Canadian Occupational Safety

26 Canadian Occupational Safety | www.cos-mag.com to ingest it somehow, what would I do? If it was absorbed into my skin, what would it do? Where do I get this information?" says Patel. "If you're not educated then you're not going to know what to do." Spill kits must be readily available in areas where drugs are stored, trans- ported, handled and administered. A spill kit includes all necessary equip- ment and PPE to clean up a spill as well as step-by-step instructions. It also explains escalation processes if it's not safe for the worker to clean the spill himself, says Nakashima. For exam- ple, if the spill is quite large, the area would need to be quarantined and the hazmat team called in to clean it up. An accessible eyewash station that meets the criteria of ANSI/ISEA Z358.1-2014 must also be available. It's very important to properly dispose of hazardous drug waste, including material used to clean the spill, used gloves, paper liners, gowns, unused pills, powder residues and containers, gauze, IV bags or drug vials that contain more than trace amounts of hazardous drugs and needles and syringes. The items must be put in a sealed container or bag that is labelled as cytotoxic waste and then set aside in a safe area before it is picked up by a third-party waste disposal company. The ministry responsible for the envi- ronment regulates biomedical wastes, which includes cytotoxic waste, so employers need to make sure they are meeting the relevant legislative requirements in their jurisdiction. "It's not just a matter of 'Throw it into the green garbage bin in the back of the parking lot.' This is material that needs to be properly disposed, that needs to be properly identified and dealt with in a correct fashion," says Hansen. EDUCATION Worker training on chemotherapy drugs has to start from the ver y beginning with a comprehensive orientation and it has to include everybody, from front-line workers to managers, says Patel. "It can be regulated staff, unregu- lated staff, you're a manager or leader, whether you're in a hospital setting, a community setting, it doesn't matter where, if you are working with indi- viduals receiving hazardous drugs or cytotoxic drugs, you should be aware of this," she says. Supervisors may need additional training so they understand their responsibilities in monitoring workers and ensuring they are doing what they are required to do under occupational health and safety law, says Hansen. "These front-line supervisors have to have more knowledge than the front-line workers. These are people who your nurses, your environmental services, your maintenance individu- als are going to to ask questions," he says. "They are the point of resource." As a best practice, the training should be offered in various ways to meet individual learning needs. "Some people like to read, some people like to listen, some people like to do, so make all three of those opportunities available so (workers) can learn in the way that they best learn," says Patel. The training should offer a prac- tice component so workers can have the chance to test out what they have learned and make mistakes. At BC Cancer, new pharmacists practice just with water first, rather than the actual drugs, until their one-on-one trainer deems them ready to try real drug mixing. Throughout the training process, it's important for employers to be forth- coming with their workers so they understand the severity of the risks and take safety protocols seriously, says Hansen. "A lot of employers don't want to use the direct words that 'These drugs can cause you cancer.' They are trying to downplay it," he says. "But wouldn't that grab the attention of the worker a little bit more to ensure that on a day- to-day basis once I provide them the training, education, the proper PPE, that they are going to wear it?" Health and safety professionals should make sure to evaluate the success of their cytotoxic drug risk prevention plan. Start by observing workers completing tasks (see sidebar) and asking them questions about the medications and safe handling proce- dures. An anonymous survey can also be deployed to the workforce. "If everything is in place, they should be able to explain that program to you as a health and safety profes- sional. They should be able to educate you on the program — it shouldn't be the other way around," says Hansen. "That's the ideal world here." In order for the cytotoxic drug risk prevention program to be success- ful, upper management needs to be involved. Not only do they need to approve any additional costs for PPE, spill kits and training, they also set the tone for the rest of the organization. "That's where it starts," says Nakashima. "If I don't commit to the same standards of care and if I don't support them, then nobody else is going to either. From my perspective, the buck stops here. If I am going into an area, I can't be an exception; I have to follow the exact same policies and procedures as the rest of the staff." While it elicits some negative reac- tions, Hansen compares chemotherapy drug exposure to that of asbestos, saying the dangers of the drugs have not been properly explained to work- ers and the adverse health issues may be yet to come. He is urging employers to take action and put policies and pro- cedures in place before their workers suffer any consequences. "If the information is there and as an employer you're either A) blind to it or B) you're ignoring it, not only are you in violation of your required due diligence as an employer, I am going to start using the word neglect — and you don't want that."

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