Prevention Guide - Safe Handling of Hazardous Drugs - Irsst

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8. DRUG PREPARATION ‣ avoid sudden movements of the arms or hands in the front access area; slide the hands perpendicular to the front panel to enter and leave the cabinet. The cabinet air flow should be allowed to stabilize before resuming work; ‣ place the sterile products in the centre and the non-sterile products (e.g. waste receptacle) along the sides of the cabinet. APES, p. 5-7, 5-8 ♦ ASHP, p. 1180-1181, 1188 ♦ CS, 72 ♦ CSHP, Section 8.6.2 ♦ ONS, pages 19, 21 ♦ OPQ, Sections 9, 9.1, 9.4 ♦ OSHA, Section Vc 8.3.3 Removal of Packaging RATING: ++ Remove the packaging, when applicable, and clean all of the drug containers before taking them into the preparation cabinet. RECOMMENDATIONS 8.3.3.1 If the vials were not cleaned at the time of unpacking (see 6.3.3), this should be done now, to remove any potential chemical contamination due to drug residues. The packaging should be removed and the hazardous drugs placed on a tray. The vials may be cleaned with a disposable cloth and a solution of detergent and water, from top to bottom. Premoistened towelettes (e.g. Wet-Ones) may also be used. 8.3.3.2 For sterility, the vials should be disinfected with ethyl alcohol or isopropyl alcohol 70% before being taken into the preparation cabinet. To do so, pour alcohol on a piece of sterile gauze using a wash bottle and wipe the containers, from top to bottom. The hazardous drug containers may also be sprinkled with alcohol using a wash bottle and then wiped with a pad or a piece of sterile gauze, from top to bottom. The first method is preferable, however, as it may help prevent projection of any drugs which may be on the containers. (+) 8.3.3.3 Supplies (e.g. syringes, solutions, sterile gauze, etc.) should be unpacked above the grille or in the first 10 cm of the hood. Unpack the critical parts of the material (e.g. needles, syringe tips, syringes without protective tips, sterile gauze) in the sterile area. If the supplies are unpacked before transfer into the preparation cabinet (e.g. infusion systems, solutions, etc.), disinfect them with alcohol (see 8.3.3.2). ASHP, p. 1183, 1188 ♦ OPQ, Sections 9.4.2, 9.4.3 8.3.4 Handling Techniques RATING: +++ Use handling techniques that limit the risk of injury or accidental exposure. RECOMMENDATIONS 8.3.4.1 Workers who prepare hazardous drugs should use dilution and sampling techniques that minimize exposure risks and pressure differences: ‣ unless using a closed-circuit system, a transfer device with a 0.22 micron hydrophobic filter should be used at all times; one device should be used for each drug container; ‣ a closed-circuit system (e.g. PhaSeal ® , Tevadaptor ® ) may be used. While the scientific literature has demonstrated the effectiveness of this equipment in reducing contamination versus other preparation techniques, the cost-effectiveness ratio is still poorly-understood. We suggest their use in the following instances at the very least: major, documented environmental contamination problem, despite compliance with the recommendations of this guide; 8-4 ASSTSAS PREVENTION GUIDE – SAFE HANDLING OF HAZARDOUS DRUGS
8. DRUG PREPARATION inadequate infrastructure and upgrading not possible; very low preparation volume and lack of standard infrastructure; note that the use of a closed-circuit system must not allow preparations to be compounded outside a biological safety cabinet. ‣ the chimney technique using a needle and 0.22 micron hydrophobic filter may be used; the use of an ordinary needle or filtering needle is not recommended; ‣ the negative-pressure technique should no longer be used. 8.3.4.2 Workers should use administration containers that minimize exposure risks and pressure differences: ‣ use syringes and other devices with Luer-Lock fittings and proper connectors; ‣ do not fill syringes more than ¾ full, with the exception of vesical syringes for BCG with a closed-circuit system; ‣ avoid overfilling infusion bags by adding too much solution (i.e., a maximum acceptable volume can be established locally, in order to facilitate safe administration by the caregiving staff); when transferring to an infusion bag, be careful not to perforate the side of the injection port or the side of the bag; ‣ do not attach a needle to the syringes prior to transport to the drug administration site; instead, use standard Luer-Lock plugs on the syringes; ‣ use appropriate red seals on the bags containing hazardous drug additives, to avoid other additions/handling and exposure risks; ‣ correct the amount withdrawn prior to removing the needle from the vial; ‣ as much as possible, avoid using glass containers during preparation and administration, to reduce the risk of breakage; ‣ lightly tap the ampoules and vials to bring down the liquid or powder from the cap or neck; wrap the neck of the disinfected ampoule with sterile gauze before opening it; slowly pour the diluent into the ampoule or vial, down the side, and shake gently; ‣ upon completing a manipulation, do not put the protective tip back on the needle; dispose of the needle immediately. 8.3.4.3 Workers should perform certain preparation steps in the cabinet, to limit any additional handling of hazardous drugs by other health professionals: ‣ prime and remove the air from the tubing in a biological safety cabinet in the pharmacy before adding the hazardous drug to the infusion solution; otherwise, this may be performed at the patient’s bedside; ‣ prepare hazardous drugs for inhalation (e.g. pentamidine, ribarivin) in a biological safety cabinet. The pharmacy should prepare the drugs in the administration device to avoid having to handle them during administration. 8.3.4.4 The Head of the Pharmacy Department must periodically check that the workers are trained in the preparation techniques; the implementation of a microbiological validation protocol is recommended to monitor microbial contamination. APES, p. 5-8, 5-9 ♦ ASHP, p. 1178, 1180-82, 1188 ♦ CSHP, Sections 8.6.3, 8.6.4, 8.9.3 ♦ LSST, Art. 51 NIOSH, p. 12-14 + Alert p. 2 ♦ OPQ, Sections 9.4, 12.3 ♦ OSHA, Section Vc 8.3.5 Labeling RATING: ++ Properly label the hazardous drugs such that microbial and environmental contamination is avoided. RECOMMENDATIONS 8.3.5.1 Hazardous drug labels must inform those using these preparations of the nature of the drugs and the precautions to be taken. At the very least, the label must display the “Cytotoxic” hazard symbol or the word “Cytotoxic” (see 4.1.5.3) (antineoplastic drugs) PREVENTION GUIDE – SAFE HANDLING OF HAZARDOUS DRUGS ASSTSAS 8-5
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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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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.
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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 66 and 67: Fridge 7. PLANNING THE ONCOLOGY PHA
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Page 70 and 71: 8. DRUG PREPARATION The product nev
Page 74 and 75: 8. DRUG PREPARATION or “Caution
Page 76 and 77: 8. DRUG PREPARATION 8.3.9 Preparing
Page 78 and 79: 8. DRUG PREPARATION Wearing both
Page 80 and 81: 9. TRANSPORT AND STORAGE FOLLOWING
Page 82 and 83: 10. ADMINISTRATION OF DRUGS Adminis
Page 84 and 85: 10. ADMINISTRATION OF DRUGS Nurses
Page 86 and 87: 10. ADMINISTRATION OF DRUGS Primary
Page 88 and 89: 10. ADMINISTRATION OF DRUGS Establi
Page 90 and 91: 10. ADMINISTRATION OF DRUGS if a o
Page 92 and 93: 10. ADMINISTRATION OF DRUGS 10.3.10
Page 94 and 95: 10. ADMINISTRATION OF DRUGS 10.3.13
Page 96 and 97: 10. ADMINISTRATION OF DRUGS contain
Page 99 and 100: 11. PATIENT CARE 11 PATIENT CARE 11
Page 101 and 102: 11. PATIENT CARE arrive (see 13.3.1
Page 103: 11. PATIENT CARE Table 8. Hazardous
Page 106 and 107: 12. MANAGEMENT OF WASTE, ACCIDENTAL
Page 112 and 113: 13. HYGIENE AND SANITATION 13.2 Exp
Page 115: 14. LAUNDRY 14 LAUNDRY 14.1 Issues
Page 118 and 119: 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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