Applying Aseptic Practices To Protect Yourself From COVID-19

During this COVID-19 pandemic, we have all heard it: Wash your hands with soap and water for at least 20 seconds. That is the best defense to stay healthy. There are lots of tips circulating on media outlets to stay healthy; essential household and basic first-aid supplies are hard to find; and people are dying at frightening clips. This is my first time experiencing a global pandemic and although I imagine it could be worse, it is still intense. This article focuses on transferring basic aseptic techniques and good hygiene practices learned in the pharmaceutical industry to help you dodge the COVID-19 bullet.

What We Know About COVID-19

I have seen a few debates on the internet and news outlets about the origins of COVID-19. We all agree that this disease comes from a novel β-coronavirus that was never seen in humans until late 2019. The virus likely came from bats in China, and there is a theory that an intermediate animal may have first hosted the virus.¹ This host animal may have allowed the virus to mutate and evolve in order to be able to jump species to humans, a theory scientists say is highly likely.¹ Possible intermediate host animals include pangolins, cats, buffalo, cattle, goats, sheep, and pigeons, but scientists have not identified the intermediate animal at this point.¹

The highly publicized story is that COVID-19 came from someone who was infected with the virus at the Huanan seafood market in Wuhan, China. A series of infections grabbed the attention of doctors in December 2019 when a cluster of viral pneumonia patients began showing up in hospitals in Wuhan. A study of the first 41 patients known to have contracted the virus revealed that 27 (or 66 percent) of them had direct exposure to the Huanan seafood market.² 

The virus causes symptoms like the severe acute respiratory syndrome (SARS) coronavirus outbreak that also originated in China in 2003.³ The virus that causes the disease COVID-19 is named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The name of the disease triggered by the SARS-CoV-2 virus is COVID-19.³ COVID-19 stands for “coronavirus disease 2019”.⁴ Symptoms are appearing within two to 14 days after exposure and include fever, cough, and shortness of breath.⁴

The virus is known to spread in the following ways:

• Person to person through respiratory drops from coughing and sneezing.⁴
• From infected people who are asymptomatic. ⁴  
• From contaminated surfaces.⁴

The virus is proving to be harder on senior citizens (people 65 and older) and people with underlying health conditions. There is currently no vaccine for SARS-CoV-2.⁴ As of April 20, 2020, the pandemic has infected more than 2,426,788 people and killed more than 166,122 people worldwide.⁵ In the United States alone, 765,613 people had contracted SARS-CoV-2 and 40,620 people had lost their lives to COVID-19 as of April 20, 2020.⁵

Using Aseptic Practices And CDC Guidelines To Stay Safe

People and communities around the world are trying to avoid developing COVID-19. In the United States, many communities are under stay at home orders. We are asked to avoid close contact with people and to stay 6 feet apart from people with whom we do not share a household. We are only allowed to leave our homes for what are deemed essential activities, such as grocery shopping. Frustratingly, basic supplies that we need to stay healthy are now scarce. There are shortages of face masks, alcohol, hand sanitizer, disinfectant wipes, paper towels, and toilet paper.

The CDC recommends doing the following to prevent catching SARS-CoV-2:

• Wash your hands with soap and water for at least 20 seconds after you have been in public, blowing your nose, coughing, or sneezing.⁴ 
• Use a hand sanitizer with at least 60 percent alcohol if soap and water are not available.⁴ 
• Avoid touching your eyes, nose, and mouth.⁴ 
• Avoid close contact with people who are sick.⁴ 
• Cover your mouth and nose with a cloth face cover when around others.⁴ 
• Cover coughs and sneezes.⁴ 
• Clean and disinfect frequently touched surfaces daily.⁴ 

An essential activity that we must all do is buy groceries, and for my family, I am typically the person to brave the grocery stores on the weekends. Sometimes, I witness people not practicing social distancing because they are not taking the pandemic seriously or because the layout of the store makes it difficult to maneuver around other shoppers safely. How do you stay safe when other people are not taking the pandemic seriously? How do you prevent your elderly loved ones from getting sick? During my weekend grocery shopping trips, I realized that my years of service in the pharmaceutical world are going to help my family and me stay safe.

Here are some tips from the pharmaceutical industry for staying safe when you must go out in public:

Blood Borne Pathogen Training

Recall how you were trained to treat all blood like it is contaminated with blood pathogens? Treat all humans like they are contaminated with the virus. Respectfully keep a 6-foot distance whenever possible, as people who are asymptomatic can carry and spread SARS-CoV-2.

Good Hygiene Practices (Aseptic Behavior Training)

In aseptic manufacturing training, you are told to take a shower daily to limit skin shedding, frequently wash your hair, and practice good hygiene. I would like to take that a step further and say make sure you are brushing and flossing your teeth. What does that have to do with COVID-19? If you do not properly take care of your basic hygiene and health needs, like brushing your teeth, you could get cavities, gum disease, or an abscessed tooth. With many dental offices closed, you may find yourself in an emergency room with sick patients. While you may find an emergency dentist, you are increasing your risk of exposure to SARS-CoV-2.

Proper Hand Washing Technique (Aseptic Behavior Training)

The CDC says to wash your hands for at least 20 seconds with soap and water. In aseptic training, we are taught a specific hand washing technique that ensures all surfaces of the hands are cleansed.

• Wet hands with warm water and bring the soap to a lather.⁶
• Rub your palms together to wash your palms. ⁶
• Rub the back of both hands with the palm of the opposite hand while interlacing your fingers to wash the backs of your hands. ⁶
• Interlace fingers with palms facing each other and rub your hands together to wash between your fingers. ⁶
• Interlock your fingertips and rub the backs of your fingertips into the opposite hand’s palm. ⁶
• Using a fist from one hand, rub your thumb in the closed hand by using a rotating manner. Clean down between your index finger and thumb. ⁶
• Rub the fingertips onto your palms for both hands.⁶
• Rub both of your wrists in a rotating manner with the other hand.⁶
• Rinse off the soap and thoroughly dry your hands.⁶

Wear Face Masks (Aseptic Behavior Training)

Again, treat everyone as if they are contaminated. You may even be contaminated and not know it! Just as we wear face masks in cleanrooms, cloth face masks may prevent you from spreading your germs to the environment and other people. Remember that when wearing face masks, they are not a total barrier to viruses or microorganisms. Avoid excessive talking or yelling.

Also, ensure you are wearing the mask correctly. I have witnessed several people in public wearing their masks covering only their mouths, with their noses hanging out. The virus can enter and exit your body through your nose.

Wear Gloves (Aseptic Gowning)

Although many grocery stores are paying an employee to sanitize the carts before passing them off for your use, I still like to wear gloves into the store. You never know which items may be contaminated with the virus (SARS-CoV-2). It is not 100 percent foolproof, though.

After I shop, I like to load my groceries in my car, then walk to an external trash can and aseptically remove and dispose of my gloves. Then, I walk to my car and use hand sanitizer to sanitize my hands before getting in the car and removing my cloth face mask. As soon as I get home, I wash my hands properly.

Proper Glove Removal (First Aid and Blood Born Pathogen Training)

1. Grasp the outside of one glove at the wrist and peel it away from your body.⁷
2. Hold the glove you just removed that is now inside-out in your gloved hand.⁷
3. Insert the fingers of your ungloved hand inside the cuff of the gloved hand and wriggle the glove off your hand and away from your body. This glove should now also be inside-out, and the other glove should be safely inside this glove.⁷
4. If needed, push the trash can open with your elbow or outer part of your wrist.⁷

Clean And Disinfect Frequently Touched Surfaces Daily (Cleanroom Disinfection)

Human coronaviruses can remain infectious on inanimate surfaces for up to nine days.⁸

Using a household disinfectant like diluted bleach (e.g., 0.1 percent sodium hypochlorite), Clorox Cleanup, Lysol, 70 percent isopropyl alcohol, disinfect highly touched surfaces such as doorknobs, handrails, light switches, toilets, water faucets, phones, remotes, refrigerator doors, microwave doors and buttons, car steering wheels, radios, gear shifts, etc. on a frequent basis.

Behave as if you are disinfecting a cleanroom. I suggest looking at the manufacturer’s label and following their directions. However, if you find yourself having to make homemade disinfectant wipes, diluting your own bleach, etc., you can use contact times that you may be familiar with from your manufacturing facility. For example, before the outbreak, I would buy 70 percent isopropyl alcohol and pour it into a spray bottle to disinfect my home, especially the bath and shower area. I would spray it on, wait 1 minute, then rinse it off. The same can be done with a sodium hypochlorite solution (bleach).

The Parenteral Drug Association (PDA) technical report 70 says, in general, contact times for alcohols should not exceed 120 seconds or 10 minutes for disinfectants and sporicides.⁹ G. Kampf et al., describe disinfect efficacy data with coronaviruses. They state that surface disinfection with 0.1 percent sodium hypochlorite or 62 to 71 percent ethanol significantly reduces coronavirus infectivity on surfaces within 1 minute of exposure time. They go on to say that they expect a similar effect against SARS-CoV-2.⁸

Avoid Touching Exposed Skin (Aseptic Behavior Training)

In the cleanroom, we do not have exposed skin, but we do not reach under our masks or goggles to scratch at our face. The same should be true now. Do not touch your nose, eyes, or mouth when you are in public. If you need to scratch your face, wipe your face on your clothed arm.

Personnel And Material Flow

Many stores are now making the narrow shopping aisles one way only. Follow the safety guidelines of the store. If they have floors marked, go with the store’s suggested flow. Try to get what you need and do not linger in the aisles. Other shoppers will get frustrated and give up on social distancing practices.

Avoid Touching Items (Aseptic Behavior Training)

In a cleanroom, we do not go around touching everything because we do not want to contaminate the environment. The same is true with COVID-19. Avoid touching items that you do not intend to buy. This may prevent you from transporting the virus around or contaminating the item if you are a carrier of the virus.

Use Cards Instead Of Cash

It is true that money is dirty. Imagine how many hands that dollar bill has passed through. It is also paper and difficult to clean. We do not allow non-cleanroom paper into our cleanrooms. Credit cards are probably safer than cash right now (if you have one and can use it correctly). Plastic cards can be periodically wiped down with disinfectant. Better yet, touchless paying through smartphones or online ordering is even a cleaner solution.

Essential Employee

We love our friends and colleagues. But do you know if they take the same precautions as you do to stay safe? Are you required to go to work because you are an essential employee? Avoid hugging, avoid shaking hands, and try to keep your 6-foot social distance whenever possible throughout the day. When you get home, avoid your family, wash your hands, change clothes, and take a shower. This could help prevent spread of the virus to your family.

Send One Family Member To The Store

Just like the number of employees is limited in an aseptic manufacturing suite, the number of people in stores is now being limited. Only send one family member. This will allow more families to shop at the same time and could potentially protect your family if you utilize good aseptic practices and social distancing while shopping.

Airplane Travel

Are you required to travel by airplane for business? Wear a cloth mask and take hand sanitizer and sanitizing wipes onto the airplane. Wipe the high-contact areas around your seat, including arm rests, the seat belt buckle, and the tray table while the other guests are boarding the flight. When you are finished, disinfect your hands with your hand sanitizer. When the plane lands, go to the restroom and wash your hands with soap and water.

Other Recommendations

• Treat everything as if it is contaminated.
• Try to touch only the part of your shopping cart that was sanitized (i.e., the handle).
• Do not smell all the fruit.
• Avoid going to stores during peak hours.
• Get in, get out. Go to the store with a list of items you need, buy those items, and leave.
• Some stores offer delivery or curbside pickup. If you can get onto the schedule, this may be a safe option. Just pay attention to your behaviors when bringing in the groceries and wash your hands and your fruits and vegetables.

Conclusion

Staying safe during the COVID-19 pandemic may be causing anxiety in the population. However, pharmaceutical employees can help keep themselves and their families safe by practicing good aseptic behaviors they learned on the job.

It is important to remember to practice social distancing (i.e., stay 6 feet apart), practice good hygiene, properly wash your hands, and wear cloth face masks in public places. You may be carrying SARS-CoV-2 and not know it. Please be courteous, patient, and polite, especially to the frontline workers and essential employees.

Grocery shopping is no longer a social event; it is an essential event. Practice the shopping recommendations enumerated above to keep you and your family — and store employees and other members of the public — safe.

Remember, treat your home like it is your clean area. If you take the proper precautions and minimize your exposure risks to SARS-CoV-2, you should be safe at home.

References:

1. Readfearn, Graham (2020) How did coronavirus start and where did it come from? Was it really Wuhan's animal market? The Guardian. Accessed on 09APR2020 at https://www.theguardian.com/world/2020/apr/09/how-did-the-coronavirus-start-where-did-it-come-from-how-did-it-spread-humans-was-it-really-bats-pangolins-wuhan-animal-market
2. Huang, Chaolin, M.D. et al. (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. Accessed on 09Apr2020 at https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext#%20
3. World Health Organization (WHO). Accessed on 09Apr2020 at https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it
4. Center for Disease Control and Prevention (CDC). Accessed on 09Apr2020 at  https://www.cdc.gov/coronavirus/2019-ncov/index.html
5. Worldometer COVID-19 Coronavirus Pandemic (2020) Accessed on 16Apr2020 https://www.worldometers.info/coronavirus/?utm_campaign=homeAdvegas1
6. Marquez, Charity, R.N. (2018) Hand Washing Technique: Steps to Break Away from Infection. RN speak. Accessed on 13Apr2020 at https://www.rnspeak.com/hand-washing-technique-steps-to-break-away-from-infection/
7. Shale, Steve (2015) How to Safely Remove Disposable Gloves. Globus Group. Accessed on 13Apr2020 at https://www.globus.co.uk/how-to-safely-remove-disposable-gloves
8. Kampf, G. et al (2020) Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. The Healthcare Infection Society. Published by Elsevier Ltd. Accessed on 13Apr2020 at https://www.journalofhospitalinfection.com/article/S0195-6701(20)30046-3/fulltext
9. Parenteral Drug Association Technical Report 70 (2015) Fundamentals of Cleaning and Disinfection Programs for Aseptic Manufacturing Facilities.

About The Author:

Crystal M. Booth, M.M., is a regional manager with PSC Biotech. She has over 20 years of experience in pharmaceutical microbiology, working in quality assurance, CDMOs, R&D, and quality control laboratories, including startup companies. During her career, she has developed and validated methods for antibiotics, otic products, topical creams, topical ointments, oral solid dose products, oral liquid dose products, veterinary products, human parenterals, vaccines, biologics, aseptically filled products, and terminally sterilized products. Those methods include microbial limits testing, bacterial endotoxins testing, particulate testing, sterility testing, pharmaceutical water system validations, environmental monitoring programs, surface recovery validations, disinfectant efficacy studies, minimum inhibitory concentration testing, antimicrobial effectiveness testing, hold time studies, and various equipment validations.