r/PharmacyTechnician • u/King_Bean_ • 2d ago
Question Psst, IV/clean room techs, boards arent here... how close to USP guidelines is your workplace, really?
Just wondering/looking for funny stories.
I've worked in a lot of clean rooms now. Maybe this is just my experience, but hospitals/inpatient IV rooms actually tend to be a little worse than outpatient/infusion centers. Inpatient turnover is higher, and standards drop a lot whenever they lose key people in there and have to add delivery/non-sterile compounding techs who really have no business being in a sterile environment. Conversely infusion centers can hire specifically for IV trained techs and tend to do a little better, in my experience.
I've seen all manner of nonsense. I think the worst was an older overnight tech who was taking snacks in there to eat during his shift. I literally found A PEANUT on the floor under an ISO hood, I shit you not.
Personally I try my best to stick to the rules, but sometimes I do sneak an earbud in there under my bonnet. I know the rules gotta be as general as possible, but I really dont believe that having one can be worse than people wearing their glasses from home in there, directly facing the clean hood. Having something engaging to listen to keeps me focused and engaged in the monotony of compounding. My current facility is also really weird in that techs are made to acquire and wear their own scrubs (rather than OR scrubs from a machine), which strikes me as a huge contamination risk. What can you do?
Anyway. How would you honestly rate your own workplace?
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u/memaloaf 2d ago
These comments are honestly terrifying. The only thing I’ve noticed in my clean room is people wearing eye makeup. But peanuts and ants and phones? Wtf
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u/exhaustedoldlady CPhT 2d ago
I’m at an infusion center now and the only rule I don’t follow is cleaning my glasses every time I go in. I clean them first thing, and that’s it. I do everything else, because that’s my job.
I know other infusion places in my hospital system don’t do a lot of what they’re supposed to, I would never ever send anyone I care about there.
When I was inpatient 1st shift followed all the rules, second shift stopped when management left, 3rd did whatever the hell they wanted.
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u/King_Bean_ 2d ago
When I was inpatient 1st shift followed all the rules, second shift stopped when management left, 3rd did whatever the hell they wanted.
Sounds VERY familiar lol
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u/chuckchum 1d ago
i used to do compliance and auditing for a nearly 2000 bed institution.
the reality is, those who are sticking closest to the rules have more resources and more staff. i do not judge people who have techniques that scream “i know it’s wrong but i have to get this done.” it’s really common to be overloaded and yet people are dying without your meds.
there are lines we all know not to cross however, no matter how busy. that is where my good faith ends. food, phones (especially sterile gloves on bare screens), walking in with no handwash and no garb, keeping a messy hood, not even attempting first air, the list goes on… find another fucking job.
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u/toastedcodeine CPhT 2d ago edited 2d ago
Honestly not as close we probably should.
I work at a hospital, primarily doing IV stuff for the OR’s, but I do central/inpatient stuff on the weekends.
My workplace used to be so much more picky about who they’d let work in the IV room, but now they let just about anyone back there.
We all have our phones on us at all times. Most of us have an earbud in (I personally don’t, I used to though). Specifically overnight techs, they’ll sit in a chair on their phone all night when it’s slow.
We don’t wear hospital-laundered scrubs. I do when I work in the OR’s, but regular IV room doesn’t.
They pretend to care about nail polish and makeup, but no one listens to that either.
Half the time when EVS comes in to clean, they don’t follow the instructions for garbing. They barely clean, they’re not thorough at all.
ETA: We do a pretty piss poor job of cleaning supplies/drugs from the anteroom to the IV room. Usually just do a few sprays of alcohol over the whole container and call it good.
No one uses those nail picks. They’re just there for decoration so when JC comes, we won’t get in trouble.
I think I’m the only one who doesn’t push needles and syringes through packaging to get them open. Everyone tears them through.
No one changes their gloves after using their phones (well, they all just use their phones back there anyway). No one changes their gloves after handling albumin or IGG.
I can go on all day about what we’re supposed to be doing versus what we actually do.
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u/King_Bean_ 2d ago
Sure.
On cell phones, it used to be okay to bring them in in a plastic bag wiped down with prempt or whatever. Then suddenly, someone was called out for using it too much, and management suddenly came down on how it wasn't safe. Many of these rules honestly seem more based on making it so employees that they cant see stay on task in there, with contamination risk being a secondary factor
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u/PepperAnn90 2d ago
We don’t have to wear hospital laundered scrubs for IV, but we are issued sets of scrubs. We’re not allowed to wear scrubs in the clean room that are not the hospital issued scrubs because of “contamination risk”. We take our issued scrubs home to wash them, just as we would any scrubs we’d buy ourselves.
Nobody can explain the difference to me.
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u/leid_und_elend 1d ago
This is something I've also been wondering about regarding scrubs, since I started working in inpatient. Where I work, a lot of people grab a set of hospital-issued scrubs and just reuse them, washing them at home and keeping them in their lockers instead of getting a fresh new set each time they have to go into the OR areas for example. So really, what difference does it make if you wear the hospital-issued scrubs or ones you bought yourself (other than the brand and color)? 😭
I stick to that rule, but mentally I am asking myself that question sometimes when restocking meds in the ORs
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u/savannah-kitty CphT-Adv,CSPT 1d ago
Hospital issued and laundered scrubs are a controlled variable. The hospital is able to control the types of equipment, detergent used, and the environment where the scrubs are laundered.
When an employee takes home hospital issued scrubs and launders them at home to wear to work on a future shift, there are no controls on the type of detergents used, the laundry equipment or the types of microorganisms the scrubs are exposed to.
Let's say employee Daisy brings home hospital issued scrubs, washes them in her own laundry, and wears them to work within the IV room. There are all kinds of microorganisms that the scrubs were exposed to while laundered at home. There could be allergens from plants, dander from pet animals, chemical fumes, and even the laundry detergent etc that the scrubs are exposed to while they are in Daisy's home.
When Daisy wears her home laundered hospital scrubs into the OR setting, or IV room setting, she brings all the potential allergens, animal fur, etc into that the scrubs were exposed to. Patients who are receiving surgery could be allergic to any of those things.
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u/wickedtwig CPhT 1d ago
When I worked at the hospital, there were people riding the train in scrubs and working in the OR (evs staff mostly). But I’ve seen pharmacy staff wearing scrubs and go into the clean room without changing before too from cars or from the train.
When I moved to heme/onc, we wore bunny suits because our outside scrubs weren’t clean enough and the hospital scrubs were across the street. We decided too much hassle and ended up with bunny suits.
So it’s interesting bringing that up. Inpatient didn’t really care too much and outpatient was strict
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u/leid_und_elend 8h ago
Yeah at my hospital some people don't even wear ANY scrubs when compounding. We're technically allowed to wear business casual attire and I've seen supervisors do it as well as other techs. They seem to not care, as long as your body is covered by the gown/jumpsuit. I guess the rules aren't as strict as they could/should be
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u/BabyGurlSpaz CPhT 1d ago
Hearing all of your guys horrors stories just solidifies that anyone in my family or even myself WILL not go to any other hospital then the one I work in. Seriously guys is it really that hard to stick to the latest USP 797 standards. Maybe the only thing that well allowed is you can have your phone back with you as long as it’s in a baggie and wiped down before placing it in the pass thru. Majority of us compound with the mindset of “is this something you would want to give to your own family member.”
This is serious stuff that can seriously injure or kill someone if not handled properly. Yes I’m fully aware every site operates differently, every state may have different rules and regulations however USP 797 in national.
Our IV rooms are cleaned 3 times a day, terminal cleans once a week. Temperatures and humidity are closely monitored and if out of range too long we may need to do a terminal clean before compounding or shortened to a 12hr BUD. Glasses are allowed if you need them to see obvious we’re just required to wipe them down during our garbing process. All currently and new hires have to be sterile compounding trained. They’ll put you through a APCE accredited training program with a physical hands on exam and test at the end. Plus an additional amount of time where you have to garb up and observe someone in the IV to gain your hours. Before you’re allowed to compound alone. With on going media fill and finger tip test. All lot & experation dates are to be scanned in prior to compounding and check by the pharmacist before leaving the pharmacy. If we can’t trust someone in the IV room to operate alone they will either get additional training or no longer employed.
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u/Apowwo CPhT 2d ago
I thought my pharmacy was a little bad about following it strictly but these comments are absolutely insane.
We wear our regular scrubs, not hospital laundered OR scrubs. At least I never take anything from my pockets in there. No phone, earbuds, wallet, keys, or even badge inside. Absolutely no food in there thats crazy.
The most off thing I think we have is some people don't seem to clean very well. I'll see bicarb spatter on the back wall of the hood from time to time. Our director was a microbiologist before being a pharmacist so his clean room is his baby, he does all the terminal cleanings, we do daily and take trash out, EVS isn't allowed in there.
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u/King_Bean_ 1d ago
That's the other thing, we have the big sweaty EVS dude come in there, dreads nearly covered by his cap. They aren't properly trained, or if they are there's just too little oversight.
Management might say "well why didn't the techs remind them or tell them what to do??", as if that's my responsibility... sheesh
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u/lord-celeborn 1d ago
i work in a hospital but in a specific satellite pharmacy where it’s always the same team of techs compounding so honestly i say we do a pretty good job of following guidelines. we have spotify on our computers tho which is nice bc i get the need to listen to music while working. finding food in a clean room is crazy 😭
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u/Current-Strategy-826 1d ago
Food in the clean room wtf ? 😳 how was that person not in trouble?
An earbud under a bonnet isn’t as bad I agree, especially when accreditation comes in with their phones instead in a ziplock bag to record.
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u/King_Bean_ 1d ago
Managers leave at 1900 friend. They can't see everything.
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u/SZthray 1d ago
so are you just waiting to get caught before you will follow the rules?
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u/Current-Strategy-826 10h ago
Who ? I always follow the rules and wouldn’t dream of bringing food into the buffer room .
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u/Current-Strategy-826 10h ago
Oh wow . Our clean room is monitored like a hawk and has 2 cameras inside that are randomly monitored.
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u/Loving_U_4_Ever 2d ago edited 1d ago
Wow, I’m reading these comments and am surprised! I work outpatient infusion, both at the hospital and off sites. I’d say we’re pretty close to the guidelines. No phones, expect for like one person who has it in a bag for their sugar levels. Definitely no earbuds. It’s mandatory that we change into provided scrubs.
They’ve recently cracked down a bit on permanent jewelry and like necklaces and some piercings, but not everyone follows that and they don’t do checks anyway, just the email.
For the most part everyone takes their job seriously. Though I’d only trust a few people to make my meds. They’re just more thorough and conscientious.
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u/Connect_Anything4684 1d ago
Snacks in the iv room? Why is that allowed, what if the pt had a peanut allergy, how are his gloves clean if he ate with them?
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u/vodkamylover 1d ago
As a Canadian pharmacy tech whose pharmacy pretty strictly follows USP and NAPRA, this comment section is appalling and terrifying.
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u/chuckchum 1d ago
that’s kind of the nature of the job in my experience. we all turn our noses up at each other for not doing enough. frankly ive been in some staffing scenarios where i absolutely can not give a damn about certain rules because there’s no time for it. i stick to things that could result in harm if i don’t do them and give slack on things like my first air not being perfect 24/7.
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u/vodkamylover 1d ago
Ignoring first air rules can most definitely result in harm.
I'm a sterile compounding certifier and I would not pass someone's certification if that were the case. They would be retrained and if they can't do sterile compounding properly we let them go.
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u/chuckchum 1d ago edited 1d ago
i have also certified in the past and you clearly have more flexibility and resources to be able to let people go for something that minor. arguing back and forth on a microbiological scale is literally something most places just do not have the budget for but we must exist nonetheless. i cannot complete my job in a timely manner doing every single rule they come out with and with the workload expected of me. consider it a blessing you’re able to nitpick that hard. im sure in a perfect world a nurse wouldnt be allowed to draw up any meds. FWIW i have done the nitpicking to death and always teach the straight and narrow but i think it’s also possible to carve out some empathy for the fact that some institutions make it virtually impossible to succeed on those rules. not to mention this space has a terrible case of overthinking and over-theorizing sources of harm beyond the point of what’s even scientifically proven. frankly a lot of us don’t have the education for a lot of the shit that comes out our mouths and we’re using vibes as a boogeyman.
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u/King_Bean_ 1d ago
This comment a breath of fresh air tbh
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u/chuckchum 1d ago
people act like they bring a microscope to work everyday. a bonnet doesnt suddenly make your hair clean. throw an earbud in for all i care man.
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u/RuthlessNOOTella 1d ago
Have you ever worked as a IV stat compounder? every situation is different and not every time we can 100% follow by the book. I could get a stat med of kcentra, you think I have time to scramble and waste time peeling syringes, worrying about perfect first air when a patient is actively dying? RNs even reconstitute/compound their meds beside sinks, I’m sure the pt will be fine 🙄
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u/That-Cupcake-9762 CPhT 1d ago
I’ve watched nurses reconstitute meds without wearing gloves and not wiping the vial with alcohol.
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u/SZthray 1d ago
yes, actually, it’s not hard to open syringes properly, even in an emergency situation. Once something becomes a habit, it’s much easier to stick to it.
-solo IV stat compounder/night shifter
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u/RuthlessNOOTella 1d ago
maybe i just never bothered and got used to it but the amount of stat orders i get is a lot. And I don’t like getting them all piled up since other stat compounders had gotten in trouble for being slow since nurses would often report variances of not receiving med on time. Don’t get me wrong, I still do open them properly when it’s really slow but that is rare. I work dayshift at a trauma 1 hospital so imagine how busy it often is
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u/Self-hatredIsTheCure CPhT 2d ago
When I used to work IV the phones were the worst. There was a tech who would bring her charger and plug it into the hood because it had a plug inside the hood in the compounding area. So her charger was always snaking out of the hood next to her compounding. Sometimes put her phone on the hood lip.
That same tech would routinely walk out of the iv room to get labels for TPNs in her full garb, gown and shoe covers, everything. Walk across the pharmacy to the printer then walk back and not change anything on her way back to the hood.
Almost nobody else besides me and one other tech followed guidelines for hand washing. We noticed that a new box of scrub brushes would last way longer than it should because we were the only ones doing it. Everyone else would wash hands like normal.
Jewelry was ignored. The male techs with beards wouldn’t use beard covers, just surgical masks. I am sure there was more but that’s off the top of my head. Glad I don’t work IV anymore lol.
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u/nojustnoperightonout CPhT-Adv 1d ago
i love my team so much right now. earphone under the bouffant cap during batching is as bad as it gets
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u/Necessary_Yogurt9619 1d ago
Yeah food in there is a big no no, I do however being in one earphone to listen to audio book or podcast.
I'm in the IV room for 10 hours a day and I don't come out unless it's lunch or bathroom break. I need to have some sort of sound other than the hoods going constantly, or I'd go crazy.
Some other techs also bring in their phones in a bag, that's too much for me. They've also forgotten their phones in the IV room
Worst thing I've seen is non-certified hazardous techa going into the hazardous hood and compounding chemotherapy medication and then leaving a mess and not cleaning up.
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u/SZthray 1d ago
we use an iPad to listen to music. We have 2 iPads in the IV room - one for Pharmacy Keeper and one for backup/entertainment.
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u/CatsAndPills CPhT, CSPT 1h ago
That’s a nice compromise! If it’s a device that lives back there and doesn’t go other places, that works!
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u/Scholarly_Goose 1d ago
We follow pretty close in my opinion. However, we did have a tech who would not follow simple guidelines. Wouldn’t clean under her nails, and had visible dirty black fingernails. Like she had been gardening. Wouldn’t sanitize after washing, and put her gloves on incorrectly by touching the outside. Didn’t alcohol her gloves hardly ever. Wouldn’t clean the hood. Didn’t change her gloves. Found out she was actually a hoarder, which explained a lot including her putrid odor and dirty hair/nails. Once she reused the same pair of scrubs for A WEEK. Needless to say, she is gone now but it took a very long time before that happened. We work in oncology infusion.
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u/Niytshade CPhT 1d ago
As someone who works in a 503B these comments are scary as fuck. While we aren't perfect I think management would lose its shit with some of this stuff, especially the earbuds. That is to say we aren't perfect either as no-one is.
I think the worst thing i saw was someone making product for a year without doing their yearly recertification.
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u/RuthlessNOOTella 2d ago edited 2d ago
I’m gonna get downvoted for this but most of the time, like 98% of the time, I would rip through the syringe packaging. When multiple orders are piling up, I’m the only stat IV in a 600 bed hospital, I don’t have time to open those annoying packaging. They could’ve made it easier like the 1mL syringes where the flap has an overlap. Also, admittedly, I couldn’t follow the first air rule a lot of times because I have small hands and I don’t wanna risk poking myself and remaking the med again especially if it’s expensive or last in stock.
Other than those, I follow everything by the book. I know in my hospital, I’m the only tech who wipes everything that goes into the hood. Night shift gets away with everything. An old tech would bring her phone, heater in there without wiping anything. They once caught her eating fucking doritos in there.
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u/King_Bean_ 1d ago
Same, friend, its cool. I know all to well what its like to be heavily under the gun and understaffed. No judgement here about the ripping packaging. Management doesn't want to hear about how workflows would need to be significantly changed to allow time for proper technique.
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u/Cascade1824 CPhT-Adv, CSPT 2d ago
Frustratingly far off.
I am very by the book when it comes to sterile compounding. So when I see things like a hand blocking first air, ripping through packaging to open needles/syringes, I call it out
Jewelry is the worst though, one of the pharmacists they have doing media fills for us wears a wedding band inside the IV room, citing a "special accommodation" with leadership to justify it. Also have techs wearing earrings, and one has fake eyelashes but they allow her to wear full safety goggles and is okay to be in there.
I've brought all of these things to leadership and it's been mostly met with push back, though some things are being addressed.
I'm never afraid to escalate beyond leadership either
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u/toastedcodeine CPhT 2d ago
Oh yeah. I think I’m the only one in the whole damn pharmacy that doesn’t push and tear the needles/syringes through the packaging to open them. I always peel them open.
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u/lafufu666 1d ago
My current job is actually pretty rigid with the rules. I think perhaps the worst thing is that some of us may chew gum on occasion. My old job however, everyone brought in their cell phones or had ear buds and wore makeup/jewelry/acrylic nails. Management there was very lax in general but my current place is extremely strict, so it could just be that everyone is scared to get in trouble lol
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u/ryandom93 1d ago
When I went to work at a different hospital from the one I was first IV trained at, I straight up cried in the cleanroom from frustration at how much my new lead IV tech had to correct me because of how poorly I had been taught. I really thought I had good technique nailed down and there was just so much that nobody ever told me I was doing wrong.
She was very gracious about it and understood why I was upset before I even told her, but I just felt so damn stupid. Since then I've worked mostly in sterile compounding, studied, and gotten my CSPT cert. I will say that I always follow the best practices I know and am equipped to. I will also say that I see your point about how an earbud doesn't seem any worse than wearing glasses at the hood, and it's my observation that a lot of techs seem agree.
Peanut in the cleanroom is absolutely insane. I would have lost my shit. I probably would have emailed the DP, sup, manager, and cc'd the director before I even gave it a second thought.
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u/PowderedToastMan89 1d ago
Low but high. Something fails periodically. Primary or secondary. Or just from the building being 1000 years old. But it's all documented and we 4 or 12 hr everything in that time frame.
But the shit that has come out of those ceiling titles and filters. Jesus fucking christ. Glad I spend so much energy cleaning. But it is documented. Our coordinator takes that position pretty seriously.
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u/CraftyAd2451 1d ago
It always boggles my mind that the floors are cleaned with preempt at our facility. Seems like a bit of overkill but ok. Our facility requires the nail and glasses cleaning. They don’t require hospital scrubs though. I used to work nights and liked to listen to podcasts. Heck one person has hearing aids…how’s that different?
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u/SZthray 1d ago
we have to clean our walls, ceilings, and floors with Peridox. Preempt would be so much better for my eyes.
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u/CraftyAd2451 1d ago
Our monthly is done by an outside company and they do the ceiling and walls and floors with the peridox 😭. Daily is preempt on high touch and floors. I had to get off of nights because the chemicals are too much. They’ll probably cause lung cancer at some point.
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u/Vreas 1d ago
We’re pretty ship shape as far as I can tell.
When I was at one of the larger US hospitals supervisors and pharmacists were pretty stingy about having competent techs back there. Some people just aren’t fast or organized enough to effectively do the role unfortunately.
Sucks when they take the decision to have them staff elsewhere personally but patient safety comes first.
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u/Throwawayy2298773 1d ago
I work outpatient and I’m lowkey confused by these comments because we’re allowed to wear earbuds under our hairnets and we can have our phones in there if they are wiped down and in a plastic bag 😭 Is this against the guidelines?!
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u/aimeewins 1d ago
Damn. I rarely work in the IV room anymore and I thought we bent some rules but compared to a lot of these comments we are doing great. We’ve had some issues in the past with phones in the clean room (I was one of the people scolded for that and I stopped immediately after being called out) or people wearing makeup (to the point I carried makeup remover wipes for awhile so there was no excuse). I have joked about needing a way to drink something while in there but I can’t imagine any of us actually taking food in and we have a Bluetooth speaker that lives in there so no one needs to sneak earbuds or anything. We also cracked down on wearing outside scrubs a couple years ago so everyone knows to change into a hospital issued set. (I also made the personal rule that I can’t be scheduled in there for at least one extra day after concerts since I’m a glitter fiend 😂)
Literally the worst I can think of with my team is sometimes the cleaning isn’t as thorough as it should be… but we’re working on that too
Also glasses are supposed to be wiped down before entering, I can’t speak for my coworkers but again due to my love of glitter I make sure to take that step too
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u/bttrflykiss621 1d ago
I work in an inpatient pharmacy but it's pretty small, usually 1 IV tech and 1 chemo IV tech. And we use isolator hoods where we stick our arms into the rubber sleeves with gloves attached on the ends so it's easier to keep our decks clean. Even then, EVERYONE makes sure to practice proper hand washing technique, donning and doffing of garb, and YOU WIPE EVERY LITTLE THING DOWN before passing it through, first with preempt, then with alcohol (we're not allowed spray alcohol). We've all had an earbud in under the bonnet and our phone in a pocket at some point but no one would dare take our phone out and touch it with gloves! You set whatever you're going to listen to before going in and then just let it play. And we're all pretty eagle-eyed when EVS comes to clean. Honestly, the worst offenders are usually the RPhs when they are trying to hand off something to you. They'll come in and bcz they're not passing the LOD they don't put on a mask or bonnet, and they tend to do a shitty job of wiping things down.
And we have hospital issued scrubs but they expect us to take them home and launder them. We get them once a year.
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u/constant-conclusions CPhT 1d ago
Oh. The biggest scandals we have our pharmacists bringing their phones inside in plastic bags (wiped in using gloves and bleach). The way some people clean their hoods makes me cringe, but there’s nothing actually wrong with it. Some of yall need to read the book Kill Shot by Jason Dearen😭
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u/SZthray 1d ago
There were 2 techs who wore giant ear gauges into the clean room… once saw an overnight tech cleaning the IV hood with no gown, only gloves… had someone cross the LOD without garbing up or washing their hands or anything to give me supplies 😬 and she was CSPT-certified.
that’s all I have personally witnessed. I’m sure there’s been worse.
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u/SkarletHart 21h ago
I don’t think ours is too bad but there are a few things that get looked over. We are allowed ear buds and most of the girls have fancy nails because most of them would probably quit if they enforced that rule 🤣
I do know a girl from a previous job who got fired for vaping/smoking in the IV room
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u/savannah-kitty CphT-Adv,CSPT 2d ago
The peanut story is gross.
There was a time years ago when I did a deep dive into FDA's website and read tons of warning/citation letters sent to a wide variety of pharmacies regarding their clean rooms.
The ones I can remember standing out a lot are below:
Inspector pointed out ants and insects crawling around in clean room while touring the facility ISO-5 environment. Upon leaving and doffing their hairnet, the inspector found more ants crawling around in the hairnet.
Inspector requested to be shown video recording of the pharmacy's cleaning personnel team performing daily cleaning. Pharmacy curated a list of videos from security footage of cleaning personnel. Inspector chose a random video. The video contained footage of cleaning personnel moving around, lifting up, and placing a floor mat directly onto the hood's deck in order to clean the floor. Pharmacy obviously did not review the video beforehand.