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Changes in Workflow To A University Pharmacy To Facilitate Compounding
Changes in Workflow To A University Pharmacy To Facilitate Compounding
A R T I C L E I N F O A B S T R A C T
Keywords: This article is a report from an experience about a work developed by Farmácia Universitária at UFRJ (FU-UFRJ)
Coronavirus during the nCov-19 pandemic period. The aim of this work was to describe its contribution in the production of
Gels antiseptics antiseptic supplies used to prevent contagion by the new coronavirus. The work routine at the pharmacy has
Actions against Covid-19
been changed to allow the implementation of local workflow during the pandemic, and to adapt the protection
Compounding pharmacy
rules to meet the safety measures. FU-UFRJ started to manipulate two antiseptic formulations: 70% ethyl alcohol
and gel alcohol, which are included in the National Form, manufacturing around 100 L of these formulations,
weekly, to donate to different health units. The experience enabled the adaptation to emergency health stan
dards, planning and meaningful guidance to pharmacists and technicians to attend clinics at university hospitals,
vaccination center and UFRJ city hall, in order to facilitate the access to adequate hand hygiene to the
population.
* Corresponding author. Federal University of Rio de Janeiro, Carlos Chavas Filho Avenue, 373, 21.941-902, Rio de Janeiro, Brazil.
E-mail addresses: ricci@pharma.ufrj.br, ericcijunior@hotmail.com (E. Ricci-Júnior).
https://doi.org/10.1016/j.sapharm.2020.09.016
Received 27 September 2020; Accepted 28 September 2020
Available online 1 October 2020
1551-7411/© 2020 Elsevier Inc. All rights reserved.
Please cite this article as: Fiammetta Nigro, Research in Social and Administrative Pharmacy, https://doi.org/10.1016/j.sapharm.2020.09.016
F. Nigro et al. Research in Social and Administrative Pharmacy xxx (xxxx) xxx
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Another action to confront COVID-19 was the development of an were manipulated, according to the GHP, with the supervision of the
alcohol formulation alternative to the one found in the Brazilian Phar handling process by a pharmacist, registered with the Regional Phar
macopeia National Form,16 using ingredients with the same pharma macy Council of the State of Rio de Janeiro. The raw materials were from
cotechnical function, as determined by Resolution No. 347.13 In qualified suppliers and analyzed by the quality control of FU-UFRJ. The
addition, controls on the manipulated formulations were also per purified water was produced on the same day of the products handling at
formed, as determined by the Resolution No. 67 publicized by National the pharmacy, in addition to physical-chemical and microbiological
Health Surveillance Agency (ANVISA),18 such as: description of the tests performed at the FU-UFRJ laboratories, that belong to the Brazilian
formulations developed, aspect, organoleptic characteristics, pH (Bante Network of Analytical Health Laboratories (REBLAS); the handling
Instrument - model 9220), viscosity (Brookfield viscometer, model process followed previously defined Standard Operating Procedures
DV-II), and recorded in the manipulation order. All the manipulation (SOP). The products label presented all the information required by the
work took place in an environment that obeys Good Handling Practices legislations issued by regulatory bodies.16,18 In the face of the pandemic,
(GHP), as determined by Resolution No. 67 (ANVISA, 2007).18 In there was an increase in the consumption of gel alcohol and 70% ethyl
addition, efficacy and safety tests of the alternative formulation and alcohol, by society, as a preventive measure against the transmission of
traditional formulation of 70% alcohol gel were executed. The effec nCov-19. This high demand caused the lack of these products in the
tiveness of the two formulations was tested according to the protocol of market at first, in addition to the abusive price increase. Another
the National Institute for Quality Control in Health (INCQS) 65,3210, negative fact was the encouragement of homemade alcohol gel pro
019,19 with a few modifications. Ten sterile stainless steel cylinders were duction, in addition to product counterfeiting, without considering the
dipped for 15 min at room temperature, in a pool of microorganisms risk of accidents, as they were not subjected to quality controls to
(Staphylococcus aureus, Salmonella choleraesuis and Pseudomonas aerugi guarantee their efficacy and safety, contrary to the Brazilian
nosa) grown in Casoy broth for 48 h at 32.5 ◦ C ± 2.5 ◦ C. Each cylinder legislation.13,16,18
was carefully removed with the aid of a sterile hook, placed on filter Selling of liquid alcohol in concentrations above 54◦ GL (Gay-Lussac)
paper and in an oven for 40 min. After that time, every 1 min, a cylinder has been forbidden by ANVISA, since 2013, according to Resolution No.
was placed in a tube containing 10 ml of each alcohol gel formulation. 46 (2002), which considered the risks offered to public health resulting
After placing the 10th cylinder, totaling 10 min, the first cylinder was from accidents, as fires, high-grade burns and skin and mucous mem
removed and placed in a tube containing 10 mL of Casoy broth, suc branes irritation. For solutions with a degree above 54◦ GL, the standard
cessively repeating the procedure every 1 min for the other cylinders. gel form is allowed.21
The ten tubes containing the cylinders were incubated in a bacterio According to Empresa Brasil de Comunicação (EBC), Agência Brasil
logical oven at 32.5 ◦ C ± 2.5 ◦ C for 48 h. published that the Civil Police arrested a Central scheme that produced
As for safety tests, the formulations were analyzed in accordance counterfeit alcohol gel.22 This led ANVISA to publish an orientation for
with Resolution No. 481(1999) which establishes Microbiological Con the purchase of alcohol gel6 and a technical note on the requirements
trol Parameters for Personal Hygiene Products, Cosmetics and Per that must be met for the donation of 70% ethyl alcohol7 to minimize
fumes.20 According to the Resolution No. 481, for Total Count of Aerobic these risks.
Microorganisms, 10 g of sample was transferred to a flask containing 90 Thus, ANVISA has advised to always purchase these products from
ml (1:10) of Casoy broth under agitation until complete dissolution of establishments that guarantee compliance with the minimum standards
the sample. Counting was carried out using 1 ml aliquots of the 1:10 of BHP, with a professional responsible for the technical supervision of
dilution in four Petri dishes. Two plates had about 20 ml of casein-soy the activity, with raw materials that meet the technical requirements of
agar (TSA-medium for bacterial count) and for the other two, about quality and safety of the official compendiums. Besides, the labels/
20 ml of potato dextrose agar (PDA-medium for mold and yeast count), packages must include Company’s Name, CNPJ, address, telephone
in addition to 0.3 ml of 10% w/v tartaric acid. After homogenization, the number of the establishment, validity, alcohol concentration, indication
plates were incubated in a bacteriological oven at 32.5 ◦ C ± 2.5 ◦ C, for of use, complete formulation and warnings.6,7 Due to the scenario, given
24–48 h, for the TSA plates; and 22.5 ◦ C ± 2.5 ◦ C, for 5–7 days for PDA the exponential infection growth, the FU-UFRJ adopted agile and
plates. After the incubation period, the plates were examined for mi effective actions to enable quick and large-scale access to antiseptic
crobial development. products that could be used to combat the pandemic.
As for safety tests, the formulations were analyzed in accordance As of March 16, 2020, the FU-UFRJ with its reduced staff, started to
with Resolution No. 481 (1999) which establishes Microbiological operate according to the document prepared by the Federal Pharmacy
Control Parameters for Personal Hygiene Products, Cosmetics and Per Council (FPC), which describes that compounding pharmacies must
fumes.20 According to the referred Resolution, for Total Count of Aer implement emergency plans and local workflow during the nCov-19
obic Microorganisms, 10 g of sample was transferred to a flask pandemic.23–26
containing 90 ml (1:10) of Casoy broth under agitation until complete Therefore, to meet safety measures, FU-UFRJ provided personal
dissolution of the sample. Counting was carried out using 1 ml aliquots protective equipment (PPE), such as a face mask, disposable cap, glasses,
of the 1:10 dilution in four Petri dishes. Two plates had about 20 ml of latex gloves, disposable apron, for the whole team. In addition, recom
casein-soy agar (TSA-bacteria count medium) and for the other two, mended 2 m distance between people, talking as little as possible. The
about 20 ml of potato dextrose agar (PDA-mold and yeast count me constant use of hand sanitizer was mandatory along with the attention to
dium), in addition to 0.3 ml of 10% w/v tartaric acid. After homoge the initial symptoms of the infection (fever, cough, body pain, indispo
nization, the plates were incubated in a bacteriological oven at 32.5 ◦ C sition) also guided the employees when they got home on how to put on
± 2.5 ◦ C, for 24–48 h, for the TSA plates; and 22.5 ◦ C ± 2.5 ◦ C, for 5–7 all the clothes to wash, how to quarantine shoes, wash hands correctly
days, for PDA plates. After the incubation period, the plates were and finally how to take a shower.13,23,24
examined for microbial development. After the emergency plan and work flow were implemented, FU-
UFRJ started to manufacture 50 L of alcohol gel and 55 L 70% ethyl
Results and discussion alcohol weekly, according to the Brazilian pharmacopeia National
Form,16 aiming the needs of some clinics at Clementino Fraga Filho
Alcohol gel and 70% ethyl alcohol are antiseptic agents, used by the University Hospital (HU-UFRJ), the Vaccination Center and the City
population in order to mitigate the expansion and spread of nCov-19 as Hall. The City Hall that began the distribution of antiseptics to the
hand sanitizer and surface sanitizer. Therefore, it is very important to ambulance and bus drivers that continued to circulate around UFRJ
ensure the safety and effectiveness of these products. The action carried campus compliant to the rules established by ANVISA for the public
out by FU-UFRJ was relevant in the health context, as all formulations health emergence.
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F. Nigro et al. Research in Social and Administrative Pharmacy xxx (xxxx) xxx
The substitution of acrylic derivatives, such as Carbopol®, with other Organoleptic Gel transparente e Transparent and Liquid and
thickening agents, was a way of circumventing the lack of it in the characteristics homogêneo homogeneous gel transparente
Ph 6.9 ± 0.1 5.6 ± 0.01 5.5 ± 0.01
market, considering its performance in forming gel in the presence of
Viscosity (cps) 13,700 ± 360 10,833 ± 208
high concentrations of alcohol, when compared to other hydrogels.27
–
a
However, the copolymer of sulfonic acid acryloyldimethyltaurate and Formulações manipuladas de acodo com o Formulário Nacional (Brasil,
vinylpyrrolidone, also known as Aristoflex® AVC, belongs to a modern 2012).
group of viscosity modifiers, conferring good spreadability and sensory
characteristics to the formulation, in a concentration of use similar to
Table 3
Carbopol®, without the need of neutralization.28 Table 2 shows the Safety results of formulations developed according to the specifications con
physical-chemical results of the formulations manufactured by tained in the Brazilian Pharmacopoeia.30
FU-UFRJ.
Test(s) Result(s) Specifications*
It was observed that the physical-chemical characteristics obtained
were similar between the formulations for alcohol gel. On the other Standard Plate Count <10 CFU/mL Maximum limit
5 × 103 CFU/mL
hand, the pH resulting from the addition of Aristoflex® AVC showed
Yeasts and Moulds <10 CFU/mL Maximum limit
greater compatibility with the skin, considering its slightly acidic 5 × 102 CFU/mL
characteristics (4.8–5.5).29 The pH for 70% ethyl alcohol is in line with Staphylococcus aureus Absent Absent
skin pH.29 Pseudomonas aeruginosa Absent Absent
In the microbiological test, all formulations inhibited the growth of Escherichia coli Absent Absent
None.
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F. Nigro et al. Research in Social and Administrative Pharmacy xxx (xxxx) xxx
Márcia Maria Barros dos Passos: Methodology, Writing- Reviewing 16. Brasilb. Brazilian pharmacopeia National Form. Ministry of health. National health
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