It’s not every day that you open a brand new, leading-edge medication system during a pandemic ” and yet, that is exactly what happened at Scarborough Health Network (SHN) Centenary hospital’s Pharmacy department. On July 9, staff celebrated the grand opening of a brand new, 1200-sq.-ft. Clean Room (sterile compounding area).

What is a Clean Room?

A Clean Room is a controlled environment where pollutants like dust, airborne microbes, and aerosol particles are filtered out in order to provide the cleanest area possible. Most Clean Rooms are used for manufacturing products such as electronics, medical equipment, and in this case – intravenous pharmaceutical medications. “Compounding” refers to the mixing or adjusting of ingredients of a drug or drugs, in order to create medications prescribed by physicians. Sterile environments are essential for certain medication compounds, since even small particles can adversely affect the manufacturing process.

Given the critical requirement for pharmacists to have such a specialized space, the celebration was infused with pride and excitement, as the team gathered to reflect on the previous years’ work.

“We are thrilled to be able to celebrate with everyone,” said Shelley Dorazio, Director, Pharmacy Services, as she welcomed staff and vendors at the small ceremony. “It’s truly a recognition of the investment of Senior Leadership Team in our medication system.”

Researching a better way forward

The work began in January 2019, following a mandate from the Ontario College of Pharmacists (OCP) to implement new physical infrastructure to support sterile and non-sterile compounding. The research and planning that would unfold over the next two years involved multiple vendors, over 15 plan drafts, and five site visits and consultation with other hospitals in Ontario, Quebec and the U.S.

As advice was being sought on best practices, SHN’s own frontline experts were eagerly offering their own vision for the space. From the beginning, Pharmacy staff were empowered to build a space grounded in practical use and flow, which led to creative solutions to adapt the existing space. The revised plans, improved the work flow and expanded the space to our maximum physical capacity. During construction, Pharmacy staff worked in a temporary Pharmacy space.

“You’re the trailblazers,” said Glyn Boatswain, Acting Vice President of Clinical Programs, who was in attendance for the ribbon-cutting. “Our heartfelt thank you to each and every one!”

The resulting brand new sterile and non-sterile compounding areas have both positive and negative pressure ” one for hazardous (chemotherapy) and one for non-hazardous (other intravenous products) ” is now open for business. Developed as a “hub and spoke” model, the new Clean Room will be the primary source for delivering compound intravenous (IV) medications to SHN’s three hospitals

Establishing ourselves as a High Reliabilty Organization

It’s an innovative solution, that relies heavily on our assertion that we are stronger together. By meeting the accreditation standards from the OCP, and exceeding them in some areas, SHN has demonstrated commitment to its S.A.F.E.T.Y. pillars. This achievement is another exciting way we are relentlessly prioritizing safety, and truly establishing ourselves as a High Reliability Organization.

“I couldn’t be more proud of our internal and external teams,” said Swasti Bhajan Mathur, Manager of the Centenary Pharmacy department, beaming with excitement. “The frontline pharmacy voices really led the way.”

Congratulations to everyone who contributed to this capital project, and thank you to all of the teams from Pharmacy, Senior Leadership, Capital Planning, IPAC, Facilities, Environmental Services and Workplace Health and Safety, as well as the vital external partnerships with Plexxus, Labworks, Parkin Engineering, HEPA, OCP and ADEC Construction. This was an amazing accomplishment and celebration!

Clean Room Ribbon Cutting