[MCOH-EH] [EXTERNAL] Re: [External] Medical surveillance for employees who work with hazardous drugs

[Wendy Thanassi]

Do you include OR formaldehyde on the list of hazardous exposures?

I learned more about this recently, and we are looking to revise the
guidelines for persons who work in the OR dropping samples into
formaldehyde. so that it includes using closed systems instead of open-air
formaldehyde cups.

Is anyone else using these systems?

Wendy

On Tue, Jul 29, 2025 at 12:53 PM Swift, Melanie D., M.D., M.P.H. via
MCOH-EH <mcoh-eh at mylist.net> wrote:

> Hi Elizabeth, we presented our experience with hazardous medication
> medical surveillance at Mayo at the 2024 AOHC. We do offer surveillance. It
> is “opt out” for nurses, pharmacists & others who are identified as
> handling hazardous medication, and “opt in” for workers who have less
> exposure (like housekeeping staff). The surveillance interval is every 2
> years and consists of an electronic questionnaire. We included an optional
> CBC initially, but after evaluating our data, we determined this was not
> helpful. Over 50% had some CBC abnormality and on regression analysis there
> was no association between lab abnormalities and exposure frequency,
> intensity, or duration, exposure to a spill, or spill cleanup.
>
>
>
> We’ve found that the most valuable part of the questionnaire is a question
> asking if they have any safety concerns in their work area. Some workers
> feel more comfortable reporting concerns to OHS, and we’ve been able to
> facilitate improvements in communication, training or procedures.
>
> I hope this helps. We do plan to publish our experience, so stay tuned!
>
>
>
> Melanie
>
>
>
> *Melanie Swift, MD, MPH*
>
> Professor of Medicine
>
> Vice Chair, Division of Public Health, Infectious Diseases and
> Occupational Medicine
>
> Medical Director, Mayo Clinic Physician Health Center
> <https://www.mayoclinic.org/departments-centers/preventive-occupational-aerospace-medicine/physician-health-center/referrals>
>
> Associate Medical Director, Occupational Health Service
>
> Vice Chair, Institutional Biosafety Committee
>
> _______________________________
> *Mayo Clinic*
> 200 First Street SW
> Rochester, MN 55905
>
>
>
> *From:* MCOH-EH <mcoh-eh-bounces at mylist.net> *On Behalf Of *Winters, Tom
> (BIDMC - Occupational Health)
> *Sent:* Monday, July 28, 2025 12:07 PM
> *To:* MCOH-EH <mcoh-eh at mylist.net>
> *Cc:* Elizabeth Esty <ELIZABETH.ESTY at cuanschutz.edu>; mcoh-eh at mylist.net
> *Subject:* [EXTERNAL] Re: [MCOH-EH] [External] Medical surveillance for
> employees who work with hazardous drugs
>
>
>
> At several Harvard teaching hospitals we have post exposure programs, no
> annual surveillance
>
> Tom Winters
>
>
>
>
>
> On Jul 28, 2025, at 11:35 AM, Esty, Elizabeth via MCOH-EH <
> mcoh-eh at mylist.net> wrote:
>
> 
>
> Hi All,
>
>
>
> I've tried to look through the archive, but I don't see anything
> addressing this topic since 2017. (It's very possible I missed something.)
>
>
>
> I've recently begun working in a medical center occupational health
> clinic. We have a medical surveillance program for employees who work with
> hazardous drugs that adheres to OSHA standards
> <https://urldefense.com/v3/__https://www.osha.gov/hazardous-drugs/standards__;!!AIv8Mrc!-LpJ_2E5zKb_xbDRcMmEyB1czgsW7ik4hFMKNj6102xLpXDnPpJCnI8ip7NrHF2x5h9VHSelnTniq0eThXYIon7m$>,
> USP 800 and ONS/ASCO guidance. We also use NIOSH materials, including the
> 2024 update
> <https://urldefense.com/v3/__https://www.cdc.gov/niosh/newsroom/updates/upd-12-20-25.html*:*:text=Updates*20in*20the*202024*20list,Drug*20Exposure*20in*20Healthcare*20webpage.__;I34lJSUlJSUlJQ!!AIv8Mrc!-LpJ_2E5zKb_xbDRcMmEyB1czgsW7ik4hFMKNj6102xLpXDnPpJCnI8ip7NrHF2x5h9VHSelnTniq0eThcLMEs8J$> on
> list of hazardous drugs.
>
>
>
> We've been debating whether or not to expand surveillance to housekeepers
> and OR staff with frequent exposures and to nurses who handle only oral
> drugs on the NIOSH list.
>
>
>
> I reached out to several larger hospital systems and found that at least
> two do not have surveillance programs of any kind. They've decided that
> their employees don't have significant exposures and that the challenge of
> linking exposure to outcome is too great to make surveillance effective.
> The Joint Commission appears not to require a program.
>
>
>
> I would love to know how other medical center occupational health centers
> across the US (and abroad) are approaching medical surveillance. If your
> medical center is opting not to surveille at all, please let me know.
>
>
>
> Thank you,
>
> Elizabeth Esty
>
>
>
>
>
> Elizabeth Esty, M.D., M.P.H.
>
> Board Certified in Occupational and Environmental Medicine
>
> Assistant Program Director, University of Colorado Residency in
> Occupational and Environmental Medicine
>
> Department of Environmental and Occupational Health
>
> University of Colorado Anschutz Medical Campus
>
> Level II Certified, Colorado Division of Workers' Compensation
>
> elizabeth.esty at cuanschutz.edu
>
> 303-229-2325
>
>
>
> <Outlook-id2h2v2r.png>
>
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> The MCOH-EH List has always been moderated by members of the ACOEM Medical
> Center Occupational Health Section. It is currently moderated by Joe
> Fanucchi MD FACOEM.
> List membership is free, but only subscribers may post to the list.
> To post send messages to: mcoh-eh at mylist.net
> To become a subscriber, or to change your subscription options (turn off
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> MediTrax / Occupational Health Systems, Inc. provides financial support to
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