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Safe Handling


Hazardous drugs require ... Safe Handling * Exposure Protection Guidelines Spill Guidelines Spill kits should be available in all areas where cytotoxic drugs ... – PowerPoint PPT presentation

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Title: Safe Handling

Safe Handling
  • At the completion of this session the participant
    will be able to
  • Describe the occupational exposure risks of
  • List components of safe handling and disposal
  • Identify components of personal protection

  • Chemotherapeutic agents are used successfully to
    treat a variety of malignancies - these agents
    may also cause malignancy in individuals who
    handle them
  • The Occupational Safety and Health Administration
    (OSHA) (1995), reports that safe levels of
    occupational exposure to cytotoxic agents cannot
    be determined and no reliable method of
    monitoring exists

  • The National Institute for Occupational Safety
    and Health (NIOSH) reports in studies that there
    is evidence of health risk, and safe levels of
    exposure to cytotoxic agents have not been
    determined by a reliable method (NIOSH, 2004).
  • Biotheraputic agents also can be associated with
    exposure risks. OSHA also has classified them as
    hazardous materials Use safe handling for any
    biotherapy agent labeled hazardous by the
    manufacturer or OSHA (e.g., interferon) (NIOSH,

Occupational Exposure Risk
  • Health care workers handling chemotherapy and
    biotherapy agents are at risk for occupational
    exposure to these toxins, and the long-term
    effects are unknown

Occupational Exposure Risk
  • The potential health risks include
  • Carcinogenicity
  • Genotoxicity
  • Teratogenicity
  • Organ toxicity
  • Acute symptoms such as headache, nausea,
    dizziness and skin, eye or throat irritation
  • (Valanis, Vollmer, Labuhn, Glass, 1993)

Occupational Exposure Risk
  • The potential routes of exposure are
  • Injection through needle stick
  • Ingestion direct or through food or beverage
  • Inhalation of drug by aerosolization
  • Absorption through mucous membranes after direct

Safe Handling Policy
  • Institutions are required by OSHA to develop and
    implement policies regarding the safe handling of
    cytotoxic and biologic agents

Safe Handling Policy
  • Protection measures must include at a minimum
  • Safe administration, storage, transport and
    disposal of hazardous agents
  • Provision of mandatory training of employees
    regarding hazardous materials
  • Monitoring of long term occupational exposure and
    minimization of employee risk
  • Hazardous drug spill management

Safe Handling Policy
  • Protection measures must include at a minimum
  • Prohibition of eating, drinking, chewing gum,
    storing food, and applying cosmetics in areas
    where cytotoxic/biologic agents are prepared or
  • Provision of protection for employees who are
    pregnant, breast-feeding or planning a pregnancy
  • Monitoring compliance with the above indicated
    institutional policies and procedures

Exposure Protection Guidelines
  • Personal Protective Equipment (PPE) is to be used
    whenever there is a possibility of
    cytotoxic/biologic agents being released into
    the environment. This includes
  • Preparing or transferring
    medications from vials, or
    ampoules spiking, priming
    or changing IV equipment
  • Expelling air or transferring
    medications using needles
    or syringes

Exposure Protection Guidelines
  • PPE usage (continued)
  • Contact with leaking tubing or connection sites
  • Managing cytotoxic spills
  • Disposing of cytotoxic/biologic agents and mixing
  • When handling the body fluids of a patient for 48
    hours after they receive chemotherapy

Exposure Protection Guidelines
  • PPE includes
  • Gloves
  • Gowns
  • Face shield or goggles

Exposure Protection Guidelines
  • Labeling and Storage
  • Medications must be clearly labeled for
    content and hazardous nature
  • Material Safety Data Sheets (MSDS) must
    be available for all medications
  • Any area that contains chemotherapeutic materials
    must be inaccessible to children with locked

Exposure Protection Guidelines
  • Administration
  • Obtain medication
  • Wash hands and don PPE
  • Place a sterile, plastic-backed absorbent pad on
    the work surface
  • Always work below eye level
  • Ampoules wrap absorbent sterile pad around the
    neck of the ampoule and break away from yourself.
    Use a filtered straw for withdrawal

Exposure Protection Guidelines
  • Administration
  • Packaged medications, oral tablets and capsules
    avoid aerosolization, which results from
    pressure. Use venting devises to release the
    pressure. Capsules and tablets should be crushed
    under a BSC
  • Wear gloves when mixing agents that cause skin or
    other irritation (e.g., rituximab).
  • Do not overfill syringes to prevent the plunger
    from separating

Exposure Protection Guidelines
  • Administration
  • Excess medication or air contained within a
    needleless syringe should never be expressed into
    the air, but should instead be expressed directly
    into a sterile gauze pad that is placed in a
    sealable plastic bag
  • Sterile technique should be maintained throughout
    parenteral drug preparation

Exposure Protection Guidelines
  • Administration
  • IV tubing should be primed under a hood or be
    primed with 10-20ml of compatible solution using
    the backflow method
  • IV tubing should have
    Luer-lock connections
  • Wipe the tubing or
    syringe with moist
    gauze then place in
    sealable plastic bag
    for transport

Exposure Protection Guidelines
  • Administration
  • An absorbent pad with a plastic back is necessary
    for collecting any spill that may occur when
    connecting the tubing to the patient
  • A cytotoxic medication caution label is attached
    to the IV set for the duration of the
    chemotherapeutic/cytotoxic/biologic agent infusion

Exposure Protection Guidelines
  • Administration
  • After administration, remove the IV bag with the
    tubing attached (NIOSH, 2004). Do not remove the
    spike from the bag or reuse the tubing.
  • Dispose of all equipment that has come in contact
    with the hazardous drug by placing the equipment
    in a container labeled cytotoxic waste.
  • Use detergent and water to clean surfaces that
    have been in contact with hazardous drugs
    (Polovich, 2004).
  • Remove and discard PPE
  • Wash your hands before leaving the preparation
    and administration area

Exposure Protection Guidelines
  • Administration
  • Review hospital-specific
  • administration guidelines

Exposure Protection Guidelines
  • Disposal Guidelines
  • Hazardous medical waste containers must be
    available in all areas where hazardous
    medications are prepared and administered
    (NIOSH, 2004).
  • The waste containers should be
    puncture-proof, have a secure
    lid, and be clearly labeled as
    hazardous waste.
  • Unused medicine returned
    to pharmacy

Exposure Protection Guidelines
  • Body Fluid Guidelines
  • Utilize PPE and standard universal precautions
    when handling patients body fluid or lines for
    48 hours after administration of chemotherapy
  • Patients may use regular bathroom facilities

Exposure Protection Guidelines
  • Body Fluid Guidelines
  • Diapers should be disposed of in the same manner
    as other hazardous waste by placing them in
    appropriately labeled plastic hazardous waste
  • Bedpans, hats, urinals and emesis basins that are
    rinsed carefully with soap and water may be
    reused. After use, they should be discarded in
    the hazardous waste receptacle.

Exposure Protection Guidelines
  • Body Fluid Guidelines
  • Linens that are contaminated with body fluids
    should be placed in a plastic bag and labeled as
    contaminated by chemotherapy before placing them
    with other hospital laundry
  • The toilet should be flushed twice with the lid
    down after disposing of excreta from these
    patients for 48 hours following chemotherapy

Exposure Protection Guidelines
  • Spill Guidelines
  • Spill kits should be available in all areas where
    cytotoxic drugs are stored, prepared,
    transported, and administered
  • Only trained personnel with appropriate PPE
    should clean up cytotoxic spills

(No Transcript)
Exposure Protection Guidelines
  • Spill Guidelines
  • Review hospital-specific
  • spill kit and policy

Safe Handling at Home
  • Precautions for family members to protect
    themselves from exposure
  • Pregnant caregivers should not mix or handle
    cytotoxic agents without appropriate PPE and
  • Protective equipment use is demonstrated and a
    return demonstration given by the caregiver

Safe Handling at Home
  • Precautions for family members to protect
    themselves from exposure
  • Designate a workplace in the home for handling
    cytotoxic agents
  • Special instructions for crushing tablets or
    opening capsules must be instituted in the home
    setting to protect caregivers and family members

Safe Handling at Home
  • Emergency interventions and reporting mechanisms
    for accidental drug exposure
  • Medication-specific exposure hazards reported by
    the manufacturer should be reviewed with the
  • Types of exposures and prevention/ precautions
    such as inhalation, splash, spill are reviewed
    with the caregiver

Safe Handling at Home
  • Emergency interventions and reporting mechanisms
    for accidental drug exposure
  • Teaching sheets reviewed by the RN with the
    caregiver must include safeguards such as
  • What to do for skin contact, eye contact and
    environmental/clothing contact
  • How to clean up a spill and dispose of
    contaminated material
  • Who to call and include the telephone numbers

Safe Handling at Home
  • Safe disposal of utensils, capsule remnants and
    contaminated materials
  • Protection of children and pets in the home from
    exposure to cytotoxic medication or waste
  • Demonstration of appropriate disposable equipment
    should be provided to the caregiver
  • Explanation of safe disposal with specific
    individualized home setting considerations, as
    well as, county and state regulations

Safe Handling at Home
  • Review hospital-specific teaching materials for
    administering chemotherapy at home