Closed systems as a means of preventing medical personnel diseases

N.E. Prohach, Cand. honey. Sci., doctor-oncologist of the highest category

The main result of the activity of medical workers - the health of the patient - is largely determined by the working conditions and the health status of the health workers themselves. A study of the health status of physicians convincingly shows that many diseases in them are professional and depend on the nature and severity of occupational hazards.

Currently, the most common adverse factor in the work environment of health workers is the air pollution of work premises with aerosols of medicinal substances, especially extremely toxic, such as hormones, antibiotics and antitumor drugs. At the same time, the working conditions of medical staff of oncological institutions using antitumor drugs are considered to be the highest degree of harmfulness, in which severe forms of occupational diseases, including loss of general working capacity, can arise [2].

Studies of working conditions and the state of health of specialists using antineoplastic agents in the treatment showed that this group of medical workers constitutes a risk group for the development of occupational pathology. The personnel of the chemotherapeutic departments have a high level of diseases of the gastrointestinal tract, kidneys, cardiotoxic changes, the dependence of hematologic shifts on the length of work with chemotherapy has been revealed. Women who have professional contact with cytostatics have amenorrhea and premature birth.

Antineoplastic antibiotics are causally important allergens for the development of professional dermatoses, vasomotor rhinitis, asthmatic bronchitis in persons in contact with them. Local toxic effects of cytostatics include inflammatory processes of the mucous membranes, skin pigmentation, ulceration of the cornea when individual drugs fall on the eye mucosa and other [3].

Medical staff working in chemotherapy departments and daily dealing with a huge range of cytotoxic drugs, unfortunately, often view these drugs only as factors conditioned by the specifics of the profession, not realizing the dangers posed by these substances. "The danger of cytotoxic drugs has always been assumed, but the problem is that to see or smell the notorious mutagenicity, teratogenicity and carcinogenicity, alas, it was impossible," - this is a quote from the speech of the chief regional pharmacist of the Israeli Ministry of Health Yakov Kassa at the plenary session "Modern Requirements for environmental safety and medical personnel in dealing with dangerous drugs "within the framework of the XIII Russian Cancer Congress (November 2009). His speech was caused by the fact that the point of view that existed for many years about maximum protection of the personnel of European clinics having professional contact with cytostatics was not confirmed. Despite strict safety requirements,
adopted in the European

The Union, with inspections of European hospitals, traces of contamination with cytotoxic drugs were found almost everywhere: in hospital pharmacies, in fume cupboards for the preparation of solutions for intravenous administration and in hospital wards. Studies have shown that vials with cytostatic drugs used in oncology may contain traces of drug substance on their surface and when handling such vials, there is a risk of penetration of a hazardous substance through the skin and mucous membranes. The risk also arises from the inhalation of vapors and aerosols of dry and liquid substances, contact with the skin and mucous membranes, surface contamination and needle pricking.

Having familiarized with the data of these studies, the specialists of the National Institute for Occupational Safety and Industrial Hygiene (NIOSH) came to the conclusion that existing methods of preventing environmental pollution and exposing personnel to cytotoxic drugs are "insufficient". Physicians were advised to use protective devices - "closed" systems. 

The definition given by NIOSH to "closed" systems reads: "A device for transferring a preparation that mechanically prevents environmental contaminants from entering the system and leakage of concentrations of a dangerous preparation or its vapors outside the system". And such systems, providing additional safety in the cultivation and introduction of cytostatics, are already widely used in Europe, North America.. 

Similar systems for transfusion of infusion solutions S-IS-DUO two-way and S-SI-QUAD four-way trade mark MEDICARE appeared on the pharmaceutical market of Ukraine. "S-SI-DUO" and "S-SI-QUAD" systems minimize the risk of contact with health-hazardous components of medications at all stages of interaction with them: dilution, mixing, and administration.

The device prevents the release of harmful vapors and aerosols into the external environment, preserves the sterility of the drug, reduces the contact of medical staff with the active substances. In addition, the use of the "S-SI-DUO" and "S-SI-QUAD" systems reduces the risk of getting a wound by a nurse with a needle. This is no less important, since medical personnel working with needles and other sharp instruments are at increased risk of accidental needle pricking, which can be accompanied by contamination by bloodborne pathogens, including hepatitis B viruses (HBV), hepatitis C (HCV) and human immunodeficiency virus. 

Compared with the results of using a standard needle and syringe, the multi-pass systems "S-SI-DUO" and "S-SI-QUAD" prevent leakage of toxic compounds into the environment, provide sterility even with significant bacterial contamination, while being safe and easy to operate [4].

The use of two-and four-way systems "S-SI-DUO" and "S-SI-QUAD", provides the following advantages: safety of dilution, administration and storage of drugs containing hazardous to human health and the environment components; versatility - compatibility with standard vials, syringes, infusion bags; reducing the number of manipulations prevents the risk of accidental needle pricking; simplicity in operation - to start work, almost no additional training is required, since the design and operation of the multi-pass "S-SI: systems is very simple. Thus, the use of the multi-pass systems "S-SI-DUO" and "S-SI-QUAD" of the trade mark MEDICARE in the chemotherapy departments will contribute to the important strategic task of reducing the incidence of medical personnel having professional contact with toxic drugs.

Additional information on this and other products of the Medicare trademark can be obtained on the website of LTD "DopomogA-1":
www.dopomoga1.com,
info@dopomoga1.com
tel .: 380 44 417-40-69

Literature
1. EVKhvorova // Factors influencing the occupational morbidity of medical workers. Legal Aspects: Mater. VII Russian Cancer Conference, November 27, 2003.
2. K.Sedov // Work of medical staff is both dangerous and difficult: mother. XIII Russian Cancer Congress, November 17, 2009
3. Professionally dependent dermatoses from contact with antitumor drugs / SM. Fedorov, I.V. Sharipova, GD Selissky, Yu.V.Perlamutrov // Bulletin of Dermatology and Venereology. - 1998. - № 5. - P. 31-32.
4. Connor T.H., Sessink P.J. et al. Three reports of external contamination on chemotherapy drug. Vials in clinical and manufacturing settings and evaluation of new cleaning techniques in manufacturing.// Approved for publication in Am. J. Health. Pharm. - 2005. 5. LLC "Dopomoga-1": www.dopomoga1.com   

The pharmacist, 2011. No. 20