![]() | The examples and perspective in this article deal primarily with the United States and do not represent a worldwide view of the subject.(November 2009) |
In pharmacology, hazardous drugs are drugs that are known to cause harm, which may or may not include genotoxicity (the ability to cause a change or mutation in genetic material). Genotoxicity might involve carcinogenicity , the ability to cause cancer in animal models, humans or both; teratogenicity , which is the ability to cause defects on fetal development or fetal malformation; and lastly hazardous drugs are known to have the potential to cause fertility impairment, which is a major concern for most clinicians. [1] These drugs can be classified as antineoplastics , cytotoxic agents, biologic agents, antiviral agents and immunosuppressive agents. This is why safe handling of hazardous drugs is crucial.
Safe handling refers to the process in which health care workers adhere to practices set forth by national health and safety organizations, that have been designed to eliminate or significantly reduce occupational exposure. Some of these practices include but are not limited to, donning of personal protective equipment such as a disposable gown, gloves, masks and the utilization of a closed-system drug transfer device. The key safe handling is to protect the health care worker throughout the three phases of contact with the hazardous drugs. These phases are drug preparation, administration and disposal. Some studies have shown that while compounding hazardous drugs in a Class II BSC in conjunction with a closed-system drug transfer device, a significant decrease in drug contaminants inside a Class II BSC has resulted. [2] This led the Oncology Nursing Society (ONS) to make the statement in 2003 that a closed-system drug transfer device is viewed as one of safest measures to prevent hazardous drug exposure in a clinician’s working environment. [3] However, a Cochrane review published in 2018 that synthesized all available controlled studies found no evidence of a closed-system drug transfer device offering an additional decrease in contamination or exposure to safe handling practices alone. [4]
It has been determined that current personal protective equipment (PPE) does not provide adequate protection against workers handling hazardous drugs - NIOSH states that “... measurable concentrations of some hazardous drugs have been documented in the urine of health care workers who prepared or administered them − even after safety precautions had been employed.” [1] Further, NIOSH recommends that institutions should "consider using devices such as closed-system transfer devices. Closed systems limit the potential for generating aerosols and exposing workers". [1] Other guidelines outline that "As other products become available, they should meet the definition of a closed system drug transfer device established by NIOSH and should be required to demonstrate their effectiveness in independent studies". [2]
Chemotherapy is a type of cancer treatment that uses one or more anti-cancer drugs as part of a standardized chemotherapy regimen. Chemotherapy may be given with a curative intent or it may aim to prolong life or to reduce symptoms. Chemotherapy is one of the major categories of the medical discipline specifically devoted to pharmacotherapy for cancer, which is called medical oncology.
Personal protective equipment (PPE) is protective clothing, helmets, goggles, or other garments or equipment designed to protect the wearer's body from injury or infection. The hazards addressed by protective equipment include physical, electrical, heat, chemicals, biohazards, and airborne particulate matter. Protective equipment may be worn for job-related occupational safety and health purposes, as well as for sports and other recreational activities. Protective clothing is applied to traditional categories of clothing, and protective gear applies to items such as pads, guards, shields, or masks, and others. PPE suits can be similar in appearance to a cleanroom suit.
Coal dust is a fine powdered form of which is created by the crushing, grinding, or pulverizing of coal. Because of the brittle nature of coal, coal dust can be created during mining, transportation, or by mechanically handling coal. It is a form of fugitive dust.
A blood-borne disease is a disease that can be spread through contamination by blood and other body fluids. Blood can contain pathogens of various types, chief among which are microorganisms, like bacteria and parasites, and non-living infectious agents such as viruses. Three blood-borne pathogens in particular, all viruses, are cited as of primary concern to health workers by the CDC-NIOSH: HIV, hepatitis B (HVB), & hepatitis C (HVC).
An occupational injury is bodily damage resulting from working. The most common organs involved are the spine, hands, the head, lungs, eyes, skeleton, and skin. Occupational injuries can result from exposure to occupational hazards, such as temperature, noise, insect or animal bites, blood-borne pathogens, aerosols, hazardous chemicals, radiation, and occupational burnout.
The National Institute for Occupational Safety and Health is the United States federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. NIOSH is part of the Centers for Disease Control and Prevention (CDC) within the U.S. Department of Health and Human Services. Despite its name, it is not part of the National Institutes of Health. Its current director is John Howard.
Occupational noise is the amount of acoustic energy received by an employee's auditory system when they are working in the industry. Occupational noise, or industrial noise, is often a term used in occupational safety and health, as sustained exposure can cause permanent hearing damage. Occupational noise is considered an occupational hazard traditionally linked to loud industries such as ship-building, mining, railroad work, welding, and construction, but can be present in any workplace where hazardous noise is present.
Occupational hygiene is the anticipation, recognition, evaluation, control, and confirmation (ARECC) of protection from risks associated with exposures to hazards in, or arising from, the workplace that may result in injury, illness, impairment, or affect the well-being of workers and members of the community. These hazards or stressors are typically divided into the categories biological, chemical, physical, ergonomic and psychosocial. The risk of a health effect from a given stressor is a function of the hazard multiplied by the exposure to the individual or group. For chemicals, the hazard can be understood by the dose response profile most often based on toxicological studies or models. Occupational hygienists work closely with toxicologists for understanding chemical hazards, physicists for physical hazards, and physicians and microbiologists for biological hazards. Environmental and occupational hygienists are considered experts in exposure science and exposure risk management. Depending on an individual's type of job, a hygienist will apply their exposure science expertise for the protection of workers, consumers and/or communities.
A chemical hazard is a (non-biological) substance that has the potential to cause harm to life or health. Chemicals are widely used in the home and in many other places. Exposure to chemicals can cause acute or long-term detrimental health effects. There are many types of hazardous chemicals, including neurotoxins, immune agents, dermatologic agents, carcinogens, reproductive toxins, systemic toxins, asthmagens, pneumoconiotic agents, and sensitizers. In the workplace, exposure to chemical hazards is a type of occupational hazard. The use of protective personal equipment (PPE) may substantially reduce the risk of damage from contact with hazardous materials.
A health professional, healthcare professional, or healthcare worker is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a nurse, physician, physician assistant, registered dietitian, veterinarian, veterinary technician, optometrist, pharmacist, pharmacy technician, medical assistant, physical therapist, occupational therapist, dentist, midwife, psychologist, or who perform services in allied health professions. Experts in public health and community health are also health professionals.
An occupational hazard is a hazard experienced in the workplace. This encompasses many types of hazards, including chemical hazards, biological hazards (biohazards), psychosocial hazards, and physical hazards. In the United States, the National Institute for Occupational Safety and Health (NIOSH) conduct workplace investigations and research addressing workplace health and safety hazards resulting in guidelines. The Occupational Safety and Health Administration (OSHA) establishes enforceable standards to prevent workplace injuries and illnesses. In the EU, a similar role is taken by EU-OSHA.
An occupational exposure limit is an upper limit on the acceptable concentration of a hazardous substance in workplace air for a particular material or class of materials. It is typically set by competent national authorities and enforced by legislation to protect occupational safety and health. It is an important tool in risk assessment and in the management of activities involving handling of dangerous substances. There are many dangerous substances for which there are no formal occupational exposure limits. In these cases, hazard banding or control banding strategies can be used to ensure safe handling.
Workplace health surveillance or occupational health surveillance (U.S.) is the ongoing systematic collection, analysis, and dissemination of exposure and health data on groups of workers. The Joint ILO/WHO Committee on Occupational Health at its 12th Session in 1995 defined an occupational health surveillance system as "a system which includes a functional capacity for data collection, analysis and dissemination linked to occupational health programmes".
A physical hazard is an agent, factor or circumstance that can cause harm with contact. They can be classified as type of occupational hazard or environmental hazard. Physical hazards include ergonomic hazards, radiation, heat and cold stress, vibration hazards, and noise hazards. Engineering controls are often used to mitigate physical hazards.
A closed system drug transfer device or "CSTD" is a drug transfer device that mechanically prohibits the transfer of environmental contaminants into a system and the escape of hazardous drug or vapor concentrations outside the system. Open versus closed systems are commonly applied in medical devices to maintain the sterility of a fluid pathway. CSTDs work by preventing the uncontrolled inflow and outflow of contaminants and drugs, preserving the quality of solution to be infused into a patient. Theoretically, CSTDs should enable complete protection to healthcare workers in managing hazardous drugs, but possibly due to improper handling or incomplete product design, contaminants can still be detected despite use of CSTDs.
ICU Medical, Inc. is a San Clemente, California-based company with global operations that develops, manufactures, and sells medical technologies used in vascular therapy, oncology, and critical care applications.
Occupational safety and health (OSH), also commonly referred to as occupational health and safety (OHS), occupational health, or occupational safety, is a multidisciplinary field concerned with the safety, health, and welfare of people at work. These terms also refer to the goals of this field, so their use in the sense of this article was originally an abbreviation of occupational safety and health program/department etc.
Occupational hearing loss (OHL) is hearing loss that occurs as a result of occupational hazards, such as excessive noise and ototoxic chemicals. Noise is a common workplace hazard, and recognized as the risk factor for noise-induced hearing loss and tinnitus but it is not the only risk factor that can result in a work-related hearing loss. Also, noise-induced hearing loss can result from exposures that are not restricted to the occupational setting.
Engineering controls are strategies designed to protect workers from hazardous conditions by placing a barrier between the worker and the hazard or by removing a hazardous substance through air ventilation. Engineering controls involve a physical change to the workplace itself, rather than relying on workers' behavior or requiring workers to wear protective clothing.
The health and safety hazards of nanomaterials include the potential toxicity of various types of nanomaterials, as well as fire and dust explosion hazards. Because nanotechnology is a recent development, the health and safety effects of exposures to nanomaterials, and what levels of exposure may be acceptable, are subjects of ongoing research. Of the possible hazards, inhalation exposure appears to present the most concern, with animal studies showing pulmonary effects such as inflammation, fibrosis, and carcinogenicity for some nanomaterials. Skin contact and ingestion exposure, and dust explosion hazards, are also a concern.