Safe Handling of Cytotoxic Drugs

September 5, 2013 |

The below blog post was created on September 5th 2013, by Komal Patel and is reproduced here due to popularity:

Have you ever heard a nurse colleague say, “I don’t want to wear double gloves and/or gown when I’m administering chemotherapy? I haven’t had to in the past 10 years, so why should I change my practice now?”  Many of you are most likely nodding your head yes.  So, is it okay not to wear the appropriate personal protective equipment(PPE) when administering chemotherapy regardless of the route? Of course not! You want to protect yourself.

Many chemotherapy drugs and some biotherapy drugs are classified as hazardous drugs.  Ifind it mind boggling when healthcare professionals feel that it is not important to wear PPE when working with cytotoxic agents such as chemotherapy. Safe handling is a vital consideration for nurses administering and providing care to individuals receiving these.

Because oncology nurses are exposed to cytotoxic agents many times a day, up to five days a week, for their entire career, PPE’s are a must as they help reduce the risk of exposure. Furthermore, it is important to remember that even though chemotherapy agents used to treat individuals with cancer have side effects, the benefits outweigh the risks; for nurses/healthcare professionals the exposure has no benefit.

Did you know that Occupational exposure to cytotoxic drugs was recognized as a potential hazard for health care workers in the 1970s a group of scientists were studying mutagenicity of urine sample and discovered that there was potential risk for nurses handling these drugs? You are shocked?

There’s a great research article called Safe Handling of Parenteral Cytotoxics: Recommendations for Ontario by Esther Green and Colleagues that explains how the cytotoxic guidelines and standards for Ontario were developed. I would definitely recommend reading it as it will give you a better understanding the importance of wearing PPEs. If you want to read the document with recommendations, click here.

de Souza Institute has standardized the education that registered nurses in Ontario receive about chemotherapy and biotherapy. Want to learn more about chemotherapy, biotherapy, and safe handling, consider enrolling in de Souza’s Provincial Chemotherapy and Biotherapy Course for the latest evidence based information.

I would like to hear what are your thoughts about wearing PPE when administering cytotoxic agents by IV, SC, and by mouth?

Below are the comments we received in 2013:

hazardous medication – Submitted by Dr. Vincent Wong (not verified) on Mon, 2013-11-18 16:22.

In your presentation do you consider hazardous medication that are not cytotoxic agents and do you differentiate between final oral form solids and injectables with regard to exposure risk. As you are probably aware the current listing of hazardous medication from NIOSH is extensive and are not limited to cytotoxic agents. In fact it includes some very commonly used medications like paroxetine, risperidone and clonazepam. What would be the recommendation for appropriate PPE for not only the cytotoxic agents but for other medications considered hazardous by NIOSH?
Thank you for you post Dr. Wong. In my blog, I was only highlighting chemotherapy and biotherapy agents. However, you are absolutely correct that there are medications that are not labeled chemotherapy or biotherapy that are considered as hazardous by NIOSH. NIOSH recommends that employers provide appropriate PPE to protect individuals who handle hazardous drugs in their workplace. So the same PPE guidelines apply. I have attached an article by NIOSH called Personal Protective Equipment for Health Care Workers Who Work with Hazardous Drugs that you might find valuable in reading:

Refreshing – Submitted by Anonymous on Sun, 2013-10-20 23:17.

Thank you for the refreshing information in regards to the safe handling and administering of cytotoxic agents, especially the parenteral route. I can understand some of my senior nursing colleagues not wanting to adhere to recent changes for appropriate PPE with the administration of cytotoxic agents, but it amazes me to see the younger nurses that are new in the profession not adhering to the PPE protocols. They have gone through the proper training and education for the safe handling and administration of cytotoxic agents. When informing these colleagues of the proper method, they will either ignore the advice or look at you as threat to their daily practice, as if you have wronged them in some way. As a colleague, I practice safe handling of these agents, as they can be harmful to my patients, their families and most importantly, me. Sometimes, what we can not visibly see, we tend to ignore the methods put in place and rush through such delicate situations. Staff nurses becoming busier and overworked with the increasing patient loads, tend to cut corners to get all their patient care done as fast as possible.

Cytotxic Drugs – Submitted by Anonymous on Tue, 2013-10-15 17:26.

Have you (de Souza Institute) thought about developing a course on safe handling of cytotoxic agents for all healthcare professional and caregivers working with individuals receiving such agents? I know that there are nurses and healthcare professionals who work in other health care areas besides oncology who would benefit from learning about how to safely handle and dispose of cytotoxic drugs.
Thank you for an informative blog.
Hello, The team has definitely thought about developing a course on safe handling of cytotoxic agents for healthcare providers. Interestingly enough, we will be meeting in a few weeks to discuss development of the course. You are absolutely right that anyone who works with individuals receiving cytotoxic drugs will benefit from such course since everyone should be aware of how to safe handle cytotoxic agents. I’m not really sure when the course will be available, however, I recommend that you continue to keep referring to our website for new courses. Take care,

Here’s a short article that – Submitted by Komal Patel on Wed, 2013-09-25 11:46.

Here’s a short article that highlights what hazardous drugs, how HCP are exposed, what the health effects are, what the law says, and what we can do everyone can do to minimize/ eliminate exposure. It’s short and can serve as a reminder to why is vital to maintain safety when working with cytotoxic/ hazardous drugs. The article is called Antineoplastic Drugs- Hazardous, Handle with Care:…
Absolutely agree!! Why take the risk………..I even tape all my connections on the IV lines in case of drips, etc…………..and when checking chemo, always glove, but so many don’t anymore and it’s scary, even though most the RN’s at my work have taken the de Souza courses!!!! I guess they figure they’ll beat the odds!!
Thank you for your post. That’s definitely alerting. A few simple safety steps definitely helps to minimize long term effects of everyone. What’s an extra 1 or 2 minutes one needs to take to protect themselves? As I always say, safety first. How can you play a role as a mentor to your colleagues who are not following the safety protocols on your unit and in your organization?