The CSTD significantly reduced, but did not totally eliminate, surface contamination with cyclophosphamide. In addition to other protective measures, increased usage of CSTDs should be employed to help protect health care workers from exposure to hazardous drugs.

The World Health Organization defines counterfeit medication as "one which has been deliberately and fraudulently mislabeled with respect to the identity and/or the source. Counterfeiting can apply to both branded and generic products and may include products with the correct ingredients or the wrong ingredients, without active ingredients, with insufficient active ingredients, or fake packaging." 1 Counterfeit medications have become more common in the last decade and, with this, so has the need for health care workers to stay informed about this threat.It is impossible to know exactly how many medications are counterfeit. The Centers for Disease Control and Prevention has estimated that the percentage varies from approximately 1% to 10% in developed countries and could be as high as 30% in countries in Africa, Asia, and Latin America. 2 Commonly counterfeited drugs include antibiotics, antimalarials, hormones, and steroids. 3 Counterfeit medications can lead to resistant bacteria, treatment failure, or death. They may contain insufficient amounts of active ingredients or may contain the proper ingredients but may not have been properly stored and/or shipped. Some medications are delicate and can easily degrade when exposed to varying temperatures or light or when shaken. This can result in a product that may be below needed potency or altogether ineffective. Some counterfeit medications have even been shown to contain toxic ingredients such as lead-based paint. For example, 3 pregnant Argentinean women were treated for anemia with a counterfeit injectable iron product. Two of the women died after being exposed to the toxic ingredients contained in the counterfeit iron. The third woman survived but gave birth prematurely at 26 weeks' gestation. 4 Because of the risks posed by counterfeit medications, it is imperative that midwives and other health care providers stay informed about counterfeit medications so they can help protect women from an increasingly tainted drug supply.

Background: Adverse reactions, including anaphylaxis, to messenger RNA coronavirus disease 2019 (COVID-19) vaccines rarely occur. Because of the need to administer a timely second dose in subjects who reported a reaction to their first dose, a panel of health-care professionals developed a safe triage of the employees and health care providers (EHCP) at a large health-care system to consider administration of future dosing. Methods: There were 28,544 EHCPs who received their first dose of COVID-19 vaccines between December 15, 2020, and March 8, 2021. The EHCPs self-reported adverse reactions to a centralized COVID-19 command center (CCC). The CCC screened and collected information on the quality of reaction, symptoms, and timing of the onset of the reaction. Results: Of 1253 calls to the CCC, 113 were identified as requiring consideration by a panel of three (American Board of Allergy and Immunology) ABAI-certified allergists for future dosing or formal in-person assessment. Of the 113 EHCPs, 94 (83.2%) were recommended to get their second dose. Eighty of 94 received their second planned dose without a severe or immediate reaction. Of the 14 of 113 identified as needing further evaluation, 6 were evaluated by a physician and subsequently received their second dose without a serious adverse reaction. Eight of 14 did not receive their second dose. Only 5 of the 113 EHCPs reported reactions (4.4%) were recommended to not take the second dose: 3 (2.6%) because of symptoms consistent with anaphylaxis, and 2 because of neurologic complications (seizure, stroke). Conclusion: The panel demonstrated that, by consideration of reaction history alone, the ECHPs could be appropriately triaged to receive scheduled second dosing of COVID-19 vaccines without delays for in-person evaluation and allergy testing.