Handling Chemotherapy Premedications

Are there resources that outline if chemo premeds must be mixed in the laminar air flow hood or can they be mixed in the pharmacy on the counter and not under the hood? — Marsha Ellison, RN, BS

Hazardous medications must always be manipulated in an appropriate biological safety cabinet (BSC) to prevent exposure to staff. With nonhazardous medications such as chemotherapy premedications, the risks of compounding outside of a hood and cleanroom include the risk of microbial contamination compromising the final product and exposing the patient to an infection risk. 

The United States Pharmacopeia (USP) <797> chapter on pharmaceutical compounding of sterile preparations provides guidance and outlines requirements for sterile product compounding, including immediate use and low-, medium-, and high-risk preparations. These regulations are currently being revised, so additional requirements or classifications may be in the updated publication (anticipated December 2019). For more information, visit www.usp.org/compounding/general-chapter-797.

State boards of pharmacy, Joint Commission, other regulating bodies, and your organization may also have additional regulations for sterile product preparation beyond those listed in USP <797>, so I would defer to the advice of your pharmacy leadership for how this information applies to your facility’s sterile compounding needs. — Lisa Thompson, PharmD, BCOP