Issue link: https://beckershealthcare.uberflip.com/i/1191144
48 Executive Briefing For the last 20 years, we have concentrated on developing and implementing tools and processes to ensure owners' programs meet their full potential. Since our inception we transformed from a local MEP Commissioning firm to one of the leading Subject Matter Experts in Mission Critical, Healthcare, Science + Technology, and Biologics. Our work in both the domestic and international markets led to our appointment as Subject Matter Experts in many prestigious academic and commercial institutions. Our reach and expertise can be seen throughout the world in demanding programs where failure is not an option. We are a collection of specialists from various disciplines focusing our expertise on creating solutions for mission-critical programs and facilities. We solve technically complex (issues) process, building and regulatory issues by providing key consulting and support services for regulated medical manufacturing, healthcare, science + technology, commercial, government, and iconic programs. We have 9 divisions including WB | Clinical. IV pumps and hospital beds, among others. Once a health system has implemented a four-step cleaning program, it must regularly evaluate its effectiveness. USP <800> recommends an environmental wipe sampling program. After wiping different areas, facilities look for measurable levels of hazardous drug residue. If contamination levels are found, employees are at risk of occupational exposure to hazardous drugs. "Wipe testing should be done routinely to monitor cleaning practices. Surface hazardous drug residue is an opportunity for organizations to reevaluate work practices, retrain personnel on handling and administering hazardous drugs, and reinforce the importance of the four-step cleaning procedure," said Dr. Strauss. Best practices for assessing and addressing hazardous drug exposure When it comes to addressing hazardous drug exposure, an essential first step for health organizations is to maintain a list of hazardous drugs used by the facility. This is required by USP <800>. The list should include any products that are on the current NIOSH hazardous drug list. Creating this list isn't a one- time event. "Each time the pharmacy team and formulary committee add a new drug to the formulary, they must evaluate whether the drug should be included on the organization's hazardous drug list," Dr. Strauss said. "In addition, every 12 months, health systems should conduct a complete a full review of their hazardous drug lists and exposure risks." In addition to creating a hazardous drug list, healthcare organizations should perform a risk assessment. This process traces all the areas where a hazardous drug and hazardous drug contaminated waste may travel after leaving the pharmacy. Hazardous drugs and hazardous drug waste are often transported on elevators, placed in medication storage rooms or even placed in environmental service areas alongside cleaning supplies. Each time a hazardous drug or waste is handed off, there is a risk of exposure. According to Dr. Strauss, it's important to observe and interview staff members involved in patient care activities after patients have received a hazardous drug. "Be sure to ask questions like: Are staff members wearing the right personal protection equipment while cleaning? How are employees disposing of cleaning supplies after they have cleaned a patient's room?" After conducting a walkthrough of the entire hazardous drug process, the next step is to perform a gap analysis. During this process, the organization reviews facility standard operating procedures (SOPs), develops new SOPs, and ensures all SOPs reflect the current guidelines for limiting hazardous drug exposure in patient care areas. Employee education abut exposure is also essential. "We're finding an incomplete understanding of the challenge, especially at large healthcare organizations. Downstream staff, like nursing assistants, environmental services and custodial employees haven't been educated about this," noted Mr. Last. In some cases, hospital administrators and physicians may not even fully recognize the severity of the problem because they don't understand how different hazardous drugs are metabolized. It's the responsibility of healthcare leaders to keep team members safe, so they can do their best when taking care of patients. USP <800> recommends facilities collaborate with employee health departments to develop a medical surveillance program. Healthcare workers who regularly handle hazardous drugs should be enrolled in this type of initiative. Medical surveillance programs assess and document employee symptoms, as well as laboratory values like blood counts. The goal is to identify deviations from expected norms. "If health systems have integrated electronic record management systems, as soon as a doctor writes a prescription for a hazardous drug, it can start a chain of alerts and a cascade of enforcement that results in better control than we see now," explained Mr. Last. Although USP <800> focuses on hazardous drug exposure in healthcare settings, exposure in patients' homes is also becoming an issue as home infusions grow in popularity. Hazardous drug contamination in a home bathroom, for example, could adversely affect children or pets. Conclusion Healthcare systems have routinely found hazardous drugs in areas where they shouldn't be. In response, they want to rapidly determine where hazardous drugs contamination is occurring and how to prevent it. Applying traditional biocontainment techniques to the larger health system landscape, however, usually isn't the answer. According to Mr. Last, "Engineering controls that work in a 2,000 square foot pharmacy aren't going to be effective in a 700,000 square foot hospital. It's not possible to control that large a space in the same way. Organizations must find new ways to scale hazardous drug controls so they can be used in much larger facilities. This will require thought, time and money." n