Preventing Occupational Exposure to Hazardous Drugs

Preventing Occupational Exposure to Hazardous Drugs Preventing Occupational Exposure to Hazardous Drugs - Start

2017-10-04 88K 88 0 0

Preventing Occupational Exposure to Hazardous Drugs - Description

Consultation Education and Training Division. Michigan Occupational Safety and Health Administration . www.michigan.gov/miosha. 517-284-7720. Module 2. Before Beginning Module 2. Please review . Module 1. ID: 592895 Download Presentation

Download Presentation

Preventing Occupational Exposure to Hazardous Drugs




Download Presentation - The PPT/PDF document "Preventing Occupational Exposure to Haza..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.



Presentations text content in Preventing Occupational Exposure to Hazardous Drugs

Slide1

Preventing Occupational Exposure to Hazardous Drugs

Consultation Education and Training DivisionMichigan Occupational Safety and Health Administration www.michigan.gov/miosha517-284-7720

Module 2

Slide2

Before Beginning Module 2

Please review Module 1 of this training series before proceeding. Module 1 includes:An overview of the hazards of certain drugsPersonnel and procedures with greatest risk for exposureMIOSHA regulatory requirements

2

Slide3

Module 2 Training Overview

Identify routes of exposureList the hierarchy of controlsDescribe recommended procedures for controlling exposure during:PreparationAdministrationDisposalDecontamination and spill clean-upReview additional consideration, resources and references

3

Slide4

Routes of Exposure

Absorption – skin contactInhalation – aerosolizationIngestion – contamination of food or beveragesInjection – needlesticks

4

Slide5

Increasing Effectiveness

Eliminates the exposure

before it can occur

Requires a physical

change to the workplace

Requires employer/workerto DO something

Requires workerto WEAR something

Hierarchy of Controls

5

Slide6

Elimination and Substitution

Professional healthcare providers prescribing hazardous drugs:Consider possible elimination or substitution for less hazardous drugsForm or delivery of the drug (i.e. tablet vs. liquid)Thorough understanding of occupational health hazards of prescribed drugs

6

Slide7

Engineering Controls: Highest Level Protection

Examples of controls*:Externally vented Biologic Safety Cabinet (BSC)Compounding Aseptic Containment Isolator (CACI)Closed system transfer device (CSTD)Advantages:Isolates and Contains the hazardIndependent of the worker

ASHP, 2006; NIOSH, 2014; ONS, 2011

* U.S. Pharmacopeial Convention (USP <800>) requires the use of engineering controls when administering antineoplastic HDs

7

Slide8

Engineering Controls

ControlLocationType of VentilationSpecial FeaturesContainment (Primary Control)Inside a Compounding RoomVentilated device (i.e. biological safety cabinet, compounding aseptic isolator)Nonsterile compounding: external vent preferredSterile compounding: external vent requiredCompounding Room(Secondary Control)Physically separated from other roomsExternally vented through high-efficiency particulate air (HEPA) filterNegative PressureClosed system device(Supplemental) Compounding and adminsteringNoneNot a substitute for a Primary Control when compounding

References: U.S. Pharmacopeial Convention (USP <800>) OSHA Technical Manual, Chapter 2 MIOSHA Part 520 Ventilation Controls

8

Slide9

Examples of Controls

Compounding aseptic isolator

Biological Safety Cabinet

9

Slide10

Administrative Controls

Examples:Written policies & procedures Hazardous Drug List*Education, training & competency*Medical SurveillanceAlternative duty around pregnancy - may be discriminatory

* Required by MIOSHA Hazard Communication Standard and USP <800>

10

Slide11

Work Practice Controls

Examples:Label HDs with appropriate hazard warningsTransport HDs in sealed bagsInspect HD containers for leaksWash hands after removing PPEAvoid touching unnecessary items with contaminated glovesAvoid wearing PPE outside drug handling areasAvoid spiking & priming IV tubing (without a closed system)Discard used IV equipment intact

11

Slide12

Personal Protective Equipment (PPE): Gloves

Tested with hazardous drugs Powder-free Latex, nitrile, neoprene*Wear two pair

DonningInner glove worn under gown cuffOuter glove worn over gown cuffDoffingRemove gloves one at a timeTurn gloves inside out while removingKeep contaminated surface from touching uncontaminated

ASHP, ASTM, NIOSH, OSHA, ONS

*USP<800> requires chemo gloves to

meet ASTM standard D6978 (or its successor)

12

Slide13

PPE: Gowns

Gowns: DisposablePolyethylene or vinyl-coatedTested with hazardous drugsCuffs & back closure

Single-useRemove & discard gown:When visibly contaminatedAt the end of handling activitiesWhen leaving the handling area Do not hang up & re-use

ASHP, NIOSH, OSHA, ONS

13

Slide14

Other PPE: Face/Eye/Respiratory

Eye protectionWhen splashing is possibleRespiratorFor aerosols & spillsFitted (tight seal) respirator Appropriate to the hazardN 95 rated (filtering particulate respirator)Powered Air Purifying Respirator (PAPR)

14

Slide15

USP <800> requirements for PPE

Appropriate PPE MUST be worn when handling HDs during:ReceiptStorageTransportCompounding (sterile and non-sterile)AdministrationDeactivation/decontamination, cleaning, and disinfecting

15

Slide16

Recommended Precautions: Administration

Form / Route of AdministrationDouble GlovesProtective GownEye ProtectionRespiratory ProtectionEngineering ControlIntact tablet or capsuleNo, single gloveNoNoNoN/ATablet or capsule (manipulated)YesYesYesYes, if not done in control deviceYesOral liquidYesYesNoNoN/ATopical DrugYesYesYes, if liquid could splashIf inhalation potentialN/ASubq / IMInjectionYesYesYes, if liquid could splashYes, if inhalation potentialYes – Sharps protectionIntravenous SolutionYesYesYes, if liquid could splashYes, if inhalation potentialRecommend CSTDIrrigationYesYesYesYesN/AInhalationYesYesYesYesYes

NIOSH, 2014

16

Slide17

Hazardous Drug Spills

Spills happenSpraysDropped vials & bagsPunctured IV bagsBroken totes from wholesalersPatient unit / infusion areaSpill consequencesPersonnel / patient exposureEnvironmental contamination

17

Slide18

Cleaning Contaminated Surfaces - Summary

Cleaning StepPurposeAgentsDeactivationRender compoundinert or inactiveAs listed in the HD labeling or if no specificinformation available, sodium hypochlorite orother Environmental Protection Agency (EPA)-registered oxidizerDecontaminationRemove inactivatedresidueSterile alcohol, sterile water, peroxide, orsodium hypochloriteCleaningRemove organic andinorganic materialGermicidal detergent and sterile waterDisinfectionDestroy microorganismsSterile alcohol or other EPA-registereddisinfectant appropriate for use

Resource: U.S. Pharmacopeial Convention (USP <800>), Table 5. Summary of Cleaning Steps

18

Slide19

Recommended Contents of a Spill Kit*

Sufficient supplies to absorb 1 literPPE to protect worker2 pair chemo-tested glovesUtility glovesCover-all or gown & shoe coversFace shieldAbsorbent plastic-backed sheets or spill control “pillows”Disposable towels2 sealable, thick plastic waste bagsDisposable scoopPuncture-resistant container

*ASHP, 2006; ONS, 2014

19

Slide20

Assess the Spill

Evaluate:

Drug spilledSurface(s) affectedFloor?Countertop?Furniture?Size of spillPresence of vapors

Consider:

Glass debrisLiquidPowder/DustExposure or potential for exposurePersonal Protective neededNeed for additional assistance*

*Defined in policy

20

Slide21

Spill Notification

Restricted area vs. PublicIsolation of area (vapors)Need for evacuationInternal spill response team?External Haz Mat Team?

21

Slide22

Step 1:

Cover (contain) the spill

Liquid:Absorbent padsCloths/ paperSpill control pillowsPowder:Dampen pads, cloths or paper

22

Slide23

Step 2:

Don PPE

Scoop debrisDo NOT use hands!

23

Slide24

Step 3:

Remove residue

Consider surface materialRefer to facility policy for methods to manage spills on carpet/ upholstery

24

Slide25

Post-Spill Decontamination & Deactivation*

Oxidizing agent2% sodium hypochlorite + detergentEffective for bleomycin, daunorubicin, etoposide, fluorouracil, mitomycin, vinblastine, vincristine30-second contact timeNeutralizer1% sodium thiosulfateEffective for cyclophosphamide, ifosfamide, melphalan, methotrexate30-second contact timeRinse with water

*Hard, washable surfaces

25

Slide26

Contain Clean-up Materials

Place in disposal bag #1:Absorbent padsPapers/ clothsSpill control pillowsOther disposablesSharps in rigid container

Place in Disposal Bag #2:Bag #1 with its contentsShoe coversOuter glovesFace shieldRespirator (if disposable)

26

Slide27

Finally…

Place in Bag #2GownInner glovesClose bag #2Dispose of Bag #2 in designated containerWash hands with soap and water

(Image used with permission)

27

Slide28

Document the Spill

Recommend creating a designated spill report form:Who, what, where, whenParticipants in clean upSteps taken to clean the spillFollow-up

28

Slide29

Managing Acute Exposure

Type of ExposureImmediate CareFollow UpSkin exposureRemove contaminated clothing/ PPEWash affected area with soap & waterConsult SDS for drug-specific instructions.Report to Employee Health Professional or Emergency Department, based on symptomsComplete report of employee injury/ exposureFollow policy related to Workers Compensation.Eye ExposureFlush eye(s) with water or isotonic eye wash for 15 minutes.Consult SDS for drug-specific instructions.Inhalation ExposureMove to area with fresh airConsult SDS for drug-specific instructionsIngestionDo not induce vomitingConsult SDS for drug-specific instructions

Polovich, 2011

29

Slide30

MIOSHA Resources: Standards and Compliance

State Emphasis Program (SEP)Part 92 and 430 Hazard CommunicationPart 431 Hazardous Work in LaboratoriesPart 33 and Part 433 Personal Protective EquipmentPart 451 Respiratory ProtectionPart 474 SanitationPart 554 Bloodborne Infectious DiseasesRecording & Reporting of Occupational Injuries & Illnesses

30

Slide31

MIOSHA Resources: Consultation and Training

Preventing Exposure to Hazardous Drugs Training Module 1 – OverviewPreventing Exposure to Hazardous Drugs Training Module 2 – Staff Fact Sheet: Preventing Exposure to Hazardous Drugs (doc)Hazard Communication Sample Plan (doc)Personal Protective Equipment Guide (doc)Respiratory Protection Program (doc)Bloodborne Sample Exposure Control Plan (doc)

31

Slide32

Federal Resources

Centers for Disease Control and Prevention:NIOSH Hazardous Drugs webpageOSHA:Hazardous Drugs WebsiteHazardous Drugs eToolTechnical Manual Section VI: Chapter 2:Controlling Occupational Exposure To Hazardous Drugs

32

Slide33

Questions?

Consultation Education and Training DivisionMichigan Occupational Safety and Health Administration www.michigan.gov/miosha517-284-7720

33

Slide34

Acknowledgements

Christopher R. Friese, PhD, RN, AOCN®, FAANAssistant ProfessorUniversity of Michigan School of NursingThomas H. Connor, PhDResearch BiologistDivision of Applied Research and TechnologyNational Institute fro Occupational Safety and Health

34

Slide35

References

American Society for Testing and Materials [ASTM]. (2013). D 6978-05 standard practice for assessment of resistance of medical gloves to permeation by chemotherapy drugs. West Conshohocken, PA: ASTM.American Society of Health-System Pharmacists. (2006). ASHP guidelines on handling hazardous drugs. American Journal of Health-System Pharmacy, 63, 1172-1193. doi: doi:10.2146/ajhp050529 Fransman, W., Roeleveld, N., Peelen, S., de Kort, W., Kromhout, H., & Heederik, D. (2007). Nurses with dermal exposure to antineoplastic drugs: Reproductive outcomes. Epidemiology, 18, 112-119. Hansen, J., & Olsen, J. H. (1994). Cancer morbidity among Danish female pharmacy technicians. Scandinavian Journal of Work and Environmental Health, 20, 22-26. doi: 8016595International Agency for Research on Cancer. (2012). Agents Classified by the IARC. IARC Monographs, 1-104(March 2012). http://monographs.iarc.fr/ENG/Classification/ClassificationsGroupOrder.pdfLawson, C. C., Rocheleau, C. M., Whelan, E. A., Lividoti Hibert, E. N., Grajewski, B., Spiegelman, D., & Rich-Edwards, J. W. (2012). Occupational exposures among nurses and risk of spontaneous abortion. American Journal of Obstetrics and Gynecology, 206(4), 327.e321-327.e328.

35

Slide36

References (cont’d)

Martin, S. (2005). Chemotherapy handling and effects among nurses and their offspring (Abstract). Oncology Nursing Forum, 32, 425. McDiarmid, M. A., Oliver, M. S., Roth, T. S., Rogers, B., & Escalante, C. (2010). Chromosome 5 and 7 abnormalities in oncology personnel handling anticancer drugs. Journal of Occupational and Environmental Medicine, 52(10), 1028-1034. doi: 10.1097/JOM.0b013e3181f73ae6National Institute for Occupational Safety and Health. (2014). NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings, 2014. (Publication Number 2014-138). Cincinnati, OH: DHHS (NIOSH).OSHA. (1999). OSHA technical manual, TED 1-0.15A Sec VI, Chapter II Categorization of drugs as hazardous Retrieved from http://www.osha.gov/dts/osta/otm/otm_vi/otm_vi_2.html#2 Polovich, M. (Ed.). (2011). Safe handling of hazardous drugs (2nd ed.). Pittsburgh, PA: Oncology Nursing Society.Polovich, M., Olsen, M., & LeFebvre, K. B. (Eds.). (2014). Chemotherapy and Biotherapy Guidelines and Recommendations for Practice (4th ed.). Pittsburgh, PA: Oncology Nursing Society.Skov, T., Maarup, B., Olsen, J., Rorth, M., Winthereik, H., & Lynge, E. (1992). Leukaemia and reproductive outcome among nurses handling antineoplastic drugs. British Journal of Industrial Medicine, 49, 855-861.

36


About DocSlides
DocSlides allows users to easily upload and share presentations, PDF documents, and images.Share your documents with the world , watch,share and upload any time you want. How can you benefit from using DocSlides? DocSlides consists documents from individuals and organizations on topics ranging from technology and business to travel, health, and education. Find and search for what interests you, and learn from people and more. You can also download DocSlides to read or reference later.