Safe handling of hazardous materials Flashcards
What are the four hazards in the work place?
Physical e.g. manual handling
Chemical e.g. corrosive
Biological e.g. viruses, vaccines
Psychological .e.g bullying, stress
Drugs that meet what criteria should be handled as hazardous?
Carcinogenicity Teratogenicity Reproductive toxicity Organ toxicity at low doses Genotoxicity
What is the NIOSH list?
List of harzardous drugs
NIOSH stands for what
National Institute for occupational safety and health
COSHH stands for what
Control of substances hazardous to health
PPE regulations were introduced when?
2002
What does IARC stand for?
International agency for research on cancer
What are the exposure routes of hazardous drugs?
Ingestion of contaminated foods
inhalation of drug aerosol or dust
absorption through skin
direct contact/injection
What are the risks of cytotoxic drugs to the patients?
Patients may develop secondary neoplasams from treatment with chemotherapy agents
what are the risks of cytotoxic drugs to hospital personnel?
Potential health hazard to those exposed through preparation and administration.
Where are the highest levels of surface contamination found?
In the pharmacy: Work surfaces, air-foil and floor in front of BSC
Administration area = highest levels on floor by the bed
Outline the hierarchy of control
Assessment of risk Elimination Substitution Good working practice Engineering controls PPE
How can we eliminate the risk of cytotoxic drugs?
Remove from general areas
Segregation of workflows - radiopharmacy/cytotoxics/ non-harzardous civas/biologicals
Purchase of ready to use liquids instead of powders - powders are much harder to handle so have greater risk (this is more substitution rather than elimination)
The development of new drugs
Administrative controls have 4 aspects - what are these?
- Education and training
- Availability of information
- SOPs, policies, agreed working practices
- Surveillance, monitoring and supervision
How can the use of procedures reduce the risk of cytotoxic drugs?
Minimum no. of staff
Adherence to recommended work practices substantially reduce worker exposure
Standardises prescribing, ordering and documentation to reduce areas
Clear, unambiguous and detailed written SOPs
Use of illustrations and diagrams (videos are ideal)
what are the benefits of monitoring the handling of cytotoxic drugs?
Lack of supervision and understanding has been shown to be a key factor in error rates
Good supervision ensures:
- good technique adhered to
- procedures undertaken accurately, correctly and safely
- less waste as less goes wrong
- enhances operator and patient safety
What are the two aspects of engineering controls in terms of when handling cytotoxic drugs?
- product protection
2. operator protection (PPE)
What personal protective equipment should be used when handling cytotoxic drugs?
Gowns, sleeves Gloves, glasses and masks undergarments - best strategy is multiple layers Mats, swabs Shields, dispensing aids Waste handling equipment
What is good practice in terms of gloves in the use of ppe?
All gloves are permeable to some extent, and permeability increases with time.
Therefore should change regularly and should use nitrole or neoprene gloves as these offer better protection. Multilayers are also effective (due to air gap)
What is the recommended practice when using luer-lock syringes?
Size used should be greater than the required volume - should never be more than 75% full (if we overfill syringe is more likely to leak)
Use vented needles or filtered needles to normalise vial pressures and minimise aerosols.
Discuss the disposal of cytotoxic?
Should follow waste disposal guidelines - HTM 07-01 The safe management of healthcare waste memorandum.
Guidelines must be available on site for waste disposal.
Cytotoxic waste should be diposed of in bins with a purple lid.
Cytotoxic waste should be disposed of in what coloured bin?
Purple
The EU directive 2010/32/EU states what in terms of resheathing?
States that re-sheathing of needles is NOT permitted in a health care setting
risk of litigation if do not take measures to reduce risks of needle-stick injury
How can we minimise the risk of harm caused by cytotoxic spillages?
Safe packaging PPE Containment Prompt action disposal facilities Spillage kits - neutralisers Incident reporting and documentation
What are CIVAS products?
Central intravenous additive service (CIVAS) products
what are the risks of CIVAS products?
infection thrombophlebitis extravasation air embolism dose erros incorrect drug given incorrect site incorrect rate incorrect formulation
What are the starting material specifications for subcutaneous products?
Volume restricted to
What are the starting material specifications for intrathecal products?
Avoids antimicrobials, antioxidants, pyrogens and preservatives as can be toxic to the CNS
Should not contain any other additives ‘use sodium chloride as tonicity adjusting agent’
Particulates okay
Lower endotoxin limit
What is the equation for calculating the endotoxin limit?
EL = K/M
K- the max no. of EU of toxin which the patient may receive without suffering toxic reactions
M= maxiumum dose of drug substance per person (or per kg) per hour
What is the K value for parental preparations?
K= 350 per person EXCEPT intrathecal preparations
What is the K value for intrathecal preparations?
14 per person
What is trissel?
Contains drug monographs and provide stability and compatibility information. (no peer review)
Most CIVAS product recalls are due to what?
Labelling errors
