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NIOSH Publication No. 2007-117:Medical Surveillance for Health Care Workers Exposed to Hazardous Drugs |
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SummaryHealth care workers who handle, prepare, or administer hazardous drugs may face risks to their own health such as skin rashes, cancer, and reproductive disorders. NIOSH recommends that employers establish a medical surveillance program to protect workers who handle hazardous drugs in the workplace. Description of ExposureDrugs are considered hazardous if studies in animals or humans show that exposures to them have a potential for causing cancer, reproductive toxicity, birth defects, or acute harm to health. In the United States, an estimated 5.5 million health care workers are potentially exposed to hazardous drugs or drug waste at their worksites. Figure 1. Multi-channel infusion pump for delivery of chemotherapy. Many hazardous drugs are used to treat illnesses such as cancer or HIV infection (see Figure 1). For the patients, the potential benefits of hazardous drugs outweigh the possible negative side effects. However, exposed health care workers risk the same side effects with no positive benefit. Workers exposed to hazardous drugs have developed skin rashes, adverse reproductive effects, and possibly leukemia and other cancers. For example, nurses and pharmacists who were exposed to hazardous drugs at their worksite reported an increase in adverse reproductive events including spontaneous abortions, stillbirths, and congenital malformations compared with unexposed health care workers [NIOSH 2004]. Exposure to hazardous drugs may occur through inhalation, skin contact, skin absorption, ingestion, or injection. Inhalation or skin contact and absorption are the most likely ways a worker may be exposed to hazardous drugs. However, ingestion (from hand to mouth) or injection through a needlestick or sharps injury is possible. Medical SurveillanceA comprehensive approach to minimizing worker exposure should be used as 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. 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 establish a baseline of workers’ health and then 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 [ASHP 2006; OSHA 1999]. This includes workers who directly handle hazardous drugs such as nurses, pharmacists, and pharmacy technicians. In addition, other workers (e.g., nurses’ aides, laundry workers) who may come directly into contact with patient wastes within 48 hours after a patient has received a hazardous drug should be included in a medical surveillance program. Elements of a Medical Surveillance ProgramThe elements of a medical surveillance program for hazardous drugs should include (at a minimum):
Periodic health questionnaires and laboratory results should be looked at for trends that may be a sign of health changes because of exposure to hazardous drugs. If health changes are found, the employer should take the following actions:
AcknowledgmentsThe principal authors of this document were Melissa Leone, Apria Healthcare; Melissa McDiarmid, University of Maryland; Marty Polovich, Oncology Nursing Society; Barbara Coyle, Wisconsin State Laboratory of Hygiene; Luci Power, University of California Medical Center in San Francisco, and Thomas H. Connor and Laurence D. Reed of the National Institute for Occupational Safety and Health. John J. Whalen, under a contract with the Division of Federal Occupational Health, served as the lead writer/editor. References
For More InformationNIOSH has published an Alert describing measures to control worker exposure to hazardous drugs: www.cdc.gov/niosh/docs/2004-165/. Additional information about hazardous drugs is available on the NIOSH website at www.cdc.gov/niosh/topics/hazdrug/default.html. To receive copies of NIOSH publications, contact NIOSH at: NIOSH Telephone: 1–800–35–NIOSH (1–800–356–4674) Or visit the NIOSH Web site at www.cdc.gov/niosh. For a monthly update on news at NIOSH, subscribe to NIOSH enews by visiting www.cdc.gov/niosh/eNews. Medical Surveillance for Health Care Workers Exposed to Hazardous Drugs |
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