Download Surface contamination

Safe Handling of
Hazardous Drugs
Objectives
The learner will be able to:
1. Identify the potential adverse effects of
handling cytotoxic and other hazardous
drugs.
2. List the recommended personal protective
equipment needed when caring for a client
receiving a hazardous agent.
3. Describe the cytotoxic spill clean-up process.
Safe Handling
• Hazardous drugs (HDs), are those drugs that
exhibit one or more of the following
characteristics:
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Carcinogenicity
Teratogenicity
Reproductive toxicity
Organ toxicity at low doses
Genotoxicity
Any drug similar in structure or toxicity to drugs
classified as hazardous
Adverse Health Effects of Occupational Exposure
to Hazardous Drugs
• Integumenary/Mucosal
– Skin irritation or contact dermatitis
– Mouth and nasal sores
– Partial alopecia*; hair thinning
• Neurologic
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Headaches
Dizziness
• Respiratory
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Dyspnea
• Gastrointestinal
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Nausea and vomiting
Abdominal pain
Adverse Health Effects of Occupational Exposure
to Hazardous Drugs (con’t)
• Hypersensitivity
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Allergic asthma
Eye irritation
• Reproductive
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Infertility
Prolonged time to conception
Premature delivery/low birth weight
Ectopic pregnancy
Spontaneous abortions/miscarriages
Stillbirths
Learning disabilities in offspring
Adverse Health Effects of Occupational Exposure
to Hazardous Drugs and Biotherapy Agents
• Malignancies
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Leukemia
Non-Hodgkin’s lymphoma
Bladder cancer
Liver cancer
• Biotherapy Agents - Data remain limited.
Most biologic agents do not affect DNA, including:
– Antiangiogenics
– Some targeted therapies
– Interferon
– Conjugated monoclonal antibodies
The spectrum of risk is mainly a function of the
concentration of the hazardous drug at the time
you are handling it.
Exposure Risks
Studies show:
• Chronic low-level exposure to HDs can lead to
absorption.
• Chronic low-level absorption may cause
significant long-term side effects.
• Acute exposure may cause acute symptoms.
• The use of personal protective equipment
(PPE) reduces the risk of absorption.
Types of Exposure
• Absorption (through skin, eyes, or mucous
membranes)
– Surface contamination has been found in every single
study that has tested for it.
– Unprotected skin easily can become contaminated if
surfaces are contaminated.
• Injection (accidental needle sticks)
• Ingestion
• Inhalation (sprays, aerosolization, drug dust,
spills)
Controls to Exposure
• Engineering (Mechanical) Controls* (Primary Engineering
Controls)
– Biologic safety cabinets (BSC) (Class II)
– “Hoods”
– Needless/needle-safe administration systems
• Work Practice Controls (procedures performed to reduce
exposure)
─ Prime IV tubing in the BSC, with saline/locking connections
• Administrative Controls
– Provide clear policy/procedure, education, training, and evaluation.*
• Personal Controls
─ Personal Protective Equipment – known as “PPE”
Guidelines for PPE
(Photo courtesy of Sam Smith, The George
Washington University Hospital, Washington, D.C.)
(Photo courtesy of Georgia Cancer Specialists,
Atlanta, GA)
When Should PPE Be Used?
• Introducing or withdrawing needles from vials
• Transferring drugs from vials to other containers
using needles or syringes
• Opening ampoules
• Expelling air from a drug-filled syringe
• Administering HDs by any route
• Spiking IV bags containing HDs and changing IV
tubing
When Should PPE Be Used?
• Priming IV tubing
• Handling leakage from tubing, syringe, and
connection sites
• Disposing of HDs and items contaminated by HDs
• Handling the body fluids of a patient who received
HDs in the past 48 hours
• Cleaning HD spills
Drug Preparation
• In a restricted area
• In a Biologic Safety Cabinet, Class II device, using PPE
Drug Transport
• Drug should arrive to you in a sealed transport
bag, with a container inside. Container AND bag
should be labeled as HAZARDOUS. It should also
have a label stating that you need to wear gloves
to handle it.
• Outside of transport bag should have been wiped
down during preparation in the BSC.
• Syringes should not have attached needles
(should have luer end capped).
Drug Administration
• Administration guidelines are required regardless of where the drug
is given, or the condition for which it is given. A HD is a HD,
regardless of where you find it.
• Perform all work at eye level; never over your head.*
• Have a spill kit nearby.
• Prepare your work area before starting.
• Put on all PPE before reaching into the delivery bag to remove the
drug container.
• Do not reuse gowns after use.
• Wash hands with soap and water, not alcohol-based gels; friction is
necessary to remove HDs.
Disposal of HDs
Hospital
• Place in leak-proof container. Label as hazardous.
Put sharps in a puncture-proof container.
• Seal containers when full.
• Decontaminate reusable equipment (IV poles).
Home
• Send patients home with sharps container.
• Keep HDs away from pets and children.
• Follow local regulations regarding disposal.*
Post-Administration: Body Fluids
• HDs are found in urine, feces, sweat, vomitus, breast
milk, and seminal fluid.
• Consider all bodily fluids as contaminated for at least
48 hours after completion of drug administration.
• Cover toilets without a lid before flushing to avoid
spray contamination. Encourage use of toilet instead of
urinal/bedpan to decrease exposure.
• Protect the skin of incontinent patients.
• Remember: Diapers can be contaminated too!
• Wear PPE when emptying Foley catheters, urinals, etc.
Post-Administration: Linen
• Prevent exposure: Use plastic-backed
disposable pads under incontinent patients.
Use vinyl/plastic pillow covers.
• If linen becomes contaminated with any body
fluid within the 48-hour post-administration
period:
– Don PPE. Bag as contaminated. Double wash.
– If home: Double wash separately from other linen.
Cytotoxic Spill Management
(Photo courtesy of Georgia Cancer Specialists, Atlanta, GA)
Spill Management
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Prevent spills as much as possible!
Be prepared for one if it happens (spill kit).
Post signs where spill is located; evacuate area.
If clothes or skin are contaminated, remove clothes; wash
skin with soap and water; get medical attention.
• Wear full PPE, including respirator mask and shoe covers,
before attempting to control spill.
• Use spill kit to control spill area.
• Patients receiving HDs at home should have a spill kit too,
and instructions on how to use it.
Acute Accidental Cytotoxic Exposure: What to Do
Skin
– Remove contaminated
garments.
– Immediately wash skin
with soap and water.
– Refer to MSDS, drug insert,
or emergency department.
Eye
– Immediately flush eye(s).
– Seek emergency
treatment.
– Refer to MSDS, drug insert,
or emergency department.
Inhalation
– Move away from area of
exposure.
– Seek emergency treatment.
– Refer to MSDS, drug insert, or
emergency department.
Ingestion
– Do not induce vomiting unless
indicated by MSDS.
– Seek emergency treatment.
– Refer to MSDS, drug insert, or
emergency department.
Medical Surveillance
• The collection and interpretation of longitudinal
data that detect health changes in workers with
potential exposure to HDs or other work hazards
• Its purpose is to minimize adverse health effects
on the working population.
• Includes history and physical, laboratory studies,
and ongoing biologic monitoring (such as periodic
blood tests or dosimetry badges)
Reference
Polovich, M., Whitford, J., & Olsen, M. (Eds.). (2009).
Chemotherapy and biotherapy guidelines and recommendations
for practice (3rd ed.). Pittsburgh, PA: Oncology Nursing Society.