Exposure of Pharmacy Workers to Pill Dust – studies and case reports

In 2004, robotic prescription dispensing machines began to appear in the market with a new twist … certain manufacturers used air pressure to eject pills into the bottle. This was promoted as a great idea because it was claimed that the compressed air would cause the pills to dispense at a faster rate. The higher you ramp up the pressure, the faster the pills are blown out into the bottle.

As we observed these machines in operation, it became clear that pill dust was being blown into the air, both inside and outside the machines. Some people working with the machines complained about the pill dust. They were concerned both about the potential effects on workers who would breathe in the dust or otherwise come in contact with it, and also about the potential for cross-contamination of drugs in the machine and the implications for patients receiving these drugs.

There are many regulations to protect the population from adverse effects of pharmaceutical products. Drugs must go through a tremendous amount of screening and testing before they are allowed into the market. Their use is limited to written orders from qualified prescribers. They can only be obtained and dispensed through doctors or licensed pharmacists. Powerful drug utilization software is employed to ensure that a patient’s health is not undermined by drug interactions or inappropriate therapies. Our government inspects drug manufacturing facilities to check on exposure of workers to pill dust.

But with all these safeguards, there seems to be a glaring hole in the system if pharmaceutical compounds are being converted to microscopic dust by air pressure-activated pharmacy dispensing machines, and that dust is then blown into the air for everyone in the area to breathe.

Attached is a background sheet on studies initiated by ScriptPro in 2007 to obtain real world facts, and also opinions of qualified independent researchers, regarding this issue. From the very beginning the results were shocking … and especially surprising to leading air quality experts who did not suspect that this kind of man-made exposure would be occurring in thousands of U.S. pharmacies. Test methodologies and results were reported at national air quality meetings and in the pharmacy press.

The National Institute for Occupational Safety and Health (NIOSH) has now released a report covering their own initial pharmacy air quality study.   The NIOSH study did not involve machines using air pressure-activated dispensing, but it did highlight concerns about the use of compressed air in cleaning drug cells. NIOSH is now planning an expanded study that will address the use of air pressure-activated dispensing machines. Pharmacies using these machines have requested to be test sites.

NIOSH officials have expressed appreciation for the documented research made available through the lab and peer review work initiated by ScriptPro.

It takes time for an industry to come to grips with practices which, while they may seem to be convenient and efficient, may also lead to unsafe working conditions. The issue is now being studied by the national organization charged with responsibility to identify and evaluate threats to the health of U.S. workers and make recommendations to avoid or mitigate adverse results.

Reference to pre-NIOSH studies and peer reviews:

October 15, 2008 – “Investigation into the Impact of Air Pressure Driven Drug Dispensing Machines on the Environment of Pharmacy Workers, Results in 15 U.S. Pharmacies, – McKesson/Parata RDS, – ScriptPro SP 200, -Manual Dispensing.”

20081015_Alburty_Lab_Results_in_15_Pharmacies.pdf
20081015_Alburty_Lab_Results_in_15_Pharmacies_Summary.pdf

December 23, 2008 – Peer Review, Dennis D. Lane, PhD, N.T. Veatch Distinguished Professor of Environmental Engineering, University of Kansas.

20081223_Dennis_D_Lane_PhD_Peer_Review.pdf

January 6, 2009 – “Investigation into the Impact of Air Pressure Driven Drug Dispensing Machines on the Environment of Pharmacy Workers, Results in Two U.S. Pharmacies, – McKesson/Parata Max.”

20090106_Alburty_Lab_Parata_Max_Results_in_Two_Pharmacies.pdf
20090106_Alburty_Lab_Parata_Max_Results_in_Two_Pharmacies_Summary.pdf

July 27, 2009 – “Investigation into the Impact of Air Pressure Driven Drug Dispensing Machines on the Environment of Pharmacy Workers, Results in Two U.S. Pharmacies, Personal Exposure Monitoring, – McKesson/Parata RDS, – McKesson/Parata Max.”

20090727_Alburty_Lab_Parata_RDS_Parata_Max_Personal_Exposure_Monitoring.pdf
20090727_Alburty_Lab_Parata_RDS_Parata_Max_Personal_Exposure_Monitoring_Summary.pdf

August 14, 2008 – Peer Review, Dr. Ralph M. Keller, P.E., Certified Industrial Hygienist.

20090814_Ralph_M_Keller_PE_CIH_Peer_Review.pdf

October 22, 2009 – Presentation, David S. Alburty, Pamela S. Murowchick and Ann K. Packingham, 28th Annual Conference of the American Association for Aerosol Research.

20091022_Alburty_Lab_AAAR_Presentation.pdf

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