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Introduction


be volatile, resulting in risk of inhalation. This is especially of concern during drug spills. Drug uptake can occur through the ingestion of contaminated food and drink, if they has been inappropriately stored near preparation areas of the drugs. The risk of dermal contact comes from handling of the drug (and its packaging) during drug dispensing and preparation processes. Needlestick injuries from hazardous drugs pose a significant risk to healthcare professionals and can be considered an occupational hazard for those working in healthcare. There is increased awareness of needlestick risks, especially with the potential for transmission of disease through sharps injuries. Similarly, cuts from glass fragments of vials or ampoules can also result in inadvertent exposure to hazardous drugs. The risks of needlestick injuries carry legal and cost implications for the respective organization, as well as personal injury cost to the victim. The disposal of equipment used within the workplace, such as syringes and used vials, is another area of risk and exposure. Safe disposal and handling of waste such as sharps, syringes, vials and cleaning agents needs to be managed effectively and safely. Environmental contamination from hazardous drugs is very difficult to eliminate once an area has been contaminated. The only method for eliminating a drug from the environment is removal of the contaminated surfaces. Decontamination using chemical inactivating agents is difficult and dependent on individual drug characteristics. There is no single validated method of decontaminating the varied types of hazardous drug, which are used in practice, from workplace surfaces. Cyclophosphamide is most commonly used to evaluate workplace


contamination, as it is a known human carcinogen, easily sampled, measureable and stable in work environments. In studies of the workplace, contamination has been detected and reported on surfaces of biological safety cabinets as well as the floor of pharmacy preparation suites. Contamination has been detected on gloves, gowns and shoes of staff as well as on office equipment such as chairs and telephones. It is therefore no wonder that contamination has been traced to clinical areas and even the homes of individuals through spread from workplace clothing.


Importance of protecting healthcare personnel


Employers have a legislated duty to protect


staff and public.2


Therefore, a risk


assessment of the management of hazardous drugs is essential in any organisation. Cross-organisational policies for the management of hazardous drugs are the first step in the safe management of the risks of hazardous drugs. It is also recommended, following a risk assessment for staff potentially exposed to hazardous drugs, to determine whether routine health surveillance of staff is necessary.


Control measures should be


implemented using the risk management hierarchy of: 1. Eliminate the hazard, unless not reasonably practical


2. Use totally enclosed systems for controlling the hazard


3. Control exposure at source 4. Use personal protective equipment (PPE), where adequate control of exposure cannot be achieved by other measures alone.


If PPE is chosen, it must be suitable for the task, suited to the use and environment and used correctly. This includes the use gloves, eye goggles, respiratory masks and protective clothing such as aprons and overshoes. The use of PPE is especially necessary in managing hazardous drug spills and drug exposure from, for example, extravasation. The potential for exposure to a drug begins at receipt of the product from the manufacturer. There is a risk of breakage and spillage of the primary packaging, as well as contamination of the container (for example, the vial) and secondary packaging. By far the highest level of


exposure risk is present during a drug spill. Therefore, all organsations must have spill procedures as well as procedures for the management and disposal of hazardous waste.


When designing systems for managing hazardous drugs in the workplace, consideration needs to be given to the following: ● Policies and procedures to manage processes (including treatment protocols)


● Environmental monitoring (maintaining cleanroom / barrier technology specification)


● Equipment validation and monitoring (including PPE)


● Staff training and competency ● Final product integrity testing and health surveillance


● Waste handling


Workplace policies need to include receipt and storage of hazardous drugs. Work practices must be designed to ensure minimal handling and containment of potential exposure from spills. The principles of lean working can be used to design processes in the workplace that minimise risk and allow for effective control of both processes and workload. The next potential for exposure occurs during drug preparation. It is recognised that parenteral chemotherapy must be prepared in environmentally controlled conditions in the pharmacy. This is not only to ensure that the products prepared are sterile and free of contamination, but also to protect the staff preparing doses. The National Institute for Occupational Safety and Health1 has developed a


www.hospitalpharmacyeurope.com


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