PPE

Joey Sweeney, PharmD, BCPS

Keeping the pharmacy workforce safe from hazardous drugs has come into focus recently. Although USP Chapter <800> is not yet enforceable, some institutions have decided to put its requirements in place, especially as it relates to personal protective equipment (PPE). USP Chapter <800> is meant to protect the workforce from exposure to hazardous drugs, an important component of worker safety.

“[We’d] done a great deal of planning to prepare, so we decided not to delay putting those plans in place,” said Matt Kelm, PharmD, MHA, associate chief pharmacy officer at Duke University Hospital. Kelm presented information on implementing USP <800> during the ASHP 2020 Midyear Clinical Meeting and Exhibition.

In addition to the actual cost of PPE, there is a perceived labor cost associated with donning it in the pharmacy.

A team of investigators at Duke University Hospital performed an observational study to evaluate the time cost associated with increased PPE usage. They looked at how much time preparation, gowning, compounding, labeling, and checking PPE took prior to adhering to USP Chapter <800>, and how much time these tasks took after becoming compliant.

“The addition of more stringent PPE and protective settings did not significantly impact technician or pharmacist time when preparing daily batches of hazardous syringes,” Kelm said.

A big shift

As part of keeping pharmacy workers who handle hazardous drugs safe, USP Chapter <800> says that pharmacy technicians should wear two sets of chemo gloves, a gown, a head/hair covering, and shoe covers. In the past, some pharmacy technicians may have only worn gloves when compounding hazardous drugs. These changes represent a big shift for some institutions’ pharmacy technicians.

Wearing extra PPE does add time to the total compounding workflow. However, the process of compounding a large batch of hazardous drugs takes significantly longer. Even if putting on more PPE takes twice as much time as before, it is still a small percentage of time taken in relation to the overall compounding process.

Institutions can be smart about ways to make this process more efficient—and pleasant—for pharmacy employees.

“We have also found that taking an ergonomic approach to donning and doffing of PPE, such as having a seating option so someone can safely don shoe covers, assists with efficiency,” said Kelm.

Considerations

The Duke University Hospital study primarily considered batched hazardous compounding in its analysis, which means the findings would not directly apply to a technician who makes hazardous drug compounds, such as chemo drugs, that cannot be batched ahead of time.

“When it comes to chemo, a lot is patient-specific,” said Karen Sempf, CPhT, IV suite specialist at Advocate Aurora Health. “You really need to consider having a dedicated chemo tech.”

When figuring out whether to batch a chemo drug ahead of time, personnel may end up making more than needed prior to the batch expiring. “The cost of chemo is high, and you also don’t want this ending up in a waste stream, so you have to be careful about making things up ahead of time,” said Sempf.

Disposing of hazardous drugs is not only costly from a wasted supply perspective, but also costly from an environmental perspective. Hazardous drugs are disposed of in special containers with high-priced removal/replacement service contracts needed for the institution.

Pharmacy managers must remain flexible when it comes to considering the time expense of PPE donning, even if it makes up a low percentage of total compounding time. However, when making sporadic hazardous compounds, such as one or two per compounding sequence, the donning time takes up a larger percentage of the total compounding time.

“The last thing we want is for the pharmacists and techs to be pushed to hurry up,” said Fred Massoomi, PharmD, senior director of pharmacy services for Visante, a pharmacy consulting firm. “We want them to garb appropriately so that it protects them and their patients as they are in the process of compounding and verifying.”

USP Chapter <800> is a much-needed improvement for the safety of pharmacy workers who compound hazardous drugs. Pharmacy managers need to be cautious when considering the time implications for increases in total compounding time. Determining the staffing changes needed to support this new chapter will vary depending on the type of hazardous compounding performed.