\hline \text { Lamp } & \$ 106.00 & \$ 219.98 & 40 \% & \text { a. } More recent studies, using analytical methods specific to HDs and significantly more sensitive than the Ames test, have shown environmental and worker contamination occurs in HD workplaces despite the use of a Class II BSC (Connor, 1999; ASHP, 2006; Connor, 2010; Wick, 2003). Spiking an IV set into a solution containing HDs or priming an IV set with HD solution in an uncontrolled environment should be avoided. Gilbar PJ [2005]. Several studies also linked environmental sampling results to bio-monitoring results of drug levels in workers' urine, documenting an uptake of drug levels in contaminated work environments (Minoia, 1998; Wick, 2003; Mason, 2005; Connor, 2010; Hon, 2015). Boiano JM, Steege AL, Sweeney MH [2014]. In the years since the 2004 NIOSH Alert was issued, over 400 papers on HDs have been published in the peer-reviewed literature. The micronucleus assay determination of chromosomal level DNA damage. For most known HDs, type A2 cabinets offer a simple and reliable integration with the ventilation and pressurization requirements of the C-SEC. This connection allows the container to be spiked with a secondary IV set and the set to be primed by backflow from a primary non-HD solution. American Society of Clinical Oncology/Oncology Nursing Society. The entire cabinet is under negative pressure, and operations are performed through attached gloves. 29 CFR 1910.1200. For example, a Danish study of female pharmacy technicians found a statistically significant increased risk of non-Hodgkin's lymphomas (Hansen, 1994), a cancer seen in excess in cancer patients following certain therapies (Krishnan and Morgan, 2007). Baker ES, Connor TH [1996]. Contaminated reusable items, for example glassware and scoops, should be cleaned with mild detergent and water after use. The worker's health and exposure history may also influence the decision of the occupational medicine physician. Documenting the exposure in the employee's medical record. 169. Air exchanged from the surrounding environment should not occur unless it is first passed through a microbially retentive filter (HEPA minimum) system capable of containing airborne concentrations of the physical size and state of the drug being compounded. Levin L, Holly E, Seward J [1993]. Experiences in developing legislation protecting reproductive health. Implementing such mechanisms generally required collaboration between the employee health unit, human resources personnel, the specific service (nursing, pharmacy), and the worker. Department of Health and Human Services. Drug Saf 20(4): 347-359. Multiple Sclerosis Cluster Evaluation in an Inpatient Oncology Ward - Wisconsin. Department of Health and Human Services. Gabriele P, Airoldi M, Succo G, Brando V, Grazia Redda MGR [1993]. These regulations require workers and employers to consider all overhead power lines to be energized until (1) the owner of the lines or the electric utility indicates that they are not energized, and (2) they have been visibly grounded [29 CFR 1910.333 (c)(3); 29 CFR 1926.550(a)(15)]. On August 11, 1990, a 33-year-old well driller was electrocuted when a metal pipe lifted by a truck-mounted crane contacted a 12,000-volt overhead power line. 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)]. Per USP <800>, training should occur prior to preparing or handling HDs, and its effectiveness should be demonstrated by HD handling competencies (USP 800, 2016). Non-Hodgkin Lymphoma Secondary to Cancer Chemotherapy. Selevan SG, Lindbolm ML, Hornung RW, Hemminki K [1985]. 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. The National Personal Protective Technology Laboratory (NPPTL). HD needles used on patients present a bloodborne pathogen hazard as well. Adults aged 25-42 are more likely than all other adults to say employers could encourage employees to take time off (45% vs. 33% of adults aged 18-24, 35% of adults aged 43-56, and 33% of adults aged 57+), provide mental health resources (43% vs. 31%, 31% and 30%, respectively), and promote diversity, equity, and inclusion efforts (39% vs . J Oncol Pharm Pract 12:95-104. An increased micronucleus frequency inperipheral blood lymphocytes predicts the risk of cancer in humans. Vol 9. NIOSH [1993a]. Exposure to anti-cancer drugs during preparation and administration. Rudolph R, Suzuki M, Luce JK [1979]. Absorb liquids with spill pads or toweling. Liver damage in nurses handling cytostatic agents. 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. Nyman H, Jorgenson J and Slawson MH [2007]. Department of Health and Human Services. Evaluate jobsites before beginning work to determine the safest areas for material storage, the best placement for machinery during operations, and the size and type of machinery to be used. removing air from the IV administration sets by running HD containing fluid through the set (i.e., priming the line). a study conducted by osha showed that nearly . Hansel TT, Kropshofer H, Singer T, Mitchell JA, George AJ [2010]. 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). Where volatile HDs are prepared, the exhaust air from the isolator should be appropriately removed by properly designed building ventilation. \text { Overhead } \\ Kiffmeyer TK, Ing KG, Schoppe G [2000]. http://www.acoem.org/Reproductive_Developmental_Hazard_Management.aspx. Reproductive health risks associated with occupational exposures to antineoplastic drugs in health care settings: A review of the evidence. Mooney K, Melvin M, Douglas T [2014]. Sargent EV, Kirk GD [1988]. Carcin 29(6):1178-83. 2007. http://www.cetainternational.org/reference//CAG005-v15.pdf. Aerosolised pentamidine. Nearly 30% of these electrocutions involved cranes. These items should be disposed of in properly labeled, covered, and sealed disposal containers and handled by trained and protected personnel. All staff who will be handling HDs should be fully trained in the receipt, storage, handling, and disposal of these drugs (USP 800, 2016). Chemotherapy glove - A medical glove that meets the American Society for Testing and Materials (ASTM) Standard Practice (D6978-05(2013)) for Assessment of Resistance of Medical Gloves to Permeation by Chemotherapy Drugs. Morgantown, WV: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Fatality Assessment and Control Evaluation (FACE) Report No. Combining various cleaning techniques, however, resulted in even less residual concentration of CP after cleaning was performed (Touzin, 2010). HSE (Health and Safety Executive) [2003]. Int Arch Occup Environ Health 64:105112. Epub 2015 Jan 28. Epub 2008 Mar 19. Exposure assessment of all employees who have worked with HDs is important, and the maintenance of existing records is required by 29 CFR 1910.1020 (OSHA, 2011a). November 2012. HD contamination has also been identified and quantified on gloves and other PPE through the use of sensitive assays of marker drugs of cyclophosphamide, fluorouracil, and methotrexate. While controversy previously existed as to the degree of hazard that handling HDs presented to pregnant HCWs or those attempting to conceive, data published recently have shown excess reproductive loss in those workers, even with the use of BSCs as mentioned above (Peelen, 1999). J Oncol Pharm Pract 17:39-48. Detection of contamination with antineoplastic agents in a hospital pharmacy department. J Occup Med 34:149-55. USP chapter 797 ("Pharmaceutical CompoundingSterile Preparations"), notes that when compounding sterile preparations of HDs, they should be handled with caution at all times during receiving distribution, stocking, inventorying, preparation, and disposal (USP 797, 2012). December 2011. 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. The authors chose to test "elimination type" solutions (cleaners), whose main action is to dissolve chemical products on the surface, and "degradation type" (deactivating) solutions, which react with the chemical structure of compounds leading to their degradation and, possibly, the formation of expected non-cytotoxic compounds. The drug may then be transferred to an IV bag or bottle. Detergents, as surfactants, may assist in removing HD residue from the C-PEC (Lamerie, 2013). Particle counts sampled approximately 6 to 12 inches upstream of the critical exposure site should maintain ISO Class 5 levels during compounding operations. Sotaniemi EA, Sutinen S, Arranto AJ, [1983]. The NIOSH HD Alert of 2004, ASHP HD Guidelines of 2006, USP <797> of 2012, and USP <800> of 2016 all address the need to handle HDs using containment facilities, special equipment, and appropriate ventilation (NIOSH, 2004; ASHP, 2006; USP 797, 2012; USP 800, 2016). Answer Selected Answer : Correct Answer : arrives at the establishment to be inspected and displays official credentials . Guidelines for Environmental Infection Control in Health-Care Facilities. McDiarmid MA, Oliver MS, Roth TS, Rogers B, Escalante CP [2010]. All amounts are shown in thousands of dollars. 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. 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