- 期刊
醫院化學治療作業工作安全衛生調查
An Investigation on the Hygiene Factors of Chemotherapy Works in Taiwan Hospital
摘要
化學治療藥物具有細胞毒性，醫院工作人員在藥物處理流瀉、照護病人、處理廢棄物過程中，可能因為藥物外滲、揮發、飛沫、或接觸病患排泄物而造成職業暴露。長期暴露可能會影響工作人員健康率。 本研究於93年對台灣有化學治療的醫院進行工作防護狀況之調查，分別發送問卷給57家之安全衛生室、藥劑部與護理部，回收率各為52.6%、71.9%及54.3%。調查結果顯示，常用化療藥物超過50種，5-氟尿嘧啶為最常用的3種藥物之一，其次為順一雙氨雙氯鉑。藥劑部80%具負壓隔離艙，65%備有藥物之物質安全資料表。護理部在給藥地點及藥瓶上有警告標示者僅64.5%，對懷孕及哺乳期工作人員僅38.7%有特別保護措施。處理病患排泄物時，使用隔離衣及護目鏡者只有51.6% 綜合結果顯示護理人員與藥劑師均了解藥物的副作用，亦接受過配藥給藥之安全教育，常使用防護具，有定期健康檢查，但僅70%有特殊健康檢查。83.3%醫院有提供專業防護訓練，所用教材約70%為院方編寫。殘餘物及廢棄物委外處理者超過80%。所有受訪單位都發生過藥物洩漏事件，但備有緊急處理器材的僅有47.5%，事件後會就診者僅46.3%。 整體而言，暴露預防政策及化療藥物操作規範，各醫院無一致的作法。化療作業相關各部門，應採用同樣安全衛生管理措施，並應加強洩漏事件的後續補救與暴露危害追蹤。
並列摘要
Most anticancer drugs are cytotoxic, and healthcare workers may be exposed to these drugs via drug extravasation, volatilization, and while providing patient care. Long term exposure may result in harmful effects, including a carcinogenic risk for workers. In 2004, we conducted a survey to assess exposure prevention measures for chemotherapy workers in the divisions of health and safety, pharmacy, and nursing among 57 hospitals. The response rates were 52.6%, 71.9%, and 54.2%, respectively. Among over 50 chemotherapeutic drugs commonly used, 5-Fluoro-uracil was the most frequently prescribed, with Cisplatin the second most common. Approximately 80% of the hospitals were equipped with negative pressure clean rooms in the pharmacy divisions, and 65% provided Material Safety Data Sheets. Most nursing divisions posted warning posters at drug delivery locations. Only 64.5% of hospitals used warning labels on drug bottles and 38.5% provided additional protective measures for pregnant or postnatal nurses. Only 51.6% provided a safety apron and glasses to workers who disposed of patient excrements. All nurses and pharmacists received safety training concerning drug preparation and delivery, protective clothing, and annual health examinations. Only 70% provided special health examinations, and 83.3% provided workers with special training about occupational safety. Over 80% of the hospitals contracted with cleansing companies to dispose of chemotherapy waste. All hospitals experienced chemical leakages, but only 47.5% of them prepared proper drug-spill treatment packages and only 46.3% of related workers received medical attention after such events. Exposure prevention measures for handling anticancer drugs varied greatly among hospitals. Chemotherapy drug safety should be compromised among all divisions in hospitals, and follow-up actions for leakages and other types of exposure should be strengthened.