Elements of a medical surveillance program
Elements of a medical surveillance program
According to the National Institute for Occupational Safety and Health, the minimum elements of a medical surveillance program for hazardous drugs should include:
- reproductive and general health questionnaires completed at the time of hire and periodically thereafter;
- laboratory work, including complete blood count and urinalysis, completed at the time of hire and periodically thereafter. Additional tests, such as liver function and transaminase tests, may be considered.
- physical examination completed at the time of hire and then as needed for any worker whose health questionnaire or blood work indicates an abnormal finding;
- follow-up for those workers who have shown health changes or have had a significant exposure (substantial skin contact, cleaning a large spill [a broken bag, leaking IV line], etc.).
Review periodic health questionnaires and laboratory results for trends that may be a sign of health changes due to exposure to hazardous drugs. If health changes are found, the employer should take the following actions:
- Evaluate current protective measures:
1. Engineering controls (biological safety cabinets/isolators, ventilation, closed system transfer devices, and closed IV systems).
— Compare performance of controls with recommended standards.
— Conduct environmental sampling when analytical methods are available.
2. Policies for the use of PPE and employee compliance with PPE use and policies.
3. Availability of appropriate PPE such as double gloves, nonpermeable gowns, and respiratory protection.
- Develop a plan of action that will prevent further employee exposure.
- Ensure confidential notification of any adverse health effects to an exposed worker and offer alternative duty or temporary reassignment.
- Provide ongoing medical surveillance of all workers at risk to determine whether the new plan is effective.
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