Based on NIOSH 2014 standards that is below. They will read the definition of a drug considered dangerous, how we are exposed to it and its effects…

QuestionAnswered step-by-stepBased on NIOSH 2014 standards that is below. They will read the definitionof a drug considered dangerous, how we are exposed to it and its effects on the health of the nurse. After reading it, you will respond in writing to the following question: Do you consider that, in health areas, nurses staff are oriented about dangerous drugs and how to handle them “A BRIEF GUIDE TO DANGEROUS MEDICINES FORNURSING PROFESSIONALS “, PREPARED BYTWO NURSES FROM THE WORKING GROUP OFOCCUPATIONAL HEALTH OF THE NURSING COUNCIL OFTHE VALENCIAN COMMUNITY (CECOVA); SO WHATIT HAS JUST BEEN PRESENTED AT CONGRESSINTERNATIONAL WORK HEALTH IN DUBLINTUESDAY, MAY 22, 2018Page 2BRIEF GUIDE TOMEDICINESDANGEROUS TOPROFESSIONALSOF NURSINGPage 3A BRIEF GUIDE TO DANGEROUS MEDICINES FOR NURSING PROFESSIONALS3DANGEROUS MEDICINESEXPOSURE PREVENTION FOR NURSING PROFESSIONALSAuthors:Amparo Benavent Benavent.ICU nurse. Clinical Hospital of Valencia. Specialist in Occupational Nursing and master’s degree in Occupational Risk Prevention.Member of the International Commission on Occupational Health (ICOH).Coordinator of the Work Group on Occupational Health. Nursing Council of the Valencian Community.Amparo Ortuño Moreno.ICU nurse. La Fe de Valencia University and Polytechnic Hospital. Master in prevention of occupational hazards.Member of the International Commission on Occupational Health (ICOH).Member of the Work Group on Occupational Health. Nursing Council of the Valencian Community.Ángeles Pavía Mañes.Nurse of Thoracic Surgery and Lung Transplantation Unit. La Fe de Valencia University and Polytechnic Hospital.Specialist in Occupational Nursing and master’s degree in Occupational Risk Prevention.Member of the Work Group on Occupational Health. Nursing Council of the Valencian Community.José Antonio Forcada Segarra.Nurse responsible for Teaching and Quality. Castellón Public Health Center.Coordinator of the Vaccination and Biological Risk working groups. Nursing Council of the Valencian Community.Acknowledgments (for their collaboration in editing this guide): María Ballesteros Tena and Jara Prades Serrano.Family and Community Nursing Residents. Multidisciplinary Teaching Unit for Family and Community Care. Castellón.Page 4A BRIEF GUIDE TO DANGEROUS MEDICINES FOR NURSING PROFESSIONALS5INDEX1. Introduction ……………………………………….. ………………………………………….. ……………………………………. 72. Definition ……………………………………….. ………………………………………….. ………………………………………. 83. Classification ……………………………………….. ………………………………………….. …………………………………… 94. Routes of Exposure ……………………………………… ………………………………………….. …………………………….eleven5. Health Effects …………………………………….. ………………………………………….. …………………………. 126. Prevention Measures ……………………………………… ………………………………………….. ………………………. 147. Legislation ……………………………………….. ………………………………………….. ……………………………………. 168. What to do if you are preparing or administering dangerous drugs and you do not know if you are protected? ….. 179. Documentation / Resources ……………………………………… ………………………………………….. ………………….. 19This brief guide has been prepared to publicize the risks to which nursing professionals are exposed.mería when handling dangerous drugs, the different routes of exposure, their main effects on health andpreventive measures to avoid exposure, especially in the phase of preparation and administration of medication.These are tasks that Nursing professionals usually perform, in which they know the risk and be able toAvoiding it can be critical to your health.Page 5A BRIEF GUIDE TO DANGEROUS MEDICINES FOR NURSING PROFESSIONALS71. INTRODUCTIONNursing professionals face different health risks on a daily basis. One of them is theexposure to dangerous drugs (hereinafter MP).Unlike other chemicals, drugs are created expressly to bind to cells and producea therapeutic effect. Sometimes at the cost of dangerous side effects that constitute a necessary sacrifice toachieve the primary objective of healing or alleviating the situation of the patient. But professionals are healthy people whoThey expose a cocktail of drugs they no longer need to their harmful effects. And, unlike sick people, whoseexposure is limited in time, nursing is exposed, potentially, 230 days a year to these drugs duringhis entire working life.These activities are carried out in the wards of the hospital. Even in the best of cases, the security conditionsthey hardly avoid the risk of coming into contact with MPs. Some situations may lead to contact through theskin, not only in preparation and administration, but also, withdrug residues on work surfaces or contaminated areasdays, handling of body fluids or bedding, actionsdecontamination and cleaning of preparation areas, etc.This exhibition has been a subject little addressed since the as-preventive and, in any case, limited to medicationsOncology in Pharmacy services. However, the rest ofnursing professionals, both in hospitals and in careprimary school, we handle dangerous drugs on a daily basis,generally knowing that they are.Page 68A BRIEF GUIDE TO DANGEROUS MEDICINES FOR NURSING PROFESSIONALSThis brochure goes beyond the reductionist approach and addresses PMs from a broader point of view, not justoncological drugs, but any that may cause adverse effects on the health of the exposed professional.This approach is essential, if we think about a repeated exposure to multiple dangerous drugs over time,throughout working life.2. DEFINITION OF DANGEROUS MEDICINAL PRODUCTFrom the Occupational Health perspective, we define DANGEROUS MEDICINE as that drug that containsan active principle whose potential toxicity represents a risk to the health of healthcare professionals who are going tomanipulate it.DANGEROUS MEDICINES are considered to be those that are liable to cause injury to the organism ofthose people who, not being recipients of the same, manipulate them voluntarily to administer or invoke them.luntaria by accidental contact.The danger of these drugs poses a chemical risk, especially due to their carcinogenic and teratogenic activity.ca, genotoxic and toxic on the reproductive process or on a specific organ at low doses, or because it is a newdrug similar to others with this type of risk.Page 7A BRIEF GUIDE TO DANGEROUS MEDICINES FOR NURSING PROFESSIONALS93. CLASSIFICATIONIn 2004 the National Institute for Occupational Safety and Health (NIOSH) published a list of PMs. In the lastpublication of 2014, dangerous drugs are grouped into 3 groups:• Group 1: Antineoplastic drugs.• Group 2: Non-antineoplastic drugs, which meet at least one dangerous characteristic, of thecited above.• Group 3: Medicines that pose a risk to the reproductive process and that can affect menand women, who are actively trying to conceive, and pregnant or lactating women,but they do not pose a risk to the rest of the staff.Medicines are classified as dangerous if studies in animals or humans indicate that their exposurecan cause the effects listed below:Page 810A BRIEF GUIDE TO DANGEROUS MEDICINES FOR NURSING PROFESSIONALSRegarding their action, we classify them as:As can be seen in the graph, the variety of categories and the volume of specific drugs shows thatto the potential, and hitherto unknown, risk for nursing professionals.Regarding their action, we classify them as:Page 9A BRIEF GUIDE TO DANGEROUS MEDICINES FOR NURSING PROFESSIONALSeleven4. ROUTES OF EXPOSUREMPs pose a risk to all workers who may come into contact with them, from the receptionin the hospital, transport, until disposal. But it is the nursing professionals who can suffer amore intense exposure because they are usually in charge of its preparation and administration.These drugs can penetrate the body through different ways, as we see in the table:intense because they are usually in charge of its preparation and administration.These drugs can penetrate the body through different ways, as we see in the table:The most frequent routes of exposure are inhalation and dermal.Page 1012A BRIEF GUIDE TO DANGEROUS MEDICINES FOR NURSING PROFESSIONALSThe most frequent routes of exposure are inhalation and dermal.The preparation and administration of medications is usually an activity in which theNursing spends a large part of its working day. For example, aerosols can be generatedWhen reconstituting powdered or lyophilized medicines, when diluting medicines in plastic bagsfluids or by crushing tablets to dissolve and administer them.5. EFFECTS ON HEALTHThe effects of exposure can be:• Acute: They last from weeks to months, produced by effectslocal and harmful due to direct contact of the drug with skin andthings. The acute effects of dangerous drugs include:dizziness, nausea, headache, dermatitis, menstrual problems, etc.• Chronic: Its subclinical onset may not be evident until manyyears later, making it difficult to establish a connection between the exhibition and therition of the disease. Among the most frequent chronic effects we find:increase of genotoxic effects in the different apparatuses and systems of theganism (lung, liver, hearing problems, bone marrow, etc.), cancer (amongmany types of cancer, leukemia and lymphomas), fetal abnormalities (malformationnes, abortions, low birth weight, etc.) and reproductive function (infertilitytemporary or permanent).Page 11A BRIEF GUIDE TO DANGEROUS MEDICINES FOR NURSING PROFESSIONALS13The fact that a dangerous medicine has not been classified as a carcinogen does not mean that it does not have thiseffect or other harmful. The International Agency for Research on Cancer, belonging to the OrganizationWorld Health Organization (WHO), has not evaluated all of them. It is usual that laboratories have done tests on mammals,and indicate the risks detected. This is a very accurate clue indicating that the producer does not ensure that these effectscould not be produced in humans.In the development of prevention policies, it is essential to develop strategies that eliminate the risk or, at least, the least.nimize. Attempting to establish causal relationships in multiple exposure to PM will require years of research. WithoutHowever, the inclusion of these MPs in the NIOSH list and the radical prevention policies in the US and Canada, shouldmake us think about the seriousness of having to wait a decade to confirm what we now intuit.CANCER  LABOR FEATURES Once started, I don’t know of; Jan even if the exposition There is no reliable limit of exposure below which there is no risk Very latency period long (up to 40 years) Individual variability (gene base; ca del individual) Page 1214A BRIEF GUIDE TO DANGEROUS MEDICINES FOR NURSING PROFESSIONALS6. PREVENTION MEASURESTo avoid exposure to dangerous drugs, the hierarchy of prevention measures should be articulated accordingly.as follows:To avoid exposure to dangerous drugs, the hierarchy of prevention measures should be articulated as followsway:1Replace the dangerous drug with another that is not, if possible.twoIsolate the procedure. Collective protection. Preparation in biological safety cabinets / robots / isolators, with closed systems oftransfer of drugs.3Place identification labels on all MPs.4Develop safe work protocols in all facilities where PM manipulations are carried out. Improve work techniques.5Adapt specific places for storage.6Use personal protective equipment: gloves, gowns, masks, goggles, leggings, hats, etc.7Mark the work areas where dangerous drugs are being handled (PM)8Place and use specific containers for PM waste: blue9Use of special equipment for the administration of dangerous medication: tree-type systems.10Provide adequate information and training. Access to the safety data sheets of the medicines and the lists ofdangerous medication.elevenHave a spill / discharge kit and a procedure for action, in a place known to all.12Carry out adequate surveillance of the specific health of professionals who handle dangerous medications. Page 13A BRIEF GUIDE TO DANGEROUS MEDICINES FOR NURSING PROFESSIONALSfifteenIn the following table we can see some of the tasks with PM and its prevention measures:ProcessWork environmentEquipmentGlovesspecialsMPJumpsuit / robewaterproofProtectionrespiratoryProtectionocular. GlasseswatertightHatHoseContainerGROUP IVCrush or fractiondangerous drugsCSB in pharmacy  YES 2 pairs Special rooms white Special* YES YES YES YES Prepare medicationsdangerousCSB in pharmacy System of transfer closed YES 2 pairs Special rooms white Special* YES YES YES YES MP Spill CleanupEvent location (kit of spills)  YES 2 pairs YES Special* YES YES YES YES Administration MP IVHospitalization room Primary care Address Closed systems tree type YES 2 pairs YES YES YES NOT NOT YES Topical MP administration,ocular, otic,nasal, etc.Hospitalization room Primary care Address Absorbent base YES 2 pairs YES Yes there are possibility of vapors * YES NOT NOT YES Intravesical administrationHospitalization room Operating room or others Consult SPRL Absorbent base  YES 2 pairs YES YES YES NOT YES YES Administration MP aerosolHospitalization room Primary care Address Room pressure negative YES 2 pairs YES Special* YES YES NOT YES MP VO administration(solid)Hospitalization room Primary care Address  YES 2 pairs NOT NOT YES NOT NOT YES MP VO administration(liquids)Hospitalization room Primary care Address  YES 2 pairs YES YES YES NOT NOT YES Intrathecal administrationHospitalization room Operating room or others Consult SPRL Absorbent base YES 2 pairs YES YES YES SPRL NOT YES Intracavitary administrationOperating room Specials. Pressure negative. Consult SPRL. YES 2 pairs YES (special)  Consult the SPRL Special* YES YES YES YES Environment manipulation andpatients who have beenmanaged MPHospitalization room Primary care Address MPs can be active until 48h YES 2 pairs YES NOT On determined cases NOT NOT YES Handling of excreta andbiological fluids fromMP patientsHospitalization room Primary care Address  YES 2 pairs YES YES YES NOT NOT YES Technical collaboration with MPDiverse Consult SPRL YES 2 pairs YES Consult SPRL YES SPRL Consumptiongo to SPRL YES Page 1416A BRIEF GUIDE TO DANGEROUS MEDICINES FOR NURSING PROFESSIONALS7. LEGISLATIONThe Constitution guarantees the right to life, physical integrity, and active health policies. This is a rightof all people, and not just patients. The guarantee of the worker’s health inspires the Union regulationsEuropean.The protection of workers against exposure to carcinogens is found in the following standards:• European Directive 2004/35 / CE, on the protection of workers against risks related to theexposure to carcinogens or mutagens during work.• Law 31/1995, on the Prevention of Occupational Risks, article 15. Defines the principlesof preventive activity and the employer’s obligation to comply with these principles.• The protection of workers against risks related to exposure tocarcinogens or mutagens is legislated by RD 665/1997 and its subsequentprevious modification by RD 1124/2004.• RD 374/2001 on the protection of workers against related riskswith exposure to chemical agents during work is applicable in these cases.The guiding principle for all these standards is to avoid any risk of exposure toemployee. For example, in 2003 the INSHT published the technical prevention note (NTP)740 Occupational exposure to cytostatics in the healthcare setting, which includes recommendations forreception, storage, preparation and reconstruction, transport, administration and equipmentof protection. Recently, in 2016, the document Dangerous Medicines was published.Prevention measures for its preparation and administration.Page 15A BRIEF GUIDE TO DANGEROUS MEDICINES FOR NURSING PROFESSIONALS17Likewise, RD 1124/2004 includes, in practice, the principles of the Directive, when it states that «… to the extentwhere technically possible, the employer shall avoid the use of carcinogens at work, in particularby means of its substitution by a substance, a preparation or a process that, under normal conditions of use, does notbe dangerous … ». (Article 4), «In the event that it is not technically possible to substitute the carcinogenic agent, the employerit shall ensure that its production and use are carried out in a closed system. ‘ (Article 5, point 2) and «Whenthe application of a closed system is not technically possible, the employer will guarantee that the level of exposure ofworkers are reduced to as low a value as is technically possible. ‘ (Article 5, point 3).Therefore, when you demand prevention policies that eliminate risk both in preparation and administrationYou are asking for the law to be followed.8. WHAT TO DO IF YOU ARE PREPARING OR ADMINISTERING DANGEROUS MEDICINES ANDDO YOU KNOW IF YOU ARE PROTECTED?If MP is prepared or administered and it is unknown if it is protected, we can contact the SPRL and request:• That the measures provided for by the legislation and necessary to avoid exposure are adopted• That you carry out a specific health surveillance for the risk of contact with PM in your workplace• Request information / training from your higher command• Notify the hospital that PM is being prepared or administered without adequate security measures• Request the procedure for handling dangerous medication from the Department of Health, and if it existsits adaptation by the workplace. If you see differences between one and the other, you should know that thevalid is the first.Page 1618A BRIEF GUIDE TO DANGEROUS MEDICINES FOR NURSING PROFESSIONALS• Consult the list of MPs of the INSHT (Dangerous drugs. Preventive measures for their preparationand administration)• Request in writing that all MPs be prepared in the Pharmacy Service, in security booths• Request that MPs be identified as such from the Pharmacy• Use closed systems for PM administration• Properly use all personal protective equipment (PPE) for the administration of PM.• Request that a registry of exposure to this risk be openedYou can request information from the CECOVA Occupational Health Group: b..v@gmail.comYou can see the videos of the CECOVA Conference on Dangerous Drugs in these links:https://www.youtube.com/watch?v=LIdgidBSrJwhttps://www.youtube.com/watch?v=fDACbrWGz7A&t=531sTo know the real situation of the exhibition we need your collaboration by carrying out this survey:https://goo.gl/forms/iVBLraNYYqHy1rwx2Page 17A BRIEF GUIDE TO DANGEROUS MEDICINES FOR NURSING PROFESSIONALS199. DOCUMENTATION / RESOURCES:• Dangerous Drugs. INSHT technical document. http://www.insht.es/InshtWeb/Contenidos/Do-documentation / DATA% 20DE% 20PUBLICACIONES / EN% 20CATALOGUE / Hygiene / 2016% 20medicamen-cough% 20hazardous / Medications% 20hazardous.pdf• UUEE MP List: NIOSH List Hazordous Drugs 2016 https://www.cdc.gov/niosh/topics/antineoplas-tic / pdf / hazardous-drugslist_2016-161.pdf• Management of PM in healthcare settings. United States Pharmacopeia: USP General Chapter <800> Hazar-dous Drugs — Handling in Healthcare Settings. United States Pharmacopeia. USP 2016.• USA. USP. Management of dangerous drugs in health centers: http://www.usp.org/usp-nf/notices/general-chapter-hazardous-drugs• Good practice guide for the preparation of drugs in Hospital Pharmacy services. Me-Ministry of Health, Social Services and Equality. June 2014: http://www.msssi.gob.es/profesionales/pharmacy / pdf / GuiaBPP3.pdf• Prevention Technical Note 233. INSHT: Biological Safety Cabinets. National Security Instituteand Hygiene at Work: http://www.insht.es/InshtWeb/Contenidos/Documentacion/FichasTecnicas/NTP/Files / 201a300 / ntp_233.pdf• Prevention Technical Note 740. INSHT: Occupational exposure to cytostatics in the health field: http: // www.insht.es/InshtWeb/Contenidos/Documentacion/FichasTecnicas/NTP/Ficheros/701a750/ntp_740.pdfPage 18twentyA BRIEF GUIDE TO DANGEROUS MEDICINES FOR NURSING PROFESSIONALSACRONYM:MP: dangerous drugSPRL: Occupational Risk Prevention ServicePPE’s: personal protective equipmentCSB: biological safety cabinetSCTM – Closed Systems for Drug Transfer (CSTD)INSHT: National Institute of Safety and Hygiene at WorkNIOSH: National Institute Occupational Safety and Health (USA)Page 19CECOVANursing Council of -the Valencian CommunityHealth ScienceScienceNursingENFERMERIA NURShare Question