A Review on Handling Hazardous Drugs

When handling chemotherapy and other potentially dangerous anti-cancer drugs, there are steps that oncology nurses should take to protect themselves and their colleagues, according to a recent presscast from the American Society of Clinical Oncology (ASCO).

The National Institute for Occupational Safety and Health (NIOSH) has 3 classifications for hazardous drugs that oncology nurses and other healthcare professionals should be aware of: group 1, antineoplastic drugs; group 2, non-antineoplastic drugs deemed hazardous by meeting one or more NIOSH criteria for a hazardous drug; group 3, which pose reproductive risks for men and women who are actively trying to conceive and women who are pregnant or breastfeeding.

Safe handling does not only come into play when providers are preparing and administering the agents. In fact, they should be taking precautions as soon as the agents enter the facility, Christopher A. Fausel, PharmD, MHA, BCOP, chair of the Hoosier Cancer Research Network at Indiana University Health, explained in the ASCO press cast.

“One of the things that we’ve learned over the years is that the outside packaging, whether it’s the cardboard boxes that the drugs come in or the vitals that the drugs themselves are in, actually have drug residue on the outside of the packaging of these hazardous drugs,” Fausel said.

Oncology nurses may also be at risk when handling bodily fluid or changing the soiled linens of patients who are receiving chemotherapy, he added.

When handling these potentially harmful drugs, there are protective measures that all healthcare providers should take. They should wear two pair of sterile gloves that meet the American Society for Testing and Materials (ASTM) standards. Gloves — which should be powder free if chemotherapy is being used – should be changed every 30 minutes or when torn, punctured, or otherwise contaminated.

Providers should also wear non-permeable gowns that are closed in the back, with no seams or closures that will allow hazardous drugs to pass through. They should be changed as frequently as the manufacturer suggests, or every 2 to 3 hours and after any spills or splashes. Nurses should remember that everyday clothing, scrubs and lab coats are not protective.

Head and hair covers should also be worn when handling hazardous drugs, along with a second pair of shoe covers that should be removed when existing the buffer room.

Fausel emphasized that institutions must develop standard operating procedures based on risk of exposure and the type of activities that are performed.

SOPs should also be in place in the event that there is a hazardous drug spill, Fausel explained.

“There needs to be a written procedure on how the staff handles cleanups,” he said. SOPs should include: the use of personal protective equipment and respirators (if necessary) documentation of the circumstances that surrounded the spill, and sending any exposed individuals for immediate medical evaluation.

“Personal protective equipment is extremely important for the pharmacy staff and the nursing staff who handle these drugs,” Fausel said.