The potential fates of a cell exposed to a HD include transformation to malignant potential, mutation, cell death, or, through repair, a normal cell may remain (Harris, 1976). 2004-165]. Entry ports should be wiped with moist alcohol pads and capped. In addition, most HCWs are exposed to multiple agents during any work shift, yielding a "mixed exposure" scenario. Rogers B [1987]. Eckstein G [2012]. 2010-150]. Infusion sets and pumps should be observed for leakage during use. Carefully remove all PPE using the inner gloves. Well driller electrocuted when pipe on crane cable contacts 12,000-volt overhead power line in Virginia. Sem Occup Med 2:109-17. However, other classes, such as the Topoisomerase II inhibitors (Pedersen-Bjergaard, 2002) and some anthracycline antibiotics, have been implicated as well. CSA guidelines list techniques that can be used when equipment contacts energized power lines [CSA 1982] (see Current Standards in this Alert). Vertical airflow C-PECs (Class II or III BSC or CACI) differ from horizontal airflow devices in several ways that require special precautions. Vol 26. Appropriate ventilated compounding equipment for sterile and non-sterile HD compounding should be available (NIOSH, 2004; USP 797, 2012; USP 800, 2016). Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. A number of studies using surface wipe sampling to detect marker HDs on surfaces in compounding and administration work areas indicate that traditional syringe/needle and open IV set techniques may be insufficient to control HD contamination (Connor, 1999; Connor, 2010). CACIs should be certified to CAG-002-2006 or current (CETA, 2008; USP 797, 2012). Use independent insulated barriers to prevent physical contact with the power lines [29 CFR 1910.333(c)(3); 29 CFR 1926. A recent study of 10 HDs, which were divided into "hydrophilic" or "hydrophobic" groups, assessed the potential of several chemical solutions to decontaminate stainless steel and glass work surfaces (Lamerie, 2013). Technicians servicing these cabinets or changing the HEPA filters should be aware of HD risks through hazard communication training from their employers and should use the same PPE as recommended for large spills. However, a drug's characteristics that allowed it to be designated as D or X remain unchanged and thus these older designations may be helpful to organizations assembling their own HD list (see https://womensmentalhealth.org/posts/fdas-new-labeling-rule-clinical-implications/). Nygren O, Olofsson E and Johansson [2008]. These devices do not lock onto the HD vial, allowing them to be transferred from one vial to another, creating an opportunity for both environmental and product contamination (ASHP, 2006). A review of the reproductive health risks associated with occupational exposure to HDs can be found in Connor (2014). Saving on the need for additional compliance officers B. To achieve this goal, the agency develops and enforces safety and health standards, provides training and education resources, and conducts inspections and investigations. Sections dealing with work areas and prevention of employee exposure to HDs at a workplace refer to workplaces where pharmaceuticals are used in concentrations appropriate for patient therapy. 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. CACIs should be serviced and certified, per the CETA guidance (CETA, 2008). This section includes requirements for hazard identification and assessment, hazard control, and safety and health training. Class II type B2 BSCs are typically reserved for use with volatile components (USP 800, 2016). Staff who may be required to wear respirators must be fit tested and trained to all OSHA respirator requirements (OSHA's RPS, 29 CFR 1910.134; NIOSH, 2009). Studies show HD contamination on the floor in front of the Class II BSC could occur when workers reach out of the cabinet to discard waste in receptacles located on the floor (Connor, 1999; Connor, 2010). CSTDs are not a substitute for ventilated engineering controls and should not be used outside of an appropriate C-PEC (NIOSH, 2004; ASHP, 2006; USP 800, 2016). Br J Ind Med 49:855-861. Chromosomal aberrations in lymphocytes predict human cancer: a report from the European Study Group on Cytogenetic Biomarkers and Health (ESCH). This includes using gloves, masks, and other personal protective equipment as needed, and following standard hygiene procedures. The employee health clinician can determine appropriate follow up intervals based on drug half-life and, for example, expected timing of blood count nadir (low point). a study conducted by OSHA showed that nearly _______ percent of work related electrocutions involved cranes 30 Who is covered by the OSH Act all workers and their employers under federal government authority what is an acceptable alternative to installing an audible back up alarm on vehicles flaggers June 2012. Seal bags and place them in the appropriate final container for disposal as hazardous waste. Details of the use of personal protective equipment and engineering controls present should be included, as well as maintenance of a confidential database with information regarding the individual's medical and reproductive history, with linkage to exposure information to facilitate epidemiologic review. Lancet I (8128):1250-1. violators can face fines and other penalties. Patients' urine, stool, emesis and sweat contain varying concentrations of drugs or their hazardous metabolites. J Occup Med 32:508-12. March 2014. Biosafety Cabinetry: Design, Construction, Performance, and Field Certification. Nyman H, Jorgenson J and Slawson MH [2007]. Rudolph R, Suzuki M, Luce JK [1979]. BSCs and CACIs should not be overcrowded to avoid unnecessary contamination with HD residue and possible interference with laminar flow for puncturing critical sites (ASHP, 2006; USP 797, 2012; USP 800, 2016). Decontamination based on SDS for the agent of exposure. Spills that cannot be contained by two spill kits may require outside assistance. Assessing exposures of health care personnel to aerosols of ribavirin -- California. As many HDs are also hazards that are identified in the revised HCS, the requirements of the HCS must also be met [29 CFR 1910.1200] (OSHA, 2012b). Guidelines for cytotoxic (antineoplastic) drugs. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Most recently accessed December 15, 2015. Toronto, Ontario, Canada: Construction Safety Association of Ontario. As the larger waste containers are frequently not covered, or the cover is opened throughout the day, the containment bag provides additional protection from exposure. You'll save time and money, ensure compliance, and reduce risk, all with one tool. USP <797> specifies that compounding garb for sterile doses should include the following (USP 797, 2012): NIOSH has recommended the following practices to provide eye and face protection to employees working with HD (NIOSH, 2009): Follow these recommended work practices when wearing gowns: Whenever respirators are used, OSHA's Respiratory Protection Standard (RPS) [29 CFR 1910.134] (OSHA, 2011b) must be followed, which includes requirements for respirator selection, medical evaluation, fit testing and training. The circumstances and management of HD spills should be documented (ASHP, 2006; USP 800, 2016). Examination and laboratory evaluation should be guided by the individual's history of exposures and follow the outline of the periodic evaluation. When compounding non-sterile HDs (e.g., crushing, dissolving, or preparing a solution or an ointment), PPE should include non-permeable gowns and double gloves (ASHP, 2006). Centers for Disease Control and Prevention. Browse: Home. Skov T, Lynge E, Maarup B, Olsen J, Rorth M, Winthereik H [1990]. NIOSH requests that the following individuals and organizations bring this Alert to the attention of workers who are at risk: editors of trade journals, safety and health officials, construction companies, unions, suppliers and manufacturers of building materials, crane manufacturers, electric utilities, and others who use cranes or boomed vehicles. Waste containers stored inside the C-PEC should be sealed and decontaminated before removing from the C-PEC for discard, due to the potential HD contamination on the outside of the container (ASHP, 2006). 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). Department of Health and Human Services. Mark safe routes where cranes must repeatedly travel beneath power lines. EPA (Environmental Protection Agency) [1991a]. The standard addresses the following issues: The Construction Safety Association of Ontario, Canada (CSA) recommends safe work practices in addition to those addressed in the OSHA and ANSI standards [CSA 1982]. Morgantown, WV: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Institute for Occupational Safety and Health, Fatal Accident Circumstances and Epidemiology (FACE) Report No. (NIOSH, 2004; ASHP, 2006; TJC, 2015; USP 800, 2016). Factors Influencing Oncology Nurses' Use of Hazardous Drug Safe-Handling Precautions. Socie G, Henry-Amar M, Cossett JM, Devergie A, Girinsky T, Gluckman E [1991]. OSHA [2012b]. FDA [2014]. External contamination of antineoplastic drug vials. Morgantown, WV: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Institute for Occupational Safety and Health, Fatal Accident Circumstances and Epidemiology (FACE) Report No. Once compounding is completed, decontaminate the C-PEC. Most recently accessed December 11, 2015. 10:374-83. Combining various cleaning techniques, however, resulted in even less residual concentration of CP after cleaning was performed (Touzin, 2010). Do not use cage-type boom guards, insulating links, or proximity warning devices as a substitute for de-energizing and grounding lines or maintaining safe clearance [29 CFR 1926.550(a)(15)(v)]. Health hazards to personnel handling antineoplastic agents. Latchford T, Shelton B. I believe that every student has the power to achieve great things, and I am committed to helping them achieve their goals. These SOPs and P&Ps should address receiving, storage, transport, preparation, administration, spill cleanup, handling HD waste, handling patient waste, and disposal of HDs in order to protect the safety and health of all health care workers who are responsible for handling HDs. Thoroughly clean and decontaminate the C-PEC. Class II BSCs and CACIs that have laminar flow in the work area may have a removable work tray as the work surface. Does the manufacturer suggest the use of special isolation or other techniques in its handling, administration, or disposal? (abstract). NIOSH recommends that gloves should be worn and gowns should be in such circumstances (NIOSH, 2014a). Disinfectant - A chemical agent that destroys or inhibits the growth of microorganisms that cause disease. Date accessed December 2014. Standard precautions are based on the understanding that any blood or other body fluid may contain potentially harmful pathogens, regardless of the persons health status. Bonassi S, Znaor A, Ceppi M [2008]. Sodium hypochlorite 0.5 percent, a degradation type solution, showed the highest overall effectiveness, with removed 98 percent contamination all 10 drugs from both surfaces. This section includes requirements for process safety information, process hazard analyses, and operating procedures. NIOSH [2014b]. Keeping exposures as low as reasonably achievable (ALARA). OSHA [1999]. OSHA, The Joint Commission, and NIOSH joint letter to hospitals, dated 4 April 2011, on hazardous drugs. 95-108sum.pdf (Worker/Employer Summary Sheet Only) pdf icon[PDF 373 KB]. CETA (Controlled Environment Testing Association) [2008]. The following should be readily accessible for disposal of HD contaminated waste: a puncture resistant container for sharps, plastic HD waste disposal bags, and HD waste containers (ASHP, 2006). OSHA [2015]. Surface contamination of chemotherapy drug vials and evaluation of new vial-cleaning techniques: Results of three studies. Signs identifying that HDs are in use and restricting the access of unauthorized personnel should be prominently displayed.
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