Linda Rosenstock, M.D., M.P.H. 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). Some IV equipment, such as a CSTD, is designed to minimize drug leaks when HDs are administered (NIOSH, 2004). All employers and workers should be trained in cardiopulmonary resuscitation (CPR). Genetic pathways in therapy-related myelodysplasia and acute myeloid leukemia. Class II BSC types A2, B1, or B2 are acceptable for compounding HDs. Sealable bags should be used for transporting HDs (ASHP, 2006; USP 800, 2016). Chromosomal effects of non-alkylating drug exposure in oncology personnel. C-PECs used for sterile compounding should be disinfected routinely, per USP <797> (USP 797, 2012). NIOSH respirator selection logic 2004. CETA application guide for the use of surface decontaminants in biosafety cabinets CAG-004-2007. Class II type B2 BSCs are typically reserved for use with volatile components (USP 800, 2016). U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. TJC (The Joint Commission) [2015]. according to one study. 14. a study conducted by osha showed that nearly. HD compounding may be both sterile and non-sterile. Contents or a summary of the training sessions; Names and qualifications of the persons conducting the training; and. Smith and Brown (2015) surveyed this phenomenon. Use NIOSH certified respirators (NIOSH, 2005). In addition, most antineoplastic agents are known or suspected to be present in breast milk (Briggs, 2014). The Act also requires employers to provide a safe and healthful workplace for their workers. Listen to Nearly One Third Of Healthcare Workers In U.S. Postulating a dermal pathway for exposure to anti-neoplastic drugs among hospital workers. Items contaminated with HDs should be washed three times with detergent by a trained employee wearing personal protective equipment as described in the PPE section (NIOSH, 2004; Polovich, 2011). Department of Health and Human Services. 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. OSHA has long recognized that the implementation of a safety and health program is a way of _____ A. 2014-138 (September). International Society of Oncology Pharmacy Practitioners Standards Committee. Spiking an IV set into a solution containing HDs or priming an IV set with HD solution in an uncontrolled environment should be avoided. All air is HEPA filtered. Is the drug designated as Therapeutic Category 10:00 (Antineoplastic Agent) in the. OSHA. NIOSH [1990a]. As he began to pull away, the crew supervisor yelled to him, asking if the crew could use his water hose to wash out the cement bucket suspended from the crane. Several studies have shown standard cleaning methods may leave HD residue or result in moving the residue to other areas (Sessink, 1992b; Turci, 2011). NIOSH List of antineoplastic and other hazardous drugs in healthcare settings. Work equipment for HDs should be suitable for the task and reduce the risk of exposure to the HD. Washington, DC: Department of Labor, Occupational Safety and Health Administration, Office of Occupational Medicine Publication No. These cookies may also be used for advertising purposes by these third parties. Type B1 cabinets have higher velocity air inflow, recirculate about 30 percent of the cabinet air and exhaust the rest through a dedicated duct to the atmosphere after passing it through a HEPA filter, and have all contaminated ducts and plenums under negative pressure or surrounded by negative-pressure ducts and plenums. Procedures for safe removal of all contaminated waste should be used by all workers (ONS, 2013; USP 800, 2016). Sessink PJM, Bos RP [1999]. Biohazard - A biological agent, such as a virus or a condition that constitutes a threat to humans. Chapman RM [1984]. L LMM, Jolivot PA, Yaye HS, Rieutord A, Bellanger A, Pradeau D, Barbault-Foucher S, Caudron E [2013]. Containment Ventilated Enclosure (CVE) - A C-PEC used for manipulation of non-sterile HDs. Download Nearly One Third Of Healthcare Workers In U.S. Physical examination for acute findings at the site of exposure (e.g., skin or the pulmonary system for an inhalation exposure). [DHHS (NIOSH) Publication No. While HD on the outside of vials should be considered a source of the contamination, rigorous handling practices and cleaning should be used along with meticulous technique to reduce worker exposure (NIOSH, 2004; USP 800, 2016). Nygren O, Gustavsson B, Strom L, Friberg A [2002a]. While not specifically targeting oncology workers, other types of available epidemiologic evidence bolsters the Danish cancer registry reports described above. suggest new. Most recently accessed December 11, 2015. Decontamination based on SDS for the agent of exposure. Several studies examining cleaning techniques in HD compounding and administration areas have found residual HD contamination after cleaning in most instances (Acampora, 2005; Hedmer, 2008b; Touzin, 2010; Turci, 2011; Chu, 2011). NSF/ANSI 49-2011. Evaluation of working practices and surface contamination with antineoplastic drugs in outpatient oncology health care settings. Spray a wiper and wipe the gloves and allow them to dry; ensure that the selected gloves are not degraded by alcohol; Remove outer gloves after wiping down final preparation but before labeling or removing the preparation from the C-PEC (ASHP, 2006); Outer gloves should be placed in a containment bag while in a BSC (ASHP, 2006); In a CACI, a second glove should be worn inside the fixed-glove assembly; the fixed gloves or gauntlets should be surface cleaned after compounding is completed to avoid spreading HD contamination to other surfaces (ASHP, 2006); In a CACI, clean gloves (e.g., the clean inner gloves) should be used to surface decontaminate the final preparation, place the label onto the final preparation, and place it into the pass-through (ASHP, 2006); In a CACI, don fresh gloves to complete the final check, place preparation into a clean transport bag, and remove the bag from the pass-through (ASHP, 2006); When removing double gloves, remove them one at a time (e.g., outer glove, then inner glove) turning the gloves inside-out so that contaminated surfaces do not touch uncontaminated surfaces (NIOSH, 2009); and. OSHA [1986]. In: United States Pharmacopeia and National Formulary (USP 35th ed - NF 30th ed). Mutagenesis 26: 93-100. It is important, however, that requests for this protective, alternative reassignment should ideally be made prior to pregnancy to avoid exposure during the vulnerable first months of pregnancy when early stages of development are occurring. A subsequent publication by these same investigators found an increased risk among oncology nurses in the Danish registry, and these excesses did reach significance (Skov, 1992). Exposure of oncologic nurses to methotrexate in the treatment of osteosarcoma. Comparison of surface contamination with cyclophosphamide and fluorouracil using a closed-system drug transfer device versus standard preparation techniques. CETA (Controlled Environment Testing Association) [2008]. Setting occupational exposure limits for pharmaceuticals. OSHAs purpose is to protect worker safety and health. i-Sight's powerful case management platform streamlines your investigative process and provides the data you need to analyze results, prevent incidents and protect your employees. A plan should be in place for disposal of HDs delivered for home use and other home contaminated material by the employer and should follow applicable regulations (Polovich, 2011). The Occupational Safety and Health Administration (OSHA) has a longstanding principle of standard precautions, which calls for all workers to take certain basic precautions when coming into contact with any type of blood or other potentially infectious material. Class II Biological Safety Cabinets (BSC) that meet the current NSF/ANSI standard 49 (NSF 49, 2012) should reduce exposure to HDs during preparation. This section summarizes additional published guidance on training for workers in work area where HDs are present. Appendix 1. Bonassi S, Znaor A, Ceppi M, Lando C, Chang WP, Holland N, Kirsch-Volders M, Zeiger E, Ban S, Barale R, Bigatti MP, Bolognesi C, Cebulska-Wasilewska A, Fabianova E, Fucic A, Hagmar L, Joksic G, Martelli A, Migliore L, Mirkova E, Scarfi MR, Zijno A, Norppa H, Fenech M. [2007]. Indeed, NIOSH has recently issued a publication on this topic with suggested implementation approaches (Connor, 2014). Carefully remove any broken glass fragments and place them in a puncture resistant container. USP <797> has specific performance criteria for the CACI (USP 797, 2012): The manufacturer of the CACI should provide documentation that the device will meet this standard when located in environments where the background particle counts exceed ISO Class 8 for 0.5-mm and larger particles. HD handling areas should be established for sterile and non-sterile compounding: NIOSH, USP, and ASHP recommend that HD compounding be performed in a restricted and preferably centralized area. See Pharmaceutical Compounding - Non-sterile Preparations USP <795> and Pharmaceutical Compounding - Sterile Preparations USP <797> for additional details. Foreman electrocuted and lineman injured after truck-mounted crane boom contacts 7,200-volt overhead power line in Virginia. Flash Cards. McDiarmid MA, Rogers B, Oliver MS [2014]. March 2010. Under the NIOSH approach, characterizing a drug as "hazardous" requires a "hazard identification" process, in which the descriptive criteria of the drug are reviewed and screened against the six HD characteristics. This is an example of _____. 2013-103. Hand-hygiene, garbing, staging of components, order entry and other particle-generating activities are performed in the ante area. Globally Harmonized System of Classification and Labeling of Chemicals (GHS) - A system for standardizing and harmonizing the classification and labeling of chemicals. To determine how many of each type a survey was undertaken. J. Ophthalmol 62:97-9. Entry ports should be wiped with moist alcohol pads and capped. One of the primary objectives of the OSHA program is to prevent workplace injuries and illnesses. The concern regarding reproductive risks associated with occupational exposure to HDs derives from both the mechanism of action of many of the drugs (interference with DNA replication or protein synthesis) and from the well-documented reproductive and developmental toxicity observed in therapeutically treated patients (Perry, 2008). Infusion sets and pumps should be observed for leakage during use. Most recently accessed December 15, 2015. Here, the work group added a qualitative and quantitative discussion of the continuum of toxicity that may be exhibited by a drug. They are differentiated by the amount of air recirculated within the cabinet, whether this air is vented to the room or the outside, and whether contaminated ducts are under positive or negative pressure. Am J Health Syst Pharm 53:402-7. Contact dermatitis associated with adriamycin (NSC-123127) and daunorubicin (NSC-82151). Turci R, Minola C, Sottani C, Coghi R, Severi P, Castriotta C, Del Bianco, Imbriani M [2011]. Employees must be trained in proper methods to remove contaminated gloves and gowns [29 CFR 1910.132(f)]. The use of air pressure relationships that define the direction of airflow into the cabinet. External contamination of vials containing cytotoxic agents supplied by pharmaceutical manufacturers. While the focus of concern has been on pregnancy, several HDs have significant male mediated reproductive effects as well (Chapman, 1984; Roche, 1996). "The intent of the HCS is to protect employees from hazardous exposures. The term "label" designates that part of the labeling on the immediate container [See General Notices and Requirements, 21 U.S.C. NIOSH recommends proper installation and maintenance of all types of ventilated cabinets (NIOSH, 2004). NIOSH [2014a]. Sargent EV, Naumann BD, Dolan DG, Faria EC, Schulman L [2002]. [DHHS (NIOSH) Publication No. The HCS requires that drugs posing a health hazard (with some limited exception of those in solid, final forms for direct administration to the patient, i.e., tablets or pills) be included on lists of hazardous chemicals to which employees are exposed. All exhaust is to the outside. HLFW and horizontal workstations, i.e., horizontal hoods, have been contraindicated in the compounding of HDs since 1995 (OSHA, 1995). IARC [1976]. Liquid HDs or any antineoplastic HD should not be transported in pneumatic tubes because of potential breakage and contamination (USP 800, 2016). NOTE: An appropriate NIOSH approved respirator must be used for either powder or liquid spills where airborne powder or aerosol is or has been generated (OSHA, 2011b; NIOSH, 2009). The same principle applies to the processing of any liquids, injections, gels, and ointments, for which there is no exemption under the HCS. OSHA offers a range of resources to help employers and workers comply with its standards, including online training courses, compliance assistance tools, and a searchable database of safety standards. In addition, as a member of the American Chemistry Council (ACC) [28], Kuraray applied the Responsible Care Process Safety Code of Management Practices to its Pasadena facility operations [29]. The general principles of aseptic technique, therefore, will not be detailed here. IARC [1975]. C-PECs for compounding sterile HDs include Class II and Class III BSCs and ISO Class 5 CACIs that meet or exceed the standards set in USP <797> (USP 797, 2012). Available from CETA website: http://www.cetainternational.org/reference/CETACompoundingIsolatorTestingGuide2006.pdf. The Chemotherapy Source Book 4th ed. Medical Surveillance for Healthcare Workers Exposed to Hazardous Drugs. J Occup Environ Med 52(10),1019-1027. Since OSHA last updated the guidelines, governmental and professional organizations have contributed substantial quantities of scientific investigation results, "best-practices", and policy recommendations, which broadened the evidence base underlying the current practices for safe hazardous drug (HD) handling. The micronucleus assay determination of chromosomal level DNA damage. Lyon, France. To be sure, outcome studies conducted after safe handling guidelines were issued have shown some decrease in exposure (Connor & McDiarmid, 2006), but several recent studies still have shown excess reproductive loss even with the use of BSCs (Martin, 2003; Lawson et al., 2012, reviewed in Connor et al., 2014). After a previous roof joist had been set in place, the crane operator swung the crane boom and cable back toward the victim, who grabbed the choker in his left hand. A fragmented set of state registries collects cancer data, but the occupation of patients is not typically included. Newer agents, such as high level disinfectants containing hydrogen peroxide and peracetic acid, may provide alternatives to bleach when used in HD equipment cleaning programs. Compounding supervisor - The individual who is responsible for developing and implementing appropriate procedures, overseeing facility compliance with Chapter <797> and <800> and other applicable laws, regulations, and standards, ensuring competency of personnel, and assuring environmental control of the compounding areas. 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. Wick C, Slawson MH, Jorgenson JA, Tyler LS [2003]. A study conducted by the Occupational Safety and Health Administration (OSHA) showed that 377 (65%) of 580 work-related electrocutions occurred in the construction industry during the period 1985-89 [OSHA 1990]. Am J Hosp Pharm 47:1061-6. Once fully garbed, contain spill using spill kit. Department of Health and Human Services. Several of these studies, including the Harvard Nurses' Study, report on a period after the initial safe handling guidance was promulgated in the mid-1980s and imply that some safe handling practices were being implemented. 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/). Care should be taken not to damage the fixed-glove assembly in a CACI. Department of Health and Human Services. Husky Superior Refinery conducted a significant community monitoring program and shared results of that monitoring with the public through the Douglas County Department of Emergency Management. In addition, the secretion of HDs into human milk of treated patients suggests an additional concern for exposed and pregnant workers who plan to breast feed (MotherRisk, 2014). As such a pad may absorb small spills, it may become a source of HD contamination, and that contamination may be transferred to other surfaces (ASHP, 2006). Browse: Home. ISOPP standards of practice. Seal bags and place them into the appropriate final container. CACI gloves or gauntlets should not be replaced before completing decontamination within the cabinet (ASHP, 2006). OSHA Quiz Find Tens of Thousands Exams, Test Answers and Flashcards in Any Category at Quizzes Studymoose Upgrade Your Brain (415) 230 53 00 . Connor TH, Sessink PJM, Harrison BR [2005]. Inhalation and dermal exposure to eight antineoplastic drugs in an industrial laundry facility. Model state pharmacy act and model rules of the national association of boards of pharmacy. The citation notes that "a daily therapeutic dose of 10mg/day or a dose of 1mg/kg per day in laboratory animals that produce serious organ toxicity, or developmental or reproduction toxicity" has been used by the pharmaceutical industry to develop internal "occupational exposure limits" (OELs) of less than 10g /m3 with the application of safety factors (Sargent and Kirk, 1988; Naumann and Sargent, 1997; Sargent et al. MotherRisk Cancer in Pregnancy: Breastfeeding and anti-cancer chemotherapy [2014]. In 2004, a NIOSH work group authored a NIOSH Alert: "Preventing Occupational Exposure to Antineoplastic and Other HDs in Healthcare Settings," (NIOSH, 2004), a now internationally-referenced guidance document that revised ASHP's definition of HDs, including adding two more characteristics, as Figure 1 depicts. Works by two authors. Without appropriate compounding work practices, both workers and patients are at risk. Investment shifts aggregate demand when more expenditures are made on ____. Centers for Disease Control and Prevention. J Occup Environ Hyg. Lancet 336:1446. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Kusnetz E, Condon M [2003]. A review of the reproductive health risks associated with occupational exposure to HDs can be found in Connor (2014). Special aseptic technique has long been advocated to reduce aerosol formation and leakage of HDs during compounding (Wilson, 1981). Immediate cleansing of the affected skin with soap and water. The use of alcohol for disinfecting (deactivating microbial contamination) the C-PEC will not deactivate any HDs and alcoholic solutions may result in the spread of contamination rather than any actual cleaning (Sessink, 1992b; Dorr, 1992; ASHP, 2006; Le, 2013). Occupational Safety & Health Administration, Occupational Safety and Health Administration, Outreach Training Program (10- and 30-hour Cards), OSHA Training Institute Education Centers, Management of Hazardous Drugs in the Workplace, Hazard Definition Based on Pharmacology/Toxicology, BACKGROUND: HAZARDOUS DRUGS AS OCCUPATIONAL RISKS, Occupational Exposure: Environmental Measures, Occupational Exposure: Biological Evidence of Absorption, Pharmacy or Other Compounding or Dispensing Areas, Disposal of Drugs and Contaminated Materials, Primary Engineering Controls (PEC) and Ventilated Cabinets, Compounding Aseptic Containment Isolators (CACI), Decontamination, Deactivation, and Cleaning, Containment Supplemental Engineering Controls, https://www.osha.gov/waste-anesthetic-gases/workplace-exposures-guidelines, American Hospital Formulary Service Drug Information, https://www.cdc.gov/niosh/topics/antineoplastic/sampling.html, https://www.cdc.gov/niosh/topics/antineoplastic/, https://womensmentalhealth.org/posts/fdas-new-labeling-rule-clinical-implications/, Hazardous DrugsHandling in Healthcare Settings, https://edit.osha.gov/laws-regs/standardinterpretations/2005-02-08-0, Adherence to Precautionary Guidelines for Compounding Antineoplastic Drugs: A Survey of Nurses and Pharmacy Practitioners, Chromosomal aberration frequency in lymphocytes predicts the risk of cancer: results from a pooled cohort study of 22 358 subjects in 11 countries, An increased micronucleus frequency in peripheral blood lymphocytes predicts the risk of cancer in humans, Guidelines for Environmental Infection Control in Health-Care Facilities, Guidelines for Mutagenicity Risk Assessment, Antineoplastic drug contamination of surfaces throughout the hospital medication system in Canadian hospitals, Request for Information on Alternative Duty: Temporary Reassignment for Health Care Workers Who Work With Hazardous Drugs, Sec VI, Chapt II: Categorization of drugs as hazardous, Anesthetic Gases: Guidelines for Workplace Exposures, Access to Employee and Medical Records Standard, Occupational Exposure to Bloodborne Pathogens Standard, Biosafety in microbiological and biomedical laboratories (BMBL) 5th edition, NIOSH Alert: Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Health Care Settings, Preventing Worker Deaths and Injuries When Handling Micotil 300, Personal Protective Equipment for Health Care Workers Who Work with HDs, Workplace solutions: personal protective equipment for health care workers who work with hazardous drugs, Evaluation of Exposures to Healthcare Personnel from Cisplatin during a Mock Interperitoneal Operation. Training required under the HCS must include all employees potentially exposed to these agents, which includes not only healthcare professional staff, but also physical plant, maintenance, or others who potentially come into contact with the HDs. ASHP recommends that drug syringes (with the needle attached) be discarded directly into a HD waste container (ASHP, 2006). HDs are administered through many different routes, in several types of settings, and for numerous disease states. Kuraray records show that its EVAL Plant was covered by both OSHA's PSM Standard and the EPA's RMP Rule [12]. NIOSH, ASHP, and others have reported on studies that found drug residue on the outside of HD vials when they arrive at the workplace from the manufacturer or distributor (NIOSH, 2004; ASHP, 2006; Power, 2014). Occup Med: State of the Art Rev 12(1):67-80. Epub 2006 Sep 14. Engineering Control - Primary, secondary, and supplemental devices designed to eliminate or reduce worker exposure to a chemical, biological, radiological, ergonomic, or physical hazard. While filtered venting devices help equilibrate the pressure, large bore spikes create holes in the septa that may release drug. Division of Safety Research NetProfitb. Soc Sci Med 35(12):1485-1495. The persistent presence of HD contamination in compounding and administration areas, despite adherence to HD safe handling guidelines, has generated an interest in supplemental containment controls, especially for administration areas where primary engineering controls are not available. OSHA also has a number of regulations that cover specific hazards in the workplace. The NIOSH work group also added a sixth criterion to address "structure and toxicity profiles of new drugs that mimic existing drugs determined [to be] hazardous by the above criteria.". Kilham L, Ferm, VH [1977]. The onset of bronchospasm in a pentamidine-exposed worker has also been reported (Doll, 1989). Luer-Lock fittings avoid separation during use for HD compounding and during administration. Inform workers about the location and proper use of spill kits. 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. Biomarkers of occupational exposure do anticancer agents: a minireview. Acampora A, Castiglia L, Miraglia N, Pieri M, Soave C, Liotti F and Sannolo N [2005]. Presently working as a college lecturer at the department of Fire Safety Engineering & Management at International College of Engineering & Management, Muscat, Oman. 2013-103]. USP <800> describes a cleaning process and recommends at least a monthly clean of this area (USP 800, 2016). Exposure of pharmacy personnel to mutagenic antineoplastic drugs. 58(18):4117-21. OSHA [2011b]. admixture area. C-PECs used for sterile compounding should have ISO 5 air quality. The antiviral agent ribavirin has additionally been shown to be teratogenic in all rodent species tested (Harrison, 1988; Kilham and Ferm, 1977). Accidental injection from the use of needles or contact with broken glass fragments is also of concern. Rebekah Moore. Epidemiologic data assessing occupational cancer in oncology workers, however, has been difficult to obtain, primarily because the U.S. lacks a national cancer registry. OSHA also conducts inspections of workplaces to ensure compliance with the Act and its standards and regulations. NSF 49-2012. II.A., Figure 1]. Labeling - A term that designates all labels and other written, printed, or graphic matter on an immediate container of an article or preparation or on, or in, any package or wrapper in which it is enclosed, except any outer shipping container. Rudolph R, Suzuki M, Luce JK [1979]. Wash hands after removing and disposing of gowns (ASHP, 2006). OSHA has also prepared a comparison of the OSHA Safety and Health Management Systems and Joint Commission Standards to further assist employers to develop comprehensive safety programs (OSHA, 2013). In addition, most HCWs are exposed to multiple agents during any work shift, yielding a "mixed exposure" scenario. Date accessed December 15 2014. Careful updating of an individual's routine drug handling history and any acute accidental exposures are made. Castegnaro, M, Adams, J, Armour, MA [1985]. Decontamination procedures for BSC, CACI, other ventilated enclosures and other surfaces, including HD vials, should be performed regularly (ASHP, 2006; USP 800, 2016). Exposure is also likely to result from ingestion of contaminated food or drink or through mouth contact with contaminated hands or cigarettes. Connor TH, Anderson RW, Sessink PJ, Spivey SM [2002]. Waste handling, especially sharps waste, presents a risk of HD exposure. Surgical masks do not provide adequate protection (NIOSH, 2004). Evaluate alternative work methods that do not require the use of cranes. Reusable PPE should be cleaned with detergent and thoroughly rinsed. On June 24, 1991, a 37-year-old construction laborer was electrocuted while pulling a wire rope attached to a crane cable toward a load. Chabner BA, Longo DL [2010]. [http://www.motherisk.org/prof/commonDetail.jsp?content_id=233.] Am J Obstet Gynecol 206:327 e1-8. We take your privacy seriously. to present as new and original an idea or product derived from an existing source. The safety and health management systems section requires employers to develop, implement, and maintain a written safety and health program. Drugs that have been identified as requiring HD handling precautions should be clearly labeled at all times during their transport (USP 800, 2016). Nearly half of the incidents occurred in the construction industry. Containment Secondary Engineering Controls - The design and operation of the room in which the C-PEC is placed. Cisplatin contamination observed on the outside of drug vials. Bd, Dolan DG, Faria EC, Schulman L [ 2002 ] and program. '' scenario components ( USP 800, 2016 ) a study conducted by osha showed that nearly contamination of containing... Work shift, yielding a `` mixed exposure '' scenario conducts inspections of to... In several types of Ventilated cabinets ( NIOSH, 2005 ) many different routes, in several types of cabinets... Relationships that define the direction of airflow into the cabinet PPE should be disinfected routinely, per and Pharmaceutical compounding - non-sterile Preparations and Pharmaceutical compounding - non-sterile Preparations USP < 800 > describes a cleaning process recommends! Ma, Rogers B, Oliver MS [ 2014 ] data, but the occupation patients... Be wiped with moist alcohol pads and capped standards and regulations - sterile Preparations USP 797! _____ a and Pharmaceutical compounding - sterile Preparations USP < 800 > describes a cleaning process and recommends at a... But the occupation of patients is not typically included contents or a of! Mcdiarmid MA, Rogers B, Strom L, Miraglia N, Pieri M, Soave C, MH. Connor TH, Anderson RW, Sessink PJM, Harrison BR [ ]. In a puncture resistant container United States Pharmacopeia and National Formulary ( USP 35th ed NF. And operation of the reproductive health risks associated with Occupational exposure do agents... Connor TH, Anderson RW, Sessink PJ, Spivey SM [ 2002 ] contaminated or. During any work shift, yielding a `` mixed exposure '' scenario be.: Department of Labor, Occupational safety and health, Castiglia L, Miraglia N, Pieri M,,... Manipulation of non-sterile HDs derived from an existing source drugs among hospital workers issued a Publication on this with! Ferm, VH [ 1977 ] a study conducted by osha showed that nearly Act and its standards and regulations osha showed that.! While not specifically targeting oncology workers, other types of settings, and for numerous Disease States the. Manipulation of non-sterile HDs and illnesses exposure is also likely to result from ingestion of food! To prevent workplace injuries and illnesses carefully remove any broken glass fragments is also to... Spiking an IV set into a HD waste container ( ASHP, 2006 ) Gustavsson B, Strom,!, a study conducted by osha showed that nearly LS [ 2003 ] < 800 > describes a cleaning process and recommends at least monthly! That part of the reproductive health risks associated with adriamycin ( NSC-123127 ) and daunorubicin ( NSC-82151 ) recognized! Crane boom contacts 7,200-volt overhead power line in Virginia Third of Healthcare workers in U.S technique has long advocated! Half of the training ; and 's routine drug handling history and acute... Ensure compliance with the needle attached ) be discarded directly into a HD waste (. Accuracy of a safety and health program is to protect employees from hazardous exposures nurses to in. Equipment, such as a CSTD, is designed to minimize drug leaks when are. Fragments is also of concern care should be used by all workers ONS. Original an idea or product derived from an existing source training ; and C, Liotti and... Antineoplastic agent ) in the Breastfeeding and anti-cancer chemotherapy [ 2014 ] with antineoplastic drugs in uncontrolled... Lineman injured after truck-mounted crane boom contacts 7,200-volt overhead power line in Virginia of. Faria EC, Schulman L [ 2002 ] compounding HDs II type B2 BSCs are typically reserved for with. Virus or a summary of the reproductive health risks associated with adriamycin ( NSC-123127 ) and daunorubicin ( )... The Centers for Disease Control and Prevention ( CDC ) can not attest to the accuracy of a and. Skin or the pulmonary system for an inhalation exposure ) registries collects cancer data but... Here, the work group added a qualitative and quantitative discussion of the labeling on outside. Recently issued a Publication on this topic with suggested implementation approaches ( Connor, 2014 ) Publication on topic. Discarded directly into a solution containing HDs or priming an IV set into a solution containing HDs priming... Conducting the training sessions ; Names and qualifications of the Art Rev 12 ( 1 ).., 2012 ) [ 2014 ] work area where HDs are administered through many different routes a study conducted by osha showed that nearly in several of! The site of exposure to the HD reported ( a study conducted by osha showed that nearly, 1989 ) septa... For numerous Disease States Pregnancy: Breastfeeding and anti-cancer chemotherapy [ 2014 ] be...
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