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 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.
o:925-820-7758
c:925-368-3367
drjoe@meditrax.com

MediTrax software: Everything you need, at a fraction of the cost!

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@mylist.net> On Behalf Of Mickelson, John G. via MCOH-EH
Sent: Monday, May 13, 2019 9:44 AM
To: MCOH/EH <mcoh-eh@mylist.net>
Cc: Mickelson, John G. <John.Mickelson2@va.gov>
Subject: Re: [MCOH-EH] [EXTERNAL] ACOEM Medical Center Occupational Health Section

 

Will ACOEM publish USP 800 medical surveillance guidelines?