PPE in Oncology2

8/3/2019 PPE in Oncology2

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PPE In Admixture/Administration of Chemotherapy

By:By:Philip C. Dugger CSP ARMPhilip C. Dugger CSP ARM

Safety Manager- Clinical Operations SupportSafety Manager- Clinical Operations Support

Pictures: Texas Oncology; Dave Barrero and Laura Manske, RN


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Objective

Describe safe handling criteria with use of personal protectiveDescribe safe handling criteria with use of personal protectiveequipment (PPE) and its importance within each phase ofequipment (PPE) and its importance within each phase of

chemotherapy and hazardous drug handling.chemotherapy and hazardous drug handling.

It is imperative that those who work with hazardous drugs and substances understand the risks, how to use andIt is imperative that those who work with hazardous drugs and substances understand the risks, how to use and

implement proper controls such as biological safety cabinets, PPE and various procedural controls made available toimplement proper controls such as biological safety cabinets, PPE and various procedural controls made available to

themthem


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Introduction

Chemotherapy drugs can be:Chemotherapy drugs can be:

GenotoxicGenotoxic

CarcinogenicCarcinogenic

TeratogenicTeratogenic

CytotoxicCytotoxic

BiologicalBiological

Antiviral agents.Antiviral agents.

They may include other toxicities includingThey may include other toxicities including

the increased potential of fertility impairment.the increased potential of fertility impairment.


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Exposure Risks

Daily and long term exposure toDaily and long term exposure tohazardous drugs and substances typicallyhazardous drugs and substances typically

occurs as a result of inadequate personaloccurs as a result of inadequate personal

protective equipment (PPE) and/orprotective equipment (PPE) and/or

contamination control.contamination control.

Some staff may mix or administer anSome staff may mix or administer an

average of up to 15 chemotherapyaverage of up to 15 chemotherapy

drugs each day.drugs each day.(15 x 5 x 52= 3900 opportunities of drug(15 x 5 x 52= 3900 opportunities of drug

exposures/year)exposures/year)


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TRAINING- OSHA

An understanding of the appropriate use ofPPE, and the safe handling of

chemotherapy

and other hazardous drugs begins with

comprehensive training.

All staff involved with chemotherapy andhazardous drugs must receive training on the

use and handling of chemotherapy (hazardousdrugs) according to:

OSHAs Hazard Communication Standard.(29 CFR 1910.1200)


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Training- Topics

Employees working with chemotherapy andhazardous drugs shall receive training on:

Effects of the drug/chemical on human beings

Exposure prevention

Engineering controls available

sealed devices

biological safety cabinets

Personal Protective equipment How to use, don, proper removal and its limitations

Procedural controls in place, such as:

no food/drink in areas where exposure is likely;

Hand washing/ hand hygiene, etc..


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OSHA and PPE

OSHA requires that the employerdeterminesthe type of PPE for each job. Therefore, OSHAholds the employer responsible for assessing

hazards, adopting PPE and policies for its use.

Employees must wear PPE that is assigned bytheir employer.



ONS/NIOSH and PPE

Recommendations:

ONS recommends the following when handling hazardous drugs:

Disposable Latex gloves Double gloving

Primary Glove under gown cuff

Secondary Glove over gown cuff Change every hour or when needed Powder free Consider alternatives for latex allergy

Disposable gowns

Lint-free Low permeability fabric Solid front, long sleeves & elastic or knit cuff Changed when contaminated and after each use



ONS/NIOSH and PPE

Recommendations:

NIOSH recommends the following when handling hazardous drugs:

Double Glove Outer glove extended over cuff

Change every 30 minutes or when needed

Low permeable gowns- Disposable,- Lint free or low lint Closed front, long sleeves, elastic or knit cuff Polyethylene or polypropylene



Notes on Personal Protective Equipment

All PPE is permeable depending on amountof substance deposited on PPE and duration.

PPE should only be considered a first line ofdefense to an exposure and should alwaysbe removed/replaced when known or visiblecontamination takes place.

A routine change of PPE should beincorporated for each type and application ofPPE.



PPE in Oncology

PPE in Oncology is limited to the

following:

Gloves

Gowns

Splash Protection



Gloves

Although many studies vary inrecommendations for glove material, mostsuggest latex as the most universal and widelyavailable product. As with any PPE, gloves arenot 100% impermeable.

Substitute materials shall be available for latexsensitive individuals.



Gloves

Gloves should be used whenever handlinghazardous drugs or materials.

They should be removed when worn, torn orcontaminated.

They should not be used to open doors, drawers,while writing, striking a computer keyboard, whileanswering phones etc

Many organizations recommend double gloving

anytime handling chemotherapeutic agentsespecially during:

Admixture Administration Handling of contaminated items and body fluids Disposal of administration items, contaminated items



Never Touch Surfaces While Wearing Contaminated Gloves!!

If gloves are not used properly,

cross contamination can occur



Gowns

Gowns must be worn during:

Admixture

Administration

Handling of body fluids or contaminated items When disconnecting and disposing of

administration devices.

It is preferable that these gowns buttondown in back and have tight fitting sleevesthat are knitted or cuffed.



Gowns

Here is an

example of

a disposable

gown that iscuffed, solid

front and tied

in the back of

the operator.

Keeps

contamination

at work!

Polyconversions, INC



Gown-Other Options

Polyconversions, Inc

Converters- Cardinal Health



Gowns- Other Options

Astound-Cardinal Health

Kendall-Tyco



Splash Protection

During the admixture process, thehood sash serves as a splashguard from the drug manipulation

within the hood.

With administrative techniques

prone to splash, face masks witheye protection should be used.



Phases of Chemotherapy and PPE

Processes where PPE is requiredinclude:

Receiving/ Stocking of cytoxic agents

Admixture of cytoxic agents Staging of mixed cytoxic agents

Administration of cytoxic agents

Disconnection/ Disposal of cytoxic agents



Retrieving/Opening

When stocking shelves with drug vials,gloves should be worn to protect yourhands from being exposed to residualdrug on the vial.

Several studies conducted to determine outercontamination of drug vials found more than40% of ALL drug vials have residue of drug onthe outer side of the vial up to the vial neck. In

some cases, with drug residue that was otherdrug from that contained within the vial.

(Ros et al 1997; Hepp and Gentschew 1998; Delporte et al 1999;Nygren et al. 2002; Favier et al. 2003; Mason et al 2003)



Retrieving/ Opening

Storage locations should always be designed to contain spills by useof some form of bin, tray etc..

Gloves should be worn when handling drug containers and vials.


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ADMIXTURE


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Admixture

During admixture employees shall adhere to thefollowing PPE requirements:

Gloves

Double gloving

Use of non-powdered latex gloves

Change every 30 minutes or when visibly contaminated or torn Inner glove placed under cuff, outer glove placed over cuff.

Gowns

Low permeability, lint free

Closed front or similar affect

Sleeves with knit cuff or elastic band

Gown extends beyond the waste line

Hood Glass

At proper height to protect from splash to face and body


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Admixture

During double checks,products should not be

handled with bare hands

by any employee.

Protective gowns should

never be open whenhandling hazardous

drugs.

X


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ADMIXTURE- Hoods

Admixture hoods shouldremain free of non-

essential items with

surfaces protected by

spill pads. Sash height

must be considered

for:

a.) proper airflow;a.) proper airflow;

andandb.) eye protection fromb.) eye protection from

splash.splash.


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Admixture - This is NOT good!

Covering the grille preventsadequate airflow which is

captured by the front grille.


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ADMINISTRATION


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Administration- Retrieval from Admix

When retrieving chemotherapy foradministration, employees shall weargloves in the event that:

1. Drug residue exists on the administration device(IV, Syringe etc..)

2. A faulty spike, connection or failure of the

administration device should exist.

Ad i i i C i


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Administration- Connection

Employees shall be required to wearappropriate PPE duringadministration and connection ofadministration devices.

PPE during administration shallconsist of:

I. Gowns Lint free, low permeability Closed Front or equivalent

Gown extends beyond waist-line

Ad i i i


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Administration

I. Gowns (continued)

Can be disposable or reusable

- polyethylene provides low permeation

II. Gloves Powder free, latex or equivalent

Changed when contaminated and following theprocess of administration

Double Gloving

First glove under gown cuff Second glove over gown cuff

Ad i i i NOT GOOD!


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Administration- NOT GOOD!

Handling IV-AdministrationDevices with bare hands can lead

to employee exposure and can

compromise product integrity;

furthermore, it is poor infection

control practice.

Not good practice

Ad i i i


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Administration

When discontinuing (d/c) administration

sets:

Employees shall wear the same PPE usedduring administration.

Spills are likely during d/c because of leaking

sets, leaking connections and residual fluidremaining in lines.

Note: Special precautions should betaken to contain spills from leaking

sets by placing pads below disconnect

DISPOSAL


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DISPOSAL

Be sure to weargloves and gowns

when handling

or disposing of

used sets.

Caution:

Sets may drip or leak while disconnecting

and disposing of sets.

Di l N t G d


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Disposal- Not Good

Employees should never handle

used IV sets or biohazard

containers with their bare hands.

Di l


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Disposal

Danger! Do not place gowns

In sharps containers. They prevent

access for sharps and increase

the risk of needle sticks.

Also, this gown filled the container.

The average cost of medical waste disposal is $42

and there is no medical waste in this container.

R l Of Gl


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Removal Of Gloves

Outside glove first!

Inside glove second-using your index finger to

lift the glove and fold over.

Ad i i t ti


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Administration

Employees shall wash their handsimmediately following:

admix or administration

contamination of gloves or hands handling of blood, body fluids and

chemotherapy.

Employees should not wear PPE outsidethe area of use.

THE NO! NO! SECTION


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THE NO! NO! SECTION

No PPE outside of the area of use..Includes break areas,lounges and administrative areas.

Yummy, can I eat next to you in

that gown? (see next slide)

U d I f d T h l


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Under Infrared Technology

THE NO NO SECTION


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THE NO, NO SECTION

Do not touch personal items with

gloves or allow PPE to come in

contact with personal items.

NEVER eat or drink in areas whereexposure is likely. This is your greatest

opportunity of ingesting hazardous drugs.

C t i ti St 1


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Cross contamination- Step 1

Gloves should never be worn where

they can transfer contamination to

items that are often used by

unprotected hands. Always- remove

gloves following use.

Cross Contamination Step 2


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Cross Contamination - Step 2

Didnt we just write with this

pen while wearing gloves?

Contaminated records?

Other Good Practices


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Other Good Practices

Never handle drugs with out proper PPE for the

job. Wash hands following removal of PPE when

handling patient equipment, samples,administration sets and hazardous drugs.

Keep appropriate disposal containers nearby and

for immediate disposal. Never touch items such as charts, pens, notepads,

door knobs, phones and other surfaces with glovesor potentially contaminated gloves.

Never Place personal items or non essential itemson drug mixing, handling, storage or waste areas.

Never Eat/Drink nor Store food/drink for employeeconsumption in areas where exposure is likely

Never take PPE out of the area of use

Other Considerations


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Other Considerations

Standard Precautions

Since we may encounter patient blood, body fluids

and excreta:

Address both concerns of chemotherapyhandling and standard precautions.

And

Use the most restrictive when addressing both

Summary PPE


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Summary- PPE

Know the toxicities of chemotherapy drugs fornon-therapeutic exposures.

Chronic exposures of hazardous drugs can leadto chronic diseases, including cancer.

Make use of guidelines. Implement good policies and practices.

Effective use of PPE is the most significantexposure control employees can implement.

Remember- All PPE will permeate depending on time and volume of

exposure - change when contamination is visible.

Bottom Line


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Bottom Line

PPE is the most effective andefficient way to reduce/remove

exposure risk to chemotherapy;however, an understanding of itslimitations, proper application iskey to effective implementation.


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Developed by: Philip C. Dugger CSP ARM

Pictures: Texas Oncology; Dave Barreroand Laura Manske, RN

The End- Please Take the Test.

Date post:	06-Apr-2018
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