Prevention Guide - Safe Handling of Hazardous Drugs - Irsst

15. MEDICAL, BIOLOGICAL AND ENVIRONMENTAL MONITORING
15.3 Preventive Measures
15.3.1 Monitoring of Exposure to Hazardous Drugs RATING: +++
Be aware of and analyze worker exposure for preventive purposes.
RECOMMENDATIONS
15.3.1.1 Every institution should record the results of environmental monitoring measurements
(see 15.3.2), as well the accidental exposures to hazardous drugs (see 12.3.3.4), in
order to provide an overall analysis.
15.3.1.2 The Hazardous Drug Committee should periodically discuss the profile of the
environmental contamination and the hazardous drug-related incidents and accidents,
in order to establish their causes and effects, as well as the proper corrective measures.
The workers involved in the use of hazardous drugs should be informed of the
purposes, methods (and their limitations) and interpretation of the results of the
environmental monitoring. The steps that will be taken to improve situations deemed
critical should also be explained and understood.
ASHP, p. 1185 ♦ NIOSH, p. 18, 19
15.3.2 Environmental Monitoring RATING: ++
Establish an Environmental Monitoring Program, based on the following procedures.
RECOMMENDATIONS
15.3.2.1 Every institution should plan regular monitoring activities with respect to both the
work environment and work activities. An Environmental Monitoring Program would
allow the periodic checking of contamination due to antineoplastic type hazardous
drugs on work surfaces in the institution. The institution should contact the INSPQ
Laboratoire de toxicologie (Toxicology Laboratory), which provides tests to measure
surface contamination by three hazardous drugs (see Appendix 5).
15.3.2.2 An evaluation should be performed prior to implementing the preventive measures
proposed in the ASSTSAS guide and repeated once they are in place. Thereafter, an
evaluation should be performed annually or at the time of major changes in the
facilities (e.g. change in preparation cabinets) or practices (e.g. new preparation or
administration techniques, new cleaning protocol). The evaluations may also be used
to validate the effectiveness of cleaning activities (e.g., following the decontamination
of the safety cabinet, to validate the effectiveness of the decontamination).
15.3.2.3 Measurement of the degree of chemical contamination in the Pharmacy Department
can be based on samples from the following suggested sites:
‣ receiving and unpacking areas (unpacking table, exterior surface of drug containers
from manufacturers, floors, etc.);
‣ storage area (work table, storage shelves, cart, etc.);
‣ preparation area (preparation cabinet work surface, grille in front of the cabinet
work surface, floor in front of the hood, outside window of the preparation cabinet,
container/content verification counter, refrigerator door, floor under the
technician’s chair, exterior of drug bags, interior of hazardous drug transport
container, etc.);
While there is no minimum recommended number of sites, we feel that samples from
at least 12 sites per pharmacy are sufficient. The sampling sites and frequency of
verification are determined according to the results obtained and how often the tasks
are performed.
15-4 ASSTSAS PREVENTION GUIDE – SAFE HANDLING OF HAZARDOUS DRUGS