Prevention Guide - Safe Handling of Hazardous Drugs - Irsst

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2. RISKS RELATED TO THE USE OF HAZARDOUS DRUGS Medication Circuit Steps Potentially Exposed Workers Potential Sources of Exposure to Hazardous Drugs Transport and Storage Following Preparation (Chapter 9) Administration of Drugs (Chapter 10) Pharmacy Department workers (e.g. pharmacist, clerk, pharmacy technician) Outpatient clinic and patient care unit workers (e.g. nurse, patient service associate) Transport workers (clerk, etc.) Care unit, outpatient clinic and home care workers, i.e., nurses, patient service associates, physicians, inhalation therapists Pharmacists Hygiene and sanitation workers Other patients and families of patients Patient Care Care unit / outpatient clinic / home care workers (e.g. nurse, (Chapter 11) physician, inhalation therapist, patient service associate) Other patients, families of patients Hygiene and sanitation workers Biomedical engineering workers Breakage of a drug container due to a fall or other cause (worker exposure and environmental contamination due to the spread of liquids, powders or aerosols or through the diffusion of vapours). Direct contact with a drug container (as the outside of the container may be contaminated). Leaks or creation of aerosols when priming or removing air from tubing, if this is not done in the preparation cabinet; Leaks or creation of aerosols during the connecting and disconnecting of syringes and tubing from the injection ports; Contamination through contact with poorly-cleaned drug bags, tubing or syringes during the preparation step. The drug containers or drug preparation transport trays may also be contaminated; Inhalation of aerosols during aerosolized administration (ribavirin, pentamidine); Surface contamination (gloves, etc.) and inhalation of particles when handling or crushing pills; Contact contamination when applying creams or ointments; Accidents: needlesticks, breakage of drug containers, spills; Direct contact due to projections, splashing or vapour inhalation during special procedures such as hyperthermic intraoperative intraperitoneal chemotherapy (HIIC) (operating room or intensive care unit). The body fluids of patients who have received chemotherapy contain drug residues. Contact with patient excreta, bedpans, sheets or wash water may be a source of contamination. 2-8 ASSTSAS PREVENTION GUIDE – SAFE HANDLING OF HAZARDOUS DRUGS
2. RISKS RELATED TO THE USE OF HAZARDOUS DRUGS Medication Circuit Steps Potentially Exposed Workers Potential Sources of Exposure to Hazardous Drugs Management of Wastes, Accidental Exposure, Spills and Returns (Chapter 12) Hygiene and Sanitation (Chapter 13) Receiving or transport clerks (e.g. stock-keeper, storeroom clerk) Waste collection workers Pharmacy Department workers (e.g. pharmacist, clerk, pharmacy technician) Care unit / outpatient clinic / home care workers (e.g. nurses, physicians, inhalation therapists, patient service associates) Other patients, families of patients Hygiene and sanitation workers Hygiene and sanitation workers The transfer of hazardous drugs and contaminated supplies to waste receptacles can cause exposure, as can the handling of these receptacles (e.g. when closing bags, during transport, etc.). While the waste receptacles are relatively leakproof, contaminated fluids may leak out if the receptacle tips over. If the waste receptacles are not closed, there is a risk of aerosol propagation or vapour diffusion. Spills constitute an exposure risk due to potential direct contact with hazardous drugs or their spread into the air as aerosols or vapours. This may occur at any step of the medication circuit. Inadequate cleaning increases the exposure of all staff working in areas where hazardous drugs are handled. Contact with contaminated surfaces (e.g. counters, furniture, etc.), wastes, excreta, soiled bedding, rags and mops used to clean contaminated areas (toilets or floors in the rooms of patients who have received hazardous drugs, preparation or administration areas, etc.). Ingestion via contaminated hands or by eating or drinking in these areas. Cleaning of hazardous drug spills or the stools, urine or vomitus of patients who have received hazardous drugs. Laundry Laundry workers Possible contact with contaminated bedding in some (Chapter 14) laundries. Inhalation of particles on the sheets in some laundries. PREVENTION GUIDE – SAFE HANDLING OF HAZARDOUS DRUGS ASSTSAS 2-9
Page 1 and 2: Prevention Guide Safe Handling of H
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Page 5 and 6: This guide has been developed by th
Page 7 and 8: Table of Contents PREAMBLE ........
Page 9 and 10: List of Tables Table 1 Medication C
Page 11: PREAMBLE In September 2004, the Uni
Page 14 and 15: 1. INTRODUCTION 1.1.1 Survey Regard
Page 16 and 17: 1. INTRODUCTION 1.3 Guide Structure
Page 19 and 20: 2. RISKS RELATED TO THE USE OF HAZA
Page 23 and 24: Pharmacy Care Wastes Support Receiv
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Page 34 and 35: 3. PREVENTION OBJECTIVES AND ACTION
Page 37 and 38: 4. GENERAL PREVENTIVE MEASURES 4 GE
Page 39 and 40: 4. GENERAL PREVENTIVE MEASURES 4.1.
Page 41 and 42: 4. GENERAL PREVENTIVE MEASURES 4.1.
Page 43 and 44: 4. GENERAL PREVENTIVE MEASURES clea
Page 45 and 46: 4. GENERAL PREVENTIVE MEASURES Tabl
Page 47: 4. GENERAL PREVENTIVE MEASURES Gras
Page 50 and 51: 5. RECEIVING AND TRANSPORT 5.3.2 De
Page 53 and 54: 6. UNPACKING AND STORAGE 6 UNPACKIN
Page 55 and 56: 6. UNPACKING AND STORAGE 6.3.3 Unpa
Page 57: 6. UNPACKING AND STORAGE 6.3.6 Spil
Page 60 and 61: 7. PLANNING THE ONCOLOGY PHARMACY 7
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Page 70 and 71: 8. DRUG PREPARATION The product nev
Page 72 and 73: 8. DRUG PREPARATION ‣ avoid sudde
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8. DRUG PREPARATION 8.3.9 Preparing
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8. DRUG PREPARATION Wearing both
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9. TRANSPORT AND STORAGE FOLLOWING
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10. ADMINISTRATION OF DRUGS Adminis
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10. ADMINISTRATION OF DRUGS Nurses
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10. ADMINISTRATION OF DRUGS Primary
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10. ADMINISTRATION OF DRUGS Establi
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10. ADMINISTRATION OF DRUGS if a o
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10. ADMINISTRATION OF DRUGS 10.3.10
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10. ADMINISTRATION OF DRUGS 10.3.13
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10. ADMINISTRATION OF DRUGS contain
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11. PATIENT CARE 11 PATIENT CARE 11
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11. PATIENT CARE arrive (see 13.3.1
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11. PATIENT CARE Table 8. Hazardous
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12. MANAGEMENT OF WASTE, ACCIDENTAL
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13. HYGIENE AND SANITATION 13.2 Exp
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14. LAUNDRY 14 LAUNDRY 14.1 Issues
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15. MEDICAL, BIOLOGICAL AND ENVIRON
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15. MEDICAL, BIOLOGICAL AND ENVIRON
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16. REFERENCES 16 REFERENCES AHQ [1
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16. REFERENCES Nygren O., Lundgren
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APPENDIX 1 - GLOSSARY APPENDIX 1- G
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APPENDIX 1 - GLOSSARY TERMS DEFINIT
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APPENDIX 1 - GLOSSARY TERMS DEFINIT
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APPENDIX 2 - LIST OF HAZARDOUS DRUG
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APPENDIX 3 - SURVEY REGARDING PRACT
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APPENDIX 4 - HAZARDOUS SPILL MANAGE
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APPENDIX 4 - HAZARDOUS SPILL MANAGE
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5. MEASUREMENT OF WORK SURFACE CONT
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