What a frustrating topic. This would be lovely if there was a biomarker for exposure that would be sensitive and specific for adverse effects from the drugs being handled, but this does not exist. Beth Baker
did an MCOH survey several years back and found that some places do health and reproductive surveys, others add basic labs like a CBC, U/A and LFTs, while others do not do any routine medical surveillance except for acute exposures. Of those who did symptom
surveys or labs, none reported this being effective or informative. (This is probably in the MCOH listserv archives somewhere, if anyone has time to search…)
Laboratory abnormalities are very common in the general population (estimates roughly 50% of the unexposed population would have some abnormal value if you do random CBC, U/A and LFTs) and if you find it in the
course of a medical surveillance program, then you have some obligation to work it up or refer the patient further. Malignancy is the main concern with most chemotherapeutic agents, and CBC, U/A and LFTs are not recommended as screening tests for any malignancy.
Furthermore, reproductive surveys run the very real risk of implying to the workers that every miscarriage is work-related, even if the rate of miscarriage is the same or lower than the general population.
We do acute and f/u evaluations after a spill or identified exposure, targeted to the specific drug and the findings one might expect at the timing indicated for that drug.
We do have a policy that allows workers who are pregnant or attempting pregnancy to request temporary reassignment.
Our safety colleagues do regular formal environmental monitoring with wipes in the pharmacy rooms with BSCs where chemo is mixed. This has been the most important thing to monitor for exposure risk and helps
greatly to reassure staff of their safety.
Melanie Swift, MD
Director, Vanderbilt Occupational Health Clinic
From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net]
On Behalf Of Hodgson, Michael - OSHA
Sent: Wednesday, May 20, 2015 11:59 AM
To: MCOH/EH
Subject: Re: [MCOH-EH] Chemo Medical Surveillance
Hi, all, OSHA is interested in that letter, too, as we are trying to consider / updating our web work. Melanie and Mark, would you send that to OSHA, too?
1.
It would be really interesting to know whether anyone does “surveillance” , i.e., whether you collect a CBC, whether you collect anything more, whether you collect information on reproductive efforts
or outcomes, and whether you ever collect biological monitoring samples, for example after spills and other unexpected exposures (like ventilation system failures in pharmacies)
2.
Do people formally acknowledge and follow Oncology Nursing Society procedures? Are those acknowledged and supported by your pharmacy and nursing leadership?
3.
Do people have a formal policy on managing workers of reproductive age who are considering / planning active reproduction? Would this group be willing to answer whether
a.
You offer people a chance to transfer to a job without exposure? (men too?)
b.
Let people transfer out of an exposed job once they are pregnant?
c.
Mandate that people transfer out of an exposed job once pregnancy is known?
4.
Does anyone do formal exposure assessment, i.e., wipe samples outside of pharmacy cabinets?
Exposed here means simply working with cytotoxic agents…
Michael Hodgson, MD
OSHA Office of Occupational Medicine and Nursing
From: MCOH-EH [mailto:mcoh-eh-bounces+hodgson.michael=dol.gov@mylist.net]
On Behalf Of Swift, Melanie
Sent: Wednesday, May 20, 2015 12:48 PM
To: MCOH/EH
Subject: Re: [MCOH-EH] Chemo Medical Surveillance
Our esteemed colleague Dr. Russi at Yale drafted a letter to NIOSH on this subject last summer which encapsulates this quagmire nicely.
Mark, would you to share this with the list or do you mind if I share it (I have it handy, I read it often…)
Melanie Swift, MD
Director, Vanderbilt Occupational Health Clinic
From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net]
On Behalf Of Schweitzer, Kit
Sent: Wednesday, May 20, 2015 11:41 AM
To: mcoh-eh@mylist.net
Subject: [MCOH-EH] Chemo Medical Surveillance
I am an Employee Health Nurse at a hospital in Oregon. Do any of you do medical surveillance for staff administering or handling chemo drugs?
If so, can you please describe your policy. If not, can you please provide reasons why.
Thank you in advance for your answer.
Kit Schweitzer, RN, BSN, COHN
Employee Health Nurse
Employee Health and Safety
Sacred Heart Medical Center
(541) 222-2544
Office
(541) 434-3140
e-Fax
3333 RiverBend Drive, Springfield, OR 97477
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