Aseptic Operation and Environment

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Questions and Answers

Considering the limitations of absolute sterility, what does a Sterility Assurance Level (SAL) of $10^{-6}$ truly represent?

  • Confirmation that all infectious matter has been completely destroyed in a batch of 1,000,000 sterilized items.
  • The probability of a single non-sterile unit existing within a batch of 1,000,000 units subjected to sterilization. (correct)
  • An absolute certainty that every unit in a batch of 1,000,000 items is completely free from viable microorganisms.
  • A guarantee that no more than one microorganism is present in a batch of 1,000,000 sterilized items.

For a novel injectable drug intended for patients with compromised immune systems, what SAL would be most appropriate, and why?

  • SAL of $10^{-1}$, because the drug goes through a comprehensive sterilization process.
  • SAL of $10^{-3}$, due to the lower risk associated with topical applications.
  • Any SAL is acceptable as long as the product is filtered through a 0.2-micron filter.
  • SAL of $10^{-6}$ or higher as it reduces the chance of infection. (correct)

How does current Good Manufacturing Practice (cGMP) guidelines address limitations in detecting all microorganisms when manufacturing sterile products?

  • By mandating a complete sterility test on the final product, thereby ensuring no microorganisms are present.
  • By requiring manufacturers to focus on process validation and environmental controls to minimize contamination risks. (correct)
  • By focusing solely on the mathematical guarantee of sterility, regardless of actual contamination.
  • By allowing a certain percentage of microorganisms in the final product, acknowledging detection limitations.

In the context of aseptic processing, how do the regulatory guidelines such as those from the European Medicines Agency (EMA) define aseptic processing relative to terminal sterilization?

<p>Aseptic processing is defined as a method that should be used only as a last resort. (B)</p> Signup and view all the answers

What implications arise when a product labeled as 'sterile' is found to be contaminated with viable microorganisms?

<p>A potential scenario where the contamination leads to product recall, potential life-threatening infections, and product spoilage. (A)</p> Signup and view all the answers

How would you interpret the statement 'Sterility of the product cannot be guaranteed mathematically or practically'?

<p>Despite rigorous processes, there are inherent limitations in ensuring a product is completely free of microorganisms. (B)</p> Signup and view all the answers

What is the central goal and implication of utilizing aseptic technique in pharmaceutical preparations?

<p>To maintain contamination at levels that present minimal risk. Aseptic technique cannot guarantee absolute sterility. (A)</p> Signup and view all the answers

Considering the data collected by the UK National Aseptic Error Reporting Scheme (NAERS), what is the most frequent type of error recorded in pharmacy compounding, and what actions could have reduced these errors?

<p>Labelling errors; implement barcode verification and double-checking procedures. (D)</p> Signup and view all the answers

If a clean room is required to maintain positive pressure, preventing the influx of 'unclean' air from surrounding areas, how are the pressure levels typically managed?

<p>Pressure levels are set to ensure that filtered air always flows from the cleanest to less-clean spaces (~10 Pa difference). (C)</p> Signup and view all the answers

How does the design and functionality of HEPA filters facilitate clean air separation in aseptic environments?

<p>By utilizing fibreglass adhesive fibres to catch viral matter and facilitate the processes of interception, impaction and diffusion. (B)</p> Signup and view all the answers

In the context of HEPA filtration systems, what strategy can manufacturers implement to provide early detection of filter failures?

<p>Regularly performing leak testing with aerosols such as dioctylphthalate (DOP) or poly-alpha-olefin (PAO). (D)</p> Signup and view all the answers

What is the most important reason that the uniformity of velocity testing is crucial in assessing the performance of HEPA filters, and how should it be conducted?

<p>To detect variations in air speed that can contribute to turbulence of airflow, increasing the potential for contamination. (C)</p> Signup and view all the answers

Why is it important to consider the 'zone of confusion' in laminar flow cabinets, and how does it influence aseptic practice?

<p>It is crucial to recognize it as a high-turbulence area downstream of obstructions and avoid placing sterile items there. (A)</p> Signup and view all the answers

What are the key considerations when deciding between using a vertical or horizontal laminar flow cabinet, especially concerning direct exposure to the operator?

<p>Vertical laminar flow cabinets prevent the operator's direct exposure to the airflow, reducing contamination risk, while horizontal cabinets may blow air directly at the operator. (C)</p> Signup and view all the answers

What key strategies are essential to ensure that personnel are adhering to aseptic practices consistently?

<p>Ensuring each operator conforms to written procedures during actual operations alongside rigorous discipline and supervision. (C)</p> Signup and view all the answers

In a pharmaceutical manufacturing plant, how should training be structured to minimize the potential risk of microbiological contamination?

<p>It should cover aseptic technique, cleanroom conduct, microbiology basics, and all relevant procedures, combined with regular assessments and updates. (D)</p> Signup and view all the answers

When an operator’s technique is assessed, what is the significance of performing 'finger dab' microbiological tests?

<p>To evaluate an operator’s handwashing technique and the efficiency of item transfer methods. (B)</p> Signup and view all the answers

According to the ISO standards regarding garment requirements for Grade A/B (ISO 5) cleanrooms, why is it important to tuck trouser-legs inside footwear, and sleeves into gloves?

<p>To prevent shedding of particles and retain any contaminants within the protective clothing, reducing the risk of environmental contamination. (C)</p> Signup and view all the answers

Given that human activity in an aseptic cleanroom can dramatically increase particle counts, what behavioral adjustments are critical for cleanroom staff?

<p>Minimizing talking and breathing, holding unidirectional airflow, keeping the entire body out of the path, moving slowly and deliberately. (D)</p> Signup and view all the answers

When determining the locations to conduct environmental monitoring in an aseptic processing area, what factors most critically influence the selection of sampling sites?

<p>Sites based both risk (personnel interventions, equipment interfaces) and historical data (previous contamination events) to reveal potential contamination. (A)</p> Signup and view all the answers

What is the major parameter used in physical monitoring that is very significant because they can contaminate and also carry organisms?

<p>Particulate matter (B)</p> Signup and view all the answers

If contamination recovery rates increase during environmental monitoring, what actions must be undertaken to address the source and prevent recurrence?

<p>Review and enhance area maintenance and sanitisation/decontamination protocols, and assess operational adherence. (C)</p> Signup and view all the answers

What role does the International Organisation for Standardisation (ISO) play in regulating aseptic processing environments, and how are these guidelines implemented in pharmaceutical manufacturing?

<p>ISO develops standards for cleanroom classifications (e.g., ISO 5, ISO 7) based on particle counts, air pressure and cleanliness. (A)</p> Signup and view all the answers

When a company outsources the aseptic processing of sterile drug products to a contract manufacturer, what responsibilities does the original drug manufacturer retain?

<p>The original manufacturer must ensure adherence to cGMP and confirm process validity. (B)</p> Signup and view all the answers

What does it mean for the manufacturing environment to maintain integrity to ensure aseptic conditions, and how is this integrity confirmed?

<p>Environment must meet required cleanliness standards, validated through regular integrity and adherence to procedures. (B)</p> Signup and view all the answers

Which of the statements below most accurately defines the relationship between 'sterile' and 'aseptic' in pharmaceutical production?

<p>Aseptic describes the 'process' for handling sterilized materials in a controlled manner. (E)</p> Signup and view all the answers

In the development of sterile pharmaceutical products, what considerations should drive the choice between terminal sterilization and aseptic processing?

<p>Terminal sterilization should be the default choice whenever feasible due to its higher assurance of sterility. (D)</p> Signup and view all the answers

A company discovers that batch of sterile products have been contaminated by a technician's technique error—what implications are likely?

<p>Product instability as well as Life-threatening results, leading to product recall due to the high health risks (D)</p> Signup and view all the answers

According to the National Aseptic Error Reporting Scheme (NAERS) in the UK, which type of aseptic error has the highest potential for patient harm?

<p>Incorrect drug (A)</p> Signup and view all the answers

An expert is evaluating a novel facility design for aseptic manufacturing in a pharmaceutical company—What are the critical factors that will be taken into account?

<p>Workflow design, air quality, sanitisation protocols, and personnel gowning (A)</p> Signup and view all the answers

Clean Room technicians enter through different ISO rated zones – if the technician begins in an unclassified (changing) area moving through ISO 7, followed by transition in ISO 6 then finally work in zone of ISO 5 classification - what action is most important

<p>Wearing proper and recommended set of garments as he/she moves through different zones (C)</p> Signup and view all the answers

When personnel enter aseptic manufacturing facilities, what is the specific focus of proper cleaning and gowning technique protocols?

<p>Minimizing contaminants from the personnel (B)</p> Signup and view all the answers

Which sampling is considered more qualitative?

<p>Swabbing, because it can provide better collection of microorganisms present in a surface that is not often flat. (C)</p> Signup and view all the answers

In constructing a new aseptic processing cleanroom, a project manager must decide whether to select all HEPA and ULPA grade air filtration systems or consider the use of isolators. How should they approach comparing or contrasting these technologies when presenting this proposal to management?

<p>The facility should construct a comparison of air quality testing, reduced contamination risk, reduced human intervention, costs benefit with pros/cons (C)</p> Signup and view all the answers

What is the most critical challenge in maintaining an aseptic cleanroom, given the particle generation from human activity?

<p>Balancing the need for personnel movement and activity with the stringent particle count requirements of the cleanroom. (B)</p> Signup and view all the answers

What is the primary rationale behind setting pressure levels in aseptic processing areas to ensure filtered air always flows from cleaner to less-clean spaces?

<p>To minimize the risk of contamination by preventing the influx of particles and microorganisms from less-controlled areas. (D)</p> Signup and view all the answers

How do variations in air velocity across the surface of a HEPA filter most directly compromise the aseptic environment in a cleanroom?

<p>They can lead to the formation of turbulent airflow patterns, which may increase the risk of contamination. (A)</p> Signup and view all the answers

Considering the limitations of relying solely on HEPA filter leak testing, why is uniformity of velocity testing crucial in assessing HEPA filter performance?

<p>To confirm that air is evenly distributed across the filter's surface, optimizing its particle removal efficiency. (B)</p> Signup and view all the answers

In aseptic processing facilities, what is the most significant implication of an increasing contamination recovery rate during environmental monitoring?

<p>The current cleaning and disinfection protocols are ineffective against the prevalent microorganisms. (C)</p> Signup and view all the answers

Flashcards

Sterility

Complete destruction/elimination of all viable microorganisms.

Sterility Assurance Level (SAL)

Probability a single unit remains nonsterile after sterilization.

10^-6 SAL application

Used for products contacting breached skin or invasive sterile products.

10^-3 SAL application

Topical products or those that won't contact breached skin.

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Aseptic

To maintain contamination at levels known to present minimal risk.

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Aseptic (sterile) Preparation

Drawing medicines into syringes or making IV bags, ensuring patient/staff safety.

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Consequences of non-sterility

Can trigger product recalls, health risks, and product spoilage.

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Aseptic sterile preparation

Drawing up medicines into syringes or making infusion bags.

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Sterile pharmaceutical products

IV infusions, small-volume injections, eye drops and contact lens solutions.

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ISO Class 5 Requirements

Air should have less than 3520 particles (>0.5µm) per m3.

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Laminar flow characteristics

The air travels at right angles to the filter face.

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Air sampling

Drawing in predetermined volumes of air over a sterile media plate.

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Settling plates

Petri dishes with sterile growth media exposed to the environment.

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Sampling area and location

ISO 5 or better, each operational shift, active air sampling.

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Risk Critical Activities

Technical and clinical check, worksheet preparation, label generation.

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High standards of personal hygeine

The description of clothing required for clean areas is defined by the specific grade.

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Aseptic Procedure - Personnel

Always avoid contamination with the human, when moving.

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Study Notes

Aseptic Operation and Environment

  • Dr. Atheer Awad can be contacted at [email protected] and is located in Office F157, Hillside House

Learning Outcomes

  • The presentation covers the principles of aseptic products
  • It explains the consequences of non-sterility in aseptic manufacturing
  • The key principles of aseptic processing are identified

Cleanliness

  • Maintaining health and safety is paramount
  • Storage protocols are important
  • Proper application techniques must be adhered to

Cleanliness Levels

  • Cleanliness can be categorized as clean, fairly clean, really clean, very clean, or sterile

Sterility

  • Sterility is defined as the complete destruction or elimination of all viable microorganisms
  • It questions whether sterilization always eliminates all infectious matter

Problems with Sterility Definition

  • It is not always possible to isolate and/or detect all microorganisms
  • Microorganisms have different inactivation rates
  • Guaranteeing product sterility mathematically or practically is impossible

Sterility Assurance Level (SAL)

  • SAL quantifies the probability that a unit remains non-sterile after sterilization
  • An SAL of 10-6 indicates a maximum of one non-sterile item per 1,000,000 sterilized items
  • SAL provides a statistical measure since it is impossible to guarantee the elimination of all bacteria through sterilization

Pharmaceutical Product Requirements

  • A SAL of 10-6 or higher is needed for products in contact with compromised tissue, invasive products entering sterile tissue, products claiming sterile fluid pathways, and surgically implanted devices
  • A SAL of 10-3 or higher is acceptable for products not contacting compromised tissue and topical products contacting intact skin or mucous membranes

Non-Sterile Pharmaceutical Products

  • These products may contain viable microorganisms
  • The European Pharmacopoeia (PhEur) establishes maximum concentration limits
  • Nonaqueous oral products allow 103 cfu/g or mL aerobic microbial count, 102 cfu/g or mL yeast and mold count, and absence of E. Coli
  • Aqueous oral products allow 102 cfu/g or mL aerobic microbial count, 101 cfu/g or mL yeast and mold count, and absence of E. Coli
  • Rectal products allow 103 cfu/g or mL aerobic microbial count and 102 cfu/g or mL yeast and mold count
  • Products used in the mouth, nose, and ears or on the skin allow 102 cfu/g or mL aerobic microbial count, 101 cfu/g or mL yeast and mold count, and absence of S. aureus and P. aeruginosa
  • Vaginal products allow 102 cfu/g or mL aerobic microbial count, 101 cfu/g or mL yeast and mold count, and absence of S. aureus, P. aeruginosa, and C. albicans

Sterile Pharmaceutical Products

  • Complete sterility is required
  • This includes all parenteral products such as IV infusions, parenteral nutrition fluids, small-volume injections, and small-volume oily injections
  • Also included are non-injectable sterile fluids, ophthalmic preparations, dressings, implants, absorbable haemostats, surgical ligatures and sutures, and instruments and equipment like syringes and endoscopes

Sterile Products and Parenteral Administration

  • The word "Parenteral" originates from Greek roots, signifying "beside the intestine”, avoiding the alimentary canal
  • Parenteral products must bypass the body's protective barriers, such as skin and mucous membranes, and must be essentially free of biological contamination
  • These products must be free from physical, chemical, and biological contaminants, and should be produced using current good manufacturing practices (cGMP)

Sterile vs. Aseptic

  • Sterile means the complete absence of viable microorganisms
  • Aseptic describes the process for handling sterilized materials in a controlled environment designed to maintain contamination at levels known to present minimal risk

Aseptic Preparation

  • Aseptic (sterile) preparation is drawing up medicines into syringes or making infusion bags such as intravenous antibiotics, ensuring patient and staff safety
  • Cytotoxic drugs for cancer treatment (e.g., chemotherapy) are prepared in aseptic areas and supplied ready-to-use to protect ward staff
  • The 'tailor made' preparation of non-sterile products (e.g., creams, ointments) also takes place within the department

Implications of contamination

  • The effects of contamination on a sterile product includes both viable and nonviable forms
    • Viable contamination includes bacteria and viruses
    • Non-viable contamination includes particles and chemicals

Life Threatening Implications from Failure

  • 1971-2: Devonport incident led to five deaths due to dextrose contaminated via a faulty autoclave
  • 1994 "Manchester Incident" Deaths of two children occurred following the administration of contaminated TPN
  • 1996: Romaira incident resulted in 35 newborn infant deaths and sepsis, caused by locally-produced IV solutions
  • 2005: USA, patients became infected from contaminated heparin IV flush

Implications for Products and Spoilage

  • Spoilage occurs from the breakdown of the active ingredients.
  • The formulation breaks down
  • Acceptability drops
  • The degradation of the preservatives

The Importance of an Error Program

  • There needs to be a protocol for reporting errors to improve procedures
  • These measures must be introduced to cover injectables, aseptic units, near misses, staff competency, human error, and other product categories

Key framework

  • Distraction, lack of training, high workload, and inadequate staffing are causes of failure
  • Selection of incorrect drug or strength, an incorrect calculated dosage, labelling medicines with incorrect patient details are all part of failure modes
  • Technical and clinical checks, worksheet preparation and label generation are all part of risk critical activities

Aseptic Procedure – Key Components

  • Processes, Equipment, Facilities, Personnel, are key components during production.
  • This is supported by Documentation, Finish Product testing, Controls & Verification

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