Assessing variability of antineoplastic drugs handling practices in clinical settings

Source avec lien : Journal of Occupational and Environmental Hygiene, (Prépublication), 10/17/2019. 10.1080/15459624.2019.1667502

Le chapitre <800> des lignes directrices de la United States Pharmacopeia (USP) sera adopté aux États-Unis et au Canada en 2019, exigeant un échantillonnage de surface régulier pour la contamination de surface des médicaments antinéoplasiques (MA) comme moyen de surveillance environnementale. Le chapitre USP <800> ne donne aucune indication sur le moment et l’endroit de l’échantillonnage. La recherche à l’appui de l’élaboration d’une telle orientation dans le cadre d’une stratégie d’échantillonnage plus large est limitée. Cette étude a été menée pour aider à combler certaines lacunes d’information sous-jacentes en identifiant les surfaces sur lesquelles le personnel infirmier et les pharmaciens sont susceptibles de communiquer et qui présentent un risque potentiel d’exposition cutanée.

The United States Pharmacopeia (USP) Chapter <800> guidelines will be adopted in the U.S. and Canada in 2019, requiring regular surface sampling for antineoplastic drug (AD) surface contamination as a means of environmental surveillance. USP Chapter <800> does not provide guidance on when and where to sample. Research to support the development of such guidance within a broader sampling strategy is limited. This study was conducted to help address some of the underlying information gaps by identifying surfaces pharmacy and nursing staff are likely to contact, presenting a potential dermal exposure risk. Observations were conducted at one regional and one urban clinic, providing insight into inter- and intra-worker variability and between-clinic differences based on size and patient load. Thirteen surfaces in the compounding pharmacies and 14 surfaces in the patient administration were initially selected for video observations. Following a preliminary assessment to eliminate surfaces that were touched infrequently or not at all, five commonly touched surfaces in the compounding pharmacy areas (vials, syringes, IV lines, IV bags, waste bags) and six commonly touched surfaces in the patient administration area (yellow containment bag, IV bag, IV line, patient port, computer workstation) were assessed further. Variability between healthcare staff and clinics in pharmacy staff was low for both the mean frequency and duration of touch to surfaces. Differences between clinics in frequency of contact among nursing staff in patient administration areas were significant (two-way ANOVA) for five of the six surfaces. Duration of contact was not significantly different except for duration of touching the IV pump. These insights will be used to give guidance in selecting locations for a longitudinal surveillance study and help tailor worker training to reduce exposure risks.

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