One-time deficiency becomes profit center
Clean room is saving, making money for hospital
When members of a site team from the Joint Commission on Accreditation of Health care Organizations frowned on the the sterile preparation procedures in the central pharmacy at Wausau (WI) Hospital, officials there dutifully took note but seemed unsure how to fix the problem.
The hospital pharmacy had been using separate locations for intravenous and antineoplastic drug prep, with the IV room housing a vertical-laminar airflow workbench and a second hood for antineoplastic work in the pharmacy's main high-traffic work area.
The problems associated with the setup were obvious and threefold: the risk of exposure to antineoplastics by staff; airflow irregularities and the impact on drug quality; and the basic time and distance hassles between supply and mixing areas.
Later, when a consultant noted there simply wasn't enough room for the second hood in the IV room, officials decided essentially to start from scratch by knocking down some walls and installing a custom-built clean room.
Now two years after completion, hospital officials say job performance has increased, projected savings have been realized, and on top of that, the facility is making money through sterilization contracts with other health care organizations.
"It's been beyond our expectations," says Glen Schumock, PharmD, MBA, BCPS, director of pharmacy and respiratory care. "We found that the employees, due to the heightened level of procedures and awareness, do a better job."
Schumock adds that to date the pharmacy has entered into contracts with a home care company, a hospice, and a nursing home to produce intravenous piggybacks largely centering on antibiotics and total parenteral nutrition. That's an estimated $20,000 a year the hospital has been saving through batch production of unit-of-use syringes unavailable in single dose, in-house compounding of other premade - and previously bought - items, and decreased waste.
Those successes came after a four- to six-week construction schedule resulting in a 9- by 18- foot clean room with three hoods, an adjacent 11- by 18-foot preparation anteroom, and a 21- by 12-foot IV room, all connected with pass-through shelves, refrigerators, and windows. The final cost was $39,486 for a class 10,000 clean room, meaning air particles per cubic foot below 10,000.
Schumock and his staff of 27 were able to justify the cost to hospital administrators based on the facility's workload, not to mention a triennial Joint Commission visit that was looming.
A 321-bed primary care hospital with 212 operational beds, Wausau averages 10,950 admis sions each year with a 4.8-day average length of stay. Wausau also treats 50,000 outpatients each year and has 24,000 annual emergency department visits as a regional emergency care referral center. That translates into an average of 6,485 small-volume and 2,898 large- volume IV solutions a month, along with the preparation of 1,136 syringes, 188 parenteral nutrition bags, and 49 antineoplastics, all serving the cardiac, spinal, orthopedic, eye, spinal, laser, plastic, and neurosurgery being done.
Obstacles few but ongoing
Despite all the benefits, the undertaking has not been trouble-free, Schumock says. "After we designed and constructed the room, we found it was cumbersome for people to get into the anteroom through a main door if they were just coming in for a short time, either to check the technicians or something just as quick because they had to get into gowns just to go in and out. So we added a pass-through window to pass the product out of the room so the pharmacists can now check products without even going into the room."
Also, he says, "We didn't anticipate the need to make sure there's good temperature control, and we're still struggling with that and had some revisions in the HVAC systems. We have heat being generated from the equipment and, on top of that, people gowning up. That combination can be uncomfortable." But temperature has not been a problem where the actual drug processing is concerned, he adds.
Finally, Schumock says, "We didn't anticipate the extra procedures for cleaning the room itself," meaning that to keep a clean room clean, specific steps for both the pharmacy and housekeeping staff had to be drawn up and then training had to be done. That training, he notes, is constant, based on the turnover of the general housekeeping staff.
Schumock advises extra-early ordering of all materials needed to put together a clean room, and he notes that the basic costs of his custom plan and that of installing a prefabricated modular clean room were not different enough to pass on the tailored options a custom-built facility would bring.
Consulting and training help
He also praises the consulting help on the design and then staff training Wausau received from the IV systems division of Baxter Health care's Baxter Pharmacy Services in Round Lake, IL.
"I think a lot of people are in the midst of trying to figure out if they should have these types of clean rooms or if they should upgrade, and from there how to do it, and the process can be daunting," he says.
He also notes that during the past five years or so, there has been increased discussion on the use of clean rooms to improve sterile products, which has been paced by various pharmacy organizations. He cites the American Society of Health-System Pharmacists, which is publishing recommendations, guidelines, and standards for their use. (See the American Journal of Health-System Pharmacists 1998; 55:458-63.)
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