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In-Depth Survey Report: Engineering Control Evaluation at Veterinary Hospital A
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2019/09/01
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Series: Control Technology Field Studies
[PDF-5.93 MB]
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Description:NIOSH researchers conducted two field surveys at Veterinary Hospital A in March 2017 and one field survey in August 2018. The purpose of the site visits was to identify and evaluate hazardous drug engineering controls as well as to sample for potential surface contamination at the hospital. NIOSH researchers also observed and interacted with the hospital's veterinarians and staff to obtain information about the hazardous drug work practices and daily activities along with the oncology treatment processes. A TSI VelociCalc(TM) Plus Model 9555-P thermal anemometer was used to measure air velocities at the face of the Class II Type A Model BBF-2SSCH biological safety cabinet (BSC), while a Wizard Stick handheld smoke generator was used to visualize air movement inside and around the periphery of the BSC. The average face velocity of the hood was 0.32 m/s (63 fpm), which is below the minimum recommended face velocity (i.e., 0.38 m/s [75 fpm]) for a Class II Type A1 BSC. However, the qualitative test on the hood using a Wizard Stick handheld smoke generator indicated good capture efficiency. The BSC recirculated 100% of the filtered exhaust air back into the chemotherapy preparation room and did not exhaust to the outdoors. The room static pressure was measured using the manometer function of the TSI VelociCalc(TM) and found to be under negative pressure. The presence of potential surface contamination was evaluated with wipe samples. These were collected in areas where the workers handled chemotherapy drugs, such as the examination rooms and chemotherapy preparation room. Wipe samples were also collected in less obvious places (i.e., telephones, door handles) to determine if current workplace safety practices at the hospital were adequate to prevent inadvertent contamination of these surfaces. Sampling and analytical procedures varied by the hazardous drug for which they would be evaluated (i.e., the analyte). In some cases, a single sample could be evaluated for more than one analyte simultaneously. Vincristine, doxorubicin, and vinblastine were the only hazardous drugs actually in use during the two NIOSH visits. Sample analyses results revealed that 4 of 13 wipe samples submitted for toceranib analyses were positive (0.11 to 0.44 ng) while simultaneously being non-detectable (ND) for mitoxantrone, lomustine, and chlorambucil during the two surveys in March 2017. Thirteen out of 13 samples submitted for N-methyldiethanolamine (MDEA) analyses were also positive (4.6 to 1940 ng) during the two surveys in March 2017. For the August 2018 survey, 3 of 3 wipe samples submitted for MDEA were positive (17.6 to 44.1 ng) while simultaneously being ND for lomustine, chlorambucil, and toceranib. During the two surveys in March, six samples submitted for vinblastine, five samples submitted for carboplatin and 21 samples submitted for simultaneous vincristine, methotrexate, cyclophosphamide, epirubicin, and doxorubicin analyses all resulted in a ND except for one, which was positive for vincristine. The ND determination means that contamination was either not present, or it was present at levels below the limit of detection of the analytical method. MDEA was monitored as a potential stable marker for the highly unstable antineoplastic drug mustargen as explained in the text. Although many of the wipe sample analytical results were ND, there is no safe level of exposure when handling hazardous drugs. The presence of vincristine contamination is a reminder that the patients themselves can be a source of exposure, even when the drugs are not handled directly by hospital personnel. The toceranib and MDEA presence serves as two reminders: (1) that hazardous drug contamination can sometimes linger despite cleaning efforts and (2) the detected contamination on cabinet surfaces one might ordinarily think of as "safe", emphasizes the importance of proper work practices regarding the use of gloves and shoe covers, hand washing, and food/drink prohibitions within the hazardous drug handling environments. Therefore, it is important to continue to use engineering controls (e.g., biological safety cabinets), supplementary controls (e.g., closed system drug-transfer devices), protective work practices (e.g., surface cleaning after every oncology patient, regardless of whether I.V. chemotherapy was administered), and personal protective equipment (e.g., gloves and gowns rated for chemotherapy protection, respirators, shoe covers, eye protection) to reduce unintentional exposures to the staff or pet owners.
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DOI:10.26616/NIOSHEPHB38011a
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Pages in Document:1-48
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Contributor:Alexander-Scott, Marissa;Drnevich, Maura;
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NIOSHTIC Number:20059171
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NTIS Accession Number:PB2021-100106
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Citation:Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, EPHB Report No. 380-11a, 2019 Sep; :1-48
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Federal Fiscal Year:2019
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Peer Reviewed:False
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Resource Number:EPHB-380-11a
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