There is a lack of specifics for Hazardous Drug medical surveillance routine screening labs.  A more targeted approach with specific labs may be indicated for a specific acute exposure rather than general medical surveillance.  I am involved in a process that is looking at this as part of USP 800 implementation as part of a pilot regional coordinated approach in the VISN 23 (upper Midwest)  of the Veterans Health Administration.

Probably a more worthwhile focus is improving employee participation and improving collection and assessment of occupational health questionnaires with reproductive history assessment with better exposure assessment .

I didn’t hear anything to strongly support routine annual laboratory medical evaluation as part of medical surveillance at this year’s ACOH Hazardous Drug medical surveillance update  other than consider baseline labs  for a baseline.

The following is a summary of guidelines from OSHA, NIOSH, USP 800.

OSHA Controlling Occupational Exposure to Hazardous Drugs (replaced OSHA Technical Manual)

4.”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.”

NIOSH Medical Surveillance for Health Care Worker exposed to Hazardous Drugs 2013

No specific labs are recommended.  It  is left up to the clinician.

“If clinical laboratory studies and/or biological monitoring is contemplated, a rational approach to selecting clinical studies would consider the toxicity patterns of the drugs to which workers are exposed.”

USP 800

“Lab studies linked to target organs affected by commonly used HDs such as a baseline complete blood count.”

No other specifics given.

Steven Kirkhorn, MD, MPH, MRO, FACOEM, FAAFP

Director, Occupational Health

Minneapolis Veterans Administration Health Care System

One Veteran’s Drive

Minneapolis, MN 55417

(office) 612-467-2985 (direct) 612-629-7662 (fax)  612-467-1592