Safe handling of medicines

Can I get in contact with medicines myself?

Yes, you may come into contact with medicines when preparing them for administration, during administration (e.g. atomisation), when cleaning up urine and faeces, when removing bedding and during direct contact with the patient. You can also come into contact with medicines during cleaning work or in the event of an incident. The measures necessary to prevent exposure must be laid down in procedures.

Where can I prepare medicines for administration?

Preparing medicines for administration, for example on a trolley, will cause contamination of the department if a spill occurs. Prepare medicinal products for administration in a separate workplace, for example on a worktop in a special workplace. Be sure to do the paperwork, such as writing labels, on another worktop or another part of the worktop.

Is extraction required when preparing antibiotics for administration?

No, additional measures need only be taken if high-risk medicines are prepared for administration in the department. Usually, high-risk medicines are prepared for administration in specially equipped rooms in the pharmacy. For other medicines, it is not necessary to use suction to remove the pressure-generated aerosols. It is more important to work carefully when preparing medicines for administration and to minimise the risk of exposure.

Do I have to wear gloves when preparing medicines for administration?

Yes, when preparing medicines for administration, overpressure may cause splashing and the formation of aerosols. The medicine may then end up on your hands. Therefore, wear gloves (nitrile or powder-free (low-)latex). Take off the gloves after spilling or when you have finished preparing the medicine for administration. The gloves are not only designed to prevent contamination of the employee but also to prevent contamination of the product.

Does the form in which the medicine is administered also determine the risk?

Yes, a solid in powder form can be blown away and so end up in your respiratory system or on your skin. Granules or tablets, on the other hand, can only be absorbed through direct contact with the skin. A substance in liquid form (drink) can end up on the skin if spilled. Aerosols are very small droplets that are not always visible. Absorption of aerosols during atomisation of medicines may occur by inhalation or if the droplets precipitating directly on the skin or on a surface. Through contact with the surface, the medicine may end up on the skin. In addition to the form of administration of the medicine and the likelihood of exposure, the harmful health effect of the medicinal product also plays a role in determining the risk.

Can I clean a cytostatics department myself?

Yes, provided you comply with the cleaning protocol. For example, you must always work from clean to dirty and used clean aids (dishcloths, mops, etc.) in every room. For further information, please refer to the OHS Catalogue of Cytostatics on the website.

Do I have to use protective equipment when administering cytostatics?

Yes, you must use personal protective equipment (PPE). For further information, please refer to the OHS Catalogue of Cytostatics on the website.

Do I have to take special precautions when atomising medicines?

Yes, often you do. This depends on the harmfulness and the use of the medicine to be atomised. In case of atomisation, the atomiser emits aerosols into the air. To prevent these aerosols from entering the ambient air and being inhaled by people other than the patient or absorbed through skin exposure, additional measures are often required. Use automatic switch-off atomisers when administration is interrupted or atomisers that can be switched off by the patient and that have effective filters for the exhaled air. Atomise medicinal products wherever possible in a specially designed room (atomiser room) that is sufficiently ventilated. Make sure that you spend as little time as possible near the atomisation, preferably none at all.

Must this atomiser room be cleaned every time after atomisation?

Yes, a number of medicines such as pentamidine and ribavirine should wherever possible be atomised in a separate room because of the harmful health effects of the substances. Damp-clean this atomiser room or have it damp-cleaned after each treatment. Because it takes some time for all aerosols to precipitate, this should be done at least 30 minutes after the treatment. You can also choose to atomise at the end of the day and only start cleaning the next day. However, post this on the outside of the room so that people do not enter the room unnecessarily. Make sure that as few items as possible are in the atomiser room and that the items that remain in the atomiser room can be cleaned properly.

Do I have to wear protective equipment when entering the atomiser room?

Yes, sometimes you do. It depends on the type of medicine being atomised and its use whether personal protective equipment (PPE) should be worn. If the risk assessment shows that PPE is necessary, it must be worn during the treatment (even if you walk in briefly) and for at least 30 minutes afterwards. You should wear respiratory protection, gloves and an apron. When leaving the room, you have to take off the PPE to avoid contamination of the environment and other rooms.

Do I have to use a double mask when working with inhaled anaesthetics?

No, it depends on the method of anaesthesia. In the case of inhaled anaesthetics, it is preferable to use cuffed tubes, as this minimises the risk of gases and vapours escaping. If another method of inhaled anaesthesia is used, it is recommended to use a double-mask system.

Patients anaesthetised in departments other than the operating theatre?

When inhaled anaesthetics are used in the outposts, contamination with inhaled anaesthetics in the breathing zone of staff members and in the room must be prevented. Outposts include the CT scan, MRI, cardiac catheterisation, etc. This can be done, for example, by applying source extraction, such as using a double mask system. The ventilation rate in the room must also be sufficiently high. The ventilation rate (measure of air circulation) must be at least 6. The same requirements apply to the disposal of anaesthetic gases (either returned to the device or disposed of in the evacuation/anaesthetic gas disposal system) as in the operating theatre. For further information, see the OHS Catalogue of Inhaled Anaesthetics on the website.