What type of surgical respiratory mask must be worn when handling hazardous drugs?

NIOSH: Use proper PPE with chemo agents

Gloves, gowns must be impermeable

The hazards of working with chemotherapeutic agents aren't always obvious. While pharmacists mixing the agents work in a biological safety cabinet, nurses administering medication and housekeepers cleaning a patient's room must use personal protection. Bodily fluids may be especially hazardous because the drugs become concentrated in the urine.

The National Institute for Occupational Safety and Health (NIOSH) has issued a "Workplace Solutions" document with recommendations to prevent exposure (www.cdc.gov/niosh/docs/wp-solutions/2009-106/).

"Personal protective equipment is the first line of protection" for many workers, says Thomas Connor, PhD, research biologist with NIOSH's Division of Applied Research and Technology in Cincinnati and an expert on the workplace hazards of chemotherapeutic agents.

The same gloves, gowns, and face shields may be used to protect health care workers from both bloodborne pathogens and chemotherapeutic agents. But the chemicals have distinct properties, and it's important to make sure the PPE is impermeable to chemicals. For example, polyvinyl chloride exam gloves do not protect against chemical exposure, NIOSH notes.

Special care must be taken to protect employees from chemical vapors, especially if there is a spill or a leak, Connor notes. N95 respirators even the surgical version that protect against splashes do not provide protection from chemical vapors. "If you have a large spill, you should have a full-facepiece, cartridge-type respirator for those doing the cleanup," he says.

Likewise, NIOSH recommends wearing disposable gowns made of polyethylene-coated polypropylene or other laminate materials. If hazardous chemicals spill on cloth lab coats or scrubs, the agents would penetrate through to the skin.

Here are some specific NIOSH work practice recommendations:

Gloves

Inspect gloves for defects before use and change gloves on a regular basis. Changing recommendations vary from 30 to 60 minutes. Whenever gloves are damaged or contact with a drug is known or suspected, carefully remove and dispose of them properly.

Use powder-free gloves since the powder can contaminate the work area and can absorb and retain hazardous drugs.

Wear two pairs of gloves when compounding, administering, and disposing of hazardous drugs.

Sterile chemotherapy gloves are required for compounding of sterile preparations under U.S. Pharmacopoeia standards.

Wear the inner glove under the gown cuff and the outer glove over the cuff. Place gloves with long cuffs over the cuff of the gown to protect the wrist and forearm.

When compounding sterile preparations, sanitize gloves with sterile 70% alcohol spray or gel and allow them to dry; ensure that the selected gloves are not degraded by alcohol.

When removing double gloves, turn gloves inside-out so that contaminated surfaces do not touch uncontaminated surfaces.

Wash hands thoroughly with soap and water both before donning and after removing gloves.

Gowns

Dispose of gowns after each use. Reusing gowns increases the likelihood of exposure to hazardous drugs.

Wear gowns whenever there is a possibility of splash or spill as in compounding or administration of hazardous drugs.

Do not wear gowns outside the compounding or administration area to avoid spreading drug contamination to other areas and possibly exposing nonprotected workers.

If no permeation information is available for the gowns you use, change them every two to three hours or immediately after a spill or splash.

Respirators

Use an appropriate full-facepiece chemical cartridge-type respirator for events such as large spills when an intravenous (IV) bag breaks or a line disconnects and leaks, or where there is known or suspected airborne exposure to vapors or gases.

Eye and face protection

Use eye and face protection when compounding a drug outside the BSC or isolator (e.g., in the operating room), working at or above eye level, cleaning a biological safety cabinet or containment isolator, or cleaning a spill.

Use face shields in combination with goggles to provide a full range of protection against splashes to the face and eyes. Face shields alone do not provide full eye and face protection.

Do not use eye glasses or safety glasses with side shields, as they do not offer adequate protection to the eyes from splashes.

A full-facepiece respirator also provides eye and face protection.

Sleeve, hair, and shoe covers

Use sleeve covers constructed of coated materials to provide additional protection for the areas of the arms that come in contact with the BSC.

Use hair and shoe covers constructed of coated materials to reduce the possibility of particulate or microbial contamination in clean rooms and other sensitive areas.

Do not wear shoe covers outside drug compounding areas to avoid spreading drug contamination to other areas and possibly exposing nonprotected workers.

PPE disposal

Consider all PPE worn when handling hazardous drugs as being contaminated with, at a minimum, trace quantities of hazardous drugs.

Contain and dispose of such PPE either as trace or bulk contaminated waste.

(Editor's note: A copy of the Workplace Solutions document on "Personal Protective Equipment for Health Care Workers Who Work With Hazardous Drugs" is available at www.cdc.gov/niosh/docs/wp-solutions/2009-106/.)

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