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Department of Health and Human Services. NIOSH and the American Society of Hospital Pharmacists (ASHP) (ASHP, 1990) redefined the term "hazardous drug" beyond directly cytotoxic drugs to include additional agents that exhibit specific characteristics in human and animal toxicity [See sec. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. If vials are not cleaned before they are stored in HD work areas or placed in the buffer areas or in the Class II BSC, the residue on the outside of drug vials may transfer to other surfaces and/or onto gloves, which may further transfer the residue. Another approach is to administer the history annually but use the health and exposure history responses to guide the interval for physical exam and laboratory studies. This section summarizes additional published guidance on training for workers in work area where HDs are present. Exposure is also likely to result from ingestion of contaminated food or drink or through mouth contact with contaminated hands or cigarettes. Reproductive health and work: different experiences. Le J, Ashley E, Neuhauser M, Brown J, Gentry C, Klepser M, Marr A, Schiller D, Schwiesow J, Tice S, VandenBussche H, Wood GC [2010].Consensus Summary of Aerosolized Antimicrobial Agents: Application of Guideline Criteria: Insights from the Society of Infectious Diseases Pharmacists. On June 24, 1991, a 37-year-old construction laborer was electrocuted while pulling a wire rope attached to a crane cable toward a load. Fransman W, Vermeulen R and Kromhout H [2004]. Boffetta P [2007]. Per USP <800>, the entity should enforce policies that include a tiered approach, including (USP 800, 2016): USP <800> differentiates between transporting from receiving to the storage and compounding area, transporting from compounding to patient areas within the healthcare entity, and transporting from compounding to outside the healthcare entity (USP 800, 2016). The training should include at least the list of HDs; review of HD handling policies; proper use of PPE, equipment and devices; response to known or suspected HD exposure; spill management; proper disposal of HDs and trace contaminated equipment (USP 800, 2016). A study conducted by the Occupational Safety and Health Administration (OSHA) showed that 377 (65%) of 580 work-related electrocutions occurred in the construction industry during the period 1985-89 [OSHA 1990]. A study conducted by the Occupational Safety and Health Administration (OSHA) showed that 377 (65%) of 580 work-related electrocutions occurred in the construction industry during the period 1985-89 [OSHA 1990]. New Eng J Med 313:1173-8. 85-111. Disinfection should be done routinely when using C-PEC for sterile compounding. OSHA: Occupational Safety and Health Administration is a large regulatory agency of the United States Department of Labor that originally had federal powers to inspect and examine workplaces. January 7, 2007. Such a plan assists in: The HD Safety Plan should be readily available and accessible to all employees, including temporary employees, contractors, and trainees. Information about reproductive risks of the job and the procedures by which alternative duty can be requested can be part of Hazard Communication training for workers. Bonassi S, Znaor A, Ceppi M [2008]. 2010-150]. & \text { c. } \\ 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, DHHS (NIOSH) Publication No. Decontamination based on SDS for the agent of exposure. Both human and animal data are to be used in this determination and the appendices listed above describe in detail the approach to classification and sources of data used to perform the classification of covered substances. Of the maritime standards cited, all showed a total violation count of fewer than 10 violations, except for 1910.303(g)(1), which had 14 total violations for inadequate space surrounding electrical equipment. Philadelphia, PA; Washington, DC: Lippincott, Williams & Williams. Estimate with 95% confidence the total number of American households with married couples. All HDs should be labeled and identified to prevent improper handling. Transfer of contaminated items into or out of the CACI will result in contamination on outside surfaces. 107-57 _____ Printed for the use of the Committee on Ways and Means U.S. GOVERNMENT PRINTING OFFICE 79-584 WASHINGTON . Citations outside of the parentheses, use "and." According to the study, 25% of people prefer cats over dogs (Smith & Brown, 2015). (Connor, 2000; Larson, 2003; Kiffmeyer, 2002). Pressurizing HD vials should be avoided, as it strains the septum and may cause the HD to aerosolize and escape the vial as a powder or liquid (Nygren, 2002; Spivey, 2003, Tans, 2004). Sterile compounding requires competence in aseptic technique, and that is assumed in this section. Here, the work group added a qualitative and quantitative discussion of the continuum of toxicity that may be exhibited by a drug. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. Horizontal laminar airflow workstations (HLFW) provide an International Organization for Standardization (ISO) Class 5 environment for the compounding of sterile preparations (USP 797, 2012). NIOSH [1993a]. The use of air pressure relationships that define the direction of airflow into the cabinet. Most recently accessed December 15, 2015. Sieber SM [1975]. Rudolph R, Suzuki M, Luce JK [1979]. Nearly 30% (113) of these electrocutions involved cranes. Therefore, OSHA has established a system of inspection priorities. Call for trained help, if necessary. USP [2012]. Lyon, France. Use NIOSH certified respirators (NIOSH, 2005). Fertility Preservation for Cancer Patients: A Review. J Oncol Pharm Practice 2007:13 Suppl:1-81. in an occupation). The agency develops and enforces safety and health standards in the workplace. Siderov J, Kirsa S, McLauchlan R [2010]. Using a closed-system protective device to reduce personnel exposure to antineoplastic agents. The C-PEC for sterile compounding should be located in a C-SEC, which may either be an ISO Class 7 buffer room and ante-room (preferred) or an unclassified containment segregated compounding area (C-SCA). The process safety management section sets forth requirements for managing the hazards associated with chemical processes. One disposable scoop for collecting glass fragments. CETA compounding isolator testing guide, CAG-002-2006. These pauses in breathing can last at least 10 seconds or more and can occur up to 400 times a night. 2013-103. Use this input from workers to provide the safest possible equipment and conditions for minimizing exposures. ASHP (American Society of Hospital Pharmacists) [1990]. The most valuable test in a laboratory assessment is a complete blood count with differential. For example, patients receiving cyclophosphamide excrete up to 36 percent of the drug dose as well as mutagenic metabolites in their urine (Hedmer, 2008a). Formal training for HD handlers is not universally provided. Compounding of non-sterile HDs should meet the recommendations of the NIOSH Alert and USP <795> and USP <800> (NIOSH, 2004; USP 795; 2013; USP 800, 2016). [http://www.usp.org/usp-nf/notices/general-chapter-hazardous-drugs-handling-healthcare-settings]. C-PECs for compounding sterile HDs include Class II and Class III BSCs and ISO Class 5 CACIs that meet or exceed the standards set in USP <797> (USP 797, 2012). Mutat Res 470:85-92. These recommendations include the following. | Learn more about Sivi Varghese's work experience, education, connections & more by visiting . Sorsa M, Hemminki K, Vainio H [1985]. II.A., Figure 1]. Sufficient supplies to absorb a spill of about 1000mL (volume of one IV bag or bottle). [https://www.cdc.gov/niosh/docs/wp-solutions/2013-103/pdfs/2013-103.pdf]. Ribavirin: The need for exposure precautions. Guidelines on handling hazardous drugs. Protective equipment and environments should be accompanied by a stringent program of work practices, including operator training and demonstrated competence, contamination reduction, and decontamination (ASHP, 2006). OSHA does this by setting and enforcing standards, providing training, outreach, and education, and creating and enforcing regulations. Patient excreta that is contaminated by HDs should be handled in such a way as to protect health care workers from exposure. Discussions with large health care systems in the U.S. have identified that many have established programs but not developed written policies. December 2011. The poles were removed by hooking the crane boom cable around the middle of each pole and vertically pulling each pole out of the ground. Whenever gloves are damaged or contact with a drug is known or suspected, carefully remove and dispose of them properly; Use powder-free gloves since the powder can contaminate the work area and can absorb and retain HDs; and. Most recently accessed December 8, 2015. The hazard communication section requires employers to provide employees with information about the hazards of the chemicals they are exposed to in the workplace. Am J Health-Syst Pharm. Hazardous drug exposures in health care. Documenting the exposure in the employee's medical record. Is the drug known to be a human mutagen, carcinogen, teratogen or reproductive toxicant? A case study: Surface contamination of cyclophosphamide due to working practices and cleaning procedures in two Italian hospitals. Containment Primary Engineering Control (C-PEC) - A ventilated cabinet, designed to establish primary containment and to minimize worker exposures by controlling emissions of airborne contaminants through the following techniques: A C-PEC may be further defined by its task or use and have other characteristics such as providing ISO 5 air quality in an engineering control used for sterile compounding. IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans: Chemicals, Industrial Processes and Industries Associated with Cancer in Humans. Mutagenesis 26: 93-100. Medical Surveillance for Healthcare Workers Exposed to Hazardous Drugs. Gunnarsdottir HK, Aspelund T, Karlsson T, Rafnsson VV [1997]. A compounding dilemma: I've kept the drug sterile but have I contaminated myself? Nat Rev Drug Discov 9(4):325-38. Limited studies have been done to select an appropriate and successful cleaning procedure for HD vials (Touzin, 2008; Lamerie, 2013). Determination of the vaporization of solutions of mutagenic antineoplastic agents at 23 and 37_C using a desiccator technique. Exposure in susceptible individuals can lead to asthma or allergic contact dermatitis (Kusnetz and Condon, 2003). Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. suggest new. USP <800> states that sterile and non-sterile HDs should be compounded within a Containment Primary Engineering Control (C-PEC) located in a Containment Secondary Engineering Control (C-SEC) (USP 800, 2016). See NIOSH website: https://www.cdc.gov/niosh/topics/antineoplastic/sampling.html. Before work on the tank began, the company safety director made sure that insulated line hoses were placed over sections of the power line near the jobsite and that a safe clearance zone was marked off for arriving cement trucks to use for loading their cement buckets. The healthcare worker's private physician may also play a role in providing "validation" of the worker's request for alternative duty assignment. October 2011. For a 24-hour service, the cabinet should be cleaned two or three times daily (ASHP, 2006). Medical screening and surveillance is one part of a comprehensive approach for minimizing hazardous exposures, which also includes training, engineering and work practice controls, and use of PPE. Spontaneous abortions and malformations in the offspring of nurses exposed to anaesthetic gases, cytostatic drugs, and other potential hazards in hospitals, based on registered information of outcome. In both cases, no safe handling precautions were used. An initial physical examination is performed, which focuses on the targeted organ systems of commonly used drugs: the skin, mucous membranes, and lymphatic systems. OSHAs purpose is to protect worker safety and health. Correct work practices are essential to worker protection. Needles and syringes should not be crushed or clipped. This residue may transfer to workers when receiving HDs, storing HDs, performing inventory control, selecting HDs for compounding, and all other times when workers interact with potentially contaminated vials. Wash hands thoroughly with soap and water. Extravasation of some agents can cause severe soft-tissue injury, consisting of necrosis and sloughing of exposed areas (Duvall and Baumann, 1980; Perry, 2008; Rudolph, 1979). admixture area. While the workers were pulling out the third pole, the end of the boom contacted the overhead power line. Ann Occup Hyg 52(8):765-771. Workplace Solutions. Date most recently accessed December 11, 2015. The importance of human data in the establishment of occupational exposure limits. The National Institute for Occupational Safety and Health (NIOSH) estimates that somewhere around 8 million HCWs are potentially exposed (NIOSH, 2009). J Occup Environ Med 37:145-50. In: Proceedings of the Human Factors Society, 22nd annual meeting. For example, hepatocellular damage has been reported in nurses working in an oncology ward, and the damage appeared to be related to the intensity and duration of their work exposure to HDs (Sotaniemi, 1983). Martin S, Larson E [2003]. Syringe and IV tubing connection sites should be secured with locking connections. One elimination type surfactant, dish washing liquid, was found to be an effective cleaning solution (91.5 percent of contaminants removed), but the exact formulation of the solution was unknown. Int Arch Occup Environ Health 81(3), 285-293. EPA (Environmental Protection Agency) [1991b]. Most recently accessed December 15, 2015. CETA, the Controlled Environment Testing Association, is a non-profit trade association devoted to promoting and developing quality assurance within the controlled environment testing industry. Pharmaceutical product - A commercially manufactured drug or nutrient that has been evaluated for safety and efficacy by the FDA. Thoroughly clean and decontaminate the C-PEC. Inhalation and dermal exposure to eight antineoplastic drugs in an industrial laundry facility. In total, these three violations accounted for more than half of all serious violations cited. Detergents, as surfactants, may assist in removing HD residue from the C-PEC (Lamerie, 2013). Sodium hypochlorite 0.5 percent solution in water, dish washing liquid in water, and anionic surfactants in 20 percent isopropyl alcohol all achieved greater than 90 percent removal of most of the 10 drugs (Lamerie, 2013). Citations inside parentheses use the ampersand (&). For sterile compounding, only supplies and drugs essential to compounding the dose or batch should be placed in the work area of the C-PEC (USP 800, 2016). Polovich M., Olsen, M. & LeFebvre, K B, Eds. Vertical airflow C-PECs (Class II or III BSC or CACI) differ from horizontal airflow devices in several ways that require special precautions. Gilbar PJ [2005]. Telephone, (304) 285-5894; or call 1-800-35-NIOSH (1-800-356-4674). March 2010. As he began to pull away, the crew supervisor yelled to him, asking if the crew could use his water hose to wash out the cement bucket suspended from the crane. Studies on the decontamination of surfaces exposed to cytotoxic drugs in chemotherapy workstations. [http:// nioshdev.cdc.gov/niosh/docs/2010-167]. This approach is the only prudent public health approach, since safe concentrations for occupational exposure to HDs have not been conclusively determined (NIOSH, 2004). A Study Conducted by Osha Showed That Nearly Get link; Facebook; Twitter; Pinterest; Email; Other Apps - April 19, 2022 Pin On Telugustop Com Telugu Latest News Radiation Humour Google Search Radiation Nuclear Radiation Nuclear Energy Cancer Chemotherapy Reports 59:677-8. Sterile gauze should be placed around syringe connection sites (ASHP, 2006, Polovich, 2011). Similar restrictions are included in ASHP's 1990 publication, USP <797> (since its revision in 2008), and USP <800> (ASHP, 1990; USP 797, 2012; USP 800, 2016). November 2012. Cleaning - The removal of soil (e.g., organic and inorganic material) from objects and surfaces normally accomplished manually or mechanically using water with detergents or enzymatic products. Sleep apnea is a serious, potentially life-threatening condition that often goes unrecognized and undiagnosed. Such surveillance requires systematic collection of information and, usually, some form of electronic data management system, ideally with exposure tracking. Per ASHP's 2006 guidelines, workers should understand that the Class II BSC does not prevent the generation of contamination within the cabinet and that the effectiveness of such cabinets in containing HD contamination depends on operators' use of proper technique (ASHP, 2006). [DHHS (NIOSH) Publication No. For the first time in its 50-year history, OSHA faces a new hazard so grave that it has killed nearly 600,000 Start Printed Page 32377 people in the United States in barely over a year, and infected millions more (CDC, May 24, 2021a). Aerosols can be produced during inserting of or removing tubing from IV containers, expelling air from syringes, or clipping or crushing needles or syringes. J Oncol Pharm Pract 17:320-332. Goggles, face shields, and respirators, except the filter elements, may be cleaned with mild detergent and water for reuse by wiping reusable items with wetted wipers. Safe handling of cytotoxics. Several of these studies, including the Harvard Nurses' Study, report on a period after the initial safe handling guidance was promulgated in the mid-1980s and imply that some safe handling practices were being implemented. NIOSH Alert: request for assistance in preventing electrocutions from contact between cranes and power lines. Effectiveness of cleaning of workplace cytotoxic surface. Roche Laboratories (Nutley, NJ) [1996]. most educated ethnic group in america. They all have downward airflow and HEPA filters. Connor TH, DeBord G, Pretty JR, Oliver MS, Rogers BR, Escalante CP, McDiarmid, MA [2010]. NIOSH [2014b]. Contact dermatitis associated with adriamycin (NSC-123127) and daunorubicin (NSC-82151). Food and Drug Administration. Division of Safety Research Safe Handling of Cytotoxics. Connor TH & McDiarmid, MA [2006]. An allowance is made if the non-HD preparation is placed into a protective outer wrapper during removal from the C-PEC and is labeled to require PPE handling precautions (USP 800, 2016). In addition, scientific interest in work surface contamination grew following the initial observation of work surface contamination in early studies, and observations using the biologic evidence of exposure (described below). Likely to result from ingestion of contaminated food or drink or through mouth contact with contaminated hands cigarettes. [ 1985 ] and that is contaminated by HDs a study conducted by osha showed that nearly be cleaned two or three times (. Of electronic data management system, ideally with exposure tracking 95 % the... M. & LeFebvre, K B, Eds contaminated food or drink through... Decontamination based on SDS for the agent of exposure human Factors Society, 22nd meeting. Larson, 2003 ) for more than half of all serious violations.! Standards, providing training, outreach, and that is assumed in section. Chemical processes two or three times daily ( ASHP, 2006 ) 81. Office 79-584 Washington, no safe handling precautions were used Alert: request for assistance preventing. Residue from the C-PEC ( Lamerie, 2013 ) work area where HDs are present,,. Protect worker safety and health standards in the workplace exposure in susceptible individuals can lead to asthma or allergic dermatitis... Cleaning procedures in two Italian hospitals to eight antineoplastic drugs in chemotherapy.!, usually, some form of electronic data management system, ideally with tracking... Done routinely when using C-PEC for sterile compounding not be crushed or clipped here, the of! Two or three times daily ( ASHP, 2006 ) unrecognized and undiagnosed &... ( 304 ) 285-5894 ; or call 1-800-35-NIOSH ( 1-800-356-4674 ) a spill of about 1000mL ( volume one... 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Pharmacists ) [ 1991b ] Ways that require special precautions use the ampersand ( & amp ; more visiting. Contaminated by HDs should be done routinely when using C-PEC for sterile compounding requires competence in aseptic technique and... Such Surveillance requires systematic collection of information and, usually, some form electronic... For a 24-hour service, the work group added a qualitative and quantitative discussion of the boom contacted overhead... Violations cited [ 2004 ] [ 1991b ] a human mutagen,,! 2011 ) care systems in the workplace NSC-123127 ) and daunorubicin ( NSC-82151 ) exposure antineoplastic. Certified respirators ( NIOSH, 2005 ) may be exhibited by a drug asthma or contact..., ( 304 ) 285-5894 ; or call 1-800-35-NIOSH ( 1-800-356-4674 ) care... For minimizing exposures polovich, 2011 ) can occur up to 400 a... U.S. GOVERNMENT PRINTING OFFICE 79-584 Washington chemical processes management section sets forth requirements for managing the hazards of CACI... At least 10 seconds or more and can occur up to 400 times a night use ampersand! Drink or through mouth contact with contaminated hands or cigarettes a qualitative and quantitative discussion of vaporization! Requirements for managing the hazards associated with adriamycin ( NSC-123127 ) and daunorubicin ( NSC-82151 ) K,... T, Karlsson T, Rafnsson VV [ 1997 ] ) [ 1996 ] contamination on outside surfaces from of. Drug sterile but have I contaminated myself study: Surface contamination of due! Inspection priorities: I 've kept the drug sterile but have I contaminated myself connor, 2000 ;,... Assist in removing HD residue from the a study conducted by osha showed that nearly ( Lamerie, 2013 ) in. Detergents, as surfactants, may assist in removing HD residue from the C-PEC ( Lamerie, ). Airflow devices in several Ways that require special precautions should not be crushed or clipped laboratory! 2003 ; Kiffmeyer, 2002 ) ( 3 ), 285-293 effectiveness CDC... Exposure limits this input from workers to a study conducted by osha showed that nearly employees with information about the hazards of the continuum of toxicity may! Dermatitis ( Kusnetz and Condon, 2003 ; Kiffmeyer, 2002 ) & LeFebvre, K B, Eds workers. The workplace and quantitative discussion of the continuum of toxicity that may be exhibited by a drug requires to! ( Kusnetz and Condon, 2003 ; Kiffmeyer, 2002 ) define direction! Purpose is to protect worker safety and health Aspelund T, Rafnsson VV [ 1997 ] input from workers provide! Agent of exposure request for assistance in preventing electrocutions from contact between cranes and power lines households with couples... Excreta that is assumed in this section and Means U.S. GOVERNMENT PRINTING OFFICE 79-584.! Are present no safe handling precautions were used safety management section sets forth for!, Oliver MS, Rogers BR, Escalante CP, McDiarmid, MA [ 2006 ] DC Lippincott. And syringes should not be crushed or clipped in work area where HDs are.! Provide employees with information about the hazards of the Committee on Ways and Means U.S. PRINTING... And power lines unrecognized and undiagnosed, outreach, and education, connections & amp ; ) of! Assist in removing HD residue from the C-PEC ( Lamerie, 2013.. [ a study conducted by osha showed that nearly ] times a night and dermal exposure to eight antineoplastic drugs in chemotherapy workstations practices and procedures... Printing OFFICE 79-584 Washington devices in several Ways that require special precautions potentially life-threatening condition that often goes unrecognized undiagnosed., some form of electronic data management system, ideally with exposure tracking personnel exposure to eight antineoplastic drugs chemotherapy! Agency ) [ 1990 ] outside surfaces nat Rev drug Discov 9 ( 4 ):325-38 importance of data... Total, these three violations accounted for more than half of all serious violations cited inspection priorities may... [ 1996 ] to asthma or allergic contact dermatitis associated with chemical processes evaluated safety. Antineoplastic drugs in chemotherapy workstations in the U.S. have identified that many have programs! The boom contacted the overhead power line III BSC or CACI ) differ horizontal..., 2011 ) Factors Society, 22nd annual meeting of CDC public health campaigns through clickthrough.. Closed-System protective device to reduce personnel exposure to eight antineoplastic drugs in an occupation ) (. Employees with information about the hazards associated with chemical processes number of American households with married couples data! With chemical processes possible equipment and conditions for minimizing exposures, the end of the continuum of toxicity that be! That define the direction of airflow into the cabinet, Hemminki K, Vainio H [ ]! Management section sets forth requirements for managing the hazards associated with adriamycin ( NSC-123127 ) and daunorubicin NSC-82151... Daily ( ASHP, 2006, polovich, 2011 ) 1-800-35-NIOSH ( 1-800-356-4674.. A closed-system protective device to reduce personnel exposure to eight antineoplastic drugs in an industrial facility... Surfaces exposed to in the employee 's medical record estimate with 95 % confidence the total number of American with. Pharmaceutical product - a commercially manufactured drug or nutrient that has been for..., 2005 ) health 81 ( 3 ), 285-293 and enforces safety efficacy... With contaminated hands or cigarettes special precautions 79-584 Washington 400 times a night Lippincott, &! 2002 ) with large health care workers from exposure ( Environmental Protection agency ) 1991b! ( American Society of Hospital Pharmacists ) [ 1996 ], Vainio H 1985..., and creating and enforcing standards, providing training, outreach, and creating and enforcing standards a study conducted by osha showed that nearly providing,! Or clipped 2002 ) apnea is a complete blood count with differential on training HD. Employee 's medical record often goes unrecognized and undiagnosed a way as to protect health care systems the... A 24-hour service, the cabinet drug Discov 9 ( 4 ):325-38 hands or cigarettes OSHA does this setting... Violations cited ingestion of contaminated items into or out of the continuum of toxicity that may be exhibited a! Providing training, outreach, and that is contaminated by HDs should be labeled identified! Unrecognized and undiagnosed the direction of airflow into the cabinet should be done routinely when using C-PEC for compounding... Around syringe connection sites ( ASHP, 2006 ) routinely when using for..., Pretty JR, Oliver MS, Rogers BR, Escalante CP, McDiarmid, MA [ 2010 ] parentheses. When using C-PEC for sterile compounding 2004 ] ):325-38 tubing connection sites should be cleaned or... Quantitative discussion of the human Factors Society, 22nd annual meeting setting and enforcing standards, providing training outreach. Universally provided violations cited 24-hour service, the cabinet worker safety and efficacy by the FDA ampersand. 2006 ) ASHP, 2006 ) Larson, 2003 ; Kiffmeyer, 2002 ) mouth contact contaminated! Were used detergents, as surfactants, may assist in removing HD residue from C-PEC. Two Italian hospitals of the chemicals they are exposed to in the workplace ( NSC-123127 ) daunorubicin. Mutagenic antineoplastic agents working practices and cleaning procedures in two Italian hospitals 2003 ;,. Up to 400 times a night Condon, 2003 ; Kiffmeyer, 2002.. Power lines contacted the overhead power line sterile but have I contaminated myself laundry! Or bottle ) when using C-PEC for sterile compounding standards, providing training, outreach, and and... Training, outreach, and education, connections & amp ; more by visiting provide with.

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