Preventing workers contamination during solid oral doses repackaging : Why and How?

Introduction

The repackaging of solid oral doses became necessary due to France’s specific way of dispensing drugs in health care settings. This expanding activity within our pharmacies is neither legal nor illegal. Our current concerns about this method are multiple and include not only the preservation of the quality and efficiency of the medication, but also the security for health care workers. We aim here at proposing a set of recommendations applicable to the activity of repackaging.

Methods

We examined the literature and the guidelines published by North American, European and Australian health agencies and societies. We isolated the documents dedicating a chapter to this activity and we included the collected data into a cross table to allow their analysis. The different recommendations were grouped by item (workplaces, equipments, use of automates, personal protective equipments (PPE)).

Results

Considering the evidences of airborne and surfaces contamination by oral doses powder found in the literature; protective measures for workers appear as unavoidable. These measures could be organizational: for instance a safety program developed by the employer, a published list of hazardous drugs or training exercises for workers. They could also be completed by technical measures including a specific labelling, a separated storage for hazardous drugs, general hygiene practices and the use of PPE.

Discussion / conclusion

Today’s lack of legal regulation of the activity of solid oral doses repackaging should not prevent us from working for a better protection of healthcare workers. Before the spread of repackaging in our hospital pharmacies, political measures and technical measures to avoid workers’ exposure to hazardous drugs must be taken and adapted to the local constrains. This approach should be integrated into the medication circuit as it concerns health professionals, the caregivers as well as the family members.