Pharmacies and the rest of the health system are still meeting and adjusting to the changes brought by USP 800. Not meeting its standards for handling hazardous drugs can pose medical risks for patients and staff as well as professional and legal risks.

But a recent review article in Pharmacy Practice News highlights the ways compliance can sometimes go astray along the journey from USP guidance to the real-world clinic.

Asking if safety practices improve over time

From their survey of earlier studies, two researchers see evidence suggesting that worker exposure and workplace contamination is surprisingly common and stable over time.

Two studies published ten years apart found comparable results for hazardous drug contamination of surfaces in areas for compounding drugs and for administering drugs to patients.

Other studies found drug uptake and chromosomal changes in cancer workers, and a 2012 study found an increase in spontaneous abortions among nurses after they were exposed to hazardous drugs on the job.

Nurses tell NIOSH that real practices fall short

To uncover the real-world practices and protection used to control exposure in the workplace, the National Institute for Occupational Safety and Health (NIOSH) sponsored an internet survey.

Nurses administering drugs mostly in hospitals, outpatient care centers and physician offices reported skipping personal protective equipment, taking home possibly contaminated clothes, and touching IV pumps and doorknobs wearing contaminated gloves. 12% reported spills and leaks of anti-neoplastic (chemotherapy) drugs.

The survey suggests shortcomings in training, perception of risk and awareness of both workplace procedures and national guidelines.

Safety not universal when compounding cancer drugs

The NIOSH survey included nurses and pharmacy practitioners who compounded chemotherapy drugs. They reported using unsafe IV priming practices and spotty use of gloves, gowns, engineering controls and closed systems.

The authors recommend emphasizing the health risks of exposure, as well as trying to identify the real causes of these failures to take precautions.