Personal Protective Equipment Use in Chemotherapy Administration

1. Personal Protective Equipment Use in Chemotherapy Administration Stacy J. Ravert, RN, BSN Master’s of Nursing Candidate University of Washington School of Nursing

2. What is Personal Protective Equipment (PPE)? • Personal protective equipment includes: • Gloves • Gowns • Shoe covers • Face/eye protection • NIOSH approved respirator

3. Why are PPE important • 1970’s found secondary cancers in patients who had received chemotherapy agents • Researchers have reported that nurses who are exposed to chemotherapy agents have increased incidence of cancers • Dermal exposure is thought to be the primary route of exposure to chemotherapy agents. • Inhalation may also be a significant source of exposure.

4. Skin Exposure to Chemotherapy Dermal exposure from chemotherapy spill. Scaring is likely to occur. Photo courtesy of: James Tinguely, TycoHealthcare

5. I Should Use PPE When: • Preparing chemotherapy • Introducing or withdrawing needles from vials • Transferring drugs using needles or syringes • Opening ampules • Expelling air from drug filled syringes • Administering all hazardous drugs by any route

6. I Should Use PPE When: • Spiking IV bags and changing any tubing in the biological safety cabinet • Note: IV tubing should not be spiked at the point of administration • Priming IV tubing • Handling leakage from tubing, syringe, and connection sites • Disposing of hazardous drugs and items contaminated by hazardous drugs

7. I Should Use PPE When: • Handling the body fluids of a patient who received hazardous agents in the past 48 hours (longer if the hazardous agent has a longer half life) • Cleaning up of hazardous agent spills

8. Gowns • Should be: • Lint free • Made of low permeability fabric • i.e. polyethene-coated material • Have a solid front • Long sleeves • Tight cuffs • Back closure Photo courtesy of Tycohealthcare

9. Gloves • Are essential • Must be worn at all times when handling drug packaging, cartons, drug vials, inventory control procedures, and when gathering hazardous drug and supplies. • Gloves should be powder free. • Wash hands thoroughly prior to and after donning gloves. Photo courtesy of Tycohealthcare

10. Gloves continued • Gloves should be worn for no more than 30 minutes • Change gloves immediately if: • They are torn • Punctured • Knowingly contaminated • Use thick Gloves • Use gloves long enough to cover gown cuffs. Photo courtesy of Tycohealthcare

11. Gloves Continued • Gloves worn to handle chemotherapy agents should be disposed of as hazardous waste • Gloves must be tested for use with chemotherapy agents • Double glove • Meets ASTM Standard D6319 (as noted on glove box)

12. Double gloves and ASTM Standard • Nurses should double glove even when using gloves conforming to the ASTM standard to prevent potential skin contamination in the following situations: • Gloves become inadvertently torn • When removing contaminated gloves • In the event of a glove puncture

13. What is ASTM • ASTM International is an international voluntary standards organization that develops and produces technical standards for materials, products, systems and services. It was formed in 1898 in the United States as the American Society for Testing and Materials by a group of scientists and engineers.

14. ASTM Standard D6319 • This test measures the resistance of protective clothing materials to liquid or gaseous chemicals under the condition of continuous contact. • For chemotherapy gloves the standard is 30 minutes.

15. Shoe covers • Use if there is a potential for floor contamination • Use if cleaning up a chemotherapy spill • Remove shoe covers with gloved hand before leaving area • Discard shoe covers as hazardous waste

16. Masks • Surgical masks DO NOT provide adequate protection • Use a NIOSH approved respirator (N95) that has been fit-tested • Wear if air contaminated. • Must comply with OSHA’S respiratory protection standard • Use when cleaning up drug spills NIOSH Approved mask Photo courtesy of Tycohealthcare

17. Use Facial Protection • If possibility for splashing or uncontrolled aerosolization will occur • If goggles or safety glasses will not provide enough protection • OSHA recommends to use a NIOSH approved respirator

18. Web links to resources • OSHA: Hazardous Drugs • www.osha.gov/SLTC/hazardousdrugs/recognition.html • OSHA Technical Manual Section VI, Chapter 2 • http://www.osha.gov/dts/osta/otm/otm_vi/otm_vi_2.html • ASHP Pre-publication guidelines • http://www.ashp.org/bestpractices/new/HD-Prepub-final.pdf • NIOSH Alert: Preventing Occupational exposures to antineoplastic and other hazardous drugs in the health care setting • http://www.cdc.gov/niosh/docs/2004-165/

19. References American Society of Health-System Pharmacist. ASHP Guidelines on Handling Hazardous Drugs. Accessed April 24, 2006, from http://www.ashp.org/bestpractices/new/HD-Prepub-final.pdf Centers for Disease Control (2004). NIOSH Alert: Preventing Occupational exposures to antineoplastic and other hazardous drugs in the health care setting. Accessed April 24, 2006, from http://www.cdc.gov/niosh/docs/2004-165/ Occupational Safety Health Administration (last updated March 2, 2004). OSHA Technical Manual: Section VI: Chapter 2. Retrieved April 23, 2006, from http://www.osha.gov/dts/osta/otm/otm_vi/otm_vi_2.html Polovich, M., White, J. M., Kelleher, L.O. (eds.) (2005). Chemotherapy and biotherapy guidelines and recommendations for practice. Pittsburgh, PA: Oncology Nursing Society.