The victim and a coworker were repairing a submersible pump for a water well at a private residence. Wiping solutions for both studies were selected due to their ease of use and lack of toxicity. A case study: Surface contamination of cyclophosphamide due to working practices and cleaning procedures in two Italian hospitals. Don PPE including double gloves and respirator. Appropriate PPE, including ASTM tested, powder-free chemotherapy gloves, must be worn when handling HDs. Master links, shackles, wire rope, and all other rigging hardware must be capable of supporting at least ___ times the maximum intended load without failure. Exposure to anti-cancer drugs during preparation and administration. December 2013. Krishnan B, Morgan G [2007]. The victim was a member of a crew that was constructing the back concrete wall of an underground water-holding tank at a sewage treatment plant. Kopp B, Schierl R, Nowak D [2013]. Washington, DC: U.S. Government Printing Office, Office of the Federal Register. Also, the toxic properties of drugs in tablet form are the same as when in liquid or powder form, and tablets can be especially hazardous when they are counted out from a bulk container in a way that generates drug powder clouds. Pharmaceutical product - A commercially manufactured drug or nutrient that has been evaluated for safety and efficacy by the FDA. Thoroughly clean and decontaminate the C-PEC. Gilbar PJ [2005]. Numerous case reports have linked chemotherapeutic treatment to adverse reproductive outcomes (reviewed in NTP, 2013). In addition, any discarded antineoplastic HDs should be managed as hazardous waste as a best practice, and as required by some states. 2005-100. Date accessed December 15 2014. 12:588-602. Standard practice for assessment of resistance of medical gloves to permeation by chemotherapy drugs. The FDA's 510(k) process does not establish independent performance standards for devices submitted as "substantially equivalent." Summary tables of much of the data presented below can be found in the scientific literature (Sorsa, 1985; Rogers, 1987; Connor and McDiarmid, 2006). Pharmacother 30(6):562-584. The crane cable was attached to a 1-inch-diameter galvanized pipe that ran to the pump inside the well. Investment shifts aggregate demand when more expenditures are made on ____. The laborer (who was working in the back of the truck) noticed that the lineman was being shocked and was unable to let go of the hand control. Personnel competency should be reassessed every 12 months (USP 800, 2016). Detergents, as surfactants, may assist in removing HD residue from the C-PEC (Lamerie, 2013). Work equipment for HDs should be suitable for the task and reduce the risk of exposure to the HD. Am J Health Syst Pharm 59:68-72. J Occup Med 32:508-12. In both cases, no safe handling precautions were used. Hum Ecol Risk Assess 8(4):805-822. Exposure in susceptible individuals can lead to asthma or allergic contact dermatitis (Kusnetz and Condon, 2003). Model state pharmacy act and model rules of the national association of boards of pharmacy. Dispose of gowns after each use. Brit J Cancer 101(7):1091-1099. Cyclophosphamide (CP) was removed, to varying extents, from vial surfaces by using several methods of wiping with a tissue wetted with soapy water, followed by a dry wipe and a wipe down with a pre-wetted commercial wiper (Touzin, 2008). The worker's health and exposure history may also influence the decision of the occupational medicine physician. Immediate cleansing of the affected skin with soap and water. [https://www.cdc.gov/niosh/topics/hazdrug/]. You can review and change the way we collect information below. I am a teacher at Smart Start Georgia, where I work with students of all ages to help them develop their skills and learn how to be successful in life. In the past thirty years, bio-monitoring studies have become quite commonplace, with more than 100 reports in the literature, about two-thirds of which documented drug uptake by measuring these drugs or their metabolites in the urine of at least some exposed HCWs. Most recently accessed March 6, 2016. Spiking an IV set into a solution containing HDs or priming an IV set with HD solution in an uncontrolled environment should be avoided. Orlando: Grune & Stratton. Falck K, Sorsa M, Vainio H [1981]. Information should be included in a confidential data base that the organization manages to track exposures as a formal log. 2008. October 2008. Type A1 cabinets recirculate approximately 70 percent of cabinet air through HEPA filters back into the cabinet; the rest is discharged through a HEPA filter into the preparation room. NIOSH [1991]. 2007-124]. Chemotherapy drug evaluation at a medical laboratory - Pennsylvania. 2013-103]. An unusual accident during the administration of chemotherapy. Clin J of Onc Nurs 7(4): 418-422. Ann Occup Hyg 48(3):237-244. Sealable bags should be used for transporting HDs (ASHP, 2006; USP 800, 2016). Drug residue may be present on the outside of vials received from manufacturers and distributors (Kiffmeyer, 2000; Nygren, 2002a; Mason, 2003; Favier, 2003; Connor, 2005; Gilbar, 2005; Touzin, 2008; Schierl, 2010; Hama, 2011; Power, 2014). Obstet Gynecol Int. . Validation of urinary excretion of cyclophosphamide as a biomarker of exposure by studying its renal clearance at high and low plasma concentrations in cancer patients. The healthcare worker's private physician may also play a role in providing "validation" of the worker's request for alternative duty assignment. Selevan SG, Lindbolm ML, Hornung RW, Hemminki K [1985]. Occup Med: State Art Reviews 2:513-24. The exact cause of HD contamination is undetermined and there are a number of issues that could contribute to the apparent failure of the BSC to contain HD residue. Vol 1-42 (Suppl 6). Gowns and additional gloves should be worn by HD compounders using a CACI. The use of air pressure relationships that define the direction of airflow into the cabinet. Department of Health and Human Services. Occupational Safety and Health If priming is done at the administration location, spiking should be performed using an adapter that minimizes leakage, and IV sets should be primed with non-drug containing solution using a backflow method. All personnel responsible for administering HDs must wear appropriate personal protective equipment as described in the PPE section. Double gloves should be worn when crushing HD tablets or opening HD capsules (NIOSH, 2014b [table 5]). The study found that the most common serious violations were failure to provide personal protective equipment, failure to provide safe working conditions, and failure to provide training. Kilham L, Ferm, VH [1977]. J. Epidem. OSHA was created in 1970 by the Occupational Safety and Health Act, which gave the agency the authority to set and enforce safety standards in the workplace. Appendix 1. Morbidity and Mortality Weekly Report 37:560-3. ASHP recommends that drug syringes (with the needle attached) be discarded directly into a HD waste container (ASHP, 2006). Seek ongoing input from workers who handle HDs and from other potentially exposed workers regarding the quality and effectiveness of the prevention program. The use of nebulizers to administer HDs presents a specific challenge to the respiratory system and exposes HCWs to the "fugitive" aerosol of the drug. Transfer of contaminated items into or out of the CACI will result in contamination on outside surfaces. Touzin K, Bussires JF, Langlois , Lefebvre M, Mtra A [2010]. IARC [1975]. b. Assess the size and scope of the spill. Spontaneous abortions and malformations in the offspring of nurses exposed to anaesthetic gases, cytostatic drugs, and other potential hazards in hospitals, based on registered information of outcome. AM J Ind Med 44:107-109. The physical examination focuses on the involved area of the body, as well as other organ systems commonly affected (i.e., for a spill, the skin and mucous membranes of the affected area; for aerosolized HDs, the pulmonary system). Jan 2019 - May 20195 months. Any discarded HDs greater than residue amounts should be evaluated as to whether they are a hazardous waste under federal U.S. EPA regulations, and if so, be disposed of in accordance with 40 CFR part 261 (EPA, 1991a and b). according to an investigation. OSHA [2013]. Laborer touching suspended cement bucket electrocuted when crane cable contacts 7,200-volt power line in North Carolina. Under USP <800>, storage areas for antineoplastic HDs requiring manipulation other than counting or repackaging of final dosage forms and any HD API should be separated from non-HDs in a manner that prevents contamination and personnel exposure. ANSI Z87.1. Department of Health and Human Services. Face and eye protection must be worn if there if splashing is a hazard [29 CFR 1910.133]. Examining factors that influence the effectiveness of cleaning antineoplastic drugs from drug preparation surfaces: a pilot study. Occupational Exposure to Bloodborne Pathogens Standard. The ASHP recommends that drugs that are carcinogenic and/or teratogenic in animals and those that exhibit reproductive toxicity or organ toxicity at low doses in animals be considered potential human occupational hazards (ASHP, 1990). USP <797> states that training for compounding personnel should include at least safe aseptic manipulation practices; negative pressure techniques when utilizing a C-PEC and correct use of CSTD devices; containment, cleanup, and disposal procedures for breakages and spills; and treatment of personnel contact and inhalation exposure (USP 797, 2012). OSHA also works with employers and workers to identify and correct workplace hazards. Date accessed November 2014. Ribavirin - Exposure to health care workers. Fair Law, Unfair Practices? Most recently accessed December 15, 2015. Br J Ind Med 49:855-861. Sessink PJM, Connor TH, Jorgenson JA, Tyler TG [2011]. Completely remove and place all contaminated material in the HD waste disposal bags. Marker HDs have also been measured in the urine of workers where a Class II BSC is the PEC (Wick, 2003). to commit literary theft. On August 22, 1990, a 24-year-old foreman for a telecommunications company was electrocuted when he grabbed the door handle on a truck-mounted crane whose boom was in contact with a 7,200-volt overhead power line. The location and availability of safety data sheets for all HDs in the work area. According to USP, HD compounding personnel of reproductive capability should confirm in writing that they understand the risks of handling hazardous drugs (USP 797, 2012; USP 800, 2016). Sharps contaminated with blood or other infectious material must be placed in puncture-resistant, leak-proof, and appropriately labeled containers as soon as possible after use and kept in such containers until properly reprocessed [29 CFR 1910.1030(d)(2)(viii)]. Chu WC, Hon C-Y, Danyluk Q, Chua PPS, Astrakianakis G [2011]. Goggles - Tight-fitting eye protection that completely cover the eyes, eye sockets and the facial area immediately surrounding the eyes and provide protection from impact, dust, and splashes. The reproductive toxicity of HDs should be carefully explained to all workers who will be exposed to these chemicals, and providing this explanation is required for those chemicals that are covered by the HCS. NIOSH [2007]. Am J Hospit Pharm 1986;43:1193-204, Zock MD, Soefje S, Rickabaugh K. Evaluation of surface contamination with cyclophosphamide following simulated hazardous drug preparation activities using two closed-system products. A small waste/sharps container may be placed along the sidewall toward the back of the C-PEC as long as it does not interfere with airflow in the ventilated cabinet or negatively impact on the particle count within an ISO 5 PEC (ASHP, 2006). Sessink PJM, Wittenhorst BCJ, Anzion RBM, Bos RP [1997]. Mooney K, Melvin M, Douglas T [2014]. University Medical Center, Safe Handling of Hazardous Drugs for Veterinary Healthcare Workers, Chemotherapy drug evaluation at a medical laboratory, Multiple Sclerosis Cluster Evaluation in an Inpatient Oncology Ward, Exposures to pharmaceutical dust at a mail order pharmacy, Chemotherapy drug evaluation at a veterinary teaching hospital, Chemotherapy drug exposures at an oncology clinic, Medical Surveillance for Healthcare Workers Exposed to Hazardous Drugs, Workplace solutions: medical surveillance for healthcare workers exposed to hazardous drugs, Evaluation of Pharmaceutical Dust Exposures at an Outpatient Pharmacy, Evaluation of safety climate, health concerns, and pharmaceutical dust exposures at a mail order pharmacy, Evaluation of Chemotherapy Drug Exposure in an Outpatient Infusion Center, NIOSH list of antineoplastic and other hazardous drugs in healthcare settings, The National Personal Protective Technology Laboratory (NPPTL), OSHA Summary Publication on Personal Protective Equipment, OSHA, The Joint Commission, and NIOSH joint letter to hospitals, Occupational Safety and Health Standards: Hazard Communication Resources Page, Occupational Safety and Health Standards: Respiratory Protection [29 CFR 1910.134], Severe Storm and Flood Recovery Assistance, Structure/toxicity profiles of new drugs that mimic existing HDs. ASTM tested "chemotherapy" gloves should be worn when counting and pouring HDs, and C-PEC designed for non-injectable HDs should be used (USP 800, 2016). This can protect against cuts and catch airborne HD aerosol. A separate OSHA document on this topic is available at: https://www.osha.gov/waste-anesthetic-gases/workplace-exposures-guidelines (OSHA, 2000). Baykal U, Seren S, Sokmen S [2009]. Good organizational skills are essential to minimize contamination and maximize productivity during compounding (ASHP, 2006). OSHA [1999]. EPA Inaction in Identifying Hazardous Waste Pharmaceuticals May Result in Unsafe Disposal. A study conducted by the U.S. Occupational Safety and Health Administration ( OSHA) showed that 377 or 65% of 580 work-related electrocutions occurred in the construction industry. A series of case reports of possible occupational cancer risks have also been published, including bladder cancer in a female pharmacist (Levin, 1993) and naso-pharyngeal cancer in an oncology nurse (Gabriele, 1993). Connor TH, DeBord G, Pretty JR, Oliver MS, Rogers BR, Escalante CP, McDiarmid, MA [2010]. Antineoplastic drug contamination in the urine of Canadian healthcare workers. Washington, DC: Department of Labor, Occupational Safety and Health Administration, Office of Occupational Medicine Publication No. Acta Med Scand 214:181-9. In addition to standard pharmacy labeling practices, all syringes and IV bags containing HD's should be labeled with a distinctive warning label, such as: As clipping or crushing used HD needles generates aerosols of HD, this process is strongly discouraged. Cancer chemotherapeutic agents and carcinogenesis. according to research carried out. One elimination type surfactant, dish washing liquid, was found to be an effective cleaning solution (91.5 percent of contaminants removed), but the exact formulation of the solution was unknown. Nat Intra Ther J 3:77-80. Oral solid forms of HDs should not be placed in automated counting machines, as these have been shown to produce "pill dust" in the work area, some of which is active drug (Fent, 2014). Chromosomal aberration frequency in lymphocytes predicts the risk of cancer: results from a pooled cohort study of 22 358 subjects in 11 countries. Rinse the area several times and place all materials used for containment and cleanup in disposal bags. 2007. http://www.cetainternational.org/reference//CAG005-v15.pdf. 29 CFR 1910.1030. 95-108sum.pdf (Worker/Employer Summary Sheet Only) pdf icon[PDF 373 KB]. Medical Surveillance for Healthcare Workers Exposed to Hazardous Drugs. 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