[MCOH-EH] [EXTERNAL] ACOEM Medical Center Occupational Health Section

[Dr Joe Fanucchi]

Colleagues,


As Dr Hodgson indicates, there was extended discussion of this subject 
at the dinner meeting of the ACOEM Medical Center Occupational Health 
Section in Anaheim. Employee Health directors from several institutions 
which routinely administer cancer chemotherapy agreed that, as Dr Andrew 
Vaughn <mailto:vaughn.andrew at mayo.edu> of the Rochester Mayo Clinic has 
stated,

    /"given the lack of truly relevant lab tests, and the difficulty of
    identifying and cleaning up contaminated surfaces, the greatest
    effort and importance should be directed at preventing
    dermal/inhalation/parenteral exposures through the use of
    engineering controls. Administering questionnaires and providing
    training on effective work practices will hopefully meet USP 800
    requirements."/

Regards,


Joe Fanucchi


*Joe Fanucchi MD FACOEM*
President and Medical Director
MediTrax / OHS, Inc. <http://www.meditrax.com/>
o:925-820-7758
c:925-368-3367
drjoe at meditrax.com <mailto: drjoe at meditrax.com>
<http://www.meditrax.com/>
/MediTrax software: Everything you need, at a fraction of the cost!/

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On 5/13/2019 8:08 AM, Hodgson, Michael - OSHA via MCOH-EH wrote:
>
> Two years ago, OSHA redid its hazardous drugs webpage about two years 
> ago, as the USP 800 document was in review and release preparation.
>
> https://www.osha.gov/SLTC/hazardousdrugs/solutions.html
>
> We did attach a white paper that went through internal concurrence and 
> so had some changes from the version initially submitted by an outside 
> consultant.  OSHA’s view was that “
>
> https://www.osha.gov/SLTC/hazardousdrugs/controlling_occex_hazardousdrugs.html#pre-placement 
>
>
> That contains the following language:
>
> 1.The most valuable test in a laboratory assessment is a complete 
> blood count with differential. This allows for a determination of any 
> pre-existing blood condition that may place the worker at increased 
> risk when handling HDs. Other laboratory testing (liver function 
> tests, blood urea nitrogen, creatinine, and a urine dipstick for 
> blood) may sometimes be appropriate (Polovich, 2011). However, these 
> tests should be conducted only at the discretion of the physician, as 
> a function of the medical history obtained, or as part of a formal 
> surveillance program with well-defined goals.
>
> 2.Due to poor reproducibility, inter-individual variability, and 
> difficulty in interpreting individual results, measures of genetic 
> effects (i.e., chromosomal aberrations, micronuclei, or other markers 
> of genotoxic exposure) are not recommended in routine surveillance.
>
> 3.Biological monitoring, i.e., the measure of a specific agent or its 
> metabolite in a body fluid (such as a urine 5-FU level), is also not 
> recommended for a screening protocol on a routine basis due to the 
> large number of agents an employee handles on a given work shift.
>
> There are additional sections on periodic and post-exposure 
> examinations.  This was discussed extensively at one of the MCOH meetings.
>
> Michael Hodgson, MD, MPH
>
> Chief Medical Officer
>
> Occupational Safety and Health Administration
>
> 200 Constitution Ave NW Rm3653
>
> Washington DC 20210
>
> 202-693-1768
>
> *From:*MCOH-EH <mcoh-eh-bounces at mylist.net> *On Behalf Of *Mickelson, 
> John G. via MCOH-EH
> *Sent:* Monday, May 13, 2019 9:44 AM
> *To:* MCOH/EH <mcoh-eh at mylist.net>
> *Cc:* Mickelson, John G. <John.Mickelson2 at va.gov>
> *Subject:* Re: [MCOH-EH] [EXTERNAL] ACOEM Medical Center Occupational 
> Health Section
>
> Will ACOEM publish USP 800 medical surveillance guidelines?
>

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