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										**Hazardous Drugs in Healthcare Settings:**  **Exposure to Antineoplastic Agents at Work**
In 2017, a 41-year-old patient care assistant working on an oncology floor developed an itchy rash approximately 30 minutes after emptying a commode of urine into a toilet (Kusnetz & Condon, 2003). She denied any direct contact with the urine, wore a protective gown and nitrile gloves, and followed hospital policy for the disposal of materials contaminated with antineoplastic drugs. The rash subsided after 1 to 2 days. Three weeks later, she had a similar reaction approximately 1 hour after performing the same procedure for another patient. Upon investigation, it was found that both hospital patients had recently been treated with vincristine and doxorubicin. The patient care assistant had no other signs or symptoms and reported no changes in lifestyle and no history of allergies or recent infections. After treatment with diphenhydramine (intramuscular) and oral corticosteroids, her symptoms disappeared. Although the cause could not be confirmed, both vincristine and doxorubicin have been associated with allergic reactions when given to patients. The aerosolization of the drug present in the urine may have provided enough exposure for symptoms to develop in the patient care assistant (Department of Health and Human Services, National Institute for Occupational Safety and Health, 2004).
**Recommendations**
At a minimum, wear safety glasses with side shields and a face shield if splashing is possible when handling any possibly contaminated substance such as urine or feces. Wear two pairs of protective chemotherapy gloves and a disposable gown if handling linens, feces, or urine from patients who have received hazardous drugs within the last 48 hours. Before use, inspect gloves for defects and change gloves on a regular basis. The manufacturer’s documentation frequently provides glove-changing recommendations, and a facility risk assessment may provide other guidelines, but generally accepted practice is that gloves should not be used for more than 30 minutes. Remove the outer gloves and the gown by turning them inside out and placing them into the chemotherapy waste container. Repeat the procedure for the inner gloves. Always wash hands with soap and water before donning protective gloves and immediately after removal (American Society of Health-System Pharmacists, 2018; Polovich & Olsen, 2018).
Place wastes such as needles, empty vials and syringes, gloves, and gowns in chemotherapy waste containers. In addition to protective clothing, while disposing of contaminated materials in toilets, close the toilet lid or use a plastic backed absorbent pad placed over the toilet without a lid during flushing. Assuring that drug-contaminated waste is properly contained will protect workers from respiratory exposure to volatile or micro-aerosolized drugs. Fold soft materials (sheets, hygiene care products) inward to prevent leakage. Place in sealed bags.
Conduct regular training reviews with all potentially exposed workers in workplaces that use hazardous drugs. Make sure that training conforms to the requirements of the OSHA Hazard Communication Standard [29 CFR 1910.1200] and other relevant OSHA requirements such as the PPE standard [29 CFR 1910.132]. In addition, establish procedures for cleaning and decontaminating work areas and for proper waste handling and disposal of all contaminated materials, including patient waste.PreviousNext
							
					
							Last Reviewed:  October 3, 2022						Source: 	National Institute for Occupational Safety and Health
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        Syndicate homeSafety Culture in Healthcare Settings
Training Informationplus icon
Introduction
Module 1: Safety Cultureplus icon
Why a Culture of Safety is Important
The Sociotechnical Model
Definition Examples of Safety Culture and Overlap with Safety Climate
Key Attributes and Joint Benefits of Safety Culture
Common Features of Positive Healthcare Worker Safety Culture
General Measurable Elements of a Safety Culture
Tools to Measure Safety Culture and Climate
A Snapshot of Safety Culture in U.S. Hospitals
References
Quiz 1Module 2: Work-Related Risks and Hazardsplus icon
Biological Hazardsplus icon
Chain of Infection Components
Risk Factors of Biological Agents and Unsafe Practices
Chemical Hazards
Enviromechanical Hazards
Physical Hazards
Psychosocial Hazards
Hazard Assessment/Determination
Case Study
References
Quiz 2Module 3: Prevention and Control of Work-Related Injury and Illnessplus icon
Hierarchy of Controls
Elimination: Physically Remove the Hazard
Substitution and Engineering Controls
Administrative Controls: Change the Way People Work
Personal Protective Equipment (PPE): Protect the Worker with PPE
Donning and Doffing PPE: Proper Wearing, Removal, and Disposal
References
Quiz 3Module 4: Leadership and Safe Work Environmentsplus icon
Commitment to Workplace Safety as High Priority and Through Role Modeling
Policies and Procedures and Safe Patient Handling
Hazard Analysis and Safe Staffing Workloads
State-of-the-Art Training and Handling Patients
Engage Healthcare Worker Champions and Observe Work
Transparency, Training, and Staff Safety Rounds
References
Quiz 4Module 5: Legal-Ethical Considerations to Promote Safe Working Conditionsplus icon
The Occupational Safety and Health Act and OSHA Standards
OSHA Healthcare Standards
OSHA Hazard Communication Standard and OSHA Guidelines
What Workers Can Do
Ethics and Healthcare Worker Exposure Considerations
Ethical Principles
References
Quiz 5Safety Culture in Healthcare Settings: Resources Follow NIOSH Facebook
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