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Common
safety and health topics:
Hazard
Communication Standard
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Hazard
Exposure to
hazardous chemicals and drugs due to untrained or unaware workers:
- Personnel who are not
aware of proper work practices and controls may be exposed to
hazardous drugs through the skin, mouth, or by inhalation.
- The OSHA Technical
Manual provides guidance regarding the
adverse health effects from hazardous drugs, ranging from
nausea and dizziness, to adverse pregnancy outcomes (OTM
vi.2.3).
Example Controls
Implement a written program which
meets the
requirements of the Hazard Communication Standard
to provide for worker training, warning labels, and access to Material Safety Data Sheets
(MSDSs).
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The Hazard Communication Standard, which
is generally applicable to hazardous chemicals, is
also applicable to certain drugs.
- The HCS only applies to
pharmaceuticals that the drug manufacturer has determined to
be hazardous and that are known to be present in the workplace
in such a manner that employees are exposed under normal
conditions of use or in a foreseeable emergency [OSHA
Interpretation Letter (1994, March 3)].
- There are exemptions
to the standard such as:
- Drugs that are in
solid, final form for direct administration to the patient,
e.g., tablets, or pills [1910.1200(b)(6)(vii)].
Note: Many nursing home facilities use only drugs which
fall within this exemption.
- Final form exemption
would also apply to tablets or pills that are occasionally
crushed, if the pill or tablet is not designed to be dissolved
or crushed prior to administration.
- Consumer
products that are subjected to the labeling
requirements of the terms as defined in the Consumer
Product Safety Act and the Federal Hazardous Substances
Act [1910.1200(b)(5)(v)].
- Chemicals with any of the
following characteristics are considered hazardous: carcinogenic,
corrosive, toxic or highly toxic, irritating, sensitizing, or target organ
effecting. [Hazard Communication Standard Appendix
A and chemicals listed in 1910.1000 Table
2].
- Both human and
animal data are to be used in this determination. The
Hazard Communication Standard, Appendix B lists sources of toxicity information.
- The OSHA Technical
Manual provides
recommendations for characterizing
hazardous drugs.
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- Provide readily available
Material Safety Data Sheets
(MSDSs)
for all hazardous chemicals, including hazardous drugs that
meet the Hazard Communication Standard criteria.
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- All personnel involved
in any aspect of the handling of covered hazardous drugs
(physicians, nurses, pharmacists, housekeepers, employees
involved in receiving, transport or storage) must receive
information and training to appraise them of the hazards
presented by hazardous drugs in the work area.
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- Employee access to
exposure records is required by 1910.1020.
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Other Recommended Good Work
Practice:
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- Develop, implement
and maintain a written hazardous drug safety and health plan to protect those employees who handle or are otherwise exposed
to drugs that pose a health hazard to them.
- The OSHA Technical
Manual Part V,
A#1, offers
guidance in the development of a drug safety and health
plan.
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- Nursing
stations on floors where hazardous drugs will be administered
should have spill and emergency skin and eye decontamination kits available
and relevant MSDS's for guidance.
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- A list of
drugs covered by hazardous drug policies and information on spill and emergency
contact procedures should be posted or easily available to
employees.
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The Utility,
Dietary, and Maintenance,
modules also address hazardous chemicals and the Hazard
Communication Standard.
Additional Information:
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Hazardous
Drugs During Preparation |
Hazard
Exposure
to hazardous drugs during preparation due to ineffective engineering/work practice
controls and PPE:
Example
Controls
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PPE: OSHA 1910.132
requires the employer to assess potential hazards and then select and ensure the
use of appropriate PPE to protect employees from hazardous chemicals, including
hazardous drugs as defined by the Hazard Communication
Standard.
- Eye and Face Protection: OSHA 1910.133
requires the use of chemical-barrier face and eye protection whenever splashes, sprays, or aerosols of HD's may
be generated that could result in eye, nose, or mouth
contamination.
Other
Recommended Good Work
Practice:
- Biological
Safety Cabinets: Approved Biological Safety
Cabinets (BSC) should be used when preparing hazardous medications. (OSHA Technical Manual
Part
V, Section B, #2).
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- Class II, type B, or Class III BSCs that vent to
the outside are recommended. (Part V,
Section B, #3, c).
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- OSHA does not recommend Horizontal BSCs for the
preparation of hazardous drugs, since they
increase the likelihood of drug exposure. (Part IV,
Section A, #3).
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- The BSC should also
contain:
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- Covered needle containers for needle disposal.
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- Covered waste container for excess fluids
disposal.
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Personal Protective Equipment
(PPE)
The OSHA Technical
Manual, describes the effective use of gloves and gowns
when working with Hazardous Drugs (Part V,
Section B, #6).
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- The thickness of the gloves used in handling
hazardous drugs is more important than the type of material. The best results have been seen with latex
gloves.
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- Double gloving is recommended because all gloves
are permeable to some extent, and their permeability increases with
time.
- When double gloving, one glove should be placed under
the gown cuff and one over. The glove-gown interface
should be such that no skin on the arm or wrist is
exposed.
- To limit transfer of contamination from the BSC into
the work area, the outer gloves should be removed after
each task or batch, and should be placed in
"zipper"-closure plastic bags or other
sealable
containers for disposal.
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- Gloves should be changed regularly (hourly) or
immediately if they are torn, punctured, or contaminated with a spill.
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- Thicker, longer, latex gloves that cover the gown
cuff are recommend with minimal or no powder since the powder may absorb
contamination.
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- The worker should wear a protective disposable gown made
of lint-free, low-permeability fabric, with a solid front,
long sleeves and tight-fitting elastic or knit cuffs.
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- Handwashing:
Hands should be washed before
gloves are put on, and after they are removed.
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Restricted
Preparation areas: OSHA and the American Society of Hospital
Pharmacists recommend that hazardous drug preparation be
performed in a restricted
area, with signs restricting the access of unauthorized personnel prominently
displayed (Part
V, Section B, #1).
- Restricted
Activities: Smoking, drinking, applying
cosmetics, or eating where hazardous drugs are prepared, stored, or used, increases the chance
of exposure, and should be prohibited (Part V,
Section B, #1).
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Handling
Practices |
Hazard
Exposure to
hazardous drugs (HDs) through improper:
Example Controls
When handling hazardous
drugs good work practice includes:
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- Hazardous
Drugs should
be prepared by pharmacists, not by nurses or
physicians without proper PPE and engineering controls. The risk of exposure
to hazardous drugs
through inhalation or direct skin contact, is present in procedures such as:
- Transferring hazardous
drugs from one container to another,
reconstituting or manipulating them.
- Withdrawal of needles from drug vials.
- Expulsion of air from a drug-filled syringe.
- Expelling air from
syringes should be done in the biological safety cabinet,
not
by the health care worker giving the injection. Technical
Chapter Part V, Section C,
#1.
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Sharps
Handling: OSHA and the American Society of Hospital
Pharmacists (ASHP) recommend that all syringes and needles used in
the course of preparation be placed in "sharps" containers
for disposal without being crushed, clipped or capped. Technical
Chapter Part
V, Section C, #1, b.
Priming
of tubing for hazardous drugs:
The OSHA Technical
Manual Part
V, Section C, #1, c, recommends that drug administration sets be attached
and primed within the BSC prior to addition of the drug. This
eliminates the need to prime the set in a less well-controlled
environment. It also states that the priming should be done
with non-drug containing solution or that a back-flow closed system
be used.
Labeling
Practices: In addition to standard pharmacy labeling
practices, all syringes and IV bags containing hazardous drugs should be labeled with a warning label
such as: Special Handling/Disposal Precautions. Technical
Chapter Part
V, Section C, #1, a.
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Hazardous Drugs
During Administration |
Hazard
Exposure of administering
personnel to hazardous drugs during administration including aerosolized drugs.
Example Controls
Good work practice
recommends:
- Personnel
administering Hazardous Drugs wear gowns, latex gloves, and chemical splash goggles or equivalent
safety glasses. OSHA's Technical Manual Chapter (Part V,
Section C, #2) and
the National Study Commission on Cytotoxic Exposure.
- When administering aerosolized drugs
additional precautions may be necessary to protect the employee from exposure such as:
- Wearing NIOSH-approved respirators.
- The use of treatment booths with local exhaust
ventilation systems, or isolation rooms with separate HEPA filtered ventilation
systems.
The American Society of
Hospital Pharmacists (ASHP) recommends these guidelines when
administering hazardous drugs:
- Only those trained to administer hazardous drugs should be
allowed to perform this function.
- Disposable gloves and gowns should be worn. The glove and gown
cuffs should be worn in a manner that produces a tight fit
(e.g., loose glove tucked under gown cuff; tight glove fitted
over gown cuff).
- Intravenous containers designed with venting tubes should not
be used.
- The use of plastic backed absorbent liners under
I.V. tubing
during administration of hazardous drugs to absorb any leakage
and prevent the solution from spilling onto patient skin.
- Work at waist level, if possible; avoid working above the head
or reaching up for connections or ports.
- Until the reproductive risks associated with handling
Hazardous Drugs have
been substantiated, staff who are pregnant or breast-feeding
should avoid contact with these drugs.
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Hazardous Drugs
During Care Giving |
Hazard
Exposure
to Hazardous Drugs during care giving:
- When dealing with excreta that may contain high
concentrates of hazardous drugs.
Example
Controls
Special precautions need to be taken by personnel while caring for
the patient who has been taking hazardous drugs.
OSHA requires:
- If personnel are unable to differentiate between
body fluid types, care should be given in accordance with the Bloodborne Pathogens Standard.
- Universal precautions must be observed to prevent
contact with blood or other potentially infectious materials.
Other Recommended Good Practices:
- Personnel (nursing, housekeeping) dealing with
excreta, primarily urine, from patients who have received
Hazardous Drugs in the last 48 hours,
should wear PPE, gloves, and gowns.
- The American Society of
Hospital Pharmacists (ASHP) recommends:
- Gloves be discarded after each use and immediately if
contaminated.
- Gowns should be discarded on leaving the patient-care area
and immediately if contaminated.
- Hands must be washed thoroughly after hazardous drugs are
handled.
- Disposable linen or protective pads should be used for
incontinent or vomiting patients.
- Contaminated non-disposable linen or protective pads require
pre-washing.
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Disposal of
Hazardous Drugs
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Hazard
Exposure to
Hazardous Drugs during disposal:
Example
Controls
Bagging and labeling:
OSHA
requires:
Other Recommended Good
Practices:
- Thick, leak-proof plastic
bags, colored differently from other hospital trash bags, should be used for routine
collection of discarded gloves, gowns and other disposable material, and labeled as Hazardous
Drug-related wastes.
- The Technical Chapter
suggests the waste
bag should be kept inside a covered waste container clearly
labeled "Hazardous Drug WASTE ONLY." At least one such receptacle
should be located in every area where the drugs are prepared or
administered. Waste should not be moved from one area to
another. The bag should be sealed when filled and the covered
waste container taped.
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Hazardous
Waste Disposal and Containers: The OSHA Hazardous Drugs
Technical Chapter (Part
IV), Section A recommends:
- Labeling needle containers and breakable items of
hazardous waste as Hazardous Drug waste only.
- The use of properly labeled, sealed and covered disposal containers,
handled by trained and protected personnel, as required under the Bloodborne Pathogens
Standard
if such items are contaminated with blood or other potentially
infectious materials.
Hazardous drug-related wastes should be disposed of
according to EPA, state and local regulations for hazardous waste.
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Hazardous Drugs
During Storage
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Hazard
Exposure to
hazardous drugs during storage.
Example Controls
The OSHA Technical
Manual recommends:
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- Storage
of Hazardous Drugs: Access
to areas where Hazardous Drugs are prepared and stored is limited to authorized
personnel only, with signs restricting entry.
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- Storage
Area for Hazardous Drugs: Bins or shelves where Hazardous Drugs are stored
should be designed to prevent breakage and to limit contamination in
the event of leakage with bins with barrier fronts, or other
design features that reduce the chance of drug containers falling to
the floor.
- Warning labels should be applied to all HD
containers, shelves, and bins, where these containers are stored.
- The American Society of
Hospital Pharmacists (ASHP) recommends hazardous drugs requiring
refrigeration be stored separately from non-hazardous drugs in
individual bins designed to prevent breakage and contain
leakage.
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Latex Allergy Some employees,
develop latex allergy from exposure to latex in
products like latex gloves. This can cause reactions from irritant
contact dermatitis, and allergic contact sensitivity to immediate
possible life threatening sensitivity. |
Hazard
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Developing
latex allergies from exposure to latex products. |
Example Controls
OSHA requires:
- Bloodborne Pathogen Standard states, The employer shall ensure that appropriate personal
protective equipment in the appropriate sizes is readily accessible
at the worksite or is issued to employees. Hypoallergenic gloves,
glove liners, powderless gloves, or other similar alternatives shall
be readily accessible to those employees who are allergic to the
gloves normally provided [1910.1030(d)(3)(iii)].
- Please note that hypoallergenic gloves, glove liners, or
powderless gloves are not to be assumed to be non-latex or latex
free.
Other Recommended Good
Practices:
- Research indicates the thickness of the gloves used in handling
hazardous drugs is more important than the type of material
used. Non latex gloves and other latex free products are
available.
- If latex is used, choose a low protein, powder free glove. (Powder
free gloves seem to reduce systemic allergic responses.)
The Laundry,
and Bloodborne
Pathogens Modules also address Latex Allergy.
Additional Information
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