Risk model for exposure to toxic substances at preparation in the pharmacy

Small-scale preparation of medicines in pharmacies may involve many different active substances and differing exposure levels. From breaking tablets for arthritic patients to filling a series of ethanol bottles and from sieving zinc oxide for a cutaneous powder to processing freeze-dried antineoplastic in capsules for children. An investigation of each specific situation and setting a specific exposure level – as some regulation seems to point at – is out of the question. However, a maximal precautionary attitude for every situation may not be feasible either. TNO (Tielemans and coworkers) developed an exposure model for us, based on exposure measurements of some typical situations. A classification model for toxicity classes is supplementing this model. The recently developed – universally available - Advanced REACH tool (ART) for estimation of exposure, uses the same principles. The approach of occupational safety in pharmacies will be explained and illustrated. The application of the model for situations of extremely low exposure to extremely toxic substances will be questioned.