Continuing Education
www.nhia.org/CE_Infusion
Aseptic Technique
Health Care’s Ubiquitous, but Unstandardized Best Tool for Fighting
Microbial Contamination
By Jeannie Counce
PHARMACISTS AND PHARMACY TECHNICIANS
This INFUSION article is cosponsored by Educational Review Systems (ERS), which is accredited by the Accreditation
Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. ERS has assigned 1.0 contact
hours (0.1 CEU) of continuing education credit to this article. Eligibility to receive continuing education credit for this
article begins November 15, 2016 and expires November 15, 2019. The universal activity numbers for this program are
0761-9999-16-286-H01-P and 0761-9999-16-286-H01-T. Activity Type: Knowledge-Based.
NURSES
Educational Review Systems is an approved provider of continuing nursing education by the Alabama State Nurses Association (ASNA), an accredited approver of continuing nursing education by the American Nurses Credentialing Center,
Commission on Accreditation. Program # 05-115-16-008. Educational Review Systems is also approved for nursing continuing education by the state of California, the state of Florida, and the District of Columbia. This program is approved
for 1.0 hours of continuing nursing education. Eligibility to receive continuing education credit for this article begins
November 15, 2016 and expires November 15, 2019.
DIETITIANS
Educational Review Systems (Provider number ED002) is a Continuing Professional Education (CPE) Accredited Provider
with the Commission on Dietetic Registration (CDR). Registered dietitians (RDs) and dietetic technicians, registered (DTRs)
will receive 1.0 hour or 0.1 continuing professional education unit (CPEU) for completion of this program/material. Eligibility to receive continuing education credit for this article begins November 15, 2016 and expires November 15, 2019.
Dietitian Knowledge Level: 2
Dietitian Learning Codes:
2080 Microbiology, food toxicology
4050 Epidemiology
5030 Home care
5270 Infectious diseases
5440 Enteral and parenteral nutrition support
Continuing education credit is free to NHIA members, and available to non-members for a processing fee. To apply for nursing or
pharmacy continuing education, go to www.nhia.org/CE_Infusion and follow the online instructions.
NOVEMBER /DECEMBER 2016
CPE
Accredited
Provider
35
Continuing Education
www.nhia.org/CE_Infusion
Approval as a provider refers to recognition of educational activities only and does not imply Accreditation Council for Pharmacy Education,
ERS, or ANCC Commission on Accreditation, approval or endorsement of any product. This Continuing Education Activity is not underwritten or supported by any commercial interests.
This continuing education article is intended for pharmacists, pharmacy technicians, nurses, dietitians, and other alternate-site infusion professionals.
In order to receive credit for this program activity, participants must complete the online post-test and subsequent evaluation questions
available at www.nhia.org/CE_Infusion. Participants are allowed two attempts to receive a minimum passing score of 70%.
EDUCATIONAL LEARNING OBJECTIVES:
1. Articulate the ultimate goal of aseptic technique
2. Identify the critical junctures in home infusion therapy delivery where proper aseptic technique is necessary
3. List and describe the key components for maintaining compliance with best practices
AUTHOR BIO
Jeannie Counce, is the Editor-in-Chief of INFUSION magazine, the bimonthly journal of the National Home Infusion Association (NHIA).
She has more than 20 years’ experience as a health care writer and editor, covering topics ranging from outpatient pharmacy and nursing to
reimbursement, regulations, and other business issues. A 1989 graduate of James Madison University, she has been involved in association
communications and publishing for nearly 25 years.
AUTHOR DISCLOSURE STATEMENT
The author declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria.
I
n health care, safeguards are put in place to protect patients and health care workers alike from the spread of
pathogens. Maintaining asepsis is especially critical for
home and specialty infusion patients whose therapy is
distinguished by direct access to the bloodstream where
pathogens can rapidly move throughout the body causing
harm. From the compounded sterile preparations (CSPs)
prescribed to home infusion patients to the supplies and
methods used to administer them, preserving sterility is a
hallmark of safe patient care in this delivery model.
Once microbial contamination occurs, an organism can
begin replicating within one to four hours, reaching an
exponential growth phase soon after.1 When you consider that normal human skin is colonized with bacteria—as
many as 100,000 colony forming units (CFUs) per square
centimeter on the forearms—it’s easy to see why practitioners need a weapon for establishing and maintaining
sterility.2 Aseptic technique is that weapon, but what exactly is aseptic technique?
Parsing Aseptic Technique
Asepsis is the absence of bacteria, viruses, and other microorganisms. Therefore, aseptic technique is the method
by which we prevent microbial contamination. There is no
standardized, universal list of which processes and practic-
es are considered aseptic technique—rather it’s a catch-all
phrase that covers a variety of health care workers and settings. Aseptic technique in the operating room may look
very different than it does in the home of an infusion therapy patient—although there are likely to be many similarities.
In our industry, aseptic technique is employed in pharmacies, cleanrooms, clinics, and patient’s homes. These
precautionary procedures are practiced by pharmacists,
pharmacy technicians, nurses, patients, physicians, and
caregivers—and apply to the preparation, storage, and administration of IV and injectable medications. That covers
a wide spectrum of people and places across a truly unique
care model. Often aseptic technique is viewed through a
different set of lenses depending on the specific aspect of
care delivery that’s being carried out. See Exhibit 1 for a
master list of where aseptic technique matters in home and
specialty infusion.
“To me, aseptic technique begins way before the pharmacist or pharmacy technician enters the cleanroom,” observes
Jeffery Reses, RPh, Accreditation Corporate Surveyor for the
Accreditation Commission for Health Care (ACHC). “Maintaining sterility involves engineering controls, certification,
and environmental testing. If those things aren’t in place,
even the best aseptic technique can’t prevent microbial contamination,” he points out.
NOVEMBER /DECEMBER 2016
Questions or comments regarding this article should be directed to [email protected].
37
NOVEMBER /DECEMBER 2016
www.nhia.org/CE_Infusion
38
“Aseptic technique is not just one thing, it’s a set of processes or procedures,” explains Lisa Ashworth, Pharmacist
at Children’s Medical Center Dallas and member of the
United States Pharmacopeia (USP) Compounding Expert
Committee from 2005 to 2020. USP <797> Standards spell
out procedures for everything from receiving drug shipments, to handwashing and garbing, to manipulations performed in the laminar airflow workbench in an attempt
to eliminate microbes at every step in the compounding
process. “Standards change, but the underlying principles
are the same,” observes Ashworth. “We want to kill microorganisms where they might be and not introduce them to
places where they aren’t.”
This essential mindset is critically important for clinicians in
learning and practicing proper aseptic technique, according to
Susan Dolan, RN, MS, CIC, FAPIC, an epidemiologist at Children’s Hospital Colorado and President of the Association for
Professionals in Infection Control and Epidemiology (APIC).
“The fundamental principles of aseptic technique need to be
understood and applied as needed depending on factors such
as risk level and environment,” she explains. “We want to provide the best chance of the patient getting well while minimizing the risk of infection.”
“The ultimate goal is to protect the patient from infection,” echoes Lisa Gorski, RN, MS, HHCNS-BC, CRNI®,
FAAN, Clinical Nurse Specialist at Wheaton Franciscan
Home Health & Hospice in Milwaukee, Wisconsin. Gorski,
who chaired the committee that developed the Infusion
Nurses Society (INS) Infusion Therapy Standards of Practice, notes that operationalizing best practices is a balancing act between risk, benefits, and cost.
The task is even more challenging when you consider that
best practices should be evidence based. “In home care, clinical trials are scarce. Within our organizations, we can and
should, collect outcome data to identify areas for clinical
improvement,” Gorski explains. INS Standards of Practice,
which apply in all practice settings where infusion therapy
Continuing Education
is administered, draw largely on a scientific body of evidence
collected in the acute care setting. This is true of the entire
patchwork of overlapping standards and guidelines that apply to our practice setting.
Pillars of Aseptic Technique
There are several recognized pillars of aseptic technique that
apply to home and specialty infusion. First and foremost is
hand hygiene. Universally listed as the first step in any procedure involving aseptic technique, hand hygiene and the appropriate use of sterile gloves work together to prevent touch
contamination. Evidence-based hand hygiene procedures for
health care workers are outlined by the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO).2-3 Both CDC and WHO favor alcohol-based
hand sanitizers for standard hand hygiene because they are
more convenient and effective.2-3
These guidelines, aimed at preventing transmission of
pathogens from patient-to-patient or health care worker-to-patient, are echoed in recommendations that address specific types of care. For example, INS Standards of
Practice and the Oncology Nursing Society (ONS) Access
Device Guidelines: Recommendations for Nursing Practice
and Education, both include hand hygiene as a precursor to
patient care that includes accessing and caring for vascular
access devices (VADs).4-5
Avoiding microbial contamination of CSPs during compounding is critical. Therefore, hand hygiene practices outlined in USP <797> are part of a larger series of preparation
procedures executed before an operator enters the cleanroom.6 To minimize the shedding of microbes from skin
contaminating the controlled environment, USP <797> calls
for donning shoe covers, a head cover, and facial mask; then
handwashing, followed by donning a low-shedding gown;
and then applying alcohol-based hand scrub before donning
sterile gloves.6
Continuing Education
www.nhia.org/CE_Infusion
Exhibit 1
Aseptic Technique Reminders
Always
• Perform proper hand hygiene
• Use the appropriate garb, including sterile gloves
and face mask
• Avoid touching any sterile surface with anything
that is not sterile
• Store and prepare medications in a clean area as
directed by the manufacturer
• Work with medications and supplies in a clean
area on a clean surface
In the Cleanroom (ISO 7 or 8) and Direct Compounding
Area (ISO 5)
• Follow all handwashing, garbing, and gowning
procedures
• Avoid touch contact with non-sterile surfaces
• Change sterile gloves with holes, punctures, or
tears
• Don’t block first-air with hands, or by placing
larger items behind smaller items
• Disinfect the rubber stoppers of vials, IV bag
injection ports, etc., before entering by wiping
with a 70% sterile isopropyl alcohol wipe and
waiting for the surface to dry
• Use a filter needle to draw up medications from
an ampule
• Label multi-dose vials, when first accessing, with a
beyond use date (BUD) of the last date they can
be accessed up to 28 days (shorter or longer per
manufacturer); check the BUD and expiration date
before using an opened multi-dose vial
• Label single-use or single-dose vials with a BUD of
6 hours from the first time they are accessed
At Bedside Medication Preparation
• Avoid unwrapping packaged sterile items prior
to the time of use
• Disinfect the stopper on medication vials and IV
bag injection ports, and allow adequate dry time
before accessing with a needle (the plastic top is
not a sterile cover)
• Use a new sterile syringe and a new sterile needle
for entry into a medication vial or IV bag
• Never use single-source medication containers
for more than one patient
• Never leave a needle inserted into the septum of
a medication vial for multiple draws
• Begin administration medications prepared outside of ISO Class 5 conditions within one hour
of the start of preparation of the CSP (includes
spiked IV bags, medications drawn up into a syringe, and reconstituted medications)
In Patient Administration
• Use prefilled syringes or single-use containers
whenever possible
• Disinfect all access points in the IV system before
using (injections ports, needless connectors, or
catheter hubs) and allow adequate dry time before administration
• Don’t further dilute medications for administration
• Keep the sterile end of an intermittent administration set covered with a sterile cap between
uses (do not loop the sterile end back into the
administration set when not in use)
Compiled from*: Centers for Disease Control and Prevention Guideline for Hand Hygiene in Health-Care Settings; World Health Organization 2009 Guidelines on Hand Hygiene in Health Care; 2016 Infusion Therapy Standards of Practice. Access Device Guidelines:
Recommendations for Nursing Practice and Education (3rd Ed.). 2011; US Pharmacopeial Convention General Chapter <797>: Pharmaceutical Compounding – Sterile Preparations; CDC 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious
Agents in Healthcare Settings; Institute for Safe Medication Practices Safe Practice 2015 Guidelines for Adult IV Push Medications.
2015; and Association for Professionals in Infection Control and Epidemiology 2016 Position Paper: Safe Injection, Infusion, and Medication Vial Practices in Health Care.
“Hand hygiene is one of the most critical components
of any health care procedure, in the cleanroom or at the
patient’s bedside,” asserts Ashworth. “We are the biggest
germ in the room.”
Sterile compounding is another pillar of home and specialty infusion. While USP <797> goes well beyond aseptic
technique, it describes activities that take place in the criti-
cal space during compounding, instructing operators to use
aseptic techniques and requiring training and evaluation in
aseptic manipulation skills for personnel who prepare CSPs.
Manipulations such as swabbing, maintaining first air, puncturing, and sealing should be the easiest to perform correctly, according to Reese. “But I still see plenty of breaches,” he
says. “The number-one issue is blocking first air, followed by
NOVEMBER /DECEMBER 2016
*See references for full citations.
39
www.nhia.org/CE_Infusion
Continuing Education
Exhibit 2
Common Cleanroom Mistakes
Quality assurance and training:
1. Outdated/not reviewed standard operating procedures (SOPs)
2. Lack of proper training and observational competency assessments
3. No evidence of initial three consecutive gloved fingertip testing
4. No evidence of annual (or bi-annual) gloved fingertip testing post media-fill procedure (mimicking the
most challenging preparation the pharmacy prepares)
5. Extended beyond use dates (BUDs) without proper
sterility testing
6. No reference(s) for BUDs or extended BUDs
Pre-sterile compounding challenges:
1. Scrubbing/garbing (no nail pics available) especially
sterile technique for donning gloves
2. No availability of a waterless alcohol surgical scrub
(and how/when/where/how long to apply)
3. Applying sterile gloves in the incorrect ISO class room
and not using the correct sterile glove donning technique
4. Incorrect cleaning/disinfecting of the ISO 7 and 8 areas
5. Incorrect pre-compounding cleaning/disinfecting of
the ISO 5 PECs (hoods)
6. Not staging drugs and supplies properly into the ISO 5
hood (items not removed from cartons prior to transport into the buffer area; not wiping down vials/bags
and all supplies prior to introduction into the ISO 5
hood area)
7. Vials tops/injection ports sprayed rather than
“wiped” with sterile 70% IPA
8. Not having enough supplies inside the work area to
complete the compounding process (which leads to
removing hands from the hood and most likely the
lack of re-spraying hands with sterile 70% IPA before
resuming compounding)
9. Environment/Facility issues:
a. Too warm in cleanroom which can lead to
sweating of compounding staff among other issues (microbial in nature)
b. Inappropriate furniture (wood stools, non-cleanable benches)
c. Open crevices at floor, ceiling tiles not secured
to grid, ledges not cleaned properly
d. Doors left open during compounding
e. Anti-fatigue mats not cleanable or not being
cleaned properly
f. Rust
g. Blocked or dirty intake vents
Aseptic Issues:
1. Blocking critical sites with hands/fingers while compounding
2. Not using sterile 70% IPA
3. Talking/interruption from other staff members in
the compounding area
4. Not following compounding records as written
NOVEMBER /DECEMBER 2016
Source: Reses J. Findings from ACHC accreditation survey reports. January 1, 2016 - September 30, 2016; unpublished.
40
not sanatizing sterile gloves after a touch, and then swabbing something with alcohol and not allowing proper drying time. Those deficiencies are mostly about training and
competency testing,” he asserts. See Exhibit 2 for a list of
cleanroom shortcomings that could lead to breaches in
aseptic technique.
USP <797> Standards apply to all persons who prepare
CSPs and all places where they are prepared. Furthermore,
USP Chapter <797> states that “opened or needle punctured
single-dose containers, such as bags, bottles, syringes, and
vials of sterile products and CSPs shall be used within one
hour if opened in worse than ISO Class 5 environments.”6
“
That’s not usually a problem,” says Gorski. “Most of the time
the medications arrive at the patient’s home compounded.
Sometimes we need to reconstitute, but it’s usually not a
problem to administer in one hour.” One exception might be
parenteral nutrition (PN) patients who see convenience in
spiking and priming their PN bag in the evening for a morn-
ing administration. “We advise them against that and try to
emphasize critical thinking in infection control,” says Gorski.
Patient Administration
Safe patient administration could be considered a third pillar
of aseptic technique in home infusion. With so many methods used to administer IV therapies and associated steps that
require aseptic procedures for each, this area is quite extensive. Home infusion clinicians are guided by well-established
INS and ONS standards as well as manufacturer instructions
for product-specific use.
“Keeping general aseptic principles in mind should help
guide clinical practices when handling an existing vascular
access device,” says Gorski. “You want to avoid touch contamination of key parts,” she explains. “The main areas where
aseptic technique is imperative include handling of needleless connectors, catheter hubs, and the tips of IV tubing.
Never touch the tip of a flush syringe and keep it capped
until you’re ready to use it.”
“Needleless connectors should be scrubbed with alcohol—and allowed to dry—before accessing,” continues
Gorski. “When IV tubing is to be reused for intermittent
infusions, a fresh sterile cap must be placed on the male
luer end of the tubing for protection after each use,” she
explains, noting that some clinicians will “loop” the end of
IV tubing back into a port on the same line, which can be a
source of contamination. The Institute for Safe Medication
Practices (ISMP) has received reports on this practice and
warned against it.7
“Another common mistake is to think that the cap
covering the rubber stopper on a vial is a sterile barrier,” Dolan adds. “Practitioners will sometimes pop off the
cap and immediately access the vial with a syringe, when
they actually need to disinfect the rubber stopper after
removing the cap and before accessing the vial.”
“Accessing implanted ports is another area of risk,” Gorski
says. “When you insert the needle through the skin, you risk
pushing microorganisms into the bloodstream. It’s critical
to first perform thorough skin antisepsis and always use
a fresh, sterile needle. Skin antisepsis, and is also required
before inserting a peripheral line,” she adds. “But, once it’s
been performed, you can’t touch the area. Some nurses
may want to re-palpate to find the vein again, potentially
introducing microbes.”
Several outbreaks of viral and bacterial infections in
various clinical settings have focused epidemiologists and
standards-setting organizations on unsafe medical practices and spurred the creation of guidelines for safe injection practices. More than 50 outbreaks occurred between
1998 and 2014, with an estimated 150,000 patients being
advised to undergo testing for exposure to bloodborne
pathogens as a result of unsafe injections.8 In its 2007
Guideline for Isolation Precautions, the CDC promotes the
use of single-dose vials over multiple-dose vials and the
use of a sterile, single-use, disposable needle and syringe
for each injection.9
Recognizing that there are instances where multiple-use
vials present a low risk (i.e. for a single patient, during sterile compounding, and for expensive medications that are
prepared in an ISO 5 environment and dispensed from the
pharmacy), ISMP recommends using prefilled syringes or
single-dose vials whenever possible to reduce the risk of
contamination, as do the INS and ONS.4,5,10 ISMP also warns
against diluting or reconstituting IV push medication by
drawing up the contents into a commercially available, prefilled syringe and withdrawing IV medication from commercially available, cartridge-type syringes into another syringe
for administration.11
These suggestions were made into a campaign called “One
and Only,” created by CDC and the Safe Injection Practices Coalition (SIPC). They have also been solidified in a CDC
frequently asked questions document for providers on safe
www.nhia.org/CE_Infusion
practices for medical injections and most recently in a 2016
position paper by APIC (see the Resources box on p. 44 for
links).12 “Like INS and ONS, our guidelines stem from CDC
guidance,” Dolan explains. “They have the largest body of evidence which is graded so it can be used as the foundation
for best practice recommendations.”
Dolan recognizes that there can sometimes be a frustrating lag between practice guidelines and health plan
coverage for the supplies and services needed to comply
with the guidelines. “Payers don’t always provide coverage
for the best products that are needed to care for catheters
and avoid infections—prefilled flushing syringes and alcohol-containing caps are good examples,” she points out.
“The evidence is showing that it’s better to remove the element of risk whenever you can to prevent infections,” she
explains, noting that risk-averse payers are likely to get on
board as more data is available.
NOVEMBER /DECEMBER 2016
Continuing Education
41
www.nhia.org/CE_Infusion
The Uniqueness of the Home Setting
“The home environment is very different than acute care,”
Dolan observes. “Patients in the home are generally at less
risk of infection because they are more stable and have
fewer catheters. Hospital procedures are more invasive and
the chance of microbial spread is higher because health
care workers are moving quickly from patient to patient,”
she explains.
Gorski also points out that the overall pool of pathogens
is smaller in the home. “But, because we are performing
an invasive procedure, there remains the risk of a bloodstream infection, especially in higher risk patients such as
immunocompromised patients or those receiving parenteral nutrition.” There may be obstacles like a messy home
or the presence of pets, she acknowledges, but most clinicians can find a way to maintain good aseptic technique.
“There’s usually a way to set up and clean an appropriate
surface, put down a barrier for placement of the necessary
supplies, and perform the procedures while maintaining
aseptic technique.”
It’s important to note that all of the standards and guideline documents mentioned thus far are written for trained,
professional clinicians. “In home infusion, patients and
caregivers are now doing a lot of the procedures needed
and may initially be less skilled than trained health care
workers,” notes Dolan. “We need to help them to become
safe and independent while making necessary resources
available for when they have questions such as in the middle of the night.”
“If we’re not good educators and don’t model good
skills—handle the supplies correctly—the patient isn’t going to be successful,” says Gorski. “When you do education,
you have to show how the procedure is done, but also get
across the why,” Dolan adds. “You want to show the various
places in the chain where breaches can occur and tie the
practice to the concepts.”
Some concepts remain the same: hand hygiene and setting
up a clean, dry area in which to work. Others need to be adapted, explains Dolan. “In the hospital there’s a separate refrigerator for medications, for example. A patient may only have one
NOVEMBER /DECEMBER 2016
Exhibit 3
Critical Messages for Patients
Regarding Catheter Care
42
1. Never let anyone handle your catheter who doesn’t
know how to do it
2. Clean and dry is good (applies to storage and environment as well as devices)
3. Hand hygiene is critical
4. Never, ever, enter a catheter without disinfecting
the hub
5. Avoid getting the catheter dressing wet
Continuing Education
refrigerator at home, so we teach them to keep their medications, especially the sterile ones, on the top shelf and the food
below. You also have to teach them about pets and hand hygiene, bathing with a catheter, and other parts of life that might
not happen the same way in a hospital.” APIC, which conducts
the “Infection Prevention and You” campaign has a consumer
portal on its website with patient resources and training materials, including catheter care information (see Resources box
on on p. 44). Exhibit 3 outlines Dolan’s advice to patients on
catheter care.
“You also have to prepare the patient for handling worstcase scenarios,” adds Gorksi. “For example, we tell them how
to hook up—attach the tubing to the bag and prime it—
without touching the critical sites. But we don’t tell them
what to do if they do touch something,” she explains. “We
want to teach them how to recover from mistakes and various scenarios where things might not go as planned.” This
is especially important with long-term patients whose technique can really make the difference in avoiding catheter-related bloodstream infections.
Depending what’s going on in the life of a patient, education can be challenging. “People only remember about 30%
of what you tell them, and when you’re training a person
who is sick or worried about a sick loved one, it’s got to be
even more confusing,” observes Ashworth. “We train and
retrain. We also offer materials with pictures—even links to
YouTube videos.”
“Education isn’t enough; it must be paired with observation—for patients and nurses alike,” continues Gorski.
“I conduct onsite observations and I believe that practitioners may not always understand when they’ve breached
aseptic technique. There is a real need to look at competency and technique,” she advises.
“The audit process is invaluable,” says Dolan. “Showing your
organization’s progress in patient safety is even better,” she says,
recommending tying audits results to infection data.
“You can’t see microbes, so it’s hard to get into the frame
of mind that they are always there,” concludes Ashworth.
“But as health care workers we need to constantly be taking
steps to stop contamination.”
References
1.
2.
3.
Newton DW. A review of bacterial and fungal growth rates: Implications for urgent-use compounded sterile drugs. October
12,2009. Prepared for the Virginia Board of Medicine.
Centers for Disease Control and Prevention (CDC). Guideline
for hand hygiene in health-care settings: Recommendations
of the healthcare infection control practices advisory committee and the HICPAC/SHEA/APIC/IDSA hand hygiene task
force. MMWR.2002;51. Available at: www.cdc.gov/mmwr/
PDF/rr/rr5116.pdf (accessed 11/1/2016).
World Health Organization (WHO). Guidelines on hand hygiene in health care.2009. Available at: apps.who.int/iris/bit-
NATIONAL HOME INFUSION ASSOCIATION
Statement of Ownership, Management, and Circulation
1. Publication Title: Infusion 2. Publication Number 1-4437 3. Filing Date: 10/15/16 4. Issue Frequency: bi-monthly 5. Number of Issues Published Annually: 6 6. Annual Subscription Price: n/a for members; $50/year for non-members 7. Complete
Mailing Address of Known Office of Publication: National Home Infusion Association, 100 Daingerfield Rd., Alexandria, VA
22314 8. Complete Mailing Address of Headquarters or General Business Office of Publication: NHIA, 100 Daingerfield Rd.,
Alexandria, VA 22314 9. Name and Complete Mailing Address of Publisher and Executive Editor: NHIA, 100 Daingerfield Rd.,
Alexandria, VA 22314; Editor: Jeannie Counce, 846 E. Baxter Lane, Bozeman, MT 59718 10. Owner (full name): National Home
Infusion Association 11. Known Bondholders, Mortgages, and Other Security Holders: None 12. The purpose, function, and
non-profit status of this organization and the exempt status for federal income tax purposes: Has not changed during the
preceding 12 months
Average No of Copies
Each Issue During
Preceding 12 Months
A. Total Number of Copies
No. Copies of Single
Issue Published Nearest
to Filing Date
8,715
8,284
8,337
8,031
2. In-County Paid/Requested
n/a
n/a
3. Sales Through Dealers and Carriers, Street Vendors, Counter
Sales, and Other Paid or Requested Distribution Outside the
USPS
n/a
n/a
4. Requested Copies Distributed by Other Mail Classes Through
the USPS
n/a
n/a
8,337
8,031
1. Outside County Non-requested Copies
n/a
n/a
2. In-County Non-requested Copies
n/a
n/a
3. Non-requested Copies Distributed Through the USPS by other
Classes of Mail
n/a
n/a
4. Non-requested Copies Distributed Outside the Mail
380
0
380
0
8,717
8,031
212
253
8,715
8,284
96%
100%
B. Paid and/or Requested Distribution
1. Outside County Paid/Requested
C. Total Paid and/or Requested Circulation
E. Total Non-requested Distribution
F. Total Distribution
G. Copies not Distributed
H. Total
I.
Percent Paid and/or Requested Circulation
I certify that all the information furnished on this form is true and complete.
Jeannie Counce, Editor-in-Chief
NOVEMBER/DECEMBER 2016
D. Non-requested Distribution
43
www.nhia.org/CE_Infusion
4.
5.
6.
7.
8.
stream/10665/44102/1/9789241597906_eng.pdf (accessed
11/1/2016).
Gorski LA, Hadaway L, Hagle M, McGoldrick M, Orr M,
Doellman D (2016). 2016 Infusion therapy standards of practice. Journal of Infusion Nursing 39(1S), S1-S159.
Camp-Sorrell D Ed). Access Device Guidelines: Recommendations for Nursing Practice and Education (3rd Ed.). 2011; Oncology Nursing Society, Pittsburgh, PA. US Pharmacopeial Convention, Inc. (USP). General Chapter
<797>: Pharmaceutical Compounding – Sterile Preparations. United States Pharmacopeia 38 – National Formulary
33. Rockville, MD: United States Pharmacopeial Convention,
Inc.; 2015:567-611.
Grissinger M. Capping intravenous tubing and disinfecting
intravenous ports reduces risk of infection. P & T. 2011 Feb;
36(2): 62, 76. Available at: www.ncbi.nlm.nih.gov/pmc/articles/PMC3086084/ (accessed 11/1/2016).
CDC Grand Rounds: Preventing unsafe injection practices in
the U.S. health-care system. MMWR. 2013;62:423-5. Available
at: www.cdc.gov/mmwr/preview/mmwrhtml/mm6221a3.
htm (accessed 11/1/2016).
Continuing Education
9.
Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee. 2007
Guideline for isolation precautions: Preventing transmission of infectious agents in healthcare settings. Available at:
www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf (accessed
11/1/2016).
10. Institute for Safe Medication Practices (ISMP). Perilous infection control practices with needles, syringes, and vials suggest
stepped-up monitoring is needed. Medication Safety Alert.
December 2, 2010. Available at: www.ismp.org/newsletters/
acutecare/articles/20101202.asp (accessed 11/1/2016).
11. ISMP. ISMP safe practice guidelines for adult IV push medications.
2015. Available at: www.ismp.org/Tools/guidelines/ivsummitpush/ivpushmedguidelines.pdf (accessed 11/2/2016).
12. Dolan S, Meehan K, Felizardo G, Barnes S, Kraska S, Patrick
M, and Blumsted A. APIC position paper: Safe injection, infusion, and medication vial practices in health care. January
2016. Available at: www.apic.org/Resource_/TinyMceFileManager/Position_Statements/2016APICSIPPositionPaper.
pdf (access 11/2/2016).
Resources
Association for Professionals in Infection Control and
Epidemiology
Position Paper: Safe Injection, Infusion, and Medication
Vial Practices in Health Care
www.apic.org/Resource_/TinyMceFileManager/Position_Statements/2016APICSIPPositionPaper.pdf
Infection Prevention and You Campaign
www.apic.org/For-Consumers/Patient-safety-resources
Centers for Disease Control and Prevention
2007 Guideline for Isolation Precautions: Preventing
Transmission of Infectious Agents in Healthcare Setting
www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf
NOVEMBER /DECEMBER 2016
2011 Guidelines for the Prevention of Intravascular
Catheter-Related Infections
w w w.cd c .gov/hicp ac/p df/guid elines/bsi-guid elines-2011.pdf
44
Clean Hands Count Campaign
www.cdc.gov/handhygiene/campaign/index.html
One and Only Campaign
www.oneandonlycampaign.org
FAQs for Safe Practices for Medical Injections
www.cdc.gov/injectionsafety/providers/provider_faqs.html
Infusion Nurses Society
2016 Infusion Therapy Standards of Practice
Available for purchase from: www.ins1.org/Store
Institute for Safe Medication Practices
Safe Practice Guidelines for Adult IV Push Medications
www.ismp.org/Tools/guidelines/ivsummitpush/ivpushmedguidelines.pdf
Oncology Nursing Society
Access Device Guidelines: Recommendations for Nursing Practice and Education, 3rd Edition
Available for purchase at: www.ons.org/store
World Health Organization
Guidelines on Hand Hygiene in Health Care
apps.who.int/iris/bitstream/10665/44102/1/
9789241597906_eng.pdf