Unfortunately, medicines do not have a package leaflet for the member of staff who administers or prepares the medicine. Some medicines, however, can cause cancer, change genetic material or cause deformities at low exposure over a long period of time. In addition, there are medicines, such as antibiotics and antivirals, for which harmful effects on health cannot be ruled out either. Given the nature of the substances and the frequent lack of data on effects at low exposure, it is important to prevent such exposure as much as possible.
Exposure to medicines may occur at the following times:
- During preparation;
- During administration (especially nebulisation);
- Via (cleaning up) excreta;
- During direct contact with the patient.
In order to prevent exposure, staff must take numerous measures. It is very important that everyone who works with medicines is aware of this. Always inquire about internal regulations and guidelines.
Measures you should instruct staff to take for the purpose of safe preparation and administration:
- Prepare medicines in the pharmacy whenever possible. If high-risk medicines are prepared in the department, the same measures must be taken as in the pharmacy;
- Use a closed system whenever possible for the preparation and administration of medicines;
- Create a separate, special workplace for preparing medicines for administration. This makes staff more aware of the preparation process. In the event of spillage, the contamination will be limited to this spot. Moreover, administrative activities, such as labelling, can be more clearly separated from the preparation of medicines.
- Prepare the drugs for administration on an absorbent mat. Change this mat after spilling and upon completion of the preparation cycle. "Preparation cycle" refers to the process of preparing one or more medicines for administration.
- Clean the entire worktop (including the back and side) with a pH-neutral cleaning agent daily or immediately after spillage.
- When preparing medicines for administration, wear gloves (nitrile or powder-free latex). Remove the gloves after spilling or after a preparation cycle.
- Dispose of gloves used with carcinogenic or reprotoxic substances as hazardous waste.
Measures for administration by nebulisation:
- If possible, use an application method that is less harmful to the environment, such as oral administration.
- Make sure the nebuliser switches off automatically or can be switched off by the patient when they remove the nozzle from their mouth.
- Provide the nebulisation system with an effective exhaled air filter.
- Use a ventilated double-wall mask.
- Give patients clear instructions.
- Nebulise high-risk drugs in a separate room or cabin with sufficient ventilation (ventilation rate of at least 10) and negative pressure. Make sure that the ventilation remains on after the treatment.
- Nebulise in the ward only when the patient cannot be transported.
- During nebulisation, place a hood with HEPA filter near the patient.
- Prevent unnecessary entry into the room by allowing the patient to be seen from outside (until at least 30 minutes after treatment) and by using the intercom, for example.
- Make sure there are as few things as possible in the room.
- Make sure that all items in the room are easy to clean and disinfect.
- Clean the room (wet) 30 minutes after each treatment.
- Depending on the type of medicine, wear personal protective equipment during treatment and for at least 30 minutes afterwards. You should wear respiratory protection P3, gloves and an apron.
- In particular, when working with cytostatics, effective measures must be taken to prevent exposure to these carcinogenic drugs altogether.
See Working safely with cytostatics.