CHEMOTHERAPY SAFETY

Mary Lynn Rae, RN, MSN, CPON

OSHA…
 Chemotherapeutic agents are used successfully to treat a variety of
malignancies - these agents may also cause malignancy in
individuals who handle them.
 Handled without proper care, antineoplastic agents may cause local
reactions and allergic reactions. This may include symptoms such
as lightheadedness, dizziness, nausea, eye irritation and headaches
(OSHA, 1995).
 Safe levels of occupational exposure to cytotoxic agents cannot be
determined. It is therefore imperative that healthcare professionals
working with cytotoxic agents adhere to practices designed to
reduce or eliminate occupational exposure (OSHA, 1995).
 Health care workers handling chemotherapy and biotherapy agents
are at risk for occupational exposure to these toxins, and the long-
term effects are unknown
APON Chemotherapy Provider Course
Safe Handling
Occupational Exposure Risk
 The potential health risks include:
 Carcinogenicity
 Genotoxicity
 Teratogenicity
 Organ toxicity
 Acute symptoms such as headache, nausea, dizziness
and skin, eye or throat irritation

(Valanis, Vollmer, Labuhn, & Glass, 1993)

APHON Chemotherapy Provider Course

Safe Handling
Occupational Exposure Risk

 The potential routes of exposure are

 Injection through needle stick
 Ingestion
 Direct or through food or beverage
 Inhalation of drug by aerosolization
 Absorption through mucous membranes
after direct contact

APHON Chemotherapy Provider Course

Safe Handling
Safe Handling Policy
 Protection measures must include at a minimum:
 Safe administration, storage, transport and disposal
of hazardous agents
 Provision of mandatory training of employees
regarding hazardous materials
 Monitoring of long term occupational exposure and
minimization of employee risk
 Hazardous drug spill management
Safe Handling Policy
 Protection measures must include at a minimum:
 Prohibition of eating, drinking, chewing gum, storing
food, and applying cosmetics in areas where cytotoxic
agents are prepared or administered
 Provision of protection for employees who are
pregnant, breast-feeding or planning a pregnancy
 Monitoring compliance with the above indicated
institutional policies and procedures

APHON Chemotherapy Provider Course

Safe Handling
Exposure Protection Guidelines
Personal Protective Equipment
 Optimal PPE includes (per OSHA,
APHON, ONS, NIOSH):
 Double Nitrile Gloves
 If allergic-wear 2 pairs of

POWDER-FREE SYNTHETIC
EXAMINATION GLOVES
 Chemotherapy Gown

 Face mask w/fluid shield

 PPE should be worn when handling

chemotherapy or body fluids of patients
receiving chemotherapy for 48 hours from
the last dose received
 SAFE HANDLING OF
BODILY FLUIDS
 Precautions are maintained for 48 hours from chemo
administration
 When handling bodily fluids, healthcare workers and family
members MUST wear blue nitrile gloves
 When spill/splashing may occur, wear face mask with fluid
shield and gown
 Discard all gloves/gowns, etc. in chemotherapy waste
container when soiled
 Diapers: dispose in chemotherapy waste container
 Flush the toilet twice
 Place used hats/urinals in chemotherapy waste container
 Linens: place in chemotherapy yellow linen bags
 Chemotherapy Spill Process:
Small Spills (< 5 mL)
 Clean up immediately by nursing personnel
wearing gowns, nitrile gloves, and face-mask with
fluid shield
 Liquids wiped with absorbent gauze pads
 Area should be cleaned three times with soap and
water and then three times with water
 Clean out to in
 Use 2 pink buckets for cleaning solution
 Place all contaminated items the chemotherapy
waste container
 Fill out an unusual occurrence report
(SERS/Peminic)
 Chemotherapy Spill Process:
Large Spills (>5 mL)
 Assess cytotoxic exposure of patient involved and isolate
patient from spill if necessary
 Locate the chemotherapy spill kit.
 Take out all contents of the kit and display sign near area.
 Put on ChemoPlus Gown, shoe coverings, respirator mask,
safety glasses and both pairs of gloves.
 Lay ChemoSorb Pads over the spill (the pads will absorb
the liquid and transform it into a gel). Avoid skin and eye
contact and do not inhale.
 Detach scoop from scraper and use both to pick up the
ChemoSorb gel. Place contaminated gel in the blue bag.
 Chemotherapy Spill
Continued…
 If there is any broken glass, use scoop to place in the chemotherapy hazardous waste
container
 Use spill towels to pick up any remaining gel. Place towels in yellow bag.
 Clean up immediately by nursing personnel wearing gowns, nitrile gloves, and face-
mask with fluid shield.
 Area should be cleaned three times with soap and water and then three times with
water
 Clean out to in
 Use 2 pink buckets for cleaning solution
 Place all contaminated items the chemotherapy waste container
 Remove shoe coverings, ChemoPlus Gown and outer pair of gloves. Discard into the
blue bag.
 Wearing respirator mask, safety glasses, and the inner gloves, close the blue bag and
place it in the Chemo Waste Bag. Remove remaining PPE and discard in the Chemo
Waste Bag. Close bag and tie wrap.
 Dispose of bag in cytotoxic waste container located in soiled utility room.
 Chemotherapy Spill
Continued…
 Call environmental services supervisor to clean the area of
the chemotherapy spill
 Fill out an unusual occurrence report (SERS/Peminic) and
notify the oncology fellow/attending if the chemo was
infusing.
 Ensure environmental knows that it is a chemo spill, and
uses proper PPE
 Mop should be thrown away in yellow bucket
 Water bucket should be properly cleaned
 Employee Contamination:
Eyes
 Flood affected area with water, isotonic eyewash, or
at an eyewash fountain for at least 15 minutes (urine
splashing/direct drug contact)
 Know your drug
 Report incident to charge nurse and clinical
manager or nursing director
 Within 24 hours
 Must fill out an injury report form within the shift
 Seek medical attention in the ED or OHS
Employee Contamination:
Mouth
 Flood affected area with pink bullets (saline)
 Know your drug
 Report incident to charge nurse and clinical
manager or nursing director
 Within 24 hours
 Must fill out an injury report form within the shift
 Seek medical attention in the ED or OHS
 Employee Contamination:
Skin
 Wash immediately with soap and water for 5
minutes (urine or direct drug contact)
 Know your drug
 Report incident to charge nurse and clinical
manager or nursing director
 Within 24 hours
 Must fill out an injury report form within the shift
 Seek medical attention in the ED or OHS