Health hazard evaluation report: evaluation of safety climate, health concerns, and pharmaceutical dust exposures at a mail order pharmacy.
Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, HETA 2012-0044-3199, 2013 Dec; :1-55
The Health Hazard Evaluation (HHE) Program received a request from a mail order pharmacy. Employees were concerned about possible health effects from exposures to hazardous drugs and pharmaceutical dust, and communication and other workplace safety climate issues. Roughly 175 employees worked at the pharmacy; the majority of whom were contractors performing most production functions (e.g., filling, labeling, packaging, and housekeeping). On average, the mail order pharmacy filled approximately 74,000 prescriptions per day using automated and manual distribution systems. HHE Program investigators evaluated the pharmacy in August 2012. We surveyed employees and talked with them about job stress, work-related health concerns, and perceptions of the job and social factors at work. We sampled air and work surfaces for lactose (inactive ingredient in pharmaceuticals) and active pharmaceutical ingredients. Overall, employees had a positive perception of safety climate. However, contractor employees were not comfortable taking time off work when ill and they reported more eye, nose, throat, and skin irritation and cough associated with work than company employees. Some employees were concerned about repetitive tasks and prolonged standing. No employees reported changes in their health consistent with exposures to hazardous drugs. However, air sampling results indicated that employees who clean or repair automatic dispensing machine cells, refill automatic dispensing machine canisters, clean manually-fed automated counters with canned air, and hand-fill hazardous drug prescriptions may be exposed to airborne dust from uncoated tablets. Inhalation exposures to active pharmaceutical ingredients were mostly below manufacturers' occupational exposure limits (if a limit was available). However, an employee who cleaned and repaired Baker machine cells was exposed to airborne Lisinopril, an antihypertension medication, above the exposure limit. Some employees were exposed to multiple active pharmaceutical ingredients, the effects of which are not well understood. The surface sampling results and our observations also indicate the potential for personal clothing contamination with active pharmaceutical ingredients and the potential for take home exposure. Employees were provided vinyl gloves but no other protective clothing. Employees demonstrated good housekeeping and hand-washing practices. To address areas of concern identified in the survey and employee interviews, HHE Program investigators recommended the employer (1) create a health and safety committee, (2) stop the punitive "point system" for discouraging absences, and (3) provide seats at workstations. To address the potential for exposures to pharmaceutical dust, HHE Program investigators recommended the employer (1) substitute uncoated tablets with coated tablets when that option is available, (2) create a list of pharmaceuticals that are dusty and use this information to determine how to handle these pharmaceuticals, (3) use local exhaust ventilation hoods that are ducted outdoors for filling hazardous drug prescriptions and other tasks that could create pharmaceutical dust, (4) require employees to wear nitrile gloves as these are better suited than vinyl gloves for pharmaceutical dust and the isopropyl alcohol used to clean surfaces and equipment, and (5) provide safety glasses and long-sleeve protective clothing to employees who hand fill hazardous drug prescriptions or create pharmaceutical dust.
Region-4; Materials-handling; Materials-transport; Pharmaceutical-industry; Pharmaceuticals; Pharmacy-workers; Drugs; Exposure-assessment; Exposure-levels; Exposure-limits; Dust-exposure; Automation; Machine-operation; Machine-operators; Ventilation; Ventilation-systems; Exhaust-ventilation; Eye-irritants; Respiratory-irritants; Skin-irritants; Dermatitis; Safety-climate; Job-stress; Antineoplastic-agents; Sociological-factors; Work-operations; Repetitive-work; Inhalants; Medicinal-chemicals; Personal-protective-equipment; Work-practices; Gloves; Exhaust-hoods; Goggles; Protective-clothing; Protective-coatings; Control-systems;
Author Keywords: Pharmacies and Drug Stores; pharmaceutical dust; pill dust; lisinopril; methotrexate; hazardous drugs; automatic dispensing machines; mail order pharmacy; dust exposures; local exhaust ventilation; eye irritation; respiratory irritation; skin irritation; safety climate; job stress