Sparks, September 2011
Safe handling of hazardous drugs in rulemaking process at the Dept. of L&I
The 2011 Legislature passed Engrossed Substitute Senate Bill 5594, which requires the Department of Labor and Industries (L&I) to adopt rules implementing the 2004 National Institute for Occupational Safety and Health (NIOSH) Alert on safe handling of hazardous drugs, such as chemo and other drugs included on the NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings. The legislation requires the rules be consistent with the recommendations set forth in NIOSH’s alert and states that the rules may not exceed these recommendations. The law and rules will apply to hospitals, pharmacies, providers – including veterinarians – and organizations representing health care personnel with occupational exposure to hazardous drugs.
The WSVMA is in the process of seeking clarification from L&I on several points contained in the rules. Once we obtain the answers that we seek, we will submit formal comments to L&I on behalf of the membership. As usual, the WSVMA office will keep members informed on developments primarily via e-mail, the WSVMA website and in Sparks E-Newsletter. Future efforts will include CE and helpful articles in Insight Magazine. In order to keep abreast of developments, please make sure the WSVMA office has your correct e-mail address and contact information on file.
Download the rules: WAC 296-62-500 Part R Hazardous Drugs and the 2010 NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings.
Should you wish to provide feedback to L&I, send all comments and questions to John Furman, 306.902.5666, or Beverly Clark, 360.902.5516.
WAC 296-62-500 Part R Hazardous Drug – Proposed Timelines:
- Proposed (CR-102) Rule Filing: October 18, 2011
- Public Hearings: December 1, 2011 (Spokane) and December 7, 2011 (Tumwater)
- Adoption (CR-103) Rule Filing: January 3, 2012
Exposure to zinc phosphide sickens Washington technician – What you should know
One minute a healthy 17 month-old spayed female dachshund, POA (a Privately Owned Animal), was playing in her yard and the next minute her owners pulled her limp body from the bushes where she had gone to vomit. She presented at a western Washington veterinary hospital unresponsive and unable to stand. Her temperature was 107 F, she had diarrhea, her pupils were pinpoint and unresponsive and her pulse was weak and thready, with a heart rate of 55 BPM.
When the veterinary technician inhaled fumes from what POA had thrown up in an attempt to determine what may be responsible for causing her sudden and apparently life-threatening illness, the technician immediately felt stomach pain and nausea that lasted about 20 minutes. POA’s owners were adamant that they did not have any potential toxins in or around their home environment. However, later that day, POA’s owners brought in a container of Mole Rid, which they remembered having placed in the yard about two weeks earlier. Mole Rid consists of grey pellets containing 2% zinc phosphide. The pellets are meant for underground application near mole holes in lawns. Zinc phosphide activates when exposed to gastric juices and produces highly toxic phosphine gas.
Personnel from the veterinary office contacted the Washington Poison Center and animal poison control for information about possible causes for the technician’s and POA’s symptoms. A staff veterinarian collected and froze a sample of POA’s vomitis. When the Washington State Department of Health Pesticide Program called to interview the technician about the reported pesticide exposure, a staff veterinarian mentioned the specimen and inquired about lab testing. The frozen specimen was then sent to the Washington Department of Labor and Industries industrial hygiene lab, where testing confirmed that the levels of zinc found were consistent with ingestion of zinc phosphide. The veterinary technician’s gastrointestinal symptoms subsided shortly after they began and POA recovered fully.
Reports of exposure to ingested zinc phosphide in the veterinary setting are seemingly rare, but do occur. In 2010, the Michigan Department of Community Health notified the AVMA of two events similar to what has been described here involving veterinary personnel after dogs that had ingested zinc phosphide pellets were induced to vomit in the exam room. Michigan's recommendations follow.
The following information is important for veterinarians and pet owners to avoid becoming sick while providing treatment to pets that have ingested zinc phosphide powder or pellets.
- Check to see if the dog has eaten a product that contains zinc phosphide.
- If the product does contain zinc phosphide, have the dog vomit outdoors, where there is plenty of air and the area can be hosed down with water.
- Stand upwind of the dog.
- Do not lower your head down to the dog. Phosphine is heavier then air and will sink to the ground.
- After the dog has finished vomiting, move it away from the vomitis.
- Hose down the area with lots of water while standing upwind of the vomit. It can be washed down a storm sewer or off a hard surface onto grass. There will be enough air movement outdoors to prevent the phosphine from reaching levels that can harm humans or pets.
- Make sure the vomit is diluted enough so it does not attract other dogs or animals. The poison in any remaining pellets in the vomit will be released by the water, making them non-toxic.
If the dog vomits indoors:
- If the dog vomits indoors, the phosphine gas may reach levels that could be harmful to people. Remove people and pets from the area and open doors and windows to ventilate the area.
- Run a fan at floor level. The gas is heavier than air and will sink to the floor. Running the fan will help move the gas out of the area.
- Call 911 to reach your local fire department. Most fire departments can determine whether or not the air is safe.
- Exposure to phosphine gas can cause: headaches; nausea, diarrhea, stomach pain, and vomiting; chest tightness, difficulty breathing, and soreness or pain in the chest; dizziness and staggering.
If anyone has these symptoms after exposure to dog vomit, have them get medical attention right away.
For more information, contact your Poison Control Center at (800) 222-1222 or go to the Agency for Toxic Substances Disease Registry website. Or contact Jennifer Sievert, Public Health Advisor, at the Washington State Department of Health Pesticide Illness Monitoring and Prevention Program, (360) 236-3338.
Source: Michigan Department of Community Health
AVMA: Phosphine gas can sicken veterinarians, clinic staff
DVM360: Toxicology Brief: A case of zinc phosphide toxicosis
Medical Management Guidelines for Phosphine
AVMA: Phosphine product precautions
USAEPA: Phosphine Hazard Summary
We Want Priceless Oral Histories from Veterinarians
It goes without saying; the veterinary profession attracts a diverse and interesting group of personalities. The WSVMA has decided to immortalize some of that from those of you who would like to volunteer to provide an oral history. We are going to make it easy, too. At this year’s annual convention in Yakima, the Association will have a small table-top sound booth and digital recorder available for those who wish to give a few minutes of your time. What is produced will be placed online to immortalize the memories of some of our colleagues in much the same way as StoryCorps, broadcast online and on National Public Radio.
What we want in our centennial year is your story. What we don’t want are opinions only with no historical context. So for instance:
- Tell us about your most interesting or humorous case?
- What has been the greatest hardship you’ve faced?
- What client has intrigued you more than any other?
- What has been your most moving experience as a veterinarian?
- Does your spouse work for the practice? How’s that been?
- What hobbies do you enjoy and how does that make you a better veterinarian?
- If you had it to do over again, would you?
So look for our booth and give us a story that will outlive us all. The plan is to post your recording online on our website for all to enjoy as they’d like.