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This Document Has Been Replaced By: In-Depth Survey Report: Engineering Control Evaluation at Veterinary Hospital B [revised]
Superseded
This Document Has Been Replaced By: In-Depth Survey Report: Engineering Control Evaluation at Veterinary Hospital B [revised]
In-Depth Survey Report: Engineering Control Evaluation at Veterinary Hospital B [superseded]
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2019/10/01
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Series: Control Technology Field Studies
[PDF-3.76 MB]
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Description:This document has been superseded and the new version can be found https://stacks.cdc.gov/view/cdc/175035 : NIOSH researchers conducted a field survey at Veterinary Hospital B in May 2017. The purpose of the site visit 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 9565-P thermal anemometer was used to measure air velocities at the face of the fume hood, while a Wizard Stick handheld smoke generator was used to visualize air movement inside and around the periphery of the hood. Both the qualitative and quantitative tests showed that the chemical fume hood was operating appropriately. The fume hood's face velocity (0.44 m/s [86.5 fpm]) was within the range of operation of 0.41 to 0.51 m/s (80 to 100 fpm) that is considered adequate for most hoods. A TSI Accubalance Plus Air Capture Hood Model 8373 was used to measure the supply (0.33 m3/s or 704 cfm) and exhaust (0.345 m3/s or 737 cfm) ventilation in the oncology department. The air changes per hour (ACH) of the oncology department was calculated from the exhaust rate to be 11, which is less than the required ACH (minimum 12 ACH) for unclassified containment secondary engineering control. The room static pressure was measured using the manometer function of the TSI VelociCalc(TM) and found to be under negative pressure, which is preferred when administering chemotherapy. The presence of potential surface contamination was evaluated through the use of wipe samples. These were collected in areas where chemotherapy drugs were handled by the workers, such as the pharmacy, oncology, intensive care unit, and research departments. Wipe samples were also collected in less obvious places (i.e., telephone, door handles) to determine if the hospital's current workplace safety practices 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. These sampling methods are internal and were created specifically for this research study. There is limited data on recovery studies from various surfaces. Carboplatin and cyclophosphamide were the only hazardous drugs actually in use during the NIOSH visit. Sample analyses results revealed that 7 of 7 wipe samples submitted for toceranib analysis (an observed patient was on toceranib) came back positive (0.063 to 4.4 ng). Seven of 7 of the samples submitted for N-methyldiethanolamine (MDEA) analyses were also positive (1.6 to 15 ng) while simultaneously being non-detectable for lomustine and chlorambucil. Two samples submitted for vinblastine, 8 samples submitted for carboplatin and 21 samples submitted for simultaneous vincristine, methotrexate, cyclophosphamide, epirubicin, and doxorubicin analyses all resulted in a non-detectable (ND) determination, meaning that contamination was either not present, or was present at levels below the detectable limit 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 toceranib and MDEA contamination serves as two reminders: (1) that the patients themselves can be a source of exposure, even when the drugs are not being directly handled and (2) that hazardous drug contamination can sometimes linger despite cleaning efforts. This 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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Pages in Document:1-41
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Contributor:Mead, Kenneth R.;Neu, Dylan;
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NIOSHTIC Number:20059174
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NTIS Accession Number:PB2021-100104
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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. 380-12a, 2019 Oct; :1-41
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Federal Fiscal Year:2020
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Peer Reviewed:False
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Resource Number:EPHB-380-12a
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