550(a)(15)] Wrap a sterile gauze pad around the ampule neck before breaking the top (Wilson, 1981; ASHP, 1990; ASHP, 2006). November 2012. As the victim raised the pipe, it contacted the power line directly above the well, energizing the crane and the handheld remote-control pendant. Lyon, France. Trace contaminated materials used in the preparation and administration of HDs, such as gloves, gowns, syringes and vials, also present a hazard to clinical support and housekeeping staff. Appropriate eye and face protection must be worn when splashing is possible. Most recently accessed December 15, 2015. Where volatile HDs are prepared, the exhaust air from the isolator should be appropriately removed by properly designed building ventilation. OSHAs purpose is to protect worker safety and health. 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. \hline Ribavirin - Exposure to health care workers. TJC (The Joint Commission) [2012]. Established in 1970, OSHA is a federal regulatory agency that promotes the safety and health of American workers. Biosafety cabinetry: design, construction, performance, and field certification. J Occup Med 34:149-55. The methods the employer will use to inform employees of other hazards at the work site. Eyewash facilities should also be made available. The training should include at least the list of HDs; review of HD handling policies; proper use of PPE, equipment and devices; response to known or suspected HD exposure; spill management; proper disposal of HDs and trace contaminated equipment (USP 800, 2016). Steam under pressure, dry heat, ethylene oxide gas, hydrogen peroxide gas plasma, and liquid chemicals are the principal sterilizing agents used in healthcare facilities. For example, it may be possible to use concrete pumping trucks instead of crane-suspended buckets for placing concrete near overhead power lines. Standards of Practice. Date accessed December 2014. Since sharps and potentially infectious materials may also be included in the trace contaminated materials, such containers should be managed as biohazardous waste under the Bloodborne Pathogens Standard [29 CFR 1910.1030(d)(4)(iii)] (OSHA, 2012a). Department of Health and Human Services. 29 CFR 1910.1030. This categorization has been changed to the Pregnancy and Lactation Labeling Rule(PLLR) that became effective June 2015. Sieber SM [1975]. The special case of administration of drugs via aerosol nebulizer treatment can lead to measurable air concentrations in the breathing zone of workers who provide the treatment (Harrison, 1988) and, depending on the medication, air concentrations may result in symptoms in exposed workers (Balmes, 1995). CSTDs should be used when administering HDs when the dosage form allows (USP 800, 2016). Respirators should be available near the spill kits. Chemotherapy-handling practices of outpatient and office-based oncology nurses. 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. [DHHS (NIOSH) Publication No. HDs may be dispensed as sterile intravenous (IV), intramuscular (IM), intrathecal (IT), subcutaneous (SQ), or other doses, which must be compounded prior to administration, oral doses of solids or liquids which must be prepared or packaged, or occasionally as a topical preparation that may require special mixing. Preventing Occupational Exposures to Antineoplastic Drugs in Health Care Settings. Essential information includes: health hazards, primary exposure routes, carcinogenic evaluations, acute exposure treatment, chemical inactivators, solubility, stability, volatility, PPE required, and spill procedures for each covered HD. Naumann BD, Sargent EV [1997]. 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]. March 2014. Factors Influencing Oncology Nurses' Use of Hazardous Drug Safe-Handling Precautions. 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). For HD administration, use of protective gowns ranged from 50-65 percent, use of chemotherapy gloves ranged from 78-85 percent, and double-gloving was particularly low, at only 11-20 percent (Polovich, 2011, 2012; Boiano, 2014). Santa Monica, CA: Human Factors Society, Inc. NIOSH [1985]. Exposure in susceptible individuals can lead to asthma or allergic contact dermatitis (Kusnetz and Condon, 2003). Connor TH & McDiarmid, MA [2006]. Prophylactic zidovudine after occupational exposure to the human immunodeficiency virus: An interim analysis. Use Luer-Lock fittings for all needleless systems, syringes, needles, infusion tubing, and pumps. Operate the crane at a slower-than-normal rate in the vicinity of power lines. 93-108. Nguyen TV, Theiss JC, Matney TS [1982]. The victim provided a path to ground and was electrocuted [NIOSH 1990c]. The comprehensive plan should address all aspects of safe handling of HDs throughout the facility, be developed using a collaborative effort including all affected departments, and specify measures that the employer is taking to ensure employee protection. Some goggles will fit over corrective lenses. REV 2 9/05. Luer-Lock fittings avoid separation during use for HD compounding and during administration. Hosp Pharm 42:219-225. Training should include at least the following elements: Employee exposure records, including workplace monitoring, biological monitoring, and SDSs, as well as employee medical records related to drugs posing a health hazard, must be maintained and access to them provided to employees in accordance with 29 CFR 1910.1020 (OSHA, 2011a). As such, this analysis does not comprise a complete four-step risk assessment. Essay topics and ideas; Free plagiarism checker; Science. 91-21. HDs that have been identified as requiring safe handling precautions should be clearly labeled at all times during their transport and use (USP 800, 2016); A list of HDs in use in the facility is required by the HCS, and is also recommended by the TJC, as Elements of Performance for Medication Management (MM).01.01.03 (OSHA, 2012b; TJC, 2015); Safety Data Sheets (SDS) must be available for all HDs on the facility list; Areas and procedures for HD storage and preparation should be designated (USP 800, 2016); Specific control measures should be used to reduce employee exposure to HDs, including appropriate ventilation controls, personal protective equipment, work practices, and ancillary devices, such as closed system drug-transfer devices (USP 800, 2016); Ventilation controls should be used to protect personnel from HD exposure, such as biological safety cabinets and containment isolators (USP 800, 2016); Appropriate personal protective equipment must be available and used based on the type of HD handling activities [29 CFR 1910.132] (USP 800, 2016); Ventilation systems and other protective equipment should function properly, and specific measures to ensure proper and adequate performance of such equipment should be in place (USP 797, 2012); Safety programs must identify and include all workers who may be at risk of exposure; Information and training for personnel responsible for HD handling must be provided; Medical surveillance and methods of protection of personnel responsible for HD handling should be provided; and. Due to poor reproducibility, inter-individual variability, and difficulty in interpreting individual results, measures of genetic effects (i.e., chromosomal aberrations, micronuclei, or other markers of genotoxic exposure) are not recommended in routine surveillance. Make these kits available near all potential sources of exposure. Examples include laboratory fume hoods, retracting syringe needles, sound-dampening materials to reduce noise levels, safety interlocks, and radiation shielding. Favier B, Gilles L, Ardiet C, Latour JF [2003]. Am Rev Resp Dis 139:1060. When used in a total safety program that includes good work practices, excellent technique, and consistent cleaning and decontamination, Class II BSCs are a valued tool for reducing occupational exposure to HDs during compounding. Occupational Safety and Health Administration and the Joint Commission. Baton Rouge, Louisiana, United States. ASHP guidelines on handling hazardous drugs. Final preparations should be surface decontaminated within the C-PEC and placed into the transport bags in the BSC or in the isolator pass-through, taking care not to contaminate the outside of the transport bag (ASHP, 2006). Pilot assessment of the antineoplastic drug contamination levels in British Columbia hospitals pre- and post-cleaning. Scand J Work Environ Health 20(1):22-6. Rudolph R, Suzuki M, Luce JK [1979]. The OSHA Act is the Federal law that establishes OSHA. Falck K, Grohn P, Sorsa M, Vainio H, Heinonen E, Holsti LR [1979]. During cleaning, the worker should wear PPE similar to that used for spills. Safe handling of cytotoxics. It is difficult to set safe levels of exposure to HDs on the basis of current scientific information because the degree of absorption that takes place during work, and the significance of early biological effects on each individual, are difficult to assess and may vary depending on the HD. All overtly contaminated materials resulting from a spill or cleanup of a spill should be managed as hazardous waste (EPA 2008). Managing Pharmaceutical Waste: A Ten-Step Blueprint for Healthcare Facilities in the United States. Reduce the HD contamination burden in the C-PEC by wiping down HD vials before placing them in the C-PEC (ASHP, 2006; USP 800, 2016). Emerging EPA Regulations of Pharmaceuticals in the Environment. While OSHA's 1986 guidelines focused on cancer chemotherapy drug safety (OSHA, 1986), OSHA's 1995 instruction enlarged the focus to include additional agents with toxicity profiles of concern. In Toxicity of Chemotherapy. Use independent insulated barriers to prevent physical contact with the power lines [29 CFR 1910.333(c)(3); 29 CFR 1926. 2007. Hon CY, Teschke K, Demers PA, Venners S [2014b]. National Institute for Occupational Safety and Health: DHHS (NIOSH) Publication No. 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). The purpose of screening is to identify the earliest reversible biologic effects so that exposure can be reduced or eliminated before the employee sustains irreversible harm. He controlled the crane boom while standing on the ground using rubber-coated hand controls mounted on the back of the truck. Harrison BR, Peters BG and Bing MR [2006]. Ann Arbor: National Sanitation Foundation. Sterile HD compounding should be performed in a C-PEC that provides an ISO Class 5 or better air quality, such as a Class II or III BSC or Compounding Aseptic Containment Isolators (CACI) (USP 800, 2016). Determining sources of workplace contamination with antineoplastic drugs and comparing conventional IV drug preparation with a closed system. PPE is especially important during administration, spill control, handling of drug waste, and handling of patient waste because no C-PECs are in place for these activities. American national standard for mobile and locomotive cranes. Am Ind Hyg Assoc J 49(6):309-313. Marker HDs have also been measured in the urine of workers where a Class II BSC is the PEC (Wick, 2003). J Occup Environ Hyg 11:728-740. Needleless devices are preferred to reduce sharps injury (NIOSH, 2004). Vapour pressures, evaporation behavior and airborne concentrations of hazardous drugs: implications for occupational safety. Am J Health-Syst Pharm. Hand hygiene in healthcare settings. 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. Am J Health Syst Pharm 62:475-484. Workplace Solutions. The safety and health management systems section requires employers to develop, implement, and maintain a written safety and health program. All ventilated equipment should be certified operational using the appropriate standards. Drugs that have been identified as requiring HD handling precautions should be clearly labeled at all times during their transport (USP 800, 2016). J Oncol Pharm Pract 17:39-48. OSHA Hazard Communication Standard. Generally, HDs would be included under the "health hazard" classification, due to the germ cell mutagenicity, carcinogenicity (known or presumed), and reproductive and developmental toxicity of many of the agents. NIOSH recommends that regular training reviews be conducted with all potentially exposed workers in workplaces where HDs are used. Personal protective equipment (PPE) - Items such as gloves, gowns, respirators, goggles, face shields, and others that protect individual workers from hazardous physical or chemical exposures. Sodium hypochlorite solution, detergent, neutralizer and rinsing have been shown to be effective on hard surfaces (Touzin, 2010). (Harrison, 1996). IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans: Chemicals, Industrial Processes and Industries Associated with Cancer in Humans. Structures and processes of care in ambulatory oncology settings and nurse-reported exposure to chemotherapy. Vol 9. 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. [http:// nioshdev.cdc.gov/niosh/docs/2012-150]. Information from previous medical examinations of the employee. Their efficacy was the highest for the most hydrophilic compounds and around 80 percent effective for anthracyclines. Sargent EV, Naumann BD, Dolan DG, Faria EC, Schulman L [2002]. To protect against electrical shock injury in the event of contact between a crane and an energized line, the CSA recommends the following: The five cases presented here were investigated by the NIOSH FACE Program between March 1990 and March 1993. Protecting employees from health hazards associated with HDs, and. The examining physician should consider the reproductive status of employees and inform them regarding relevant reproductive issues. CACIs should be serviced and certified, per the CETA guidance (CETA, 2008). Compounding and handling non-sterile HDs may present opportunities for exposure and require special precautions. J Oncol Pharm Pract 12:95-104. Mobile crane manual. Occupational Exposure to Bloodborne Pathogens Standard. The choker was to be connected to a steel roof joist that was to be lifted 150 feet across the roof of a one-story school and set in place. Verification of surface contamination of Japanese cyclophosphamide vials and an example of exposure by handling. Occupational exposures among nurses and risk of spontaneous abortion. USP [2016]. Reproductie-toxische effecten bij ziekenhuispersonel. Cancer mortality among women employed in health care occupations in 24 U.S. states, 1984-1993. 90-39. Face and eye protection must be worn if there if splashing is a hazard [29 CFR 1910.133]. Science 195:413-4. Safety Trainer: Conducted weekly safety meetings, toolbox talks, First Aid/CPR and AED training, Smith System, remote safety calls using MS Teams, and . Wipe the neck with sterile alcohol and allow it to dry. The FDA's 510(k) process does not establish independent performance standards for devices submitted as "substantially equivalent." Disinfectant - A chemical agent that destroys or inhibits the growth of microorganisms that cause disease. OSHA: Occupational Safety and Health Administration is a large regulatory agency of the United States Department of Labor that originally had federal powers to inspect and examine workplaces. Date accessed November 2014. Henderson DK, Gerberding JL [1989]. I believe that every student has the power to achieve great things, and I am committed to helping them achieve their goals. Bystander uptake of drug in non-drug handling health workers, including support staff, has also been reported (Sessink, 1992b; Hon, 2015). When CSTDs are not used, a plastic-backed absorbent pad should be placed under connection sites during administration to catch any leakage. Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. One of the purposes of OSHA quizlet is to ensure that employees are aware of their rights and responsibilities in the workplace. At the work site substantially equivalent. sodium hypochlorite solution, detergent, neutralizer rinsing... 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