Onco-pharmacist led evaluation of knowledge, attitude & practice (KAP) of safe handling cytotoxic drugs among health care professional's (HCP's) in tertiary care hospital: A hospital based interventional Study

Background Cytotoxic drugs (CDs) are hazardous in nature. But it is necessary for the treatment in cancer patients. The healthcare professionals (HCPs) act as a facilitator through which the manufactured CDs reach the patient. However, safe handling of CDs becomes a primary concern not only for the recipients but also for the HCPs. Methods On Ethics committee approval, a prospective- interventional study was conducted among HCPs who are involved in handling of CDs in Oncology department of tertiary care hospital. The participants were screened for their eligibility criteria & 73 HCPs were recruited. The initial data was collected from the HCPs through interview & questionnaires. Later the participants were trained by oncology-pharmacist (7–8 months) for safe handling of CDs. After the training the participants were tested again through interview & questionnaires. Results 73 participants, (75%) nurses & (25%) physicians were included in the study. Among these participants, only 32.87% underwent training on reconstitution whereas 67.12% of the participants didn't undergo any training. The increase in mean score of KAP after the training was observed to be 3.44 ± 4.32, 1.23 ± 1.51 and 1.3 ± 1.01 respectively. Conclusion The study concludes that mandatory requirement of training for HCPs using SOP's by qualified oncology-pharmacist to minimize the hazardous effects of CDs. It also highlights the improvisation techniques for handling of CDs will enhance the safety profile of HCPs & the patients, which helps in refining the quality of pharmaceutical and health care services provided in the cancer care settings.

BIM-SPEED Inhabitant’s App: A BIM-Based Application for Crowdsourcing of Inhabitants’ Input in Renovation Projects

This report summarizes the conceptual framework and the technical implementation of a BIM-based user-friendly application to gather inhabitant’s input in the context of renovation projects developed in the European funded project BIM-SPEED. It starts with the underlying objectives and the role of data acquisition in the project. Then, it explains and outlines the conceptual framework and the methodology used in relation to the identified use cases, where inhabitants’ input is required. Furthermore, it describes the implementation and the development of the proposed methods as a user-friendly app and, finally, it ends with ethical and privacy considerations, specifically the measures taken for safe handling of privacy-sensitive data.

Improving nurses’ performance in the safe handling of antineoplastic agents: a quasi-experimental study

Background The safe and standard handling of antineoplastic drugs can reduce the effects of occupational exposure and promote safe behaviors in nurses. Thus, the present study aimed to determine the effects ofstandard guidelines education on the safe handling of antineoplastic drugs among oncologynurses in Ardabil, Iran. Methods Thequasi-experimental study with a one-group pretest-posttest design was performed among 32 nursesworking in the oncology wards of two educational hospitals in Ardabil city, during 2020. Allthe nurses in the wards who met the inclusion criteria participated in the study. The data were collectedby usinga demographic information form and nurses’knowledge assessment questionnaire regardingthe standard guidelines for working with antineoplastic drugs, and a standard checklist for examiningtheir performance in this regard. Subsequently, they were analyzed by descriptive (mean and standard deviation) and inferential statistics (t-test)and Pearson’s correlation coefficient) in SPSS 22. Results The mean and standard deviation of the knowledge and performance scores of the oncology nurses was59.56±6.41and 18.96±2.54 respectively, which changed to 66±4.82 and 32.03±2.45 respectively three months after training. The results of the t-test represented a statistically significant difference between the level of knowledge and performance before and after the intervention (P=0.001). Conclusions Based on the results, the standard guidelines education improved the nurses’ knowledge and performance on the safe handling of antineoplastic drugs in the chemotherapy wards. Therefore, it is advised to increase the awareness of the oncology nurses in this regard in the planning and policy-making ofhealthcare centers.

Mathematical Modeling of Urea Reaction with Sulfuric Acid and Phosphoric Acid to Produce Ammonium Sulfate and Ammonium Dihydrogen Phosphate Respectively

Urea is the final product of protein metabolism in mammals and can be found in different biological fluids. Use of mammalian urine in agricultural production as organic fertilizer requires safe handling to avoid the formation of ammonia that will decrease the fertilizer value due to the loss of nitrogen. Safe handling is also required to minimize the decomposition of urea into condensed products such as biuret and cyanuric acid, which will also have a negative impact on the potential sustainable production of crops and sanitation technologies. The study of thermodynamics and reaction kinetics of urea stabilization plays a key role in understanding the conditions under which undesirable compounds and impurities in urea-based fertilizers and urea-based selective catalytic reduction systems are formed. For this reason, we studied the reaction of urea in acid media to achieve urea stabilization by modeling the reaction of urea with sulfuric acid and phosphoric acid, and estimating the reaction enthalpy and adiabatic heat difference for control of the heat released from the neutralization step using Ca(OH)2 or MgO for the safety of the process. Numerical and simulation analyses were performed by studying the effect of the surrounding temperature, the ratio of acid reagent to urea concentration, the rate of addition, and the reaction rate to estimate the required time to achieve an optimum value of urea conversion into ammonium dihydrogen phosphate or ammonium sulfate as potential technological opportunities for by-product valorization. Full conversion of urea was achieved in about 10 h for reaction rates in the order of 1 × 10−5s−1 when the ratio of H2SO4 to CH4N2O was 1.5. When increasing the ratio to 10, the time required for full conversion was considerably reduced to 3 h.

Patients’ knowledge and awareness of safe handling of oral anticancer agents at Sultan Qaboos University Hospital in Oman

Background Safe handling of oral anticancer agents is of great concern. There is a lack of clear, national guidelines on how patients can safely handle and dispose of unwanted medications. We aimed to evaluate the safe handling, storage, and disposal of oral anticancer drugs among cancer patients and caregivers at home. Method This cross-sectional survey of adult cancer patients (or their adult caregivers) used a closed-ended questionnaire from May 2019 to March 2020. Results A total of 257 patients (50 ± 15 years; range: 18–93 years) were enrolled; however, only 91% (233/257) reported self-administering oral anticancer medications. Caregivers were more likely to administer oral anticancer agents for patients ≥60 years than those <40 years old (63% vs. 8%; P = 0.001). Most patients (52%; 133/257) did not wash their hands after administering the drug; 74% (164/222) of the respondents reported that their medications were kept in a bedroom cabinet, while 18% (40/222) stored their medications in a refrigerator, and 5% (12/222) in a kitchen cabinet. A total of 55% (68/124) of patients returned their excess oral chemotherapy medications to the hospitals; however, 36% (45/124) disposed of their unused oral chemotherapy drugs in a household garbage container. Conclusion While two-thirds of patients stored their oral anticancer medications properly, more than half used inappropriate handling procedures. Disposal practices were inconsistent and did not adhere to the reported international guidelines.

Development and Evaluation of an e-Learning Module for Low- and Middle-Income Countries on the Safe Handling of Chemotherapy Drugs

Despite the growing use of chemotherapy drugs in resource-constrained settings, training opportunities on safe handling practices are lacking. This study’s objectives were to develop and evaluate an e-learning training module on the safe handling of chemotherapy drugs to strengthen knowledge and practices in low- and middle-income countries (LMICs). The module’s curriculum was developed using the Six-Step Approach for Curriculum Development for Medical Education. Asynchronous, self-paced, e-learning lessons within the module were created and uploaded onto a free online platform, Pharm-Ed. The study ran online from January to April 2021. Participant recruitment was done using convenience sampling through various channels (social media, communities of practice). Training module effectiveness was evaluated using knowledge assessments (a pre-test and post-test study design) and participant satisfaction. We developed a comprehensive e-learning module on the safe handling of chemotherapy drugs comprising 11 asynchronous, self-paced, e-learning lessons. Eighty-two participants (68% pharmacists and 17% pharmacy students) from 17 countries completed at least one lesson, with a total of 259 lessons completed. Evaluation of the different lessons showed significant improvements in theoretical knowledge (p < 0.01) in all except one lesson and a high degree of participant satisfaction. As the use of anti-cancer drugs in LMICs will continue to increase, this e-learning module is an effective means to address the lack of training opportunities on the safe handling of chemotherapies for healthcare workers in these countries. The module could be integrated into a multi-modal approach aimed at reducing occupational exposure and increasing patient safety in cancer care centers.

Barriers and facilitators for the safe handling of antineoplastic drugs

Introduction Antineoplastic drugs are widely used in the treatment of cancer. However, some are known carcinogens and reproductive toxins, and incidental low-level exposure to workers is a health concern. CAREX Canada estimated that approximately 75,000 Canadians are exposed to antineoplastic drugs in workplace settings. While policies and guidelines on safe handling of antineoplastic drugs are available, evidence suggests that compliance is low. In this paper, we identify barriers and facilitators for safe handling of antineoplastic drugs in workplace settings. Methods We utilized a unique method to study public policy which involved compiling policy levers, developing a logic model, conducting a literature review, and contextualizing data through a deliberative process with stakeholders to explore in-depth contextual factors and experiences for the safe handling of antineoplastic drugs. Results The most common barriers identified in the literature were: poor training (46%), poor safety culture (41%), and inconsistent policies (36%). The most common facilitators were: adequate safety training (41%), leadership support (23%), and consistent policies (21%). Several of these factors are intertwined and while this means one barrier can cause other barriers, it also allows healthcare employers to mitigate these barriers by implementing small but meaningful changes in the workplace. Conclusion The combination of barriers and facilitators identified in our review highlight the importance of creating work environments where safety is a priority for the safe handling of antineoplastic drugs. The results of this study will assist policy makers and managers in identifying gaps and enhancing strategies that reduce occupational exposure to antineoplastic drugs.

Covid 19 Pandemic: Assessment of Knowledge and Attitudes in Biomedical Waste Management among Health Care Professionals in Tamil Nadu

Coronavirus, which was started provincially at Wuhan of China, has become a worldwide pandemic by affecting individuals of almost all the world. The developing pandemic of COVID-19 disease requires social distancing and individual cleanliness measures to secure general wellbeing. The aim of the present study is to evaluate the knowledge, attitude, practice and awareness of biomedical waste management in this pandemic situation among healthcare workers and medical students across Tamil Nadu. A cross sectional questionnaire survey was prepared to evaluate the knowledge regarding waste management and waste handling techniques. The survey found that most of the hospitals (50%) are using plastic containers for waste collection. Almost 79.7% of the respondents said they follow colour coding while disposing waste. When asked about exact category only few gave correct answers. Nearly 72.8% answered that they collect the Covid patient’s wastes separately. As coronavirus is a contagious disease, each healthcare worker should be trained in safe handling of wastes. From this survey, it is clear that training about safe handling of waste is needed among workers. This survey will help government and healthcare providers to handle this Covid pandemic successfully and more effectively.