Prevention Guide - Safe Handling of Hazardous Drugs - Irsst

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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
15. MEDICAL, BIOLOGICAL AND ENVIRONMENTAL MONITORING 15.3.2.4 Measurement of the level of chemical contamination in the care units and outpatient clinics can be based on samples from the following suggested sites: ‣ in administration areas (tubing, floor near the administration areas, telephone, door handle, wall where the gowns (if reused) are hung, counter used to prime the hazardous drug tubing, arms of chairs, floor near the hazardous drug waste receptacles, pumps, etc.); ‣ in other areas (patient waiting room, patient rooms, cytotoxic waste storage area, storage area for sanitary maintenance equipment, etc.). The sampling sites and frequency of verification are determined according to the results obtained and how often the tasks are performed. 15.3.2.5 The institution should keep a record of the results of the environmental measurements. Based on Article 43 of the Règlement sur la santé et la sécurité au travail (Regulation respecting occupational health and safety), the records should be kept for at least 5 years. It may be useful to keep them longer for retrospective study purposes. NIOSH, p. 19 ♦ OPQ, Section 12.4.1 15.3.3 Medical and Biological Monitoring RATING: ++ Establish an accidental exposure record. RECOMMENDATIONS 15.3.3.1 Medical monitoring of effects, using questionnaires and tests (including the biological monitoring of genotoxicity), should not be introduced as it does not allow the effective prevention of health problems related to exposure to hazardous drugs. (+) 15.3.3.2 We do not recommend undertaking biological monitoring of exposure at present, as its usefulness and effectiveness have not been demonstrated and as there are no validated protocols available. 15.3.3.3 Any significant accidental exposure (i.e., direct exposure of the skin or mucosa) to hazardous drugs should be reported to the OHS Department of the institution and recorded in the worker’s file (see 12.3.3.4). 15.3.3.4 Every institution must keep the incident and accident reports sent to the OHS Department and/or keep a record of episodes of accidental exposure (see 12.3.3.4). APES, p. 5-21 to 5-23 ♦ ASHP, p. 1185 ♦ CSHP, Section 8.1 ♦ NIOSH, p. 18 ♦ ONS, p. 35-42 ♦ OSHA, Section VI 15.3.4 Precautionary Reassignment RATING: ++ Adopt rules regarding the reassignment of workers exposed to antineoplastic type hazardous drugs in certain situations. RECOMMENDATIONS 15.3.4.1 Upon receipt of a precautionary reassignment request from a pregnant or nursing worker, the employer must comply with the recommendations, in accordance with Sections 40 et seq of the LSST. When the risk of handling hazardous drugs is indicated on the certificate presented by the worker, the employer should reassign the worker to an area which is not contaminated and where there is no risk of accidental contamination. 15.3.4.2 Reassigning a worker who has been treated for cancer is not recommended, except on the advice of the attending physician. APES, p. 5-23 ♦ ASHP, p. 1185 ♦ CSHP, Section 8.17 ♦ NIOSH, p. 11 ♦ OSHA, Section Vif PREVENTION GUIDE – SAFE HANDLING OF HAZARDOUS DRUGS ASSTSAS 15-5
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Prevention Guide Safe Handling of H
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Prevention Guide Safe Handling of H
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This guide has been developed by th
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Table of Contents PREAMBLE ........
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List of Tables Table 1 Medication C
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PREAMBLE In September 2004, the Uni
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1. INTRODUCTION 1.1.1 Survey Regard
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1. INTRODUCTION 1.3 Guide Structure
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2. RISKS RELATED TO THE USE OF HAZA
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Pharmacy Care Wastes Support Receiv
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3. PREVENTION OBJECTIVES AND ACTION
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4. GENERAL PREVENTIVE MEASURES 4 GE
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4. GENERAL PREVENTIVE MEASURES 4.1.
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4. GENERAL PREVENTIVE MEASURES 4.1.
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4. GENERAL PREVENTIVE MEASURES clea
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4. GENERAL PREVENTIVE MEASURES Tabl
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4. GENERAL PREVENTIVE MEASURES Gras
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5. RECEIVING AND TRANSPORT 5.3.2 De
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6. UNPACKING AND STORAGE 6 UNPACKIN
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6. UNPACKING AND STORAGE 6.3.3 Unpa
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6. UNPACKING AND STORAGE 6.3.6 Spil
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7. PLANNING THE ONCOLOGY PHARMACY 7
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7. PLANNING THE ONCOLOGY PHARMACY
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7. PLANNING THE ONCOLOGY PHARMACY b
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7. PLANNING THE ONCOLOGY PHARMACY T
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Page 92 and 93: 10. ADMINISTRATION OF DRUGS 10.3.10
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Page 99 and 100: 11. PATIENT CARE 11 PATIENT CARE 11
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Page 106 and 107: 12. MANAGEMENT OF WASTE, ACCIDENTAL
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Page 115: 14. LAUNDRY 14 LAUNDRY 14.1 Issues
Page 118 and 119: 15. MEDICAL, BIOLOGICAL AND ENVIRON
Page 123 and 124: 16. REFERENCES 16 REFERENCES AHQ [1
Page 125: 16. REFERENCES Nygren O., Lundgren
Page 129 and 130: APPENDIX 1 - GLOSSARY APPENDIX 1- G
Page 131 and 132: APPENDIX 1 - GLOSSARY TERMS DEFINIT
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Page 136 and 137: APPENDIX 2 - LIST OF HAZARDOUS DRUG
Page 142 and 143: APPENDIX 3 - SURVEY REGARDING PRACT
Page 149 and 150: APPENDIX 4 - HAZARDOUS SPILL MANAGE
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Page 153 and 154: 5. MEASUREMENT OF WORK SURFACE CONT
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