising from overgrowth of the fungus inhabiting in the normal flora. However, it may occasionally be acquired from exogenous sources (such as catheters or prosthetic devices) [or by person-to-person transmission (such as oral candidiasis in neonates of mothers with vaginal candidiasis or endophthalmitis following corneal transplantation from an infected donor)

8 Cycle of Infection Five elements must be present for infection to occur: Reservoir Host An animal, insect or human whose body is susceptible to growth of pathogen Human carrier: host unaware they carry pathogen or disease causing microorganizm Asymptomatic Disease capable of spreading Subclinical case: host still unaware they carry pathogen Slightly symptomatic Disease capable of spreading Two types: Endogenous Infection: for some reason a normal healthy microganism has become pathogenic within the body Exogenous infection: introduction of pathogen from outside the body Means of Exit To continue cycle of infection, a pathogen must be able to exit from reservoir host a. through nose, mouth, eyes or ears b. feces or urine c. semen, vaginal fluid, or other discharges from reproductive tract d. open wounds

9 Means of Transmission To reproduce after it has exited from the reservoir host, the pathogen must spread to another host by some means of transmission This may be direct or indirect: Direct Transmission: moves immediately from one host to another generally by contact Indirect Transmission: only possible if pathogen can live independently from reservoir host can occur by: Vectors - living organisms such as insects that carry microorganisms from infected person to another person example: west nile virus Fomites - or inanimate objects Examples: clothing, body fluids, water, food or even your hands Droplets - expelled from the air by sneezing, courghing, speaking or even breathing Airborne Transmission Pathogens may enter the respiratory tract of a new host by inhalation Example: respiratory infections, influenza Pathogens may be inhaled from a variety of sources Examples: Secretion droplets - chicken pox, influenza soil particles - fungal diseases can lead to epidemics

10 Blood Borne Transmission Through contact with blood or blood borne products Direct: contaminated blood enters broken skin Indirectly: needle sticks, improper sterilized equipment, blood transfusions Hemophilia - factor 8 Ingested Transmission Ingestion of contaminated food or liquids Food can be contaminated when it is handled by infected individuals who has poor hygiene habits examples: Escherichia coli bacteria E Coli Transmission by Touching Giardia lamblia intestinal parasite (usually water) Causes severe diarrhea, gas, weight loss and fatigue Stay away from water in foreign countries Just touching someone can lead to transmission Examples: touching of hands Kissing Sharing drinking glass or lipstick Contact with mucous membranes a. sexually transmitted diseases ex) herpes, genital warts, skin warts The Hampstead Station Diner was forced to close by the DHHS in early July after food and safety coordinators deemed the restaurant unsanitary owing to the presence of rodent droppings, two dead mice found in an unused sink, and other health code violations which included non-mandatory hand washing by staff.

11 Means of Entrance Just as a pathogen needs a means of exit, it also needs a means of entrance Pathogens can enter a new host through any cavity lined with mucous membranes: Example: mouth, nose, throat, vagina, rectum They can also enter through the ears, eyes, intestinal tract, urinary tract, reproductive tract, or breaks in the skin Susceptible Host The host must not have any immunity to infection by this organism Dependent on: a. Age b. Genetic predisposition to certain illnesses c. Nutritional status d. Other diseases that may be involved e. Stress levels f. Hygiene habits g. General health Immuno Compromised: chemo pts, sickle cell, smokers Other factors: h. number of pathogens i. virulence - ability to cause disease j. point of entry blood most dangerous stomach less dangerous Doodle Space

12 Environmental Factors in Disease Transmission Disease transmission is dependent on environmental factors such as climate, food, water, animals, insects and people. Generally in higher density areas, infection rates is higher than in low density areas due to close proximity. Animals play a role in infection: Examples: unpasteurized milk Insects play a role in infection Environments that allow certain insect populations to thrive Examples: mosquito - malaria Ticks - Rocky Mountain Spotted Fever Economic and political factors involving the cleanliness of specific areas also plays a role Breaking the Cycle Asepsis - condition where pathogens are absent or controlled Your role as an IV Technician should include a. Keeping work area clean b. adhering to government guidelines c. using Aseptic Technique

13 One way to implement good asepsis is to simply Hand wash What constitutes a "good" hand washing? A thorough hand washing consists of the following steps which should last approximately 1-2 full minutes: 1. Wet both hands and forearms with warm water. 2. Apply a generous amount of disinfecting soap in the palm of one hand; chlorhexadine scrub and povidone-iodine scrub are excellent examples. 3. Using a vigorous motion, scrub each side of the hand, between the fingers and at least halfway up the arm. Be sure to wash under any rings. 4. If there is debris under the fingernails, use a hard plastic pick or stuff brush to remove the material while the soap is still on the hands. 5. Rinse both hands thoroughly with warm or tepid water. 6. Dry both hands and arms with a towel or air dryer because moisture will attract more microorganisms from the air. Since running water is not always available a tube of sanitizing cream or wet-wipes should be used. This is not a substitute for hand washing, but a great interim step until you get to a place with a suitable sink.

14 Lecture 29 - Importance of Aseptic Technique True or False 1 If there is any question about whether a sterile product such as an IV is contaminated or not, consider the object contaminated 2 Majority of microorganisms are harmless or even beneficial 3 Daily life constantly exposes us to pathogens, but we do have built in defenses 4 A patient in a hospital setting is easily susceptible to pathogens 5 The most important aseptic procedure for a pharmacy tech is hand washing 6 A contaminated IV can lead to a longer hospital stay for the patient and even death 7 A community acquired infection is also known as an nosocomial infection 8 Example of one being admitted to the hospital would be for food poisoning 9 Intrinsic contamination of an IV Admixture may occur during hospital preparation 10 Candida is the most common opportunistic infection 11 An example of an endogenous infection would be from an IV admixture 12 Indirect Transmission such as "droplets" can lead to IV contamination 13 Skin is the best defense against pathogens 14 The need for aseptic technique can never be overstated 15 An example of an immuno compromised patient would be a smoker 16 A subclinical case is a severe infection with all manifestations present 17 Asepsis is the condition where pathogens are absent or controlled 18 A carrier exhibits symptoms of infection 19 Pathogens can enter the body easily by IV Administration Go to the following link to input / send your answers via to Tech Lectures