Hygiene and Cleaning Standards, Handwashing, PPE, Counting Trays, Countertop, and Equipment
Table of Contents
Hand Hygiene (Handwashing) Best Practices
Soap Selection:
- Liquid soap is preferred because bar soap can harbor bacteria.
- Use antibacterial soap for sterile compounding (e.g., USP <797> compliance).
When to Wash Hands
✅ After using the restroom
✅ Before and after patient contact (to prevent cross-contamination)
✅ Before donning gloves for laminar flow hood work (critical for sterile compounding)
✅ Before eating or handling food
✅ When visibly soiled or dirty
Alcohol-Based Hand Sanitizers:
- Effective if hands are not visibly dirty and soap/water is unavailable.
- Must contain at least 60% alcohol.
Proper Use:
- Apply to all surfaces (palms, backs, between fingers, under nails).
- Rub until completely dry (~20-30 seconds).
Sterile Compounding: Strict Hand Scrubbing Protocol
For IV/sterile product preparation, personnel must:- Scrub hands and forearms with an antibacterial agent (e.g., chlorhexidine).
- Follow facility-mandated scrub time (often 2-5 minutes).
- Dry hands thoroughly with disposable, lint-free paper towels (no cloth towels).
Why Handwashing matters
- Prevents infections in patients receiving sterile medications.
- Reduces contamination risk in laminar flow hoods.
- Meets Joint Commission, USP <797>, and OSHA standards.
Myth Buster: Gloves Do NOT Replace Hand Washing!
Wearing gloves does not eliminate the need for hand hygiene. Hands must still be washed:
Wearing gloves does not eliminate the need for hand hygiene. Hands must still be washed:
- Before donning gloves (to prevent contamination inside the glove).
- After removing gloves (to eliminate potential residual pathogens).
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Personal Protective Equipment (PPE)
Personal Protective Equipment (PPE) serves as a critical barrier between employees and hazardous substances, protecting against chemical exposure, biological contaminants, and physical hazards. Proper use of PPE minimizes the risk of infection, injury, and contamination in settings such as pharmacies, laboratories, and healthcare facilities.Types of PPE Required
Employees must use the following PPE when handling hazardous or sterile substances:- Sterile gloves – For aseptic procedures (e.g., IV compounding).
- Masks – Surgical masks or respirators (N95 for airborne hazards).
- Goggles – Protect against splashes to the eyes.
- Face shields – Required when splashes to the eyes, nose, or mouth may occur.
- Gowns/Lab coats – Disposable or fluid-resistant for hazardous drug handling.
- Shoe coverings – Prevent tracking contaminants in sterile areas.
- Head coverings – Required in cleanrooms or compounding areas.
PPE Usage Guidelines
1. Glove Use & Removal Change gloves at least hourly or immediately after contamination.- Proper removal technique:
- Pinch the outside of one glove near the wrist (avoid skin contact).
- Peel it off, turning it inside out.
- Hold the removed glove in the other gloved hand.
- Slide fingers under the remaining glove’s wrist area and peel off.
- Dispose of gloves properly and perform hand hygiene.
- Latex allergies: Employers must provide hypoallergenic gloves (nitrile, vinyl) and liners.
2. Face Shield & Eye Protection
- Face shields must be worn when there is a risk of splashes (e.g., compounding, hazardous drug handling).
- Goggles should fit snugly and be worn with masks if full-face protection is needed.
Proper Donning & Doffing Sequence (Before Entering Cleanroom & Working in LFH)
Maintaining sterility is crucial when working in a laminar flow hood (LFH), particularly in sterile compounding environments following USP <797> guidelines. Below is the proper sequence for donning (putting on) and doffing (removing) personal protective equipment (PPE).Donning Sequence (Before Entering Cleanroom & Working in Laminar Flow Hood)
- Shoe Covers – Put on shoe covers before stepping into the cleanroom.
- Hair Cover/Beard Cover – Ensure all hair is contained.
- Face Mask – Cover the nose and mouth completely.
- Perform Hand Hygiene – Wash hands with soap and water for at least 30 seconds, then dry with a lint-free towel.
- Gown – Wear a non-shedding, sterile gown and fasten it securely.
- Perform Hand Hygiene Again – Use an alcohol-based hand sanitizer and allow hands to dry completely.
- Sterile Gloves – Put on sterile, powder-free gloves. Disinfect gloves with 70% isopropyl alcohol before handling materials inside the hood.
Doffing Sequence (After Leaving Laminar Flow Hood & Cleanroom)
- Remove Gloves – Disinfect gloves with alcohol before carefully removing them.
- Remove Gown – Undo ties/snaps and fold inward to contain contaminants.
- Remove Face Mask – Avoid touching the front surface.
- Remove Hair Cover/Beard Cover – Dispose of properly.
- Remove Shoe Covers – Step onto a clean surface before removal.
- Perform Hand Hygiene Again – Wash hands thoroughly with soap and water.
Pill Counting Tray
Proper cleaning and hygiene of pill counting trays are essential to prevent cross-contamination and ensure patient safety. Pharmacies must follow strict protocols, especially when handling high-risk medications such as antibiotics, sulfa drugs, and hazardous medications.
Special Considerations
1. Cleaning Frequency
- After each use – Especially when handling different medications.
- Before and after each shift – To maintain a clean working environment.
- Immediately after handling hazardous or allergenic medications – Such as penicillin, sulfa drugs, or chemotherapy agents.
2. Proper Cleaning Procedure
- Remove Residual Medication – Use a dry, lint-free cloth or brush to remove leftover pill fragments.
- Disinfect the Tray – Wipe the tray with a 70% isopropyl alcohol solution or an appropriate disinfectant.
- Allow to Air Dry – Ensure no moisture remains before use.
- Use Dedicated Trays if Necessary – Have separate trays for hazardous medications or common allergens.
- Inspect for Residues – Check for any remaining particles before reusing the tray.
Special Considerations
- Hazardous Drugs (e.g., Chemotherapy Agents)
- Use disposable counting trays when possible.
- Clean with USP <800> compliant decontamination methods.
- Controlled Substances
- Ensure no pill fragments remain to prevent miscounts or contamination.
- Allergenic Medications (e.g., Penicillins, Sulfa Drugs)
- Have a dedicated tray or clean thoroughly between uses to prevent allergic reactions.
Pill Counting Trays Cleaning Standards for Chemotherapy and Hazardous Drugs
Handling chemotherapy agents and hazardous drugs requires extra precautions to ensure safety and prevent contamination. Below is the proper procedure for using pill counting trays with these high-risk medications, aligned with USP <800> standards.Pill Counting Trays Procedure for Chemotherapy Agents or Hazardous Drugs
1. Wear Proper PPE- Wear chemotherapy-tested gloves (double gloving recommended).
- Wear a disposable gown, eye protection, and possibly a respirator if not working in a ventilated area.
- Use personal protective equipment (PPE) as outlined in USP <800>.
2. Use a Dedicated or Disposable Counting Tray
- Use a dedicated tray clearly labeled for hazardous drugs, or preferably, use a disposable tray.
- Never use the same tray for non-hazardous medications.
3. Work in a Proper Environment
- Ideally, count hazardous drugs in a designated containment primary engineering control (C-PEC) like a biological safety cabinet (BSC).
- If that is not possible, use a well-ventilated, designated area away from general dispensing.
4. Clean and Decontaminate
- After use: Decontaminate the tray using USP <800> compliant cleaning agents, not just alcohol.
- Steps typically include:
- Deactivation (e.g., sodium hypochlorite)
- Decontamination
- Cleaning
- Disinfection (for sterile compounding areas)
- Dispose of disposable trays and cleaning materials in a hazardous waste container.
- If using a reusable tray, thoroughly clean and store in a designated hazardous materials area.
5. Waste Disposal
- Place all waste materials (gloves, wipes, trays if disposable) into a hazardous drug waste bin, not regular trash.
