By Sarah Ellis
An ounce of prevention is worth more than just a pound of cure for students of hospital pharmacology at the South Carolina College of Pharmacy, where they're learning that using the right technique to prepare drugs can make the difference between life and death for patients.
A new lab - the Aseptic Compounding Experience - uses state-of-the-art methods to teach the proper techniques for mixing drugs in a sterile environment.
The lab, which opened Friday and cost upward of $400,000, offers students a sterile setting for mixing drugs that's as close as possible to real life — everything is real except for the drugs.
"This is in a real, live sterile environment. It's not a mock simulation," said Bob Davis, a professor in the SCCP Kennedy Pharmacy Innovation Center. "Students will have a chance to experience real, live, hands-on training in product production that can be tested to find out if the outcome is truly sterile."
Sterile compounding, as the drug-mixing process is known, involves tailoring medication to meet patients' specific needs, including preparing antibiotic IV bags and chemotherapy for use in hospitals. Students are taught the "aseptic" technique for sterile compounding, which details precise procedures for handling all of the drug-mixing components inside the lab to prevent contamination.
It was improper procedures and lax oversight at the Massachusetts-based New England Compounding Center that led to tainted steroid injections and more than five dozen nationwide deaths in 2012. Three South Carolinians were infected due the tainted injections, but none died. The tragedy was one of the major triggers for the development of the ACE lab, which aims to give students ample experience to perfect safe compounding technique.
The importance of perfecting technique is straightforward: patient safety, said Addison Livingston, a compounding pharmacist at Hawthorne Pharmacy in Columbia and chairman of the state Board of Pharmacy. Sterile compounding techniques are always evolving, he said, to continually work toward producing safer products.
"It's important that the students that come out of school understand that the way we do things today, honestly, is different than how we did things 18 months ago in practice, because we're always trying to improve our practices," Addison said. "So we want the students doing things by today's standards, not by five-years-ago standards."
The aseptic technique doesn't come naturally for students. It's kind of like driving a stick shift for the first time or throwing a ball with the wrong hand, said Fred Olafson, an SCCP lab instructor. In the same way, he said, learning how to handle tools and components in the lab can feel awkward at first.
It's the small details, such as which part of a syringe to touch, that can make a big difference in sterile compounding. For example, when handling a syringe and vial of medicine inside a sterile working hood in the lab, students are taught not to turn the backs of their hands toward where the sterile air is being pumped into the hood.
Their bodies are the only unsterile things in the room, Addison said. So students have to learn to be constantly conscious of where they're placing themselves so as not to contaminate the air or any other compounding component. That's why practicing and mastering the proper technique is of paramount importance in sterile compounding — and that's the goal of the ACE lab.
"It's an experience," Davis said. "It's just not a process; it's much more.
"We're teaching ‘an ounce of prevention' in technique."
Meeting the highest industry standards for sterile drug compounding, the lab is equipped with video recording technology to allow students and instructors to better view the details of drug-preparation technique as well as provide individualized opportunities for coaching and critique, Davis said. In addition, a two-way communication system allows instructors and students to interact while separated on either side of the sterile environment.
The ACE lab will also be a training ground for practicing pharmacists and technicians around the nation, as it will offer its first advanced education programs beginning in April. It'll be the first university-affiliated training experience of its kind in the United States.
Before the ACE lab opened, students were taught in an environment that simulated but couldn't recreate conditions of an actual sterile compounding setting. Now able to gain experience in an actual sterile environment, SCCP students should be better trained than their peers from other pharmacy schools and go into the job market with an advantage, Davis said.
The ACE lab "will give you a better idea of what you will actually be doing in the actual hospital environment when you go to work, so you'll be better prepared," said second-year pharmacy student Nathan Mitchell. "It definitely makes you more attractive from an employment standpoint if they see that you have actually had experience in a compounding lab like this."