Health & Safety
American Journal of Nursing - February, 2004 - Volume 104, Issue 02
Handling Hazardous Drugs
How safe are you?
By Barbara Coyle, BSN, RN, COHN-S, and Martha Polovich, MN, RN, AOCN
Q. My colleagues and I wear gloves when we administer chemotherapy, but have now been told to wear gowns, too. Why are gowns necessary?
A. Chemotherapy drugs are considered hazardous. For example, an increased risk of leukemia has been reported among oncology personnel exposed to the drugs. Nurses can be exposed to hazardous drugs by direct contact with skin, mucous membranes, or eyes. In addition, nurses can inhale aerosolized drugs, which can be released when removing air from a syringe. It's also possible to be exposed by accidental ingestion when eating, drinking, smoking, or chewing gum, through hand-to-mouth behavior, or by injection.
Information about the harmful effects of hazardous drug exposure in health care workers has been available since the late 1970s. And recent studies show opportunities for exposure still exist in the workplace. One study found that nurses' clothing was contaminated with small amounts of drugs. Other studies found measurable amounts of drugs on floors, overbed tables, and other items in drug administration areas. This surface contamination occurs during routine drug handling procedures and nurses can be exposed by contact with contaminated surfaces.
Drug leakage can occur
- during spiking and unspiking of iv containers.
- during priming of iv tubing.
- when connecting or disconnecting syringes from injection ports.
- when discontinuing infusions.
- when administering drugs through urinary or peritoneal catheters.
In addition, health care workers can be exposed when handling the urine, feces, vomitus, and blood of patients who have received hazardous drugs in the previous 48 hours or longer, depending on the drug’s half-life.
Despite these facts, many nurses do not use personal protective equipment (PPE) consistently when handling hazardous drugs. Failure to use appropriate PPE can result in exposure. Wearing gloves when handling hazardous drugs protects only the hands. The Occupational Safety and Health Administration (OSHA) recommends reducing your chances of occupational exposure by using the following PPE.
- Gowns—disposable, made of low-permeable fabric with a closed front and cuffs. Laboratory coats and cloth patient gowns are not considered PPE.
- Gloves—powder-free, labeled, and tested for use with chemotherapy drugs. Chemotherapy gloves are made of nonlatex products such as nitrile or neoprene or natural rubber. Latex gloves should be used with caution due to latex sensitivities.
- Face shields or goggles—for protection when splashing is possible. Face shields are better than goggles since they protect the entire face.
- Respiratory masks—when cleaning up spills. A surgical mask is not a respirator and does not protect against aerosols or vapors. A fit-tested N-95 respirator mask such as those used for TB protection should be worn.
Your hospital’s recommendation to wear a disposable, low-permeability gown is based on OSHA guidelines. In addition, your employer must
- have policies and procedures for safe handling.
- provide training for anyone who handles hazardous drugs.
- provide a biological safety cabinet for drug preparation.
- provide appropriate PPE for workers who handle hazardous drugs.
- have material safety data sheets available for all hazardous drugs.
There is no other industry where hazardous chemicals are taken so lightly as the health care industry. This is most likely due to the fact that many of the hazardous chemicals in our workplace are called “drugs.” While patients need the drugs for treatment of their conditions, we do not. Following your em ployer’s drug-handling recommendations reduces your exposure.
Controlling occupational exposure to hazardous drugs
Chemical protective clothing
Barbara Coyle, a member of the Wisconsin Nurses Association, is a certified occupational health nurse specialist in Milwaukee, WI. Martha Polovich is an oncology clinical nurse specialist in Riverdale, GA. The authors acknowledge Jeanne Beauchamp Hewitt, PhD, RN, for a critical review of an earlier draft of this manuscript.