Sheldon Lefkowitz compared the newly renovated pharmacy at St. Mary's Medical Center to entering a NASA facility and its sterile environment. "You know how they walk into a room and everybody is wearing gowns and masks and there's no bacteria, no particles, nothing that shouldn't be there?" That's a good description of the IV room at St. Mary's, and sanitary conditions are important because when patients are prescribed compounded medications – that is, those that are tailored to the precise needs of the patient – it is imperative to have them made in as safe and highly regulated an environment as possible.

For that reason, and in anticipation of regulations that went into effect in October 2014, St. Mary's Medical Center has done a complete makeover of its pharmacy. Lefkowitz is the director of the forward-looking facility that opened a few months ago, and he talked about the safe environment it houses.

He said that most hospitals have laminar flow hoods, which are enclosed benches designed to prevent contamination of any particle-sensitive materials. A hood, according to Lefkowitz, is essentially "a closed environment that allows you to do processes, but it's in a segregated cabinet. What we have at St. Mary's is a whole room that's basically like a clean air purification system. If you're in that room, 100 percent of the air is filtered – you can make sterile medications and prepare drugs for patients without containment of being done in a small area. The whole room is the area, which is unusual to most hospitals in this region."

The renovation, which took place in an already standing structure, began about a year-and-a-half ago. As Lefkowitz, who has been at St. Mary's for 12 years, explained, "The building itself was built more than 75 years ago, but we used the existing area; and a construction crew came in and took it up to 2017 standards in 2014. A lot of it was done in anticipation that the current new rules were coming out, and right now, St. Mary's is exceeding the standards."

Lefkowitz added that St. Mary's doesn't outsource any of its work. "We do everything at St. Mary's." He said some hospitals may not make their own sterile preparations, but may use an outsourcing service instead. But St. Mary's is able to do everything in-house, because of the renovation. "We go to a meeting with our NICU (neonatal intensive care unit) physicians and the first thing they say is, 'Please don't outsource!' Some days we have 45 babies here and we can take care of all of their needs. I think by in-sourcing and keeping it right here, we have better control and are able to provide appropriate care to our patients when they need it."

Not only is the pharmacy upgraded, but Lefkowitz said that the personnel have had to adapt as well. "The competency training that you have to go through to work in this sterile compounding room now is a lot different – with the additional intensive training, observation validation of their aseptic technique. "I can't go in there and work unless I am able to put on gloves properly, 'garb' properly, complete extensive didactic testing. I have to draw out solutions into syringes and then make sure there's no contamination in the compounded sterile preparation. So anybody who works there has to have an excellent sterile technique. It's basically assuring that both the employee and the patient are safe."

He concluded by saying that St. Mary's has done everything possible to assure that the integrity of the products being given to patients is the highest standard. "We've taken the next leap to even go above the proposed regulations that are not required today. We have the ability right now – in 2015 – to meet the standards in 2017. Most other hospitals are working toward meeting those expectations; we've already met them at St. Mary's."