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chemotherapy administration

Cases of Serious Harm Due to Exposure

from the CDC’s Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Health Care Settings 2004, pages 8-10.

Case 1: When the entire tubing system fell out of a bottle of chemotherapy preparation, a nurse was exposed to the solution. She was wearing gloves but not a protective gown. She washed her skin but did not change her soaked clothing. She experienced abdominal distress, including diarrhea, cramping pain, and profuse vomiting.

Case 5: A patient-care assistant working in oncology developed an itchy rash after emptying a commode of urine from a chemotheraphy patient into a toilet. She was wearing gloves and a gown, but not a face mask. It’s believed she breathed vapor from the aerosoled drug in the urine.

Case 4: Nursing personnel experienced possible serious harmful exposure to chemotherapy drug vapors from chemo drugs that were prepared in a malfunctioning BSC (biological safety cabinet).

"...worker exposure to hazardous drugs is a persistent problem... researchers have determined that surface contamination of the workplace is common and widespread. Also, a number of recent studies have documented the excretion of several indicator drugs in the urine of health care workers.”

- page 10, Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Health Care Settings, CDC, 2004







Why Chemotherapy Safety Matters

Why are chemotherapy drugs dangerous?

Even a small amount can be very toxic.

Chemotherapy drugs have been proven to be carcinogenic and harmful to the human reproductive system. Even very small exposure to these drugs on skin or inhaled as vapor can affect staff and patients.

For this reason, all aspects of handling these drugs are highly regulated by the federal government, and extreme care must be taken.

Where does contact with chemotherapy drugs happen?

Exposure can happen in any area of the facility where chemo drugs can be: receiving, storage, compounding, administration (giving chemotherapy to a patient) either in the facility or at the patient’s home, transport, and disposal.

How do we prevent contact with these drugs?

All handling of chemotherapy drugs is highly regulated (see sidebar below for the definitive regulations). Check the regulations for any specific requirementsWhen handling, use extreme care and always wear the required PPE:

  • N95 respirator mask
  • Eye goggles
  • Full face shield
  • Two pairs of chemo- approved gloves
  • Chemo-approved fluid-resistant gown
  • Head covers and shoe covers as appropriate

What should we do if there’s a chemotherapy drug spill?

All facilities that work with chemotherapy drugs are required to have:

  • Designated staff who should be trained in proper chemo drug spill cleanup procedures
  • ASHP-compliant chemo spill kits, which are stored near all preparation and administration areas
  • Deactivation products for the specific chemo drugs they use

The first step is to contact the designated, trained staff member, who will handle the spill. Spills are very dangerous and must be cleaned up and disposed of properly and immediately, according to ASHP and USP 800 recommendations. These recommendations state that a compliant spill kit must be used according to its instructions. After the spill kit is used, the designated staff member must decontaminate, deactivate and clean the area to ensure no harmful residue remains.

OSHA divides hazardous drug spills into two categories: 5ml or smaller, and larger than 5ml.

A small spill. For chemo drugs, small spills are most likely to happen in the compounding area, and could possibly include having to clean up broken glass from the vial or bottle the drug was stored in before compounding into plastic IV bags or bottles for administering to patients.

A large spill. Larger chemo drug spills are most likely to happen during administration to patients from broken plastic bags, or disconnected tubing or syringes (see Case 1 on the previous page).

How can my facility best protect staff and patients?

  • Purchase and make available chemo-approved PPE, including gowns, gloves, N95 masks, full face shields, goggles, head covers, and shoe covers.
  • Train personnel in preventive measures, including the need to always wear PPE when working with chemo drugs, and how to don, remove, and dispose of PPE properly.
  • Enforce wearing PPE in your facility.
  • Purchase ASHP and USP 800 compliant spill kits, and make sure they are stored near the compounding and administration areas. If your facility provides home administration of chemotherapy, equip your patients with chemo spill kits designed for patients.
  • Train designated personnel in ASHP and USP 800 regulations, including spill cleanup.

Recommended Contents of A Chemo Spill Kit

PPE: chemo gown, two pair of chemo gloves, full face shield, eye goggles, shoe covers, N95 respirator mask

Cleanup supplies: absorbent plastic backed sheets or spill pads, disposable toweling, disposable scoop, puncture-resistant container, two chemo waste disposal bags with twist tie closure

Other: Caution Chemo Spill sign, Incident Report Form, instructions



Related Products

Chemotherapy Compounding Spill Kit

Chemotherapy Practice Spill Kit

Patient Home Chemotherapy Spill Kit



Regulations and Guidelines for Chemotherapy Drugs:

The new USP 800 (still under development), which was written by ASHP and will be enforceable by state boards of pharmacy and other regulatory agencies

ASHP’s (American Society of Health-System Pharmacists) Guidelines on Handling Hazardous Drugs

OSHA’s Technical Manual, Chapter 2, titled Controlling Occupational Exposure to Hazardous Drugs

CDC’s Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Health Care Settings

Other Resources:

MSDS (Material Safety Data Sheets)

Certificates of Compliance and Certificates of Conformity

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