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Survey of guidelines and current practices for safe handling of antineoplastic and other hazardous drugs used in 24 countries
Purpose A survey of guidelines and current practices was conducted to examine the safe handling procedures for antineoplastic and other hazardous drugs that are used in 24 countries including the Americas, Europe, the Mideast, Far East, and Australia. Methods Subject experts were asked to complete a brief survey regarding safe handling guidelines and practices for hazardous drugs in their countries. Questions addressed practices for handling monoclonal antibodies, the use of closed-system transfer devices, medical surveillance practices, and measurements of compliance with existing guidelines....
Soignants et médicaments cytotoxiques
Place de la biométrologie dans la maîtrise des risques dans le temps Les médicaments cytotoxiques utilisés dans les traitements des cancers présentent une toxicité intrinsèque, du fait de leurs propriétés génotoxiques, tératogènes et cancérigènes. Les professionnels de santé pouvant y être exposés, il est essentiel de garantir leur sécurité et de mettre en place des programmes d'évaluation des expositions pour documenter les expositions, juger de l'efficacité...
Assessment of safe antineoplastic drug handling practices in community pharmacies, veterinary settings and long-term care homes in Ontario
Antineoplastic drugs play an important role in cancer and other chronic disease treatment though a number of these drugs are known to have carcinogenic, mutagenic and teratogenic properties. Healthcare workers in hospitals and cancer treatment centres are typically identified as the largest job group known to be at risk. However, recently other job groups have also been identified as likely at risk due to direct or indirect exposure such as: community pharmacists including retail pharmacy workers, veterinarians and veterinarian technicians, nursing and other healthcare workers employed in long...
Médicaments anticancéreux et médecine vétérinaire
Retour d'expérience du Centre hospitalier universitaire vétérinaire d'Alfort Le développement des chimiothérapies en médecine vétérinaire expose le personnel à des risques de contamination par les médicaments cytotoxiques. Après une campagne de prélèvements surfaciques montrant une contamination de l'environnement et une exposition des personnels, en particulier au niveau des gants, le Centre hospitalier universitaire vétérinaire d'Alfort a mis en place des actions correctrices...
Fentanyl Exposure Risks for Law Enforcement and Emergency Response Workers
Fentanyl is a powerful synthetic drug that is similar to morphine and heroin, but is 50 to 100 times more potent. Fentanyl and its analogs, such as carfentanil, can pose a potential hazard to law enforcement, emergency medical personnel, and firefighters who could come into contact with these drugs through the course of their work day. While there are important questions about the risks of different types of exposures (and resultant health effects) that might occur during law enforcement and emergency response activities, workers involved in these types of activities leading to potential exposures...
Chromosomal aberrations, sister chromatid exchanges, and micronuclei in lymphocytes of oncology department personnel handling anti-neoplastic drugs
Objective: Concern exists regarding the possible hazards to the personnel handling anti-neoplastic drugs. The purpose of the present study was to assess the genotoxicity induced by anti-neoplastic agents in oncology department personnel. Materials and methods: To do this, the frequency of chromosomal aberrations (CAs) induced in peripheral blood lymphocytes was assessed at G0 phase of the cell cycle using metaphase analysis, cytokinesis block-micronucleus (MN) assay and sister chromatid exchange (SCE) assay. These cytogenetic end points were measured among 71 nurses in oncology department and 10...
Liquid release as a source of potential drug exposure during the handling of intravenous infusions in nursing
Purpose: This study aims at experimentally determining the incidence and extent of liquid releases onto the operator's hands and into the work environment during common nursing operations involving infusions. Methods: A sequence of operations related to the preparation and administration of infusions was conducted by three subjects for 15 times each using fluorescein marked infusion solutions and two different infusion sets (standard set vs. safety-optimized set). Unintended release of liquid was quantified by glove and surface wipe sampling and HPLC/FD analysis of the samples. Operations concerning...
Multicenter study of environmental contamination with cyclophosphamide, ifosfamide, and methotrexate in 48 Canadian hospitals
Context: Oncology workers are occupationally exposed to antineoplastic drugs. This exposure can induce adverse health effects. In order to reduce their exposure, contamination on surfaces should be kept as low as possible. Objectives: To monitor environmental contamination with cyclophosphamide, ifosfamide, and methotrexate in oncology pharmacy and patient care areas in Canadian hospitals. To describe the impact of some factors that may limit contamination. Methods: This is a descriptive study. Twelve standardized sites were sampled in each participating center (six in the pharmacy and six in patient...
Occupational Exposure to Antineoplastic Agents
An Analysis of Health Care Workers and Their Environments Approximately 8 million health care workers are unnecessarily exposed to highly toxic drugs used to treat cancer; antineoplastic drugs can contribute to negative health effects for these workers. The drugs have been detected in the urine of workers and on the floors and counters of worksites. Safety precautions that could reduce the risk of exposure are underutilized. This cross-sectional study of 163 oncology health care workers used a survey to measure workplace and individual factors, and environmental sampling to measure surface contamination...
NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings, 2016
The National Institute for Occupational Safety and Health (NIOSH) Alert: Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Healthcare Settings was published in September 2004 ( http://www.cdc.gov/niosh/docs/2004-165/ ). In Appendix A of the Alert, NIOSH identified a sample list of hazardous drugs. The list was compiled from information provided by four institutions that had generated lists of hazardous drugs for their respective institutions, as well as a list from the Pharmaceutical Research and Manufacturers of America (PhRMA). The 2004 list was updated in 2010...
Prévenir les risques chimiques lors d'une chimiothérapie intrapéritonéale pressurisée par aérosolisation (CIPPA ou PIPAC)
Une équipe de la faculté de médecine de l'Université de la Ruhr, à Bochum en Allemagne, a récemment mis au point une nouvelle technique de chimiothérapie intrapéritonéale : la chimiothérapie intrapéritonéale pressurisée par aérosolisation (CIPPA, PIPAC en anglais). Cette procédure, apparentée à la chimiothérapie hyperthermique intrapéritonéale (CHIP) utilisée depuis plusieurs années, offre de nouvelles perspectives pour la prise en charge...
Manipulation des anticorps monoclonaux (Acm) en milieu de soins
Pratiques et mesures de prévention L'essor des anticorps monoclonaux (Acm) pose la question de la prévention à mettre en place pour le personnel qui les manipule. Un état des lieux des pratiques et des mesures de prévention est réalisé en milieu de soins pour dégager des pistes d'amélioration. Les données retrouvées dans la littérature sont limitées et la toxicité professionnelle des Acm mal connue. Une enquête est menée auprès du personnel manipulant des Acm et auprès...
Pilot study of biological monitoring of four antineoplastic drugs among Canadian healthcare workers
Purpose There are health risks to workers occupationally exposed to antineoplastic drugs. We hypothesized that implementing a biological monitoring program would be feasible. The goal was to present the results of our pilot cross-sectional study of biological monitoring of four antineoplastic drugs. Methods We recruited workers from the hematology–oncology department and control workers in a mother–child university health center. This study was preceded by an information period during which we aimed at enhancing the workers' awareness and knowledge of the risks of occupational exposure...
A review of the evidence for occupational exposure risks to novel anticancer agents
Introduction: Evidence of occupational exposure risks to novel anticancer agents is limited and yet to be formally evaluated from the Australian healthcare perspective. Methods: From March to September 2013 medical databases, organizational policies, drug monographs, and the World Wide Web were searched for evidence relating to occupational exposure to monoclonal antibodies, fusion proteins, gene therapies, and other unclassified novel anticancer agents. Results: Australian legislation, national and international guidelines, and drug company information excluded novel agents or provided inconsistent...
Occupational exposure to volatile anaesthetics: a systematic review
Background: The effects of long-term occupational exposure to small concentrations of volatile anaesthetics on health professionals are still uncertain despite the research literature available on this subject. Aims: To analyse the existing literature on the health effects of volatile anaesthetics on exposed health professionals. Methods: We performed a systematic review from March 2013 to January 2014. The literature was searched in the Medline and Cochrane libraries using the following keywords: ‘Anaesthetics AND occupational health', ‘Volatile anaesthetics AND occupational health'...
Adherence to Precautionary Guidelines for Compounding Antineoplastic Drugs
A Survey of Nurses and Pharmacy Practitioners Precautionary guidelines detailing standards of practice and equipment to eliminate or minimize exposure to antineoplastic drugs during handling activities have been available for nearly three decades. To evaluate practices for compounding antineoplastic drugs, the NIOSH Health and Safety Practices Survey of Healthcare Workers was conducted among members of professional practice organizations representing primarily oncology nurses, pharmacists, and pharmacy technicians. This national survey is the first in over 20 years to examine selfreported use of...
Risks to Health Care Workers from Nano-Enabled Medical Products
Nanotechnology is rapidly expanding into the health care industry. However, occupational safety and health risks of nano-enabled medical products have not been thoroughly assessed. This manuscript highlights occupational risk mitigation practices for nano-enabled medical products throughout their life cycle for all major workplace settings including (1) medical research laboratories, (2) pharmaceutical manufacturing facilities, (3) clinical dispensing pharmacies, (4) health care delivery facilities, (5) home health care, (6) health care support, and (7) medical waste management. It further identifies...
Antineoplastic drug contamination in the urine of Canadian healthcare workers
Purpose: The purpose of this study was to quantify the urine concentration of non-metabolized cyclophosphamide (CP), a commonly administered antineoplastic drug, among potentially exposed Canadian healthcare workers and to identify factors associated with the drug concentration levels. Methods: Participants were asked to provide two sets of 24-h urine samples (at two different sampling events), and the level of CP was quantified using high-performance liquid chromatography–tandem mass spectrometry. In addition to demographic information, participants were surveyed regarding their frequency...
Reproductive Health Risks Associated With Occupational Exposures to Antineoplastic Drugs in Health Care Settings
A Review of the Evidence Objectives: Antineoplastic drugs are known reproductive and developmental toxicants. Our objective was to review the existing literature of reproductive health risks to workers who handle antineoplastic drugs. Methods: A structured literature review of 18 peer-reviewed, English language publications of occupational exposure and reproductive outcomes was performed. Results: Although effect sizes varied with study size and population, occupational exposure to antineoplastic drugs seems to raise the risk of both congenital malformations and miscarriage. Studies of infertility...
NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings, 2014
The National Institute for Occupational Safety and Health (NIOSH) Alert: Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Health Care Settings was published in September 2004. In Appendix A of the Alert, NIOSH identified a sample list of major hazardous drugs. The list was compiled from information provided by four institutions that had generated lists of hazardous drugs for their respective institutions, as well as a list from the Pharmaceutical Research and Manufacturers of America (PhRMA). The 2004 list was updated in 2010 and 2012. The current update (2014) adds...
Chromosomal effects of non-alkylating drug exposure in oncology personnel
Therapy-related leukemia has been a recognized sequela of cancer treatment for decades with “signature” abnormalities of chromosomes 5, 7, and 11 observed in treated patients. Risk to oncology personnel handling anti-cancer agents has also been documented by non-specific measures of genotoxicity in blood and urine. Using chromosomal markers applied in clinical practice, we previously demonstrated in oncology workers, a dose-related increase in abnormalities of chromosomes 5 and 7, known to be targets of alkylating agent exposure. In the analysis presented here, we extended that work...
Safe Handling of Hazardous Drugs
May is National Oncology Nursing MonthExternal Web Site Icon. In honor of these nurses and all who work with hazardous drugs (many of which are used in the treatment of cancer) we are posting this blog on how to safely prepare, administer or otherwise handle these drugs. About 8 million U.S. healthcare workers are potentially exposed to hazardous drugs. Inhalation and skin contact or absorption are the most likely routes of exposure. However, unintentional ingestion from hand to mouth contact and unintentional injection through a needle-stick or sharps injury are also possible. Hazardous drugs...
Evaluation of Chemotherapy Drug Exposure in an Outpatient Infusion Center
We evaluated employee exposure to chemotherapy drugs at an outpatient infusion center. We found low levels of surface contamination of platinum throughout the workplace. Handling platinumcontaining compounds is the likely source of this contamination. Although we cannot definitively link all of the reported symptoms to chemotherapy drug exposures, many were consistent with those reported in the literature. Employees inconsistently used personal protective equipment. We recommended employees use chemotherapy gowns and gloves when handling chemotherapy drugs, and the company implement a medical surveillance...
Occupational Exposure to Cyclophosphamide in Nurses at a Single Center
Objective: To evaluate biological and environmental exposure to cyclophosphamide in nurses at a single institution. Methods: Biological exposure to cyclophosphamide in nurses administering cyclophosphamide compared with two control groups: nononcology nurses not administering cyclophosphamide and community members without recent hospital exposure. Environmental exposure to chemotherapy was measured using surface wipes taken from oncology and nononcology areas in the hospital. Results: More than one third of all nurses and no community controls tested positive for urinary cyclophosphamide. Oncology...
Health-care workers and antineoplastic drugs
Evaluating the risks and identifying determinants of exposure Health-care workers may be exposed to hazardous antineoplastic drugs—i.e. drugs used in chemotherapy—when handling them and/or when touching surfaces contaminated by them. Most studies looking at exposures to antineoplastic drugs in hospitals have been limited to select departments and/or workers with certain job titles. This may lead to an underestimation of the risk if all exposures during the circulation of the drug within a facility from cradle to grave (known as the hospital medication system) are not taken into account...
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