NIOSH recommends medical surveillance of HCWs
In an alert on the handling of hazardous drugs, the National Institute for Occupational Safety and Health included the following recommendations related to medical surveillance:
In addition to preventing exposure to hazardous drugs and carefully monitoring
the environment, make medical surveillance an important part of any safe handling
program for hazardous drugs.
If you handle hazardous drugs, participate in medical surveillance programs
given at your workplace.
If you handle hazardous drugs but have no medical surveillance program at work,
see your private health care provider for routine medical care. Be sure to inform
him or her about your occupation and possible exposures to hazardous drugs.
Refer to the Occupational Safety and Health Administration (OSHA) manual: Controlling
Occupational Exposure to Hazardous Drugs, Section VI, Chapter 2 (OSHA 1999).
It recommends workers handling hazardous drugs be monitored in a medical surveillance
program that includes taking a medical and exposure history, physical examination,
and some laboratory tests.
Refer to guidelines of professional organizations such as the American Society
of Health System Pharmacists (1990) and the Oncology Nursing Society (Brown,
et al, 2001), which recommends medical surveillance as the recognized standard
of occupational health practice for hazardous drug handlers. The American College
of Occupational and Environmental Medicine (ACOEM) also recommends surveillance
for these workers in their Reproductive Hazard Management Guidelines (1996).
Use a worker’s past exposure history as a surrogate measure of potential exposure
intensity.
If you are an occupational health professional who is examining a drug-exposed
worker, ask questions that focus on the worker’s symptoms relating to the organ
systems that are known targets for the hazardous drugs.
- For example, after an acute exposure such as a splash or other drug contact with skin or mucous membranes, focus the physical examination on the exposed areas and the clinical signs of rash or irritation to those areas.
- Include a complete blood count with differential and a reticulocyte count in the baseline and periodic laboratory tests. These may be helpful as an indicator of bone marrow reserve.
Monitor the urine of workers who handle hazardous drugs with a urine dipstick
or a microscopic examination of the urine for blood (Brown, et al, 2001). Several
antineoplastic agents are known to cause bladder damage and blood in the urine
of treated patients.
Conduct environmental sampling and/or biological monitoring when exposure is
suspected or symptoms have been noted.
Source: NIOSH Publication No. 2004-165: Preventing Occupational Exposure to Antineoplastic and Other Hazardous Drugs in Health Care Settings; September 2004.
In an alert on the handling of hazardous drugs, the National Institute for Occupational Safety and Health included the following recommendations related to medical surveillance.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content. TESTING
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