Handling and decontamination of live medications: What challenges for hospital pharmacies in France?

Objectives: To review the literature and national practices concerning the handling and decontamination of live medications, in order to revise our local practices.

Methods: Literature searches and questionnaire sent to establishments handling live medications on several themes, including: preparation activity, circuits, preparation equipment, decontamination techniques and agents, personal protective equipment, viruses and genetically modified organisms.

Results: Twenty establishments responded to the questionnaire (response rate: 66%) with 16 responses usable. The main live medications handled were viral vector (n=16) or cell-based gene therapies (n=14). The majority of respondents handled at least three types of live medication. The most popular and the most used preparation equipment was the biosafety cabinet (13/16). Handling was carried out in 9/16 establishments on a single piece of equipment, and in 7/16 on several. All the establishments decontaminated between two preparations of different types of live medication, and 15/16 between two preparations of the same type. None used ultraviolet decontamination. Although recommended in the literature, only five respondents distinguished between naked and enveloped viruses for decontamination. Seven out of 16 establishments had specific decontamination procedures for genetically modified organisms. There were few or no guidelines from French competent authorities or learned societies.

Conclusions: The diversification of live medications is not accompanied by guidelines or scientific publications, which makes risk assessment difficult for hospital pharmacists. Nevertheless, this work has enabled us to take stock of current practices and revise our protocols, even if the decisions we take are still based on free will.