Nursing Administration of Hazardous Drugs and How to Stay Safe

February 22, 2019

How to safely administer chemotherapy agents to your patients

I love being an oncology nurse and I love being somewhat considered a nursing influencer, but what I find challenging is that I am not apart of the "cool" club of ICU/ER nursing. With that being said, I really want to shine a big spotlight on oncology nursing!

One of the most frightening parts of the job (for me) is administering hazardous medications.

The world in which we live in is truly amazing in terms of the research and creation of drugs to fight such ruthless diseases. But it also comes with a lot of unknown for the medical provider who is administering it. As a nurse, we are always keeping the motto "patients first" at the forefront of our minds. But it is really time that we consider our own health and safety. According to USP 800, the risk associated with handling hazardous drugs include headaches, nausea and vomiting, organ damage, skin rashes, allergic-type reactions, hair loss, infertility, birth defects, miscarriage, cancer, etc.

Typically we can reference NIOSH (National Institute for Occupational Safety and Health), but there are still so many unknowns.

How do you keep yourself safe while administering drugs? 

Closed system transfer devices (CSTDs)
A CSTD is a drug transfer equipment that safely allows for the hazardous drug to be administered without contaminating the environment. They are specifically designed to keep it from leaking outside the site. They are used throughout the whole process from compounding to administration. It should be noted that not all dosage forms allow for CSTDs to be used. There are also many different options of CSTDs and the U.S. Food and Drug Administration has not yet approved testing standards.

My current place of work uses TEVAdaptor and I must say that they are not my favorite. The connection is small and hard to grasp. Thus, I am constantly double checking if it snapped closed. My old workplace used ones from Equashield and they were just amazing! It is pretty clear where the connection is and the device itself is larger and easier to screw into place. As far as compounding goes, I am not sure which is easier because that is not my job. 

Personal Protective Equipment
Typical PPE includes a gown, gloves, goggles, and/or mask. USP 800 has certain rules regarding chemotherapy gowns. I want to really highlight that these are non-reusable. That means after you are finished, please dispose of properly. I know many people who try and save the gowns and/or wear a lab coat throughout the day. According to USP 800, gowns must be resistance to hazardous drugs, back closing, have long sleeves with elastic cuffs, and seamless or taped seams.

In addition to gowns, double gloving is an absolute must! The USP 800 shares the statistic that only 25% practice double gloving when administering hazardous drugs. Chemotherapy gloves must be tested to ASTM standard D6978, powder free, and must be changed when torn, punctured, or contaminated. Also, gloves must be changed at a minimum every 30 minutes. After removing gloves, remember that only soap and water will help dispose of hazardous drugs. Hand gel does not work! 

Prior to administering medications, I always make sure to reference a few different sources to ensure I am obtaining the necessary PPE. If you work in setting with "older" nurses, then I highly encourage you to not rely on their example. Many "older" nurses have been handing chemotherapy/hazardous drugs for years without proper protection simply because there were no standards.

How do you stay safe with chemotherapy in the home?

Chemotherapy is considered a hazardous waste. Depending on the drug, waste can be eliminated for a period of time after the infusion, injection, or pill. Special precautions should be taken to protect you and your family at home. However, it is safe for you to still have contact with your loved ones during this time! If you plan on having intercourse, discuss with your doctor first.

Body Waste
It is safe to share a toilet with your family members during your treatment. If someone is pregnant then they should avoid sharing. To keep everyone safe, be sure to flush the toilet twice and wash your hands with soap and water afterward. If body fluid gets on you, wash with soap and water as well.

If your linens get soiled during chemotherapy, be careful carrying with your bare hands and wear gloves if you have them. Place all items by themselves in the washer. If a washer is unavailable, place items in a sealed bag by themselves until they can be washed. 

Hope this provided a little further insight into the world of oncology!



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