Medications

As far as drugs responsible for allergic syndromes are concerned, the only possible preventive measure, if it is not possible to replace the substance, is to take away the subject from it. As far as the iatrogenic effects are concerned, it must be said that the main routes of absorption of drugs in subjects occupationally involved in their manipulation are the respiratory (aerosol inhalation) and cutaneous routes. Therefore, prevention should be mainly focused at avoiding contact between the drug and such bodily structures during both the preparation and administration phases, as well as during the elimination of the employed materials. Therefore, particular care should be paid when handling vials, using needles both to draw out the drug from the phial and to administrate it to the patient and during aerosol therapy. Furthermore, it is necessary to wear gloves polyvinyl chloride both during the preparation of drugs and during their topic application. The elimination of the used materials (needles and syringes) and the cleaning of all working surfaces and trolleys is of primary importance.

The preparation of antineoplastic drugs should be considered separately. In particular, drugs administered as an infusion must be prepared in a room equipped on purpose, under a special laminar air flow fume cupboard on a flat working surface covered with blotting paper. Workers must: (i) wear surgical, possibly disposable, white coats,
(ii) wear polyvinyl chloride gloves (some antiblastic drugs, in fact, may cross latex gloves) after accurate washing of the hands,
(iii) wear mask over the nose and mouth.
Total compliance with the directions attached to the drugs is necessary, particularly as far as the precautions for handling vials and phleboclysis (use of syringes and safe tubes) is concerned. At the end of the operations, all employed materials must be disposed of in special cartons, which will be then incinerated.
All workers dealing with the manipulation of antiblastic drugs should be subject to health surveillance. This involves an yearly clinical examination, including, if necessary, laboratory examinations (blood test, liver function tests, coagulation).
Genotoxicity and mutagenicity tests (chromosomic aberrations, exchange of sister chromatids, mutagenic power of the urine), although highly sensitive, are aspecific (tobacco smoking, for example, can alter the results) and hardly applicable on a large scale. Finally, it must be stressed how important it is that the personnel manipulating antiblastic drugs be adequately trained in their correct employment, with refresher courses. It is the duty of the health care services direction to make sure that the hygienic rules are observed and the personal protective devices used.

	Ambulatories
	Clinical wards

	Ambulatories
	Clinical wards

Medications