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Safe Handling of Chemotherapy Agents
There are many guidelines available that address the safe handling
of hazardous drugs. Key areas in the hospital setting where exposure
to hazardous drugs may occur are listed below along with equipment
and materials designed to protect personnel. The education and training
of employees is also important in the prevention of exposure to
hazardous materials.
Areas of Exposure to Chemotherapy Agents
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During drug preparation in both the manufacturing
process and the pharmacy |
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While transporting drugs between departments
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When administering drugs to patients |
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When handling patient excreta |
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When cleaning up spills |
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When disposing of all equipment and materials
exposed to the drug and waste, such as syringes, ampules, vials,
gloves, gowns and linens |
Equipment and Materials
Equipment and materials that minimize the risk of exposure during
preparation, administration and disposal of chemotherapy agents
include gloves, gowns, respiratory protection and eye and face protection.
Education and Training of Employees
Written policies and procedures for all aspects of handling cytotoxic
drugs and their by-products should be maintained to prevent exposure
of personnel, patients, visitors and the environment to hazardous
drug contamination.
Selecting Gloves
The table that follows cites three different published guidelines
to assist with selecting gloves for use with chemotherapy agents.
Factors to consider include glove thickness, glove change frequency,
fit requirements and material.
| Guidelines |
Oncology Nursing
Society (ONS), 2nd Edition, 1997 |
American Society
of Health-System Pharmacists (ASHP) |
Occupational Safety
and Health Administration (OSHA) |
| Selection criteria |
Thickness, contact time and latex sensitivity |
Fingertip thickness, fit, length, tactile sensation
and latex sensitivity |
Thickness more important than type of material |
| Ambidextrous or hand-specific |
Not specified |
Hand-specific (surgical) for better fit and tactile
sensation, particularly in drug preparation area |
Not specified |
| Thickness (at fingertips) |
0.007" or 0.178mm (ASTM minimum 0.10mm) |
Not specified, but surgical glove is recommended
(ASTM minimum 0.10mm; thicker fingertips considered optimal) |
Not specified; however, thickness of glove is
more important than the type of material |
| Powder-free |
Yes |
Yes; if powder-free is unavailable, then the outside
of a powdered glove should be washed before use |
Minimal or no powder preferred because powder
may absorb any spilled hazardous material |
| Glove material recommendation |
Latex or nitrile; PVC only as a double glove beneath
latex glove, if necessary for latex allergy; subject to manufacturer
test data |
Latex |
Latex, unless manufacturer specifically stipulates
that some other glove provides better protection |
| Length |
Long enough to be worn under and/or over the cuffs
of a gown |
Long enough to be worn under and/or over the cuffs
of a gown |
Long enough to be worn under and/or over the cuffs
of a gown |
| Double gloving |
Yes, due to variability in permeation
within and between glove lots |
Yes, unless evidence shows that a
single glove is sufficiently protective |
Yes, due to variability in permeation
within and between glove lots |
| Glove change frequency |
Hourly or when damaged or contaminated |
Hourly, between batches, or when damaged or contaminated |
Hourly or when damaged or contaminated |
| Hand wash frequency |
Before and after donning |
Before and after donning |
Before and after donning |
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