Transcript Cytotoxic Drugs
WHAT WE HAVE LEARNED??
ONCOLOGY CLERKSHIP
GROUP B
LIM KOK HAN MD HASHIMIE BADDRUDIN BIN MAT HASSAN SURESKUMAR A/L HARISKRISHANAN CHAI YEE YIEN CHUA SUE HOON NABILAH BINTI JAMALUDIN NIK NUR NASEELA FATHIN BINTI NIK MOHD SABRI NUR FADHILAH ARSHAD NUR HAIDAR BT AKBAR TAN SIN YEIN MOHAMAD SYAHIR BIN FADZIL MOHD JAUZE BIN KOMA RUDIN MUHAMMAD IMADUDDIN BIN CHE MOHD NASIR LECTURER: Assoc Prof Saad Othman
What I have learned???
By LIM KOK HAN (95298) Group B ONCOLOGY PHARMACY CLERKSHIP 2010
• • • •
What I have learned about cleanroom?
A Cleanroomis "a room in which the concentration of airborne particles is controlled, and which is constructed and used in a manner to minimize the introduction, generation, and retention of particles inside the room and in which other relevant parameters, e.g., temperature, humidity, and pressure, are controlled as necessary .“ A “Cleanroom” is a controlled environment in which the concentration of airborne particles is controlled to specific limits- so that a desired level of cleanliness can be achieved. The level to which these particles need to be removed depends upon the standards required.
To control the contamination, the only way is to control the total environment. Air flow rates and direction, pressure, temperature, humidity etc. all need to be controlled carefully. The sources of these particles need to be controlled or eliminated whenever possible. These sources are facilities, people, tool generated, fluids and products generated.
Cleanrooms are planned and manufactured using strict protocol and methods. Cleanrooms are specifically used in many areas such as electronics, pharmaceutical, biopharmaceutical, medical device industries, operating rooms and other critical manufacturing environments, which need the product to be produced at certain level of “cleanliness”.
Cont…
• • • Types is based on the airflow pattern, either – Horizontal – – Vertical Mixed Classification based on the particles count in the room air Clean room have to be evaluated based on some parameters such as air particulate count, air velocity / air changes, temperature, humidity, pressure differences in order to ensure all the controlling parameters are within the normal range.
KEY ELEMENTS OF CLEANROOM
1)HEPA FILTERS These filters are important for maintaining contamination control. They filter particles as small as 0.3 microns with a % 99.9995 (H14) minimum efficiency. Used with central system or stand alone 2) AIRLOCK - An airlock is a passage which permits the people to pass from non-controlled environment to controlled environment and vice versa.
3) PASSBOX - Passbox is a device which enables objects, parts, tools and other work items to be passed to and from the cleanroom 4)PANEL WALLS, FLOORS, CEILINGS, LIGHTS etc :Made of non contaminant, dust proof materials
MAINTENANCE OF THE CLEANROOM
• • Maintenance of the cleanroom involves daily cleaning, weekly cleaning, and monthly cleaning, where all the cleaning work must be done properly based on the established standard cleaning procedure of cleanroom Wearing proper equipment while handling the sample that require sterile environment is highly necessary (example: TPN product , cytotoxic drug-PPE must be worn)
Parameters need to be controlled
• • • • • For example air particulate count here at clinical lab is done every 6 month & an acceptable result should shows that the Number of particles larger than 0.5 mcm should not be more than 10,000/ft 3 or 350/l of air The air velocity should be maintained at 0.45 m/sec ± 20% Air changes should be more than 20 times/hour.
Temperature should be maintained at 18 o C ± 2 o C Humidity should be maintained at 50% - 60% Pressure differences should be maintained at 15 pascal or more
What I had learned at HPP?
CYTOTOXIC DRUG REQUEST FORM(HPP)
Example of real cytotoxic drug request
* This is meant for educational purposes only…
Request form for cytotoxic drug reconstitution
• • • Requested by the physician/doctor via a form(as shown) and to be sent to the CDR unit for screening and cytotoxic drug preparation Pharmacist at CDR unit will do prescription screening from left right style.
In the request form, the physician(prescriber) has to fill up some of the details required, which includes: 1) General information on patient demographic data 2) Information about the requested drug(s)
1)General information on patient demographic data that need to be filled by prescriber: • • • • • • • • • • • • • Chemo administration date: Ward& Bed. No : Patient’s Name & I/C: Gender Age Weight(kg) Height(cm) BSA(m2)-to be calculated by the pharmacist based on patient’s weight and height Diagnosis Chemotherapy Protocol/Regimen Interval: Days or Week Cycle Number Case : Old or New • • *BSA formula used : (Body weight(kg) x height(cm)/ 3600)^0.5
2) Information about the requested drug(s) need to be filled by prescriber based on the selected protocol • • • • • • Name of the drug Dosage & Frequency Chemo Day Route IVI/IVB Diluent Final Volume Duration(hrs) **At the bottom of this form, the prescriber must hand down their signature, name, chop(if any) and date the request has made
Particulars to be filled by the pharmacist in this form include
1) Reconstitution information -product batch no -no of ampoules/vial & strenght -reconstitution solution used & volume cytotoxic drug that is available in powder form such cyclophosphamide for -final volume of drug added -infusion solution used & volume : 2 types : 0.9% NS or D5W solution -expired date of final product
Cont..things to be filled by pharmacist
2) product information • -trade name/manufacturer • -batch no.
• -expiry date Once the screening and all the particulars need to be calculated and written by the pharmacist have been completed, the pharmacist in-charge for processing this request need to hand down his/her signature, name and date it was done If there is any drug-related problem(s) detected in the cytotoxic request form, the pharmacist needed to contact the prescriber(the physician that make the order), inform them about the potential problems and recommend the intervention to be done. All form of communication between pharmacist and the physician regarding any changes to the prescription must be written in a box provided.
….
• • • • Thus in regard to this request form, the pharmacist at Cytotoxic Drug Reconstitution(CDR) screening on the unit prescription must and provide check the for best pharmaceutical care to the patient which include the through any errors/discrepancies/doubtful Thus, here screening process is still a part of the functions that pharmacist working at CDR unit .
To ascertain certain information and to clarify the values written, this prescription will be needed to be prepared by another pharmacist Since this issue has involved pharmacokinetic formulas, thus as pharmacist we have to make sure that error is at minimal level while deliver the most effective drugs to the patient at safe recommended drug level.
THANK YOU…
• Prepared by LIM KOK HAN • ( 95298) • • ONCOLOGY PHARMACY CLERKSHIP 2010 GROUP B
CDR CALCULATION
MOHAMAD SYAHIR BIN FADZIL (UF 070007) 18
Patient’s Profile
1)Name 2)I/C 3)Gender 4)Weight 5)Height 6) BSA 7)Diagnosis : ABC : 07-5510 : Male : 63 kg : 123cm :1.47m
2 : Breast Cancer 8) Protocol/Regime :FEC 9)Chemo Administration Date : 29/9/2010 10)Ward & Bed No : C19 (In Patient) MOHAMAD SYAHIR BIN FADZIL (UF 070007) 19
Cytotoxic Drug
5FU Epirubicin Cyclophosphamide
FEC Regimens
Dose (mg/m 2 )
600 75 600
Prepared in
500mL NS 500mL NS 500mL NS
Duration
Over 1 hour Over 1 hour Over 1 hour All day 1 only Recycle 3 weekly MOHAMAD SYAHIR BIN FADZIL (UF 070007) 20
Drug available in Penang GH.
Cytotoxic Drug
5 FU Epirubicin Cyclophosphamide
Strength
1g/20mL 50mg/25mL , 10mg/5mL 1g/50mL , 200mg/10mL MOHAMAD SYAHIR BIN FADZIL (UF 070007) 21
Final Volume of Drug Needed
I.
5FU
Amount required in mg
600 mg/m 2 x 1.47m
2 = 882mg ≈ 880mg
Volume need to withdrawn from vial stock solution
= 880mg 1000mg = 17.6 mL ≈ 17.5 mL MOHAMAD SYAHIR BIN FADZIL (UF 070007) 22
II. Epirubicin Amount required in mg = 75 mg/m 2 x 1.47m
2 = 110.25mg
≈ 110 mg Volume needed to withdrawn from vial stock solution is 55 mL as shown in table below. Vial strength No. of vial used 50mg/25mL 10mg/5mL 2 1 Amount (mg) Volume (mL) 100 10 110 50 5 55 MOHAMAD SYAHIR BIN FADZIL (UF 070007) 23
III.
Cyclophosphamide
Amount required in mg
= 600mg/m 2 X 1.47m
2 = 882mg ≈ 880mg
Volume needed to withdrawn from the vial stock solution
= 880mg 1000mg X 50mL = 44mL MOHAMAD SYAHIR BIN FADZIL (UF 070007) 24
Medical apparatus/devices used in the reconstitution of cytotoxic drugs Below are some of common apparatus used: Syringe Syringe filters/ Injection filter Filter Straw Vial’s spike/Vial’s adapter/ Reconstitution device Needle Vials Ampoules Bottle of infusion liquid such as normal saline, dextrose 5% etc PREPARED BY: NABILAH JAMALUDIN
•
Syringe
It is a medical instrument used to inject or withdraw fluids • Types of syringes used in cytotoxic reconstitution: Disposible syringes (three parts) luer slip Disposible syringes (three parts) luer lock Disposible syringes (two parts) • Packaging details: The syringes are packed individually in poly bag or blister package • Individual package is more easier to be handled as the syringe is sterilized.
• The syringe that has been shown to us during clerkship is disposable syringes luer lock of 10 ml and 50 ml PREPARED BY: NABILAH JAMALUDIN
Available Size of Syringes
Types of syringes
Disposible syringes (three parts) luer slip
Available size
1 ml, 2 ml, 3 ml, 5 ml, 10 ml, 20 ml, 30 ml, 50 ml, 60 ml, 100 ml Luer slip connector PREPARED BY: NABILAH JAMALUDIN
Types of syringes
Disposible syringes (three parts) luer lock
Available Size
2 ml, 3 ml, 5 ml, 10 ml, 20 ml, 30 ml, 50 ml, 60 ml Luer lock PREPARED BY: NABILAH JAMALUDIN
Types of syringes
Disposible syringes (two parts)
Available size
1 ml, 2 ml, 3 ml, 5 ml, 10 ml, 20 ml, 30 ml.
PREPARED BY: NABILAH JAMALUDIN
Parts of syringe PREPARED BY: NABILAH JAMALUDIN
Needle
• • In cytotoxics reconstitution, needles is used to withdraw drug liquid from the vial During clerkship, we have been shown the needles that been packed individually.
Needle cap PREPARED BY: NABILAH JAMALUDIN Luer connector
• Needle gauge: Indicates the diameter of the needle. • Various needle lengths are available for any given gauge • Available needle gauge: Range from 7 G (largest in diameter) to 34 G (smallest in diameter) needles PREPARED BY: NABILAH JAMALUDIN
Syringe Filter/Injection filter
• Use: To filter the solution or liquids from particles • There are also available type that use to filter gases, and remove bacteria.
• It needs to be attached at the end of a syringe for use.
• The liquid is filtered by drawing it out from the syringe through the filter into vials, bottles, etc • Most common sizes available: 0.2 or 0.22 µm and 0.45 µm pores. Membrane diameters of 10 mm, 13 mm, 25 mm are common as well. PREPARED BY: NABILAH JAMALUDIN
• It may have luer lock fittings at one side to fit into the luer lock syringe. It consists of a plastic housing with a membrane which serves as a filter. Luer lock connector PREPARED BY: NABILAH JAMALUDIN
Step
1 2
Using filter syringes
Diagram Explanation
Draw a small amount of air (about 1 ml) into the syringe. This air is used to purge the filter ensuring maximum sample throughput.
Load the sample into the syringe. Note the visible air pocket ready to purge the filter. PREPARED BY: NABILAH JAMALUDIN
Step
3
Diagram Explanation Attach the filter to the syringe at the luer lock connector.
4
Hold the assembled syringe and filter
vertically to wet the membrane. This prevents air blocks and promotes high flow rates. PREPARED BY: NABILAH JAMALUDIN
5
Step
6
Diagram Explanation
Press the syringe plunger gently. If possible, discard the first 0.25-0.5ml of sample. If the back pressure ever increases significantly, change the filter as it may have plugged. Avoid pressing excessively as this could cause the filter housing to burst.
Push the air through the filter to purge
the housing and recover any remaining sample.
PREPARED BY: NABILAH JAMALUDIN
Filter Straw
Us e: To withdraw and filter fluids from the ampoules Only be used to withdraw not to inject out the liquid It enhance patient safety by reducing the potential for glass particle injection It is a flexible straw, which can be angled for easy use, is needle-free and latex free promoting personnel safety PREPARED BY: NABILAH JAMALUDIN
Size of the Filter straw
Size: 5 µm, 4.5 cm
Short filter straw for withdrawal and filtration of fluids from small ampoules 4.5 cm filter straw 5 µm filter hub attached Blunt plastic straw Short Filter straw
Size: 5 µm, 10 cm
Long filter straw for withdrawal and filtration of fluids from large ampoules 10 cm filter straw 5 µm filter hub attached Blunt plastic straw PREPARED BY: NABILAH JAMALUDIN Filter hub Long Filter straw
•
Vials
Varies types of vials, such as screwed neck vials, vials with snap cap, crimp neck vials etc with or without rubber septa for the closure.
• Available size/volume for injection
vials (crimp neck vials) to store the
cytotoxics: 2 ml, 4 ml, 5 ml, 10ml, 25 ml and 50 ml • The vials can be used to store liquids or soluble powders like cyclophosphamide.
PREPARED BY: NABILAH JAMALUDIN
Vial’s spike/Vial’s adapter/ Reconstitution device
• Used for withdrawal or addition of drug’s fluid from or into the vials in the reconstitution process.
PREPARED BY: NABILAH JAMALUDIN
Ampoules
• Ampoules are made of glass (clear or amber) or plastic.
Break line • An ampoules may comes with a break point or a circular line around the neck for the ease of breaking it (the weakest point).
• Available sizes: Ranges from 1 ml to 25 ml.
PREPARED BY: NABILAH JAMALUDIN Break point
Bottle of infusion liquid
• For IV infusion administration, the cytotoxics is directly injected into the bottle of infusion liquid such as normal saline or dextrose 5% for reconstitution • This IV infusion bottle already equipped with the hook at the bottom for hanging purposes • Usually, the bottle contains 500 ml of infusion liquid.
PREPARED BY: NABILAH JAMALUDIN
Roles of oncology Pharmacist
In Hospital Pulau Pinang, oncology pharmacy service is divided into two subunit: Cytotoxic Drug Unit ( CDR unit ) Clinical Unit
by CHUA SUE HOON
• • • • • • • • • Roles in CDR unit: Receive prescription Screening prescription Calculation Drug reconstitution Labelling Teaching – mostly the undergraduated nurses or pharmacy students from the college and university.
Provide information to the ward Monitor stock level Provide safety talk to the personnel
• • • In Clinical part, most of the oncology pharmacist involved in: Monitoring, mainly sign and symptom of the patient.
Ward round Counselling • - providing information, advice and assistance to help patient for better adherence towards their treatment Give suggestion to the doctor
In general, oncology pharmacist play a significant roles in cancer treatment patient. They not just dispensing the drugs but also valuable information throughout the therapy; including counseling of side-effect and management of proper handling technique.
Cytotoxic Drugs
• Cytotoxic drugs has a toxic effect on cells. It is often used in the chemotherapy and management of cancer patient.
• It may also produce unpleasant side effects such as nausea, vomiting, hair loss and suppression of bone marrow function.
Colour of Cytotoxic Drugs
During the clerkship, we have been exposed to few of the chemotherapy drugs. The preceptor emphasizes us on the importance of knowing the color of chemotherapy drugs. Most of the chemotherapy dugs are colorless. There are only few drugs that have special characteristic that oncology pharmacist should take note of.
Anthracyclines group such as doxorubicin, epirubicin have red color of solution. Besides, idarubicin have a slightly red-orange colors of solution.
Idarubicin
Methotrexate, an antimetabolites cytotoxic drug have yellow color of solution.
Mitoxantrone, an anthracenedione has a blue color of solution.
By having knowledge in term of colors of each cytotoxic drusg, we can reduce the wrong drug error by identified the colors. Thus, can reduce the unnecessary wastage as cytototoxic drugs usually are expensive.
By: Chua Sue Hoon
ONCOLOGY CLERKSHIP INDIVIDUAL REPORT NAME: MD HASHIMIE BADDRUDIN BIN MAT HASSAN M/N: 95304
How to Break an Ampoule
What types of standard ampoules
• •
Ampoules can be:
self breakable (type of opening) – OPC –„one point cut“, with a cut at the place of breakage – CBR – „color break“ with colored ring at the breakage point • with code rings (CR) for easier identification • with screen print
Breaking procedures
You suppose to wrap the ampoule cap with gauze or tissue in order to avoid injuring during opening the ampoule.
Topic:isolator
• By Chai Yee Yian
Image of general isolater used, similar with isolator in HPP
Isolator in HPP
Air flow after pass thru HEPA filter Light to show pass-box’s inner door can open or not Barometer, temperature, & humidity meter Gloves Pass box with 2 side doors (inner and outer) • A closed system • Not necessary put in cleanroom • Everything bring into pass box need swab with alcohol air recirculated Switch open pass box doors by step on it
Reconstitution Solvent
• • Sodium Chloride (normal saline) Dextrose solution (dextrose 5% water, D5W)
Cytotoxic waste includes: Expired drugs and aborted dosages unused cytotoxic pharmaceuticals sharps and syringe intravenous infusion sets and containers ampoules and vials personal protective equipment and clothing dressings and bandages Caps, gloves, swabs
• • Adequate, leak-proof waste disposal containers : sharps and solids containers distinctive plastic waste bags must be available in every area where cytotoxic drugs are prepared, administered or stored, and all cytotoxic drug-related waste must be placed into these containers or bags.
Any excreta from a patient being treated with cytotoxic drugs that is handled by a worker must be treated as cytotoxic drug-related waste • • • Items to be placed in shape container : Needles syringes and breakable items glass vials before they are stored in the waste bag
• • Storage of cytotoxic waste in should be in a dedicated, and secure area which can also be easily cleaned and maintained.
Waste bins should be sealable.
Waste Disposal
• Incineration is the only acceptable technology for treating cytotoxic waste • The waste are burn at 1000-1100 ⁰C • Patient waste such as urine, faeces, vomitus and the contents of colostomy and urostomy bags may be disposed of in the normal sewage system
STORAGE OF CYTOTOXIC DRUG
Prepared by: NUR HAIDAR BINTI AKBAR GROUP B
Cytotoxic drugs are required to be stored:
• In a locked refrigerator that must be at 4 ⁰C OR • At room temperature ( below 30 ⁰C) must be stored in locked cupboard in an appropriate room for the storage of medicines
CYTOTOXIC DRUG STORAGE
Fridge items(4⁰C)
Docetaxel Paclitaxel Doxarubicin epirubicin dacarbazine vincristine Venorelbine Docetaxel
Non-fridge items(<30⁰C)
Carbopletin Cytarebine Etoporoside Irinofecam Oxaciplastin Ifosfomide Daunorubicin Bleomycin Gemcitabine 5-Fluorouracil Methotrexate
Prepared by Nik Nur Naseela Fathin binti Nik Mohd Sabri
TEMPER EVIDENT CAP LOCK SYRINGE
Ref: http://www.freepatentsonline.com/6585691.html
• • • • • A temper evident cap lock syringe in cytotoxic drug unit is used to prevent any mishandle by health practitioner.
Once the cap has been locked into the nozzle of the syringe, the cap will keep rotating at the same direction and will not responsive to counter rotation.
It has its own method to use by which a sound will be produced once it is opened.
If the lock is already tampered, it means that someone have utilized it.
Thus, it is safe and effective to be applied to special drugs like cytotoxic drugs which can be administered by specialized people only.
Protocol/Regime in Chemotherapy
What is Chemotherapy regime/protocol?
The chemotherapy protocol describes in detail the aim, the modalities, the complications and the expected results of the medical treatment which is going to be prescribed. It is used as a reference throughout the prescription.
What it is used for?
It is used for calculation of the dose need to be given to cancer patient. The amount of needed drugs times with the body surface area (BSA) gives the recommended dose for the patient.
Prepared by MUHAMMAD IMADUDDIN BIN CHE MOHD NASIR
Protocol/Regime in Chemotherapy
Example of regime/protocol
FEC – consists of Fluorouracil (5-FU), epirubicin, cyclophosphamide FEC regime is usually prescribed for treatment of breast cancer.
Information given on each protocol’s page:
1) The amount of drug e.g; 10 mg 2) Infusion and reconstitution solution e.g; Normal Saline 3) Day(s) 4) Cycle Number
Spillage Management
Mohd Jauze bin Komarudin UF070008 840622015795
Cytotoxic Spill Kit
Contents of Cytotoxic Spill Kit
• • • • • • • • • • • • 1 x Goggles 1 x Heavy Duty gloves 1 x Vinyl Gloves 1 x Respiratory Mask 1 x Biohazard Bag 3 x Spill Towels 1 x Plastic Rubbish Bag 1 x Gown 1 x Shoe Covering 1 x Scoop 1 x Report Card 2 x Cytotoxic Waste Labels
Spillage Management
Spillage Management: Surface Spills
1. Minimize air flow to area by shutting doors and windows.
2. Call for help to get the nearest cytotoxic spill kit 3. Open the kit and display the "Cytotoxic spillage" sign near the spill area 4. Put on the following from the kit in this order: a pair of gloves (inner), mask, goggles (spectacles may not be used instead of goggles), the gown, overshoes, and a pair of blue gloves (outer).
5. For small volume spills (less than 5ml or 5g) i) Cover liquid spill with absorbent towels but avoid splashing.
ii) Pick up solids with a moistened absorbent towel (wet with water or sodium chloride 0.9%)
Spillage Management: Surface Spills
6.
For large volume spills (more than 5ml or 5g) i) For liquids, cover the spill with chemotherapy absorbent gel pads.
ii) For solids, place an absorbent towel moistened with water or sodium chloride 0.9% on top of the cytotoxic material. Then cover with chemotherapy absorbent gel pads. Wait for the pad to be transformed into a gel and scoop up using plastic scoop. Ensure all of the residual gel is removed.
7. Scoop up any sharps using either the plastic scoop or swabs and place in a sharp plastic 8. Work from the outside inwards, clean the spill area with soap and water at least three times. Place all used absorbent towels in one of the yellow bags. Take care to avoid contamination of the bucket of water by only placing new absorbent towels in the water. If contamination does occur rinse the bucket thoroughly.
Spillage Management: Surface Spills
9. Place all contaminated material (including gown, outer gloves, mask, goggles and overshoes) in yellow bag. Then place filled bag and inner gloves in the other yellow bag 10. Wash hands 11. Fill in adverse event form, inform Occupational Health Department and record spill in departmental records. Fill out incident report card in spill kit and return to Oncology Pharmacist
TOPIC : PULSE TECHNIQUE & LABELLING by TAN SIN YEIN
Pulse Technique
To maintain negative pressure inside the vial. The purpose on doing this is to avoid the spillage of cytotoxic drug out from the vial.
Step : For example the pharmacist need to fill in 10 ml drug into the syringe First pull out 10 ml air from the syringe.
Then press in 1/3 of the syringe and pull out the plunger to fill in the 1/3 space of the drug.
Repeat the above step to fill in 10 ml of the cytotoxic drug.
After finish filling all the 10 ml drug. Don’t straight away pull out syringe from the vial. Pull out the plunger with extra air until 18 ml. Then only pull out the syringe.
LABELLING
The label on the drug contains the drug name, drug strength, duration for infusion, patient name, patient registration number, patient identity card number (last 6 digits) The label must be stick on upside down direction of the Normal saline Infusion label CYTOTOXIC DRUG Intravenous Fluid : Normal Saline/ _______________________ Drug(s) added Amount _______________mg __________________ _______________ml __________________ Final Volume : 1 pint (500 ml)__________________ Date and time Prepared: ________________ Expires : ________________ Duration of Infusion : _________________ Name : Ward : R/N:
Labelling for Intravenous Bolus
Drug
Route _____________________mg in _______________ml_____________ Prepared__________Expired_______ Name_________________ Ward___________R/N____________
CYTOTOXIC DRUG
Handle with care The intravenous bolus will fold and stick on the syringe after well prepared the cytotoxic drug to the patient.
What I learn in Oncology clerkship?
Sures kumar a/l Hariskrishanan 95369
What is HEPA filter?
• • EPA filters are composed of a mat of randomly arranged fibres. The fibres are typically composed of fiberglass and possess diameters between 0.5 and 2.0 micrometer.
• • Key factors affecting function are fibre diameter, filter thickness, and face velocity. The air space between HEPA filter fibres is much greater than 0.3 μm. The common assumption that a HEPA filter acts like a sieve Unlike where particles smaller than the largest opening can pass through is incorrect. membrane filters , where particles as wide as the largest opening or distance between fibres cannot pass in between them at all, HEPA filters are designed to target much smaller pollutants and particles.
These particles are trapped (they stick to a fibre) through a combination of the following three mechanisms: • • • • Interception, where particles following a line of flow in the air stream come within one radius of a fibre and adhere to it.
Impaction, where larger particles are unable to avoid fibres by following the curving contours of the air stream and are forced to embed in one of them directly; this effect increases with diminishing fibre separation and higher air flow velocity.
Diffusion, an enhancing mechanism is a result of the collision with gas molecules by the smallest particles, especially those below 0.1 µm in diameter, which are thereby impeded and delayed in their path through the filter; this behaviour is similar to Brownian motion and raises the probability that a particle will be stopped by either of the two mechanisms above; it becomes dominant at lower air flow velocities.
Diffusion predominates below the 0.1 μm diameter particle size. Impaction and interception predominate above 0.4 μm. In between, near the Most Penetrating Particle Size (MPPS) 0.3 μm, both diffusion and interception are comparatively inefficient. Therefore, the HEPA specifications use the retention of these particles to define the filter.
My understanding about negative pressure
• Negative Room Pressure to Prevent Cross Contaminantion A negative pressure room includes a ventilation system designed so that air flows from the corridors, or any adjacent area, into the negative pressure room, ensuring that contaminated air cannot escape from the negative pressure room to other parts of the facility.
• • • • • Negative pressure is created by balancing the room’s ventilation system so that more air is mechanically exhausted from a room than is mechanically supplied. This creates a ventilation imbalance, which the room ventilation makes up by continually drawing in air from outside the room. In a well-designed negative pressure room, this air is pulled in under the door through a gap (typically abot one half-inch high) for that purpose.
Other than this gap, the room should be as airtight as possible to prevent air from being pulled in through cracks and gaps, such as those around windows, light fixtures, and electrical outlets. Leakage from these sources can compromise or eliminate room negative pressure, even if the system is balanced to achieve it.
MEDICAL SURVEILLANCE
• • • Everyone who works in cytotoxic unit should be monitored in a systemic program of medical surveillance.
It is to identify the earliest reversible biologic effects so it can be reduced or eliminated before sustains irreversible damage.
Medical evaluation should be perform before starting job at cytotoxic unit, every 6 months periodically during employment, following acute exposure, transfer to other units and at time of job termination at cytotoxic unit.
PREPARED BY: NUR FADHILAH BINTI ARSHAD•85301•GROUP B
PERSONNEL ACCIDENTAL EXPOSURE
• • • • Contact with cloth – remove any cloth soaked with cytotoxic drug For skin contact – wash with soap and plenty of water For eye contact – wash with plenty of water or normal saline and immediately see a doctor Report the incident and do medical check up PREPARED BY: NUR FADHILAH BINTI ARSHAD•85301•GROUP B