CDC Guidance for Community Pharmacies During COVID-19

All pharmacy staff-along with everyone entering the pharmacy-should wear face masks, according to new guidance from the CDC.

The CDC’s “Guidance for Pharmacists” also says that pharmacies should postpone and reschedule some routine preventive services, such as adult immunizations, since they require face-to-face interaction.

“This guidance applies to all pharmacy staff to minimize their risk of exposure to the virus and reduce the risk for customers during the COVID-19 pandemic. As a vital part of the healthcare system, pharmacies play an important role in providing medicines, therapeutics, vaccines, and critical health services to the public. Ensuring continuous function of pharmacies during the COVID-19 pandemic is important,” CDC said.

According to the guidance, pharmacies should:

Implement universal use of face coverings. “Everyone entering the pharmacy should wear a face covering for source control (ie, to protect other people in case the person is infected), regardless of symptoms,” CDC said.

Pharmacists and pharmacy techs should always wear a facemask while they are in the pharmacy for source control, CDC said.

“When available, facemasks are generally preferred over cloth face coverings for health care professionals (HCP) for source control. If there are shortages of facemasks, facemasks should be prioritized for HCP who need them for [Personal Protective Equipment] (PPE). Cloth face coverings should NOT be worn instead of a respirator or facemask if more than source control is required,” CDC said.

Advise staff who are sick to stay home.

“Make sure that pharmacy staff who have fever or symptoms that may be due to COVID-19 stay home and away from the workplace until they have recovered. Ensure that sick leave policies are flexible, nonpunitive, and consistent with public health guidance and that employees are aware of and understand these policies,” CDC said.

Pharmacy staff should provide hand sanitizer containing at least 60% alcohol on counters for use by customers and have sufficient and easy access to soap and water or hand sanitizer for staff.

Encourage all prescribers to submit prescription orders via telephone or electronically. The pharmacy should develop procedures to avoid handling paper prescriptions, in accordance with appropriate state laws and regulations.

Limit direct contact with customers. After a prescription has been prepared, the packaged medication can be placed on a counter for the customer to retrieve, instead of being directly handed to the customer. “Avoid handling insurance or benefit cards. Instead, have the customer take a picture of the card for processing or read aloud the information that is needed (in a private location so other customers cannot hear),” CDC said.

To shield against droplets from coughs or sneezes, install a section of clear plastic at the customer contact area to provide barrier protection such as a plexiglas-type of material or clear plastic sheet. Configure with a pass-through opening at the bottom of the barrier for people to speak through or to provide pharmacy items, if feasible.

Avoid touching objects that have been handled by customers. “If transfer of items must occur, pharmacy staff should wash their hands afterwards with soap and water for at least 20 seconds or use an alcohol-based hand sanitizer containing at least 60% alcohol. They should always avoid touching their eyes, nose, or mouth with unwashed hands,” CDC said.

Include text or automated telephone messages that specifically ask sick customers to stay home and request home delivery or send a well family member or friend to pick up their medicine.

Pharmacists who are providing patients with chronic disease management services, medication management services, and other services that do not require face-to-face encounters should make every effort to use telephone, telehealth, or tele-pharmacy strategies.

Reduce risk during COVID-19 testing. For pharmacies that are participating in public health testing for COVID-19, state and local health departments will inform pharmacies about procedures to collect, store, and ship specimens appropriately, including during afterhours or on weekends/holidays. “Some pharmacies are including self-collection options,” CDC said.

The CDC also provides a guidance for collecting respiratory specimens.

Pharmacy staff conducting COVID-19 testing and other close-contact patient care procedures that will likely elicit coughs or sneezes (eg, influenza and strep testing) should be provided with appropriate PPE.

“Staff who use respirators must be familiar with proper use and follow a complete respiratory protection program that complies with OSHA Respiratory Protection standard (29 CFR 1910.134). Staff should also have training in the appropriate donning and doffing of PPE. Cloth face coverings should NOT be worn by staff instead of a respirator or facemask if more than source control is required,” CDC said.

Maintain social distancing (6 feet between individuals) for individuals entering the pharmacy as much as possible. “Use signage/barriers and floor markers to instruct waiting customers to remain 6 feet back from the counter, from other customer interfaces, and from other customers and pharmacy staff,” CDC said.

Promote social distancing by diverting as many customers as possible to drive-thru windows, curbside pick-up, or home delivery, where feasible. “Large, outdoor signage asking pharmacy customers to use the drive-through window or call for curbside pick-up can be useful,” CDC said.

Ensure that the waiting area is cleaned regularly. “Discontinue the use of magazines and other shared items in pharmacy waiting areas,” CDC said.

For hard non-porous surfaces, clean with detergent or soap and water if the surfaces are visibly dirty prior to disinfectant application. Frequently clean and disinfect all customer service counters and customer contact areas. Clean and disinfect frequently touched objects and surfaces such as workstations, keyboards, telephones, and doorknobs.

Use EPA’s Registered Antimicrobial Products for Use Against Novel Coronavirus SARS-CoV-2.

Promote the use of self-serve checkout registers and clean and disinfect them frequently. Encourage the use of, and have hand sanitizer and disinfectant wipes available at register locations for use by customers, CDC advised.

Close self-serve blood pressure units.

References:

1. Guidance for Pharmacies. CDC; Last reviewed April 14, 2020. Accessed April 23, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/pharmacies.html.