A cross-sectional survey on pharmacists’ protection against hazardous drugs in China based on USP <800>,NIOSH and ISOPP standards: Comparative analysis and improvement suggestions

Abstract

Objective

This study aimed to benchmark the protective practices of intravenous admixture pharmacists in Chinese tertiary hospitals against international standards, including USP <800>, the National Institute for Occupational Safety and Health (NIOSH), and the International Society of Oncology Pharmacy Practitioners (ISOPP). Specifically, it quantified the gaps in engineering controls, personal protective equipment (PPE) availability, spillage management, and occupational safety training. Based on these findings, targeted strategies for improvement were proposed.

Methods

Referring to the Hazardous Drug Handling Questionnaire (HDHQ), by comparing the similarities and differences in personal protection standards for hazardous drugs at home and abroad, a questionnaire was designed to conduct a cross-sectional survey among 354 intravenous admixture pharmacists in 21 tertiary hospitals in Guangdong Province. Four dimensions—Standards, Equipment, Behavior, and Management—were analyzed to identify disparities between current practice and international benchmarks.

Results

Equipment availability showed extreme polarization: 90% of hospitals were equipped with B2/A2 biological safety cabinets and designated waste disposal devices, but only 18.9% had closed system drug-transfer device (CSTD) and 26.8% had dedicated unpacking area. PPE adherence was inconsistent: over 80% “always” wore N95 respirators and reusable protective gowns during compounding, while 65.3% “never” used disposable protective garments during transportation/unpacking and 55.9% “never” wore goggles/face shields (compliance rate <60% for these two items). Regarding spillage management, 45.2% of respondents experienced 1–2 spillages in the past year, with 16.3% unreported and 62.1% lacking post-incident health surveillance. Although 91.8% recognized the “high necessity” of occupational protection training, only 36.7% of departments conducted quarterly sessions (training coverage <40%).

Conclusion

This study, based on a survey of the current status of PIVAS in Guangdong Province, found that pharmacists have achieved near-international standard levels in certain infrastructure aspects. Specifically, the biological safety cabinet (BSC) adoption rate reached 89%, and the personal protective equipment (PPE) adoption rate was 76%. However, significant gaps remain in engineering control measures, particularly with respect to the low adoption rates of Closed System Transfer Devices (CSTD) at 18.9% and dedicated unpacking area setups at 26.8%, indicating that the practice has yet to fully transition from a focus on “equipment provision” to “standardized usage. Based on these findings, we recommend implementing key measures such as regulatory improvements, equipment upgrades, optimization of behavioral ergonomics, and the establishment of a digital closed-loop monitoring system to drive the transformation of practice models from “provision over usage” to “usage over provision.”