Assessment of the impact of Covid-19 on preparatory practices and activity in nonsterile compounding units (hospital and community pharmacies)

INTRODUCTION
The exceptional health situation of Covid-19 has disrupted the conduct of our activities, including nonsterile compounding units. The decree of March 6, 2020 authorizes the production of hydroalcoholic solution by community and hospital pharmacies in France. However, the impact of this sanitary crisis was not limited to this aspect. This study aimed to map the Covid-19 impact on our practices, then identify and quantify changes in the production of non-sterile compounded drugs at hospital and community pharmacies.

METHOD
A survey was send to 50 community and hospital pharmacies throughout France. Questions asked dealt with: the impact on the production, new orders, the application of barrier gestures, individual protection elements, bio-cleaning of facilities, monitoring the supply of raw materials and medical devices and the organization of an operational reserve.

RESULTS
Currently, 28 pharmacies have answered and this survey is still on going. Only major results are presented here. Distribution of participation was as follows: 68% (n=19) of hospital pharmacies and 32% (n=9) of community pharmacies. In both cases, production was increased and streamlined to core activities during this period (54%, n=15). Firstly, new preparations emerged in order to suppleate industrial shortages, such as hydro-alcoholic solution (HAS).The volumes produced were impressive: 300 – 400 000L. Secondly, new formulations were created to adapt the galenic to patients (i.e. oral suspensions of lopinavir/ritonavir or hydroxychloroquine). The main difficulties encountered were related to supply: raw materials, packaging items (bottles and pumps) for the production of HAS, as well as individual protective elements for compounding (masks, hairnets and gloves). Only 11% (n=3) of pharmacies did not respect barrier gestures, such as hand washing, use of masks and social distancing. A majority of community pharmacies reinforced bio-cleaning of facilities (67%, n=6), whereas only 16% of hospital pharmacies (n=3) did.

DISCUSSION/CONCLUSION
Both community and hospital compounding units were heavily involved in the management of the covid-19 crisis. They adapted quickly to meet the needs of the population and caregivers. The increased activity was mainly related to HAS production. However, pharmacies did not face the same challenges and difficulties (supply disruptions, requests for preparations). Furthermore, the respect of barrier gestures and the reinforcement of bio-cleaning of facilities were not uniform but were certainly linked to the difference in visitor rate between community and hospitals pharmacies.