Modules Pharmacy » Personal Protective Equipment (PPE)OSHA's Controlling Occupational Exposure to Hazardous Drugs document describes the effective use of PPE such as gloves and gowns when working with hazardous drugs (Section V, C, #3).
HAZARDOUS DRUG EXPOSURES IN HEALTHCAREOverviewHazardous drugs used to treat patient illnesses can harm unprotected healthcare workers in their workplaces. To protect healthcare workers, it is recommended that workplaces assess the hazards specific to their workplace and develop hazard control strategies to mitigate those hazards. These may include use of engineering controls, such as ventilated hoods and enclosures; adoption of administrative controls, such as establishing safe handling policies, training, and routine training reviews for potentially exposed individuals; and supplying personal protective equipment (PPE), such as chemotherapy gloves and gowns, when appropriate. Factors affecting the risks posed by hazardous drugsThe chance that hazardous drugs will harm workers in healthcare workplaces, and the severity of the harm, depends on several factors, including:
Regardless of their formulation, cytotoxic drugs used to treat cancer in patients are considered especially hazardous. These drugs have manufacturers’ special handling information on them that should be followed at all times. NIOSH also considers some drugs hazardous because they meet NIOSH criteria for hazardous drugs. These include drugs that cause cancer; drugs that harm a worker’s organs, like liver, brain or kidney; drugs that may affect a worker’s ability to successfully conceive and have healthy babies; drugs that could harm women who are pregnant or may become pregnant; and drugs that could put the health of the fetus at risk. Some drugs handled or used in the healthcare workplace may also be a concern for women who breast feed, because drugs and chemicals workers are exposed to in the workplace may be found in breast milk. Steps you can take to protect workersNo single approach can protect all workers in healthcare workplaces against all hazardous drugs. These steps, however, can lessen the chance that hazardous drugs will do harm:
Managing healthcare workplace risks from hazardous drugsThe table below provides general guidance for some of the possible scenarios where hazardous drugs are handled in healthcare settings, but it cannot cover all possible situations. The actual risk to workers handling hazardous drugs is governed by many factors. In addition to proper use of engineering controls and personal protective equipment, the risk to workers in different healthcare workplace scenarios may be altered by intrinsic properties (potency, chemical and physical properties, and formulation) of the drugs used including molecular weight, volatility, and skin permeability. A site specific risk assessment including consideration of all of the relevant factors may suggest different risk management procedures for a specific workplace scenario. Whenever possible, NIOSH encourages employers to do a site-specific risk assessment that informs effective risk management procedures. Section 16 of the drug prescribing information (drug package insert) also offers advice for safely handling some hazardous drugs. Table of Engineering controls, administrative controls, and personal protective equipment for working with hazardous drugs in healthcare settings
* This table was formerly Table 5 in the 2016 NIOSH List of Antineoplastic and Other Hazardous Drugs. It provides general guidance for some of the possible scenarios where hazardous drugs are handled in healthcare settings, but it cannot cover all possible situations. For more detailed information on handling hazardous drugs, see the included references. Abbreviations used in the table: (C-PEC) Containment primary engineering control, (BSC) Class II biological safety cabinet, (CACI) compounding aseptic containment isolator, (CSTD) closed system drug-transfer device, (HIPEC) hyperthermic intraperitoneal chemotherapy. 1 1For nonsterile preparations, a ventilated engineering control, such as a fume hood or Class I BSC can be used. A containment ventilated enclosure (CVE), such as a powder hood, also may provide adequate protection. The ventilated engineering control exhaust should be HEPA-filtered or appropriately exhausted to the outside of the building. It is recommended that these activities be carried out using a control device, but it is recognized that under some circumstances, it is not possible. If using a ventilated engineering control for sterile intravenous preparations, it must be thoroughly cleaned and disinfected following the activity. 2 Needed if patient may resist (infant, unruly patient, patient predisposed to spitting out, patients with difficulty swallowing, veterinary patient) also needed if the formulation is hard to swallow. 3 Sterile gloves required for aseptic drug preparation in BSC or CACI. 4 Intravenous tubing already attached and primed. 5 NIOSH added this entry to the table in 2018 after a review of stakeholder questions and comments. NIOSH NIOSH [2004]. NIOSH alert: preventing occupational exposures to antineoplastic and other hazardous drugs in health care settings. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2004–165, https://www.cdc.gov/niosh/docs/2004-165/. NIOSH [2008]. Personal protective equipment for health care workers who work with hazardous drugs. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2009−106, https://www.cdc.gov/niosh/docs/wp-solutions/2009-106/. OSHA OSHA [2016] Controlling occupational exposure to hazardous drugs. Washington, DC: the Occupational Safety and Health Administration, http://www.osha.gov/SLTC/hazardousdrugs/controlling_occex_hazardousdrugs.htmlexternal icon. ASHP ASHP (American Society of Health-System Pharmacists) [2018]. ASHP guidelines on handling hazardous drugs. Am J Health Syst Pharm (in press), https://www.ashp.org/-/media/assets/policy-guidelines/docs/guidelines/handling-hazardous-drugs.ashx?la=en&hash=E0DF626948227B0F25CAED1048991E8E391F2007external icon. ONS Polovich M, Olsen M [2018]. Safe handling of hazardous drugs. 3rd ed. Pittsburgh, PA: Oncology Nursing Society. Polovich M, Olsen M, LeFebvre K. [2014]. Chemotherapy and biotherapy guidelines and recommendations for practice. 4th ed. Pittsburgh, PA: Oncology Nursing Society. USP United States Pharmacopeial (USP) Convention [2018]. USP<800> Hazardous drugs—handling in healthcare settings, USP41-NF 36. Rockville, MD: USP, pp. 6,598–6,617. What PPE is required for a moderate risk hazardous drug?OSHA's Personal Protective Equipment (PPE) standard [29 CFR 1910.132] requires employers to provide appropriate PPE (e.g., gloves, goggles, splash aprons) for workers who may handle or be otherwise exposed to hazardous drugs. For more information see OSHA's Safety and Health Topics page - Personal Protective Equipment.
Which type of gloves is worn when handling hazardous drugs?Double gloves are recommended, especially when working in a BSC, because it is well documented that gloves are usually contaminated when com- pounding hazardous drugs, and by withdrawing the contaminated gloved hands from the BSC, the contamination is transferred to the surrounding area.
Which personal protective equipment must be worn when cutting or crushing hazardous tablets?Manipulating tablets and capsules (cutting, crushing) will increase the risk of exposure to workers. Wear appropriate personal protective equipment including non-permeable gowns and double gloves if a hazardous drug needs to be compounded.
What PPE should you use to reduce the risk of exposure to chemical splashes?Eye and Face Protection
Eye protection is achieved by wearing eyewear specifically designed to reduce the risk of exposure to chemical splashes, laser radiation, and/or flying debris.
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