危险药物职业暴露对医务人员的危害及其防护措施

目的制定防护措施,减少危险药物的暴露风险。方法通过文献,查找危险药物暴露对职业接触的医务人员健康危害的依据,呼吁政府部门和医院领导,加强对危险药物暴露的管理,科学设置配药场所,建立教育和培训制度,采取有效防护措施,确保职业性接触危险药物的医务人员身体健康。结果国内许多医院建立了静脉药物配置中心,由受过培训的专业人员,严格按照操作程序进行抗肿瘤等危险药物的配置,减少了危险药物暴露的机会。结论我国的医务人员化疗防护培训严重不足,防范意识薄弱,应引起有关部门和医院领导的高度重视,制定并落实有效的防护措施,确保医务人员的职业安全。     

医务人员职业暴露危险因素分析与防护措施

目的 研究分析医务人员职业暴露的危险因素并制定有效的防护措施.方法 选取职业暴露的医务人员160例为观察组,另取同期未发生职业暴露的医务人员160例记为对照组.采用《职业暴露调查表》分别对每个研究对象进行调查统计,分析职业暴露危险因素,并拟定相关防护措施.结果 按照占比从高到低的顺序,导致职业暴露的物理性因素包括器械损伤、负重伤、噪音、紫外线、辐射;化学性因素包括化学消毒剂污染、吸入麻醉药物污染、细胞毒性药物污染;生物性因素包括血液污染、分泌物污染、排泄物污染;心理性因素包括抑郁、焦躁、心理疲劳、高度紧张.经多因素Logistic回归分析可得,物理性因素、化学性因素、生物性因素以及心理因素均为影响医务人员职业暴露的危险因素.结论 导致医务人员职业暴露的危险因素包括物理性因素、化学性因素、生物性因素以及心理因素,应针对上述因素给予患者针对性的干预措施,以降低职业暴露的发生率.     

手术室护士职业暴露的危险因素及防护措施

医务人员职业暴露是指医务人员在从事诊疗、护理活动过程中接触有毒、有害物质或传染病病原体,从而损害健康或危及生命的一类职业暴露.手术室是医院重点科室,担负对患者进行手术救治的重任.手术室护士频繁接触各类患者,极易发生职业暴露,应做好严密防护.笔者针对手术室护士职业暴露的危险因素及防护措施作出总结分析,现报道如下.     

医疗机构细胞毒性药物职业暴露风险防控指南

目的 为医疗机构提供细胞毒性药物职业暴露风险防控策略，提高医务人员的防护意识，降低医务人员发生潜在的职业暴露风险。方法 采用世界卫生组织指南制定手册进行细胞毒性药物职业暴露风险分级管控的防护指南的研究设计。通过系统检索，指南工作组广泛收集细胞毒性药物进入医院后的调配、使用等各环节存在的暴露风险问题，采用德尔菲法构建临床问题，采用循证研究方法形成相关证据体后，按照推荐分级的评价、制定与评估方法进行质量评价，并再次通过专家共识法对推荐意见及证据级别达成共识，最终形成《医疗机构细胞毒性药物职业暴露风险防护指南》。结果通过对143位专家进行网络调查问卷调研，采用德尔菲法对指南达成共识。将工程控制、行政控制和个人防护设备3个不同等级管理相结合，通过分级管控的方式，最终确定了37个临床问题，共形成36条推荐意见。结论 本指南涵盖运输、接收、储存、脱包、调剂、成品使用、废物处理等7个环节，可为医疗机构制订细胞毒性药物相关防控措施提供参考与补充，确保细胞毒性药物进入医院后，降低医务人员发生细胞毒性药物职业暴露的可能性，保护医务人员的安全。     

医疗机构细胞毒性药物职业暴露风险防控指南

目的 为医疗机构提供细胞毒性药物职业暴露风险防控策略，提高医务人员防护意识，降低医务人员发生潜在的职业暴露风险。方法 采用世界卫生组织(WHO)指南制定手册进行细胞毒性药物职业暴露风险分级管控防护指南的研究设计。通过系统检索，指南编写组广泛收集细胞毒性药物进入医院后调配、使用等各环节存在的暴露风险问题，采用德尔菲法调研专家并确定临床问题，采用文献调研、专家经验法整理形成相关证据体后，按照推荐分级的评价、制定与评估(GRADE)方法进行质量评价，并再次通过德尔菲法对推荐意见及证据级别达成共识，最终形成《医疗机构细胞毒性药物职业暴露风险防护指南》。结果 通过对143位专家进行网络调查问卷调研，采用德尔菲法对指南达成共识，将工程控制、行政控制和个人防护设备3个不同等级相结合，通过分级管控方式，最终确定37个临床问题，共形成36条推荐意见。结论 该指南内容涵盖运输、接收、储存、脱包、调剂、成品使用、废物处理等7个环节，可为医疗机构制定细胞毒性药物相关防控措施提供参考与补充降低医务人员发生细胞毒性药物职业暴露的可能性，保护医务人员安全。     

一起医务人员HIV职业暴露事件应急对策

目的探讨医务人员发生HIV职业暴露的危险因素及应急对策。方法对医院2011年1月发生的一起严重的医务人员HIV职业暴露事件进行应急处理以及临床干预。结果同一暴露源共发生HIV职业暴露4人,均为护理人员,经半年随访,未发生HIV医院感染。结论低年资护理人员是发生职业暴露的高危人群,主要原因是安全防护意识差、操作不规范及应变能力欠缺所致;应加强医务人员卫生职业安全教育、加强自身防护、落实标准预防等措施减少职业暴露事件的发生,保护医务人员职业安全。     

产科医务人员职业暴露的原因分析及防护措施

目的通过了解产科医务人员发生职业暴露的各种原因,呼吁社会重视职业防护,并制定相应的职业防护措施。方法分析40例产科医务人员发生职业暴露的方式,研究产科医务人员发生职业暴露的原因和对职业暴露的防护意识。结果40例发生职业暴露的方式为:针刺伤8例;被具传染性血液及体液溅染黏膜和不完整皮肤16例;未采取防护措施,致使不完整皮肤和黏膜受污染26例。40例职业暴露的发生情况:14例为意外事故,26例因未认真执行标准预防原则导致职业暴露。结论产科医务人员对职业暴露的防护意识淡薄,标准预防原则的应用不规范,应加强对产科医务人员职业暴露的防护知识的培训,增强产科医务人员对职业暴露的重视。     

化疗药物使用中护士的自我防护

目的为了强化护士的防护意识，减少护士职业接触化疗药物对健康的损害，在实际工作中，应把化疗中的安全防护放到重要位置，提高自我防护能力，规范操作程序，加强卫生监督和生物监测，降低职业危险眭。结论职业接触化疗药物的护士防护，必须建立和使用有效的防护设备及措施，实施教育与行为干预为主的防护原则，严格执行卫生防护制度，才能有效的控制护士执业接触化疗药物对健康造成的损害。     

医务人员血源传播性疾病职业暴露调查分析及防护

目的 总结医院血源传播性疾病职业暴露情况并探讨相应的防护对策.方法 对2012年1月-2013年8月该院血源传播性疾病职业暴露情况进行调查, 分析医务人员血源传播性疾病职业暴露的特点及危险因素.结果 共收到44名医务人员职业暴露的报告,发生职业暴露的职业以护士最高,占 59.1%,其次是医生和实习生,分别占 29.5%和6.8%;暴露源以各种针刺伤为主（65.9%）,其次是手术缝针刺伤（20.5%）;不同科室发生职业暴露的频次不同,手术科室占72.7%,非手术科室占27.3%;职业暴露由接触过明确病原体乙肝患者的针头器械导致占 72.7%,暴露源接种过乙肝疫苗例数占29.6%,含有乙肝抗体例数占25%,暴露后及时处理率100%,预防用药率88.6%.结论 加强职业安全防护培训,增强医务人员职业安全防护意识,规范医疗操作,暴露后采取合理有效的干预措施可降低医务人员被血源传播性疾病感染的危险.     

某综合医院职业暴露危险因素分析

目的对造成医务人员职业暴露的危险因素进行具体分析。方法选取126例发生职业暴露的医务人员作为研究对象,采用调查表的形式对职业暴露的因素进行统计。结果造成职业暴露的危险因素包括锐器伤、化学因素、生物因素三大方面,其中由锐器伤引发的职业暴露高达60%以上。职业暴露多发生在手术和注射治疗过程等操作环节,医生和护士是职业暴露的高发人群。结论职业暴露带来的危害十分严重,必须加强医务人员的个人防护意识,减少职业暴露,保障医务人员的职业安全。     

医护人员要注重经血液传播疾病的职业防护

目的引导医护人员正确认识自身职业暴露发生的血液传播性疾病感染,提高医护人员的重视程度,有效控制医院内感染,提高自身安全性。方法阐述了经血液传播疾病的职业感染状况和感染途径,并详细说明妇产科医护人员的职业防护及意外事故的处理。结果经血液传播疾病的暴露途径主要有机械性损伤,破损皮肤或非消化道黏膜与患者血液、体液接触,忽略防护,缺乏职业暴露的防护知识,缺乏合格的防护设备和用品。通过规范操作,正确处理器械,戴手套,穿隔离衣,认真洗手,暴露部位的局部处理,器械消毒,增强自我防护意识等措施可以有效预防传播。结论医疗卫生事业中,医务工作者的工作环境决定了其自身长期处于具有生物危险性的环境之下。因此,需强化自我保护意识,规范手术操作,注重血液传播性疾病的控制。     

Toxicological, medical and industrial hygiene aspects of glutaraldehyde with particular reference to its biocidal use in cold sterilization procedures

Aqueous solutions of > or =5% glutaraldehyde (GA) are of moderate acute peroral toxicity and those of < or =2% are of slight toxicity. By single sustained skin contact, aqueous GA solutions of > or =45% are of moderate acute percutaneous toxicity, those of 25% are of slight toxicity and those of or =5%. Primary skin irritation depends on the duration and contact site, occlusion and solvent. By sustained contact, the threshold for skin irritation is 1%, above which erythema and edema are dose related. With 45% and higher, skin corrosion may occur. There is a low incidence of skin sensitizing reactions, with an eliciting threshold of 0.5% aqueous GA. However, GA is neither phototoxic nor photosensitizing. Subchronic repeated exposure studies by the peroral route show only renal physiological compensatory effects, secondary to reduced water consumption. Repeated skin contact shows only minor skin irritant effects without systemic toxicity. By subchronic vapor exposure, effects are limited to the nasal mucosa at 1.0 ppm, with a no-effect concentration generally at 0.1 ppm. There is no evidence for systemic target organ or tissue toxicity by subchronic repeated exposure by any route. A chronic drinking water study showed an apparent increase, in females only, of large granular cell lymphocytic leukemia but this was not dosage related. This is most likely the result of a modifying effect on the factor(s) responsible for the expression of this commonly occurring rat neoplasm. A chronic (2-year) inhalation toxicity/oncogenicity study showed inflammatory changes in the anterior nasal cavity but no neoplasms or systemic toxicity. In vitro genotoxicity studies--bacterial mutagenicity, forward gene mutation (HGPRT and TK loci), sister chromatid exchange, chromosome aberration, UDS and DNA repair tests--have given variable results, ranging from no effect through to weak positive. In vivo genotoxicity studies--micronucleus, chromosome aberration, dominant lethal and Drosophila tests--generally have shown no activity but one mouse intraperitoneal study showed bone marrow cell chromosome aberrations. Developmental toxicity studies show GA not to be teratogenic, and a two-generation study showed no adverse reproductive effects. Percutaneous pharmacokinetic studies showed low skin penetration, with lowest values measured in vitro in rats and human skin. Overexposure of humans produces typical sensory irritant effects on the eye, skin and respiratory tract. Some reports have described an asthmatic-like reaction by overexposure to GA vapor. In most cases this resembles reactive airways dysfunction syndrome, and the role of immune mechanisms is uncertain. Local mucosal effects may occur if medical instruments or endoscopes are not adequately decontaminated. Protection of individuals from the potential adverse effects of GA exposure requires that there be adequate protection of the skin, eyes and respiratory tract. The airborne concentration of GA vapor should be kept below the recommended safe exposure level (e.g. the threshold limit value) by the use of engineering controls. Those who work with GA should, through a training program, be aware of the properties of GA, its potential adverse effects, how to handle the material safely and how to deal with accidental situations involving GA. If effects develop in exposed workers, the reasons should be determined immediately and corrective methods initiated. (c) 2001 John Wiley & Sons, Ltd.     

Update on safe handling of hazardous drugs: the advice of experts

Questions related to the handling of hazardous drug products were discussed by a panel of pharmacy practitioners. The panel addressed the following issues: pharmacists' responsibilities for instructing patients, nurses, and physicians on safe handling of hazardous drug products; safe transport of hazardous drug products outside the hospital; disposal of hazardous drug products, items contaminated by these products, and body wastes of patients receiving these drugs; appropriate operation, venting, cleaning, decontamination, and recertification of biological safety cabinets (BSCs); the protective clothing and technique that should be used by workers in BSCs; monitoring the health of workers who handle hazardous drug products; pharmacy's potential liability for nonconformance to published guidelines; whether and how pharmacies that prepare few doses of hazardous drug products should comply with stringent guidelines geared to institutions that handle many doses of these products; and precautions for handling hazardous drug products for oral administration, caustic products, and vesicants. Safe limits for time and amount of exposure to hazardous drugs are unknown, but ASHP's revised Technical Assistance Bulletin on Handling Cytotoxic and Hazardous Drugs and current guidelines from the federal Occupational Health and Safety Administration provide guidance on precautions that should be observed.     

Triethylene glycol HO(CH2CH2O)3H

TEG is a liquid higher glycol of very low vapor pressure with uses that are primarily industrial. It has a very low order of acute toxicity by i.v., i.p., peroral, percutaneous and inhalation (vapor and aerosol) routes of exposure. It does not produce primary skin irritation. Acute eye contact with the liquid causes mild local transient irritation (conjunctival hyperemia and slight chemosis) but does not induce corneal injury. Animal maximization and human volunteer repeated insult patch tests studies have shown that TEG does not cause skin sensitization. A study with Swiss-Webster mice demonstrated that TEG aerosol has properties of a peripheral chemosensory irritant material and caused a depression of breathing rate with an RD(50) of 5140 mg m(-3). Continuous subchronic peroral dosing of TEG in the diet of rats did not produce any systemic cumulative or long-term toxicity. The effects seen were dose-related increased relative kidney weight, increased urine volume and decreased urine pH, probably a result of the renal excretion of TEG and metabolites following the absorption of large doses of TEG. There was also decreased hemoglobin concentration, decreased hematocrit and increased mean corpuscular volume, probably due to hemodilution following absorption of TEG. The NOAEL was 20 000 ppm TEG in diet. Short-term repeated aerosol exposure studies in the rat demonstrated that, by nose-only exposure, the threshold for effects by respiratory tract exposure was 1036 mg m(-3). Neither high dosage acute nor repeated exposures to TEG produce hepatorenal injury characteristic of that caused by the lower glycol homologues. Elimination studies with acute peroral doses of TEG given to rats and rabbits showed high recoveries (91-98% over 5 days), with the major fraction appearing in urine (84-94%) and only 1% as CO(2). TEG in urine is present in unchanged and oxidized forms, but only negligible amounts as oxalic acid. Developmental toxicity studies with undiluted TEG given by gavage produced maternal toxicity in rats (body weight, food consumption, water consumption, and relative kidney weight) with a NOEL of 1126 mg kg(-1) day(-1), and mice (relative kidney weight) with a NOEL of 5630 mg kg(-1) day(-1). Developmental toxicity, expressed as fetotoxicity, had a NOEL of 5630 mg kg(-1) day(-1) with the rat and 563 mg kg(-1) day(-1) with mice. Neither species showed any evidence of embryotoxicity or teratogenicity. There was no evidence for reproductive toxicity with mice given up to 3% TEG in drinking water in a continuous breeding study. TEG did not produce mutagenic or clastogenic effects in the following in vitro genetic toxicology studies: Salmonella typhimurium reverse mutation test, SOS-chromotest in E. coli, CHO forward gene mutation test (HGPRT locus), CHO sister chromatid exchange test, and a chromosome aberration test with CHO cells. The use patterns suggest that exposure to TEG is mainly occupational, with limited exposures by consumers. Exposure is normally by skin and eye contact. Local and systemic adverse health effects by cutaneous exposure are likely not to occur, and eye contact will produce transient irritation without corneal injury. The very low vapor pressure of TEG makes it unlikely that significant vapor exposure will occur. Aerosol exposure is not a usual exposure mode, and acute aerosol exposures are unlikely to be harmful, although a peripheral sensory irritant effect may develop. However, repeated exposures to a TEG aerosol may result in respiratory tract irritation, with cough, shortness of breath and tightness of the chest. Recommended protective and precautionary measures include protective gloves, goggles or safety glasses and mechanical room ventilation. LC(50) data to various fish, aquatic invertebrates and algae, indicate that TEG is essentially nontoxic to aquatic organisms. Also, sustained exposure studies have demonstrated that TEG is of a low order of chronic aquatic toxicity. The bioconcentration potential, environmental hydrolysis, and photolysis rates are low, and soil mobility high. In the atmosphere TEG is degraded by reacting with photochemically produced hydroxyl radicals. These considerations indicate that the potential for ecotoxicological effects with TEG is low.     

Medical surveillance for antineoplastic-drug handlers

Elements of a medical surveillance program are described, with emphasis on a program for antineoplastic-drug handlers in a hospital setting. There are four data-gathering elements in any medical surveillance program: the history (medical and occupational), the physical examination, laboratory studies, and biological monitoring. Of these, the most useful and cost-effective is the history. The physical examination and laboratory tests should focus on the target organs of the hazardous agent in question. When results of biological monitoring are available for an unexposed control population, results for a group of exposed workers may be interpreted as greater than, similar to, or less than what was expected; thus, groups of unacceptably exposed workers may be identified. For antineoplastic-drug handling, the most important controls are use of a biological-safety cabinet and a worker education program. Estimating the average number of hours of drug handling per shift may serve as a surrogate measure of the potential exposure dose. Health-care professionals examining and testing workers who handle antineoplastic agents should give special emphasis to the skin and the hematopoietic, hepatic, renal, and urinary systems. Because of problems with assay sensitivity, cost, and interpretation of results, biological monitoring is not considered necessary in every medical surveillance program for antineoplastic-drug handlers. The Occupational Safety and Health Administration currently recommends that a permanent registry be maintained of all employees who routinely handle antineoplastic agents. Because of their opportunity for exposure to potentially hazardous drugs, pharmacy professionals should take a leading role in establishing surveillance programs that complement existing drug-handling practices and worker education programs.     

Occupational exposure to antineoplastic drugs in four Italian health care settings

Exposure assessment of health care workers to antineoplastic drugs (ADs) is still an open issue since new, critical, and emerging factors may put pharmacists who prepare hazardous drugs or nurses who administer anti cancer agents to an increased risk of developing adverse health effects. Overall, eight pharmacies and nine patient areas have been surveyed in this study. Wipe and pad samples were experienced during the surveillance program in four Italian health care settings. Urine samples were collected from workers handling ADs. Cyclophosphamide (CP), ifosfamide (IF), and gemcitabine (GEM) were detected in all the work environments by using a LC-MS/MS method-based capable of analysing all the three drugs simultaneously. In total, 54% of wipe samples were positive for at least one drug and 19% of pad samples were shown to be contaminated by cyclophosphamide. Pharmacies were generally more contaminated than patient areas with the exception of one site where a nurse had an acute exposure during the cleaning-up of an hazardous drug solution spill. In total, 22 urine samples collected from pharmacists and 78 urine samples from nurses had no detectable concentrations of any antineoplastic drugs. Despite the adherence to the recommended safety practices residue contamination on surfaces and floors has continued to be assessed in all the investigated sites.     

Toxicological profile of diethyl phthalate: a vehicle for fragrance and cosmetic ingredients.

Diethyl phthalate (DEP; CAS No. 84-66-2) has many industrial uses, as a solvent and vehicle for fragrance and cosmetic ingredients and subsequent skin contact. This review focuses on its safety in use as a solvent and vehicle for fragrance and cosmetic ingredients. Available data are reviewed for acute toxicity, eye irritation, dermal irritation, dermal sensitization, phototoxicity, photoallergenicity, percutaneous absorption, kinetics, metabolism, subchronic toxicity, teratogenicity, reproductive toxicity, estrogenic potential, genetic toxicity, chronic toxicity, carcinogenicity, in vitro toxicity, ecotoxicity, environmental fate and potential human exposure. No toxicological endpoints of concern have been identified. Comparison of estimated exposure (0.73 mg/kg/day) from dermal applications of fragrances and cosmetic products with other accepted industrial (5 mg/m(3) in air) and consumer exposures (350 mg/l in water; 0.75 mg/kg/day oral exposure) indicates no significant toxic liability for the use of DEP in fragrances and cosmetic products.     

Pesticide residue on/in the washed skin and its potential contribution to dermal toxicity

Washing the skin of humans or experimental animals after exposure to a pesticide or other chemical may leave a major portion of the dose on/in the washed skin. Questions have been raised as to whether this skin residue can contribute to the toxicity of a pesticide by continued post-wash absorption. In a set of 19 pesticides tested in the rat to determine the fate of this skin residue, absorption from the washed skin continued in 15 at all doses tested, continued in 2 pesticides at only some of the doses tested and did not continue in 2 volatile pesticides. However, only nine pesticides showed an increase in systemic concentration following absorption from the washed skin, which can be considered indicative of potential increased toxicity. The time of occurrence and magnitude of the increase varied with chemical and dose, being a combination of rate and magnitude of absorption and rate and magnitude of excretion of the absorbed chemical. Similar patterns of continued absorption of skin residue may be expected to occur in humans.     

Toxicity of middle distillates from dermal exposure

This report focuses on recent studies that investigated the effects of kerosine dermal exposure on neurotoxicity and reproductive/developmental toxicity. Background toxicity information will also be reviewed for kerosine range mid distillates. The kerosine range mid distillates have a carbon range of C9-C16 and have a boiling range of 302-554 degrees F (150-290 degrees C). This category includes kerosine, aviation fuels (e.g., Jet A, JP-5 and JP-8), no. 1 fuel oil and diesel fuel oil. In general, the kerosine range mid distillates demonstrate relatively low acute toxicity by any route of exposure. High inhalation exposures can induce central nervous system depression characterized by ataxia, hypoactivity and prostration. Kerosines are known to cause skin irritation and inflammation under conditions of acute and repeated exposure in animals and humans, but are only slightly irritating to the eye and are not skin sensitizers. In addition, the absorption of kerosine range mid distillates through the skin has been demonstrated to be fairly rapid, but limited to approximately 10-15% of the applied dose after 24 hours. The kerosine range mid distillates are generally inactive in genetic toxicity tests although positive studies have been reported. Positive results, while at times equivocal, have been reported for straight run kerosine and jet fuel A in the mouse lymphoma assay with metabolic activation, and hydrodesulfurized kerosine (mouse) and jet fuel A (rat) in the bone marrow cytogenetic assay. Effects on the nervous and reproductive systems have been reported in humans and experimental animals under conditions where inhalation and dermal exposure to specific kerosine type fuels are sometimes difficult to separate. Recent laboratory studies have addressed this point and examined the effects of dermal exposure. In these studies, rats were exposed to hydrodesulfurized kerosine by skin application to determine the potential of dermal contact to cause reproductive/developmental toxicity (OECD Guideline 421) or neurotoxicity (TSCA Guidelines on subchronic inhalation and neurotoxicity studies). These studies demonstrated that the highest dose level of kerosine does not induce reproductive/developmental or neurotoxicity effects by skin exposure in rodent studies. The dermal NOEL for HDS kerosine in rats was > or = 494 mg/kg for both neurotoxicity, and reproductive/developmental toxicity.     

医护人员对化疗药物认知与防护现状的调查

目的调查医护人员对化疗药物的认知与防护行为,以引起医护人员的重视,减少职业性健康损害。方法使用自行设计的调查问卷,对非肿瘤专科不同职称的80名医护人员对化疗药物毒性作用的了解情况,配制化疗药物的环境、使用的防护工具、意外暴露的处理情况、药物废弃物的处理情况进行调查和分析。结果医护人员对化疗药物的各调查项目的认知率均较高。对化疗药物的认知情况：主管护师的认知良好率为70%、护师为55%、护士为40%、护生为35%。职称越高,防护行为越好。结论医护人员对化疗药物的毒性认识不足,在配药和污物处理中自我防护意识和行为较差,护理管理者应重视对这方面的管理。