10-21-2011 01:22 PM
What about opening a CACI for cleaning if you are gowned, gloved, hair net, and masked? If very hard to clean it thoroughly if you do not. What happened moving the trays? In our CACI, it is easy to slide them side to side but in our CAI, the DCA tray and the ante-chamber tray (or base) does not move to clean underneath unless you remove them. I have removed them (while fully gowned) and things do fall underneath (needles, caps, and even spillage). I noted your answer that it is OK to open the CAI while fully gowned. Do you know about the trays?
Also, I just have some infor for you. We use sterile gloves as the glove for our CAI. I have discussed this with you in previous forum posts. We spray and wipe them with sterile clorox 0.52% after we change them and we change them Q shift. Our glove tips have come back all clear. In the CACI, which has very low usage in our facility, we kept the non-sterile glove as the CACI glove, and we sterile chemo glove these for compounding. However, our surface sampling were coming up positive and I noted it was only in the location of the non-sterile gloves left in the hood after compounding. We changed our process to keep sterile chemo gloves on as the CACI glove and continue to double glove for compounding. Our surface samples are now clear. Isn't this interesting? I don't know if others have found anything this interesting in their facilities. I would like to know but perhaps this is just another reason to use sterile gloves? I mention this because in the webinar you noted that you can use any glove on the gauntlet as long as you wear sterile gloves over them for compounding. We found that this really seemed to cause an in issue perhaps because our CACI is not used that much and leaving the non-sterile gloves on the CACI was just not good practice for us. Just thought I'd let you know. Sterile gloves on the CAI/CACI themselves, decontaminating them with sterile clorox and routinely wiping them down with sterile alcohol after each compounding event seems to work really well for us.
10-21-2011 08:16 PM
Thanks for the great information on the nonsterile/sterile gloves on CACIs. This is why doing environmental sampling is so important because it gives us objective information that we can use to optimize our sterile compounding practices. I will change my slides to reflect your experiences. Thanks for passing on that valuable information. Re: cleaning CACIs. I have attached an article that Luci Power and I wrote in PPP Magazine. You should also contact the manufacturer on how to best handle the trays but they should be removed when doing a "deep clean".
10-21-2011 08:18 PM
The pressure requirements for a CAI and CACI would be the same as a positive-pressure (+ 0.02" w.c.) and negative-pressure (- 0.01" w.c.) buffer area, respective.
10-24-2011 12:36 PM
I contacted the manufacturer of our stainless steel CAI and CACI and asked what kind of cleaner besides sterile alcohol should be used. Their recommendation was to just use alcohol as other cleaners cause "pitting" and they don't recommend that cleaners be used. Do you have a recommendation?
10-25-2011 07:28 PM
Alcohol alone is not sufficient since it is not a detergent and will not remove dirt and other substances that will be brought into the isolator. Most isolators are constructed out of 304 Stainless Steel which can typically within stand germicidal detergent. The term pitting has been associated with the use of sodium hypochlorite (bleach ) but if necessary you can use sodium thiosulfate (when available) along with sterile water to remove the bleach.
10-26-2011 12:00 PM
Sorry, I meant to ask you this before but can you clarify the frequency of cleaning with the germicial detergent? We are cleaning weekly with a hypochlorite spray and monthly with the Decon-spore in addition to our daily cleaning with sterile alcohol. DECON-SPORE 200 Plus® is a peracetic acid and hydrogen peroxide solution that can be used as either a steriliant or disinfectant. Should I change to the germicidal detergent weekly?
10-27-2011 02:17 PM
A germicidal detergent should be used daily for your ISO Class 5 areas and work surfaces immediately around your ISO Class 5 areas. The use of DECON-SPORE 200 Plus is good as disinfectant but it isn't a detergent which is needed to get dirt and grime off of critical surfaces. Once of those washed surfaces are dried, you want to wipe them all down with sterile IPA to remove any detergent residue.
11-02-2011 04:28 PM
We are a small hospital and just installed our CAI. Often times when we open in the morning we have stat orders that have just come through for surgery.
We had in instance this week where it took us too long to clean the hood and prepare the medication that the surgery ended up preparing because of needing to make an on-time start.
I am wondering what people would suggest for this situation -- I was thinking put on new wipe down counter, put on new sterile gloves and then either give a 1 hour or a 12 hour BUD. Any thoughts? We clean our CAI in the afternoon (after our batch fill) with detergent/ quat followed by sterile alcohol. Most of the time we do not prepare anything in the hood after it is cleaned. The next morning we disinfect the CAI with Sterile alcholol.
11-03-2011 07:35 AM
What brand detergent/quat do you use?
If this preparation for surgery is an "emergency"..then you would follow the rules as you spelled out...use within 1 hr and Beyond use would be 12 hrs to finish infusing like when the ED mixes and infuses without pharmacy present.
Upson Regional Medical Center