Corrugated Cardboard: The Necessary Evil
Pharmacy Stars
Be the one who is organized and in control of USP 795 797 800 Compliance.
Friday July 12, 2024 Volume 1 Issue 6
Corrugated Cardboard: The Necessary Evil
If you have ordered anything online lately, I think you have encountered a corrugated cardboard container (box).? This underappreciated shipping wonder has been in existence since the mid-1800’s (yep, Wiki’ed that one).? Outside of healthcare, corrugated cardboard is celebrated as a sustainable and environmentally friendly device primarily composed of pulp and paper; (note: variances in adhesives and inks could impact its overall environmental friendliness).? The estimated annual world production of corrugated cardboard is an impressive 175 million tons and continues to offer itself as an alternative to plastic packaging.? Corrugated cardboard is constructed of three different layers, the two outer layers having a smooth surface while the central inner layer is corrugated, i.e., shaped into a series of parallel ridges and grooves to give added rigidity and strength.The ‘corrugated’ or flute-height is what offers the benefits for protecting its contents by acting as a shock absorber and a barrier to the external environment (noting the limitations of paper with water and fire).? We in pharmacy depend upon cardboard to maintain the integrity of drugs and supplies from the shippers to our hands.
Masoud explains why switching from paper based logs to Compounding360 is a great decision.
However, Infection Control does not share our enthusiasm for cardboard, especially in and around medications and supplies destined for patients.? Accreditation bodies frequently survey pharmacies on cardboard management practices.? They will often question the processes associated with the receipt, breakdown and disposal of cardboard.? Their audit of this process is in line with the Association for the Advancement of Medical Instrumentation (AAMI) guidance document where it clearly states that clean or sterile items be removed from their ‘shipping container, i.e., cardboard’ prior to entry into storage areas of the sterile processing department.? So why is cardboard getting such a bad rap?
Since it acts as a protective barrier for shipping, these products have been exposed to an extreme variety of conditions on their journey.? It is often cited that cardboard is susceptible to moisture, mold, bugs, vermin and bacteria in addition to generating a significant amount of? particulate matter when torn.
If we layer in USP <797> which clearly states in the section on the movement of materials that shipping containers (thinking like wholesaler totes, coolers etc.) AND other corrugated cardboard materials really must be allowed into the compounding areas.? Just want to throw in the ‘shipping container’ point here and refer you all to this reference; all I can say is ‘gross!’? This is not new, this language has been in USP <797> since 2004; so, it should not be of any surprise.? And if the Infection Control department, accreditation body or the board of pharmacy continually comments on cardboard in your areas; well, it may be time to start doing something about it.
However, I have had the opportunity to visit many locations where I still see corrugated cardboard in compounding areas.? I have seen them used as storage bins (which by the way are not cleanable) as storage dividers and also bins themselves made out of corrugated cardboard material.? These scenarios raise red flags quickly on the overall compounding program.??
One of the great practices I have seen is in sites with formal? ‘No Cardboard Zones’ which really formalizes the process, and it is definitely a huge feather in the old' hat to infection control, accreditors, and inspectors.? Having a designated area for unboxing and readying cardboard for removal from the department in a space that is not located inside the main areas of the pharmacy demonstrates the first phase of movement of materials management.? The further you can keep filth and vermin away from medications destined for patients the better the process.? Ensure bins waiting for pick up by environmental services are not overflowing with cardboard and if there are multiple pick-ups throughout the day to properly manage.? Because we do not want ANY cardboard on the floor.? Yep, you guessed it another regulated standard: Fire Code.? Fire inspectors hate seeing anything ignitable just sitting around and not secured; and yes, corrugated cardboard is ignitable…it’s paper!
The Joint Commission sees corrugated cardboard as a hazard when excessive amounts are in areas not designed to handle the volume per LS.02.01.30 and if corrugated cardboard is laying around and unmanaged it can present itself as an obstruction as a means of egress per LS.02.01.20.? Who knew cardboard could be so dangerous.
I have seen questions asked on well-known list serv’s about non-corrugated cardboard and their use within pharmacies and the compounding areas.? A good way to assess this practice is to answer these questions:
Corrugated cardboard is a necessary evil we in healthcare need for medications and supplies to get to our facilities in the manufacturer specified conditions.? It is our responsibility to ensure that this protective material does not impact the quality of medications we compound and environments where compound.
Did you know? Upgrading to Compounding360 from another system takes about the same time it takes the Packers to beat the Bears on any given Sunday. ;-) (Pharmacy Stars calls Green Bay WI home) Get a demo today
Hey Houston, Do We Have a Problem?
Cause: Yes, it is really easy to take a box and just set it on the shelf for use.? However, keeping supplies in the compounding areas in corrugated cardboard is unacceptable. This is an “insanitary conditions” incident waiting to happen.
Effect: Do not use shipping containers/material to store medications and supplies in compounding areas…May want to check with your institution’s Infection Control department, as they may not want ANY cardboard in the pharmacy.? Best to remove items from corrugated cardboard shipping materials before they enter any compounding space; in doing this you may have placed the items in a zip lock bag or sealable container for protection.
Increasing the Gray Matter
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Why this is important: Syringes are the unsung medical device heroes for drug compounding and drug administration.? We rely on their consistency and accuracy for patient safety.?
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Why this is important: Defining a drug as being hazardous can be a challenge if it is outside of the NIOSH Drug list and the construct of the 6 hazard characteristics.? Without the application of the universally accepted Global Harmonization Symbology for chemicals (which includes drugs) pharmacies are challenged with assessing the hazard risks and if any protective equipment or containment strategies are warranted.
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