Educate pharmacy community
Lawrence A. Trissel, R. Ph., FASHP
Director, Clinical Pharmaceutics Research
University of TX MD Anderson Cancer Center, Houston, TX
Your article “Cause for Concern” (February 1999, page 24) points to potential contamination problems in the healthcare area that are all too often dismissed as unimportant.
As a principal participant in the creation of the American Society of Health System Pharmacists (ASHP) Guidelines on Quality Assurance for Pharmacy-prepared Sterile Preparations in 1992, I had great hope that improvement in the level of contamination control present in hospital pharmacies would be encouraged. Unfortunately, reaction to the guidelines and the change that has followed has been mixed. ASHP surveys indicate compliance with the guidelines among its members has not improved substantially since 1992 and may have declined in some ways.
The United States Pharmacopoeia standards for home care pharmacies appear to have had a better degree of acceptance in the home care pharmacy community. By and large, home care pharmacies utilize contamination control technologies and practices at a much higher level than do hospitals in the U.S.
Within the pharmacy profession, drug product-related issues, including sterile product preparation and the associated necessary technologies, have been deemphasized or eliminated from most pharmacy schools` curricula. Consequently the impetus for significant improvement in contamination control in hospital pharmacies may need to be generated from outside the pharmacy profession.
The attitude seems to be quite prevalent among hospital pharmacists in the U.S. that improvements in contamination control are not really needed because no problem with contaminated hospital-prepared parenteral products exists. Unfortunately, little meaningful monitoring of any kind is actually performed, so I am not sure how one would expect to know.
If this situation is to improve, it will fall to the contamination control industry to help educate the pharmacy practice community on the importance of appropriate technology and procedures in contamination control. The benefits of adequate particulate and contamination control to the electronics and pharmaceutical manufacturing industries are understood by all involved. Currently, it appears that most practicing pharmacists and the educators who train them do not think that the issue is of major importance in the patient care environment.