Pharmacies that prepare personalized medications must safeguard workers from exposure
Working with pharmaceuticals always requires attention to safety. According to the U.S. Centers for Disease Control and Prevention: “About 8 million U.S. healthcare workers are potentially exposed to hazardous drugs.” That’s a lot of exposure, especially when some of the compounds can be quite dangerous. In particular, that danger must be kept in mind at a compounding pharmacy.
In compounding specific medications for patients, pharmacists face a variety of concerns. When asked what drugs create the biggest risk, Robert Myers, an assistant professor at Idaho State University’s College of Pharmacy (Pocatello, ID), points out antineoplastics, which can be used as chemotherapy to treat some cancers.
Other experts also indicate the risk of working with cancer-related medications, plus additional materials. “Compounding used for cancer therapy and some antiviral drugs, hormone agents, and bioengineered drugs can be a big risk for those who work in areas where these drugs are made,” says Taisha Cunningham, lab coordinator at the American College of Apothecaries (Bartlett, TN). “Exposure to hazardous drugs can result in adverse health effects in healthcare workers.”
So, personnel in compounding pharmacies must be protected, and protect themselves.
Personal protection
Various devices play a fundamental role in minimizing exposure. “Protect yourself and others around you,” says Myers. That includes using the necessary personal protective equipment (PPE). Plus, Myers says that compounding pharmacies handling hazardous drugs should “use an isolated negative-pressure room with exterior venting.”
For PPE, the United States Pharmacopeia (USP) Chapter <800> is a good resource. It includes information on gloves, gowns, covers (head, hair, shoe, and sleeve), eye and face protection, respiratory protection, and how to dispose of PPE.
Pharmacists can also follow other crucial practices. Cunningham makes several valuable suggestions:
- Identify methods and safe practices to minimize the risks from exposures to chemicals and from physical hazards.
- Understand the nature and limitations of PPE, chemical hoods, and other safety equipment.
- Locate online and printed materials to identify safe practices, and consult with a more experienced chemist when necessary.
- The dress code in a lab should allow no exposed skin below the chest level.
- Use appropriate waste containers when discarding chemicals.
Some tools also make it easier to find information. To keep track of what drugs are hazardous, for example, USP developed its HazRX Mobile App. It includes more than 1,000 drugs and provides monthly updates. It also gives a compounding pharmacist “information on how to safely handle hazardous drugs in accordance to established standards.”
Another resource is the “NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings, 2016.” “This reference classifies hazardous drugs into three groups based on the type of hazard and is updated every 2 years,” Myers says.
The best start
“Pre-experiment analysis may be the most important step you can take to minimize the risks in any laboratory setting,” Cunningham says. “Incidents can happen even in the best-prepared scenario; however, careful attention to detail can minimize the risks.”
To know what hazards a worker might face, Myers recommends consulting the Safety Data Sheet (SDS) for any material that will be used. “The SDS will also include appropriate PPE to use,” he adds.
To get off to the right start in any compounding, Cunningham makes several suggestions:
- Carefully develop a list of all of the chemicals used and the quantities needed.
- Use appropriate containers for chemical distribution in the laboratory.
- Consider the physical arrangement and the facilities available in the laboratory.
To keep a compounding pharmacy as safe as possible, all personnel must be aware of the risks and practice the best prevention. That means being very consistent in proper PPE and processes.