Prevention Guide - Safe Handling of Hazardous Drugs - Irsst

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4. GENERAL PREVENTIVE MEASURES 4.1.3 Hazardous Drug Preventive Management Program RATING: +++ Establish a Hazardous Drug Preventive Management Program. RECOMMENDATIONS 4.1.3.1 The Hazardous Drug Preventive Management Program should include, at the very least, the following: ‣ an annual self-assessment of compliance with the recommendations of this guide, taking into account the steps of the medication circuit (see the assessment grid on the ASSTSAS Web site); ‣ an environmental monitoring program, as well as an environmental measures record; ‣ policies and procedures allowing the implementation of the recommendations of each section of this guide, according to the local assessment of the risk; ‣ an annual update of the policies and procedures; ‣ a training program, with an accompanying assessment; ‣ a hygiene and sanitation program; ‣ a monitoring and preventive maintenance program regarding the infrastructures (e.g. sterile preparation room) and equipment (e.g. hoods); ‣ proper, approved sets of personal protective equipment, as well as a respiratory protection program; ‣ an updated list of hazardous drugs. Any drug being used for the first time (e.g. investigational drug) is to be evaluated to determine whether it should be considered a hazardous drug, using the six criteria defining a drug as hazardous (see Section 2.1.2); ‣ the list of hazardous drugs should be readily accessible to the workers exposed at every step of the medication circuit; ‣ identification of the hazardous drugs in the management information systems, using a special code to generate a hazardous drug list. This list should specify both the trade name and the generic name, as well as the AHFS class; In the reference material, the MSDS is the tool generally recognized as being the most comprehensive regarding the following: risk identification, first aid, measures regarding fire, measures in the event of a spill, handling and storage, exposure prevention and personal protection, physical, chemical and toxicological properties, environmental information, waste management, transportation, etc. Under the Food and Drugs Act, the manufacturer is not obligated to provide a material safety data sheet for a hazardous drug, contrary to what is the case for the hazardous goods regulated by the Hazardous Products Act. We encourage the Pharmacy Departments to keep a list of hyperlinks to access the MSDSs for hazardous drugs. ‣ a communication plan, including quick, easy access to the hazardous drug list, technical data sheets and policies and procedures; ‣ an annual report regarding the situation. 4.1.3.2 The workers and families of patients should not eat, drink, chew gum, apply makeup or store food in the areas where hazardous drugs are stored or handled. APES, p. 5-5 ♦ ASHP, p. 1175, 1182 ♦ CSHP, Sections 4.1, 4.2, 8.1, 8.2.3, 8.9.5 ♦ NIOSH, p. 10, 11 ♦ ONS, p. 43 ♦ OPQ, Sections 3, 4.3, 4.4.1, 9.2.2, 12.5, 14 ♦ OSHA, Section Va, Vb1, Vc6, VIIc 4-2 ASSTSAS PREVENTION GUIDE – SAFE HANDLING OF HAZARDOUS DRUGS
4. GENERAL PREVENTIVE MEASURES 4.1.4 Continuing Education and Orientation Program RATING: +++ Establish a Hazardous Drug Continuing Education and Orientation Program for All Exposed Workers RECOMMENDATIONS 4.1.4.1 The Occupational Health and Safety Program Manager should designate an individual in each sector concerned to be responsible for continuing education and orientation regarding hazardous drugs; the learning objectives should be mutually agreed upon. 4.1.4.2 The hazardous drugs must be transported, prepared, reconstituted, administered and disposed of by properly-trained workers. Individuals in contact with excreta from patients who have received hazardous drugs or with objects soiled by such excreta must also receive proper training. 4.1.4.3 The Continuing Education and Orientation Program should, at the very least, include the following: ‣ definition of the health risks of hazardous drugs; ‣ identification and detection of these risks; ‣ use of personal protective equipment, including the proper respirators; ‣ emergency plan in the event of a spill or accidental exposure; a spill can occur at any step of the medication circuit. 4.1.4.4 The Continuing Education and Orientation Program should include the elements specific to each sector concerned and should be updated annually, if necessary. 4.1.4.5 The Training Program should include an assessment tool for each sector: ‣ an annual assessment of the quality of sterile handling in preparation cabinets; ‣ an annual assessment of the quality of handling in drug administration; ‣ an annual assessment of the quality of handling with respect to patient care; ‣ an annual assessment of the quality of handling with respect to hygiene and sanitation and cytotoxic waste management. The use of fluorescein solutions is one tool for validating the quality of handling with respect to preparation and administration. Used with UV light, they help detect droplets or leaks during handling (Favier, 2003; Spivey, 2003; Favier, 2002; Harrison, 1996). The institutions can prepare fluorescein solutions using the above-mentioned references or purchase the ready-to-use kits available from certain suppliers. 4.1.4.6 The Program can include a mechanism for documenting worker participation in the training and assessment of the quality of handling activities. 4.1.4.7 The Program should include an annual spill simulation exercise. (See Appendix 4 for the spill procedure.) APES, p. 5-5 ♦ ASHP, p. 1182 ♦ CSHP, Sections 4.2, 8.2.1, 8.2.2, 8.9.5 ♦ NIOSH, p. 11, 12, 16, 18 ♦ ONS, p. 43, 44 ♦ OPQ, Sections 4.3, 12.3 ♦ OSHA, Section VIII. PREVENTION GUIDE – SAFE HANDLING OF HAZARDOUS DRUGS ASSTSAS 4-3
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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
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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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