Proper Hand-Washing and Garbing Procedures for Sterile Compounding

Proper Hand-Washing

1. Remove all jewelry, makeup, nail polish, and false nails.
2. Prior to opening a scrub/brush pocket, squeeze it several times to activate soap. Remove scrub, sponge brush, nail pick, and throw them away.
3. Press the foot pedals to begin the flow of water. Wet your hands and forearms when the water is warm.
4. Don't set down the sponge. Use nail picks to clean under nails and throw them away when finished.
5. Scrub under nails of each finger and thumbnail on the opposite hand until clean. Clean each of the four surfaces of the thumb with a sponge.
6. In circular motion, wash the palms and back of hands, fingers and between fingers, wrists and lower arms. Rinse well from arms to hands with a clean dry paper towel or towels. Pat dry starting at fingertips working to wrist. Discard towel or towels. Repeat steps on the wet hand with a clean dry towel or towels.

Garbing

1. Removal of personal outer garments (including all visible piercings and jewelry).
2. Wear shoe covers, head and facial hair covers, and face masks and/or eye shields.
3. Proper hand cleansing with soap and drying.
4. Wear a non-shedding gown.
5. Perform antiseptic hand cleansing with alcohol-based scrub.
6. Put on sterile gloves.

IV Hood

1. Garb using proper procedure for protection.
2. Clear the hood by removing everything from it, including anything hanging inside.
3. Clean the hang bar and hook.
4. Clean the ceiling of the hood using 70% isopropyl alcohol lint-free pads. Throw away used pads.
5. Clean the side panels using 70% isopropyl alcohol lint-free pads. Throw away used pads.
6. Clean the work surface of the hood using 70% isopropyl alcohol lint-free pads. Throw away used pads.
7. Do not let any liquid seep into the HEPA filter and do not touch the HEPA filter at any time. The HEPA filter is located in the back of the hood.
8. Use aseptic lint-free non-shedding hood cleaning pads lightly saturated with 70% isopropyl alcohol.

Extemporaneous Compounding

1. Preparation, mixing, assembling, packaging, and labeling of a drug product based on a prescription order from a licensed practitioner for an individual patient.
2. Creating an oral suspension from crushed tablets.
3. Creating a topical ointment from a drug administered by a different route.
4. Mixing two solutions for eardrops.
5. Mixing powder and cream to make an ointment or mixing powder from tablets for an oral suspension.

Non-Sterile Compounding

1. For underweight children when available dosage is too strong.
2. For patients who will not swallow the solid form, convert it to a liquid suspension.
3. For patients who ordered a medication that is not available.
4. To ensure that a child will take an oral medication.
5. Used for tablets, capsules, creams, ointments, suspensions, suppositories, transdermal applications, and troches.

Compounding Records

• Name, strength, and dosage form of the compounded sterile preparation.
• Master formulation record reference for the CSP, when used.
• Date and time of preparation of the CSP.
• Assigned internal identification number or prescription or lot number.
• Signature or initials of individuals involved in each step.
• Name, vendor or manufacturer, lot number, and expiration date of each ingredient and container-closure system or measurement of each ingredient.
• Documentation of the calculations made to determine and verify quantities and concentrations, if appropriate.
• Documentation of quality control procedures in accordance with the SOP, such as filter integrity, pH, and visual inspection.
• Any deviations from the master formulation record, if used, and any problems or errors experienced during the compounding of the CSP.
• Total quantity compounded.
• Duplicate container label if prepared in a batch.

Communication Barriers

Physical barriers, perceptual, emotional, cultural, medical terminology, language, slang, and accents can create communication barriers. Use translation services if available. Do not speak louder and keep sentences short.