Do medical surveillance after drug exposure
Do medical surveillance after drug exposure
Clinical, non-clinical personnel at potential risk
It's estimated that 5.5 million workers are potentially exposed to hazardous drugs or drug waste at their worksites, ranging from manufacturing and shipment of the drug to receiving it at a hospital, storing it, delivering it to patients, and disposing of it.1 The significant threat to hospital workers has led the National Institute for Occupational Safety and Health (NIOSH) to issue an advisory on medical surveillance of health care workers exposed to hazardous drugs.
Drugs are classified as hazardous if studies in animals or humans indicate that exposures to them have a potential for causing cancer, developmental or reproductive toxicity, or harm to organs. Drugs used in treating cancers are among the most common hazardous drugs encountered in hospitals, according to the NIOSH alert.
"Health care workers must be informed and educated. Those who do not use recommended safe handling precautions are at risk for exposure," says Marty Polovich, MN, RN, AOCN, a member of the NIOSH Hazardous Drug Safe Handling Working Group. The group was formed in 2000 and issued a 2004 alert on safe handling and the April 2007 advisory on medical surveillance.
Workers at risk of exposures, other than nurses, include pharmacists and pharmacy technicians, physicians, operating room personnel, shipping and receiving personnel, waste handlers, and maintenance workers.
Exposed health care workers risk experiencing the same side effects that the drugs cause in ill patients, but with no therapeutic benefits. Occupational exposures can lead to acute effects such as skin rashes or gastrointestinal complaints, chronic effects such as adverse reproductive events (miscarriage, congenital malformation, etc.), and cancer, NIOSH reports.
A 2003 survey of more than 500 oncology nurses revealed that while more than 94% reported usually wearing gloves during chemotherapy handling, usual use of face and respiratory protection was less than 6%. Less than half (46%) said their worksites provided any type of medical monitoring.2
Educate and develop surveillance plan
A comprehensive approach to minimizing worker exposure should be part of a safety and health program that includes engineering controls, good work practices, and personal protective equipment (PPE) supported by a medical surveillance program, NIOSH advises. Medical surveillance involves collecting and interpreting data to detect changes in the health status of working populations potentially exposed to hazardous substances. The elements of a medical surveillance program are used to first establish a baseline of workers' health and then to monitor their future health as it relates to their potential exposure to hazardous agents.
Employers should ensure that health care workers who are exposed to hazardous drugs are routinely monitored as part of a medical surveillance program. These health care workers include personnel such as nurses' aides and laundry workers who may come directly into contact with patient waste within 48 hours after a patient has received a hazardous drug.
NIOSH says the elements of a medical surveillance program for hazardous drug exposures should include, at a minimum:
- Reproductive and general health questionnaires completed at hire and periodically thereafter;
- Laboratory work, including complete blood count and urinalysis completed at the time of hire and periodically thereafter. Additional tests, such as liver function and transaminase tests, may be considered;
- Physical examination completed at the time of hire and then as needed for any worker whose health questionnaire or blood work indicates an abnormal finding;
- Follow-up for those workers who have shown health changes or have had a significant exposure (substantial skin contact, cleaning a large spill [a broken bag, leaking IV line], etc.). Once a surveillance program is in place, NIOSH recommends, health questionnaires and lab results should be examined periodically to detect trends that might be a sign of health changes due to exposure.
References
1. NIOSH Hazardous Drug Safe Handling Working Group. Medical surveillance for health care workers exposed to hazardous drugs. NIOSH publication No. 2007-117. Web: www.cdc.gov/niosh/docs/wp-solutions/2007-117. Accessed May 5, 2007.
2. Martin S, Larson E. Chemotherapy-handling practices of outpatient and office-based oncology nurses. Oncology Nursing Forum 2003; 30:575.
Sources/Resource
For more information on hazardous drug exposure precautions:
- Marty Polovich, MN, RN, AOCN, Oncology Clinical Nurse Specialist, Southern Regional Medical Center, 11 Upper Riverdale Road, Riverdale, GA 30274. E-mail: [email protected].
- NIOSH Hazardous Drug Safe Handling Working Group. Preventing occupational exposure to antineoplastic and other hazardous drugs in health care settings (NIOSH publication No. 2004-165) is available on-line at www.cdc.gov/niosh/docs/2004-165.
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