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

[Davis, Sue]

And what are you doing with the information gained from the questionnaire?  Do you report to the Supervisor they admit to not following PPE?  What about the medical information?  Are you just collecting it?

Thank you,
Sue Davis MS, BSN, RN, CVRN – BC, NE-BC, CCRN-K
Director, Learning Center & Employee Health
Methodist Health System
825 S 169th St, 161, Omaha NE 68118
Phone:  (402) 354-5694
Learning Center Fax: (402) 354-5466
Employee Health Fax: (402) 354-8819
sue.davis at nmhs.org<mailto:sue.davis at nmhs.org>
Making life easier, one day at a time ☺

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Dr Joe Fanucchi
Sent: Monday, May 13, 2019 11:19 AM
To: mcoh-eh at mylist.net
Subject: Re: [MCOH-EH] [EXTERNAL] ACOEM Medical Center Occupational Health Section

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.<https://urldefense.proofpoint.com/v2/url?u=http-3A__www.meditrax.com_&d=DwMDaQ&c=kxdwc7HB3AJZ-oqYwvvR_w&r=ZWIacbfpzd_Lky_E1VB9dV9MNUM6AL2UUAw2IHT0RsM&m=UB-JugZwCD6gNr7rv1eZppNulfZFiJI2ImUa2dker44&s=wVOsKHqwh6HOnV9MpU1t78hs8N1-WTdojHCx3Kj86S8&e=>
o:925-820-7758
c:925-368-3367
drjoe at meditrax.com<mailto:%20drjoe at meditrax.com>
[Image removed by sender.]<https://urldefense.proofpoint.com/v2/url?u=http-3A__www.meditrax.com_&d=DwMDaQ&c=kxdwc7HB3AJZ-oqYwvvR_w&r=ZWIacbfpzd_Lky_E1VB9dV9MNUM6AL2UUAw2IHT0RsM&m=UB-JugZwCD6gNr7rv1eZppNulfZFiJI2ImUa2dker44&s=wVOsKHqwh6HOnV9MpU1t78hs8N1-WTdojHCx3Kj86S8&e=>
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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<https://urldefense.proofpoint.com/v2/url?u=https-3A__www.osha.gov_SLTC_hazardousdrugs_solutions.html&d=DwMDaQ&c=kxdwc7HB3AJZ-oqYwvvR_w&r=ZWIacbfpzd_Lky_E1VB9dV9MNUM6AL2UUAw2IHT0RsM&m=UB-JugZwCD6gNr7rv1eZppNulfZFiJI2ImUa2dker44&s=AjDGoivLh7IPy-T3BT79Hg-uQLZOzYbBnAfTHfeYCVg&e=>

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<https://urldefense.proofpoint.com/v2/url?u=https-3A__www.osha.gov_SLTC_hazardousdrugs_controlling-5Foccex-5Fhazardousdrugs.html-23pre-2Dplacement&d=DwMDaQ&c=kxdwc7HB3AJZ-oqYwvvR_w&r=ZWIacbfpzd_Lky_E1VB9dV9MNUM6AL2UUAw2IHT0RsM&m=UB-JugZwCD6gNr7rv1eZppNulfZFiJI2ImUa2dker44&s=76wLN40adfQG5znr2Zep7WsuJ1RIB2IhYwFpJhGWGSg&e=>
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><mailto: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><mailto:mcoh-eh at mylist.net>
Cc: Mickelson, John G. <John.Mickelson2 at va.gov><mailto: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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