Hazardous Drug Handling in the Community Pharmacy

One of the most commonly overlooked areas of community pharmacies I have either managed or worked in involves the handling and dispensing of hazardous drugs (HD) by pharmacy staff. This is unfortunate, because hazardous drugs can cause skin rashes, infertility and miscarriages, and possibly even cancer in healthcare workers that have been exposed. Guidelines have been in place for years through NIOSH and more recently with the development of USP <800>.

In the inpatient setting, HD handling precautions have gotten significant attention for quite some time; the development of closed system transfer devices (CSTD) minimizes the risk of healthcare worker exposure during compounding, negative air pressure rooms and hoods minimize the chance of exposure to volatile compounds, appropriate PPE has been mandatory, and policies and procedures as well as training have been commonplace.

These guidelines, though, apply to all settings where healthcare workers could be exposed, not just inpatient pharmacies, infusion centers, and other places we traditionally associate with hazardous drugs.

In addition, NIOSH defines a drug as hazardous if it "exhibits one or more of the following characteristics in humans or animals:

  • Carcinogenicity

  • Teratogenicity or developmental toxicity

  • Reproductive toxicity

  • Organ toxicity at low doses

  • Genotoxicity

  • Structure and toxicity profiles of new drugs that mimic existing hazardous drugs."

I've never worked at a pharmacy that doesn't have drugs that exhibit at least one of these. But are we fully protecting ourselves and our staff in the community pharmacy?

Here are some of the most commonly missed areas:

1. Gloves

First off - use them!