PHARMACY

• 07.01 - Introduction
  
• 07.02 - Handling hazardous chemicals and drugs
  
• 07.03 - Storage of hazardous drugs
  
• 07.04 - Disposal of hazardous drugs
  
• 07.05 - Latex Allergy
  
• 07.06 - Ergonomics
  
• 07.07 - Workplace Violence
  
  

Introduction

The health care personnel that are not aware of proper work practices and controls may be exposed to hazardous drugs through the skin, mouth, or by inhalation. This can occur during transfer of hazardous drugs from one container to another, reconstitution or manipulation of them, withdrawal of needles from drug ampoules or expulsion of air from a drug-filled syringe.

Handling hazardous chemicals and drugs

Potential hazards occur from the exposure to hazardous drugs because of improper:

• Handling practices
  
• Needle or sharps handling and disposal
  
• Labelling of hazardous drugs
  

Safety Precautions

• Only pharmacists with proper PPE must prepare hazardous drugs and not nurses or physicians
  
• Perform any drug preparation process in biological safety cabinets with hood. These cabinets should be equipped with covered needle containers for needle disposal and covered waste container for excess fluids disposal
  
• Handle sharps with caution. All syringes and needles used in the course of preparation must be placed in specific containers for sharps, for disposal without being crushed, clipped or capped
  
• Label all syringes and intravenous bags containing hazardous drugs. An example of warning label is: “Special Handling/Disposal Precautions”
  

Employers should:

• Inform and train the personnel involved in any part of the handling of hazardous drugs (physicians, nurses, pharmacists, housekeepers, employees involved in receiving, transport or storage) on how to recognise the hazards caused by drugs in their work areas
  
• Provide warning labels and access to Material Safety Data Sheets. It is important for the personnel to know about any operation or procedures in the pharmacy area where drugs are present
  
  

Storage of hazardous drugs

Employees are often exposed to hazardous drugs during their storage.

Safety Precautions

• Use bins or shelves for the storage of hazardous drugs designed for the prevention of breakage and limitation of contamination in case of leakage. Bins must have barrier fronts, or other design features reducing the chance of drug containers falling to the floor
• When hazardous drugs need refrigeration, store them separately from non-hazardous drugs, in individual bins to prevent any breakage and leakage

Employers must ensure that access to any area used for preparation and storage of hazardous drugs is limited and that only authorized personnel can enter. They should place proper signs to restrict entry. Also, warning labels must be placed on every container, shelf, and bin, used for the storage of hazardous drugs.

Disposal of hazardous drugs

Employees can be exposed to hazardous drugs during bagging and labelling, and/or during the disposal of hazardous waste into containers. The final disposal of this kind of wastes can be done either at an incinerator or a licensed sanitary landfill for toxic wastes, as appropriate.

Safety Precautions

• Only trained and protected employees must handle the disposal containers (that are labelled, sealed and covered)
• The bags used for the disposal of materials containing hazardous drugs must be labelled properly (i.e. “Hazardous drug-related wastes”) and coloured differently from other hospital garbage bags. They must also be thick, and leak-proof
  
  

Latex Allergy

Due to the exposure to latex in products (such as gloves), some employees might develop latex allergy. This can result to contact dermatitis and allergic contact sensitivity. (M10.03.05)

Ergonomics

Pharmacists are often exposed to Musculoskeletal Disorders (such as Carpel Tunnel Syndrome, Tendonitis, etc) due to activities involving repetitive tasks, forceful exertions, awkward postures or contact stress (e.g. opening/closing bottle lids, or typing on the computer).

Safety Precautions:

• Use assisting devices, that eliminate the need to do the task, (e.g. devices designed to open bottle lids for pharmacists, etc)
• Redesign processes, for example rotate repetitive tasks with those that do not require high repetition
  
• Use ergonomically comfortable workstations (e.g. wrist pads, adjustable padded chairs, keyboard tray, and monitors at an adjustable height, etc) (M10.02.02)

Workplace Violence

Pharmacists can be exposed to workplace violence, because at a pharmacy drugs and money are available, making them possible robbery targets.

Safety Precautions:

Employers must establish and maintain a violence prevention program as part of their workplace safety and health program, which can include:

• Installation of Plexiglas in the payment window in the pharmacy area
  
• Provision of better visibility and lighting in the pharmacy area
• Personnel training for recognition and management of hostile/assaulting behaviour
• Implementation of security devices (i.e. panic buttons, beepers, surveillance cameras, alarm systems, two-way mirrors, card-key access systems, and security guards)