Clinical Alert

In March of 2004, the National Institute for Occupational Safety and Health (NIOSH) released the following Alert: Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Healthcare Settings. The authors of the Alert are the members of a working group that has been meeting since 2000 to evaluate the occupational risks of handling hazardous drugs such as chemotherapy. The document outlines the most recent recommendations for safe handling of hazardous drugs.

A few of the recommendations in the Alert differ from those listed in the Oncology Nursing Society's publications Chemotherapy and Biotherapy Guidelines and Recommendations for Practice (Brown et al., 2001) and Safe Handling of Hazardous Drugs (Polovich, 2003). The Oncology Nursing Society participated in the preparation of the NIOSH Alert and supports the recommended changes in practice. The new recommendations follow:

Glove Wear Time
"Gloves should be changed every 30 minutes or when torn, punctured or contaminated." This recommendation is based on permeation studies using cytotoxic agents. Most tested chemotherapy gloves provide protection for a minimum of 30 minutes.

Double Gloves
"Double gloving is recommended for all activities involving hazardous drugs."
The likelihood of permeation through two layers of gloves is small; however, wearing two pairs of gloves helps to protect the healthcare workers hands from contamination that can occur when removing gloves. Outer gloves should be removed first, then the chemotherapy gown, and then the inner gloves.

Ventilated Cabinets
"When asepsis is not required, a class I BSC or an isolator intended for containment applications (containment isolator) may be sufficient."
A type I BSC may be appropriate for crushing or compounding of oral preparations.

"The exhaust from these [BSC] cabinets should be HEPA-filtered and whenever feasible exhausted to the outdoors."

References

Brown, K.A., Esper, P., Kelleher, L.O., O'Neill, J.E.B., Polovich, M., & White, J.M. (Eds.). (2001). Chemotherapy and biotherapy guidelines and recommendations for practice. Pittsburgh, PA: Oncology Nursing Society.

National Institute for Occupational Safety and Health. (2004). Preventing occupational exposures to antineoplastic and other hazardous drugs in healthcare settings. Retrieved March 25, 2004, from http://www.cdc.gov/niosh/docs/2004-HazDrugAlert/

Polovich, M. (Ed). (2003). Safe handling of hazardous drugs. Pittsburgh, PA: Oncology Nursing Society.