Drugs In Health Care Settings Research Articles

Advanced Progress of the Relationship Between Antihypertensive Drugs and Bone Metabolism.

Hypertension and osteoporosis are common comorbidities among elderly individuals. Drug therapy has been widely used in clinical practice as the preferred antihypertensive treatment. Therefore, antihypertensive drugs have become some of the most commonly prescribed drugs in healthcare settings. However, antihypertensive drugs have different effects on bone metabolism. The results of animal and clinical studies on the effects of antihypertensive drugs on osteoporosis or fracture risk are controversial and have aroused widespread concern among clinicians. Recent studies found that angiotensin receptor blockers, selective β-adrenergic receptor blockers, and thiazide diuretics might improve bone trabecular number and bone mineral density by stimulating osteoblast differentiation, reducing osteoclast generation, and other mechanism. Furthermore, nonselective β-adrenergic receptor blockers and dihydropyridine calcium channel blockers were found to have no significant relationship with bone mineral density or bone strength, and α-adrenergic receptor blockers and loop diuretics might increase fracture risk by decreasing bone mineral density. This article aimed to review previous animal experiments, clinical studies, and meta-analyses focusing on the effects of different antihypertensive drugs on bone metabolism, and to provide a new approach for the prevention and treatment of osteoporosis.

A simple approach to assess the cancer risk of occupational exposure to genotoxic drugs in healthcare settings

BackgroundSeveral drugs for human use possess genotoxic properties as a necessary consequence of their intended therapeutic effect (e.g. antineoplastics). Health workers may be exposed to these chemicals in various occupational settings such as dose preparation and administration. To date, there are no quantitative risk assessment models to estimate the cancer risk of health workers due to the handling of genotoxic drugs. We therefore developed a quantitative risk assessment model to assess the cancer risk of occupational exposure to genotoxic drugs in healthcare settings based on the threshold of toxicological concern (TTC) concept. This model was used to evaluate the cancer risk of health workers due to the handling of genotoxic drugs in modern health care facilities.MethodsWe modified the threshold of toxicological concern (TTC) concept to fit the purpose of occupational cancer risk assessment. The risk model underlying ICH guideline M7 (R1): “assessment and control of DNA reactive (mutagenic) impurities in pharmaceuticals to limit potential carcinogenic risk” was used as a starting point for our model. We conducted a short review of studies on the occupational exposure of health workers to genotoxic drugs. These occupational exposure data were compared to the acceptable exposure levels resulting from our TTC based risk model.ResultsBased on the threshold of toxicological concern (TTC) concept, we defined an acceptable daily intake (ADI) of 4 μg/day as threshold of no concern for the exposure of health workers to genotoxic drugs. Regarding the dermal exposure of health workers to genotoxic drugs, we derived a corresponding acceptable surface contamination level (ASCL) of 20 ng/cm2. Both ADI and ASCL are usually not exceeded in modern healthcare settings. Current safety precautions provide sufficient protection to health workers.ConclusionsThe application of our model indicates that workers in modern healthcare facilities are not at risk of developing work related cancer above widely accepted cancer risk levels due to the occupational exposure to genotoxic drugs. Hence, the present study may assist employers and public authorities to make informed decisions concerning the need for (further) protective measures and during risk communication to health workers.

Awareness and Views of Pharmacists and Physicians Toward Prescribing of Drugs for Off-Label Use in the Pediatric Population in Saudi Arabia.

Background: Prescribing off-label drugs in healthcare settings is a common practice worldwide. Thus, it is crucial to evaluate the knowledge and views of healthcare professionals regarding the off-label use of drugs in pediatric patients.Methodology: A cross-sectional study was conducted from June to December, 2020, among physicians and pharmacists in the Kingdom of Saudi Arabia (KSA). A 28-item questionnaire was distributed to the healthcare professionals through an electronic link. Descriptive and inferential statistics were used to report the data.Results: A total of 368 questionnaires were included in the final analysis. More than two-thirds of the respondents were aware of the correct definition of off-label drugs. Of the respondents, 37% were satisfied with their knowledge related to the use of off-label drugs in the pediatric population. Approximately half of the healthcare professionals in the study had major concerns about the efficacy and safety of off-label prescribing to children.Conclusion: Off-label drug use among pediatric patients is common practice in the KSA and healthcare professionals providing treatment to the children are also aware of the concept of off-label drugs.

Hazardous drugs (NIOSH's list-group 1) in healthcare settings: Also a hazard for the environment?

Healthcare workers can be exposed to dangerous drugs during their daily practice. The National Institute for Occupational Safety and Health (NIOSH) considers “hazardous drugs” as those that had shown one or more of the following characteristic in studies with animals, humans or in vitro systems: carcinogenicity, teratogenicity or other toxicity for development, reproductive toxicity, organ toxicity at low doses, or genotoxicity. In the actual list (draft list 2020), drugs classified in group 1 are those with carcinogenic effects. Moreover, the global human and veterinary cancer is expected to grow, so antineoplastic drug consumption may consequently grow, leading to an increase of anticancer pharmaceuticals in the environment. Not all drugs pertaining to group 1 can be classified as “antineoplastic” or “cytostatic”. Since most of the research on environment presence and ecotoxicological effects of pharmaceuticals has been focused on this therapeutic class, other carcinogenic drugs belonging to different therapeutic groups may have been omitted in previous studies. In this study we aim to review the presence in the environment of the hazardous drugs (NIOSH group 1) and their possible environmental impact. Of the 90 drugs considered, there is evidence of presence in the environment for 19. Drugs with more studies reporting positive detections are: the antibiotic chloramphenicol (55), the alkylating agents cyclophosphamide (39) and ifosfamide (30), and the estrogen receptor modulator tamoxifen (18). Although the original purpose of the NIOSH list and related documents is to provide guidance to healthcare professionals in order to adequately protect them from the hazards posed by these drugs in healthcare settings, we believe they can be useful for environmentalists too. Absence of data regarding the potential of environmental risk of certain hazardous drugs might tell us which drugs ought to be prioritized in the future.

Environmental assessment of cytotoxic drugs in healthcare settings: protocol for a systematic review and meta-analysis

BackgroundOccupational exposure to cytotoxic drugs is associated with various unfavorable health outcomes. This protocol reports a methodology for a systematic review and meta-analysis that aims to systematically review the published literature and quantify the level of environmental contamination of healthcare settings with cytotoxic drugs.MethodsThis protocol is developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol-2015 (PRISMA-P) guidelines. Six electronic databases (PubMed, Web of Science, Scopus, Cochrane Library, CINAHL, and EMBASE) will be searched with no restrictions on publication period. Eligible studies will be identified and data will be extracted using a predefined data extraction form by at least two independent reviewers following best practice. Eligible studies should report calculated or calculable estimates on the proportion of positive samples tested for cytotoxic drugs and/or estimates on the concentration of the cytotoxic drug(s) in the tested samples. Risk of bias (RoB) will be assessed by using the RoB in Studies estimating Prevalence of Exposure to Occupational risk factors (RoB-SPEO) tool, which developed by the World Health Organization (WHO) and International Labour Organization (ILO) for environmental and occupational health systematic reviews. The random-effects model will be used to perform meta-analyses.DiscussionOccupational exposure to cytotoxic drugs is associated with short- and long-term adverse health outcomes. Following this protocol, the review to be carried out will be the first to fill an evidence gap on the environmental contamination of healthcare settings with cytotoxic drugs. The findings of this review will help in the understanding of the risk of occupational exposure of healthcare workers to cytotoxic drugs and facilitate the identification of priority areas for specific interventions.Ethics and disseminationThe systematic review methodology does not require ethics approval due to the nature of the study design. The results of the systematic review will be published in a peer-reviewed journal and will be publicly available.Systematic review registrationPROSPERO CRD42020162780, dated July 14, 2020

Comparison of conventional and rapid methods for the detection of methicillin resistance in Staphylococcus aureus from blood cultures

Background: Considering the increasing rate of infections caused by methicillin-resistant Staphylococcus aureus (MRSA), reliable, accurate, and rapid testing for the detection of MRSA is essential for both initiation of antimicrobial therapy and infection control measures. Materials and Methods: Fifty clinical isolates of S. aureus from patients with bacteremia were confirmed bacteriologically and subjected to antimicrobial susceptibility testing, followed by the detection of methicillin resistance by oxacillin and cefoxitin disc diffusion methods, oxacillin agar screen test, and direct cefoxitin disc diffusion method from blood culture bottles. Results: On comparing the methods under study, 36% MRSA were detected by disc diffusion methods, whereas 44% and 46% were detected by oxacillin agar screen and direct cefoxitin disc diffusion blood culture, respectively. Conclusions: The emergence of MRSA underscores the need for programs to prevent the spread of antimicrobial-resistant organisms and control the use of antimicrobial drugs in health-care settings.

Surface wipe sampling for antineoplastic (chemotherapy) and other hazardous drug residue in healthcare settings: Methodology and recommendations

ABSTRACTSurface wipe sampling for various hazardous agents has been employed in many occupational settings over the years for various reasons such as evaluation of potential dermal exposure and health risk, source determination, quality or cleanliness, compliance, and others. Wipe sampling for surface residue of antineoplastic and other hazardous drugs in healthcare settings is currently the method of choice to determine surface contamination of the workplace with these drugs. The purpose of this article is to review published studies of wipe sampling for antineoplastic and other hazardous drugs, to summarize the methods in use by various organizations and researchers, and to provide some basic guidance for conducting surface wipe sampling for these drugs in healthcare settings. Recommendations on wipe sampling methodology from several government agencies and organizations were reviewed. Published reports on wipe sampling for hazardous drugs in numerous studies were also examined. The critical elements of a wipe sampling program and related limitations were reviewed and summarized. Recommendations and guidance are presented concerning the purposes of wipe sampling for antineoplastic and other hazardous drugs in the healthcare setting, technical factors and variables, sampling strategy, materials required, and limitations. The reporting and interpretation of wipe sample results is also discussed. It is recommended that all healthcare settings where antineoplastic and other hazardous drugs are handled consider wipe sampling as part of a comprehensive hazardous drug “safe handling” program. Although no standards exist for acceptable or allowable surface concentrations for these drugs in the healthcare setting, wipe sampling may be used as a method to characterize potential occupational dermal exposure risk and to evaluate the effectiveness of implemented controls and the overall safety program. A comprehensive safe-handling program for antineoplastic drugs may utilize wipe sampling as a screening tool to evaluate environmental contamination and strive to reduce contamination levels as much as possible, using the industrial hygiene hierarchy of controls.

New approaches to wipe sampling methods for antineoplastic and other hazardous drugs in healthcare settings.

At the present time, the method of choice to determine surface contamination of the workplace with antineoplastic and other hazardous drugs is surface wipe sampling and subsequent sample analysis with a variety of analytical techniques. The purpose of this article is to review current methodology for determining the level of surface contamination with hazardous drugs in healthcare settings and to discuss recent advances in this area. In addition it will provide some guidance for conducting surface wipe sampling and sample analysis for these drugs in healthcare settings. Published studies on the use of wipe sampling to measure hazardous drugs on surfaces in healthcare settings drugs were reviewed. These studies include the use of well-documented chromatographic techniques for sample analysis in addition to newly evolving technology that provides rapid analysis of specific antineoplastic. Methodology for the analysis of surface wipe samples for hazardous drugs are reviewed, including the purposes, technical factors, sampling strategy, materials required, and limitations. The use of lateral flow immunoassay (LFIA) and fluorescence covalent microbead immunosorbent assay (FCMIA) for surface wipe sample evaluation is also discussed. Current recommendations are that all healthcare settings where antineoplastic and other hazardous drugs are handled include surface wipe sampling as part of a comprehensive hazardous drug-safe handling program. Surface wipe sampling may be used as a method to characterize potential occupational dermal exposure risk and to evaluate the effectiveness of implemented controls and the overall safety program. New technology, although currently limited in scope, may make wipe sampling for hazardous drugs more routine, less costly, and provide a shorter response time than classical analytical techniques now in use.

USP : Handling Hazardous Drugs.

On March 28, 2014, the United States Pharmacopoeia (USP) proposed a new chapter: USP Hazardous Drugs – Handling in Healthcare Settings, which is available at http://www.usp.org/sites/default/files/usp_pdf/EN/m7808.pdf.1,2 The purpose of this proposed chapter is to guide the handling of hazardous drugs and protect health care personnel, patients, and the environment during the transport, storage, preparation, dispensing, and administration of these medications. On an annual basis, more than 8 million health care personnel are potentially exposed to hazardous medications.3 Although the incidence of cancer-related morbidity and mortality due to handling of hazardous drugs among health care personnel has not been definitively quantified, the clinical data on reproductive risks and chromosomal abnormalities are numerous. In fact, the National Institute for Occupational Safety and Health (NIOSH) maintains a comprehensive listing of published data related to the occupational exposure of antineoplastic agents (http://www.cdc.gov/niosh/topics/antineoplastic/pubs.html).4 USP does not explicitly provide health care personnel with a list of medications deemed hazardous, but it refers facilities to the 2012 National Institute for Occupational Safety and Health (NIOSH) list of antineoplastic and other hazardous drugs in health care settings (http://www.cdc.gov/niosh/docs/2012-150/).5 The NIOSH list of hazardous medications was compiled in 2004 with updates in 2010 and 2012. Health care facilities need to consistently monitor the NIOSH site for continued updates to the hazardous drug listing. USP places many responsibilities on organizations that handle hazardous drugs2: Having an assigned individual who serves as a “compounding supervisor.” The supervisor is responsible for all aspects related to hazardous medication handling including developing and implementing procedures, overseeing compliance, ensuring personnel competency, and maintaining environmental control of areas where hazardous compounding occurs. Maintaining appropriate storage of all hazardous drugs. For the most part, hazardous medications must be stored separately from non-hazardous medications, although exceptions exist. Ensuring hazardous drug sterile compounding occurs in an appropriately designed facility. There are 3 possible facility designs for sterile compounding per USP . Dispensing oral and topical hazardous medications in an appropriate manner. Utilizing closed-system drug transfer devices during preparation and administration of hazardous medications when the dosage form allows. The goal of all of the recommendations within USP is to minimize or eliminate occupational exposure to hazardous medications. Although the USP proposes standards for pharmaceutical compounding and handling, including USP Pharmaceutical Compounding – Nonsterile Preparations and USP Pharmaceutical Compounding – Sterile Preparations, the organization has no enforcement authority.6 However, various national and state agencies and organizations can either enforce or recommend the adoption of USP standards. The US Food and Drug Administration has the authority to enforce USP standards and may push state agencies to adopt USP . State boards of pharmacy may also adopt USP standards and enforce them. In addition, The Joint Commission can reference compliance with USP standards as best practice, which can result in adoption by health care facilities in order to maintain accreditation. Some states have begun to evaluate the issues surrounding occupational exposure of hazardous medications and have made rules or passed legislation regarding this topic. In October 2013, the California legislature approved a bill that requires the state Occupational Safety and Health Standards Board to adopt a standard for the handling of antineoplastic agents.7 The bill stated that the standard “be consistent with and not exceed specific recommendations adopted by NIOSH” for preventing occupational exposure to antineoplastic medications in health care facilities. Other states that have addressed, or are in the process of addressing, handling of hazardous medications include Washington, Maryland, and North Carolina. In summary, the proposed USP sets standards for the appropriate handling of hazardous medications from transport and storage to preparation and administration. The goal of these standards is to minimize exposure of health care personnel, patients, and the environment to these harmful agents. Although USP cannot enforce the standards, federal and state agencies and organizations may require implementation and adopt enforcement. Some state legislatures have already passed laws regarding appropriate handling, which impact health care facilities including hospital and community pharmacies.

Reproductive health risks associated with occupational exposures to antineoplastic drugs in health care settings: a review of the evidence.

Antineoplastic drugs are known reproductive and developmental toxicants. Our objective was to review the existing literature of reproductive health risks to workers who handle antineoplastic drugs. A structured literature review of 18 peer-reviewed, English language publications of occupational exposure and reproductive outcomes was performed. Although effect sizes varied with study size and population, occupational exposure to antineoplastic drugs seems to raise the risk of both congenital malformations and miscarriage. Studies of infertility and time to pregnancy also suggested an increased risk for subfertility. Antineoplastic drugs are highly toxic in patients receiving treatment, and adverse reproductive effects have been well documented in these patients. Health care workers with long-term, low-level occupational exposure to these drugs also seem to have an increased risk of adverse reproductive outcomes. Additional precautions to prevent exposure should be considered.

How Patients Understand the Term “Nonmedical Use” of Prescription Drugs: Insights from Cognitive Interviews

ABSTRACT. Background: With rising rates of prescription drug abuse and associated overdose deaths, there is great interest in having accurate and efficient screening tools that identify nonmedical use of prescription drugs in health care settings. The authors sought to gain a better understanding of how patients interpret questions about misuse of prescription drugs, with the goal of improving the accuracy and acceptability of instruments intended for use in primary care. Methods: A total of 27 English-speaking adult patients were recruited from an urban safety net primary care clinic to complete a cognitive interview about a 4-item screening questionnaire for tobacco, alcohol, illicit drugs, and misuse of prescription drugs. Detailed field notes were analyzed for overall comprehension of the screening items on illicit drug use and prescription drug misuse, the accuracy with which participants classified drugs into these categories, and whether the screening response correctly captured the participant's substance use behavior. Results: Based on initial responses to the screening items, 6 (22%) participants screened positive for past-year prescription drug misuse, and 8 (30%) for illicit drug use. The majority (26/27) of participants correctly interpreted the item on illicit drug use, and appropriately classified drugs in this category. Eleven (41%) participants had errors in their understanding of the prescription drug misuse item. The most common error was classifying use of medications without abuse potential as nonmedical use. All cases of misunderstanding the prescription drug misuse item occurred among participants who screened negative for illicit drug use. Conclusions: The results suggest that terminology used to describe misuse of prescription medications may be misunderstood by many primary care patients, particularly those who do not use illicit drugs. Failure to improve upon the language used to describe prescription drug misuse in screening questionnaires intended for use in medical settings could potentially lead to high rates of false-positive results.

Hazardous Drugs in Health Care Settings—Recognition and Control

NIOSH has updated its latest list of antineoplastic and other hazardous drugs in health care settings.

Hazardous Drugs in Health Care Settings—Recognition and Control

NIOSH has updated its latest list of antineoplastic and other hazardous drugs in health care settings.

DESI-MS2: a rapid and innovative method for trace analysis of six cytostatic drugs in health care setting

With the aim of establishing exposure levels for hospital personnel preparing and administering cytostatic drugs (CDs), here, we present an innovative screening method based on the use of the desorption electrospray ionization (DESI) interface coupled with a hybrid quadrupole linear ion trap mass spectrometer. A rapid, simple, and sensitive procedure was developed for the simultaneous surface monitoring of cyclophosphamide, dacarbazine, methotrexate, vincristine, gemcitabine, and cytarabine. Since analytes were in the solid state, a novel approach based on the use of passive samplers was combined with the direct analysis of wipes. A PTFE-printed glass slide was used as a passive sampler, while hydrophobic centers of Swiffer® cloths were judged extremely efficient as wipe samplers. After the sampling period, the CD collectors were directly processed with the DESI-MS system without any further treatment. MS/MS confirmatory analysis was conducted using selected reaction monitoring in the positive ion mode and detection limits were evaluated. Values were at the picograms per square millimeter levels on the passive collector and at the picograms per square centimeter levels for the wipe ones. Direct determination on solid-state samples combined with mass spectrometry selectivity provided a powerful tool so far unapplied to occupational hygiene.

Self - treatment with drugs during gestation

Background Pregnancy due to its nature is associated with some problems, which may increase the need for drugs. Drug self-treatment can cause severe complications and lack of information of mothers concerning the indications of drugs may have detrimental effects on family as well as society. Purpose This descriptive study was conducted to identify knowledge, attitude and practice of pregnant women regarding self-treatment with drugs in healthcare settings affiliated to Shaheed Beheshti Medical University in 2006. Methods 180 pregnant women referring to healthcare centers were selected in 2 steps by cluster sampling method. The stage of their gestational period was not important. An information form was used for data collection. Results Findings showed that 98.3% of women knew the forbiddance of chemical drugs during pregnancy without prescription. 70.6% agreed chemical drug prescription by a professional. Of 180 women, 100 (55.5%) took chemical drugs during their pregnancy and 97.8% used the drugs by prescription. 11.1% took herbs by prescription while 84.2% used them without prescription and by recommendation of their acquaintances or their own views. 4.7% took herbs by suggestion of herbalists. Conclusion It can be concluded that despite good knowledge of women about indications of chemical drugs, their information regarding herbs is not satisfactory. Therefore, developing appropriate educational plans in media, healthcare settings and prenatal clinics to improve their knowledge seems necessary. Keywords: Knowledge, Attitude, Practice, Self-treatment, Pregnant women.

Preventing Occupational Exposures to Antineoplastic Drugs in Health Care Settings

The toxicity of antineoplastic drugs has been well known since they were introduced in the 1940s. Because most antineoplastic drugs are nonselective in their mechanism of action, they affect noncancerous as well as cancerous cells, resulting in well-documented side effects. During the 1970s, evidence came to light indicating health care workers may be at risk of harmful effects from antineoplastic drugs as a result of occupational exposure. Since that time, reports from several countries have documented drug contamination of the workplace, identified drugs in the urine of health care workers, and measured genotoxic responses in workers. Evidence also exists of teratogenic and adverse reproductive outcomes and increased cancers in health care workers. During the past 30 years, professional organizations and government agencies have developed guidelines to protect health care workers from adverse effects from occupational exposure to antineoplastic drugs. Although many safety provisions were advanced to reduce worker exposure in the 1980s, recent studies have shown that workers continue to be exposed to these drugs despite safety policy improvements. In 2004, the National Institute for Occupational Safety and Health (NIOSH) published an alert reviewing the most recent information available and promoting a program of safe handling during their use.