2020年抗癌危害性藥品給藥防護作業指引

Guideline of Safe Handling for Anti-Neoplastic Hazardous Drugs- 2020

張黎露(Li-Lu Chang) ； 姜紹青(Shao-Chin Chiang) ； 江孟冠(Meng-Kuan Chiang) ； 陳幼貴(Yu-Kuei Chen) ； 周文珊(Wen-Shan Chou) ； 林盈秀(Ying-Siou Lin) ； 黃麗燕(Li-Yan Huang) ； 邱詩怡(Shih-Yi Chiu) ； 蔡靜儀(Ching-I Tsai) ； 李俊緯(Chun-Wei Li) ； 劉庭瑋(Ting-Wei Liu) ； 蕭信一(Xin-Yi Xiao)

《腫瘤護理雜誌》 20卷增訂刊 (2020/12) Pp. 5-76

https://doi.org/10.6880/TJON.202012/SP_20.01

摘要

第一線接觸抗癌危害性藥品或危害性廢棄物的醫護人員，可能會因為處理過程而危害自身健康。抗癌危害性藥品可能會暴露在空氣中、工作表面、醫療設備和病人的排泄物中。醫療機構應實施全面的安全防護計劃，提供抗癌危害性藥品處理教育訓練計畫，並經由工程控制，良好的工作習慣和個人防護設備（PPE）最大限度地減少職業接觸。美國USP800、ONS和NOISH三個組織發布最新的危害性藥品安全防護指引，內容作了大幅度的更新，主要更新重點包括個人防護裝備、建立安全文化、環境檢測、工程控制、密閉式藥品配置和給藥系統、醫療監控等，值得注意的是，新版指引更進一步提到懷孕工作者和替代性職責方案等。在本次2020年更新版指引中，包含以下章節：（1）抗癌危害性藥品定義與暴露風險；（2）風險管理與工程控制；（3）採購、儲存、接收與傳送；（4）藥品調配；（5）給藥；（6）廢棄物處理；（7）潑灑處理；（8）環境清潔與防護品質監控；（9）人員教育；（10）醫療人員健康監控。這個指引將提供醫療機構發展、檢討、或修訂機構內作業標準流程，以落實安全防護標準和維護人員的健康。

關鍵字

抗癌危害性藥品 ； 安全防護 ； 作業指引

並列摘要

Healthcare workers, who working on the frontline to handle antineoplastic hazardous drugs or hazardous drug waste, may have risks to their own health. They can be exposed to hazardous drugs in the air, or on work surfaces, medical equipments, and patient excreta. The organizations should implement a comprehensive prevention program that minimizes occupational exposure through engineering controls, good work practices, and personal protective equipment (PPE) and provides education about working with hazardous drugs. The most recent published guidelines from USP, Oncology Nursing Society (ONS), and The National Institute for Occupational Safety and Health (NIOSH) add more update information and contents on safety culture, environmental surveillance, personal protective equipment, engineering controls, closed systems transfer devices, and medical surveillance. Of note, the new version of guideline recommends that workers who are pregnant, trying to conceive or breastfeeding should be offered alternative duty. The 2020 versionof guideline consists of tenchapters: 1) definition of hazardous drugs and risk ofexposure; 2) risk management and engineering controls; 3) drug procurement, storage, reception, and transmission; 4) drug compounding; 5) administration of drugs; 6) management of wastes; 7) management of spills; 8) environmental decontamination and quality control; 9) staff education and training; 10) medical surveillance of healthcare workers handling hazardous drugs. The purpose of this guideline is to provide recommendations for institutions to develop, review, or revise standard procedures of safe handling practices for antineoplastic drugs. This guideline also provides important information for health care workers to minimize exposure to antineoplastic drugs.

並列關鍵字

antineoplastic hazardous drugs ； safe handling ； practice guideline

參考文獻

American Society of Health-System Phar-macists[ASHP] (2006). ASHP guidelines on handling hazardous drugs. American Journal of Health-System Pharmacy, 63, 1172–1193. doi:10.2146/ajhp050529

Boiano, J. M., Steege, A. L., & Sweeney, M. H. (2015). Adherence to Precautionary Guidelines for Compounding Antineoplastic Drugs: A Sur-vey of Nurses and Pharmacy Practitioners. Jour-nal of Occupational and Environmental Hygiene, 12(9), 588–602. https://doi.org/10.1080/15459624.2015.1029610

Carrington, C., Stone, L., Koczwara, B., Sear-le, C., Siderov, J., Stevenson, B., Michael, M., Hyde, S., Booth, A., Rushton, S., & Clinical On-cological Society of Australia (2010). The Clin-ical Oncological Society of Australia (COSA) guidelines for the safe prescribing, dispensing and administration of cancer chemotherapy. Asia-Pacific Journal of Clinical Oncology, 6(3), 220–237. https://doi.org/10.1111/j.1743-7563.2010.01321.x

Connor, T. H., DeBord, D. G., Pretty, J. R., Ol-iver, M. S., Roth, T. S., Lees, P. S., Krieg, E. F., Jr, Rogers, B., Escalante, C. P., Toennis, C. A., Clark, J. C., Johnson, B. C., & McDiarmid, M. A. (2010). Evaluation of antineoplastic drug exposure of health care workers at three univer-sity-based US cancer centers. Journal of Occu- pational and Environmental Medicine, 52(10), 1019–1027. https://doi.org/10.1097/JOM.0b013e3181f72b63

Connor, T. H., Lawson, C. C., Polovich, M., & McDiarmid, M. A. (2014). Reproductive health risks associated with occupational exposures to antineoplastic drugs in health care settings: A review of the evidence. Journal of Occupational and Environmental Medicine, 56(9), 901–910. https://doi.org/10.1097/JOM.0000000000000249