Description

Hazardous drugs include those used for cancer chemotherapy, some antiviral drugs, hormones, and bioengineered drugs.

See NIOSH list of Antineoplastic and Other Hazardous Drugs for a list. Exposures to hazardous drugs can cause both acute and chronic health effects such as rashes, adverse reproductive outcomes (infertility, spontaneous abortions and congenital malformations) and possible leukemia and other cancers.  The health risk depends on the extent of occupational exposure. Worker exposure primarily occurs through skin contact.

This SOP applies to University of Pennsylvania personnel performing animal research and veterinary medical practitioners and staff at the Ryan Veterinary Hospital and New Bolton Center.  The Hospital of the University of Pennsylvania has its own policies and procedures.

Exposure Control

In the research environment worker exposure is prevented through the use of local ventilation (typically a Class II type B biosafety cabinet, or fume hood), barrier protection, work surface protection and decontamination of work surfaces.  These same techniques are used in the veterinary clinical environment along with work practice controls in administration areas where patient care takes priority.

Research Use in Laboratories and ULAR

  • Avoid all skin contact with hazardous drugs.  Treat all vials as contaminated.  Handle vials with gloves.  Wear disposable nitrile gloves (4 mil minimum) or gloves tested for chemotherapy protection.
  • Wear appropriate barrier protection such as a lab coat when in the lab or disposable coveralls provided by ULAR
  • Wear Safety glasses or goggles and shoe covers when appropriate
  • Handle in a vented biosafety cabinet or on the bench over a disposable work surface
  • Dispose of syringe as chemically contaminated sharps.
  • Change gloves after syringe removal from vial.
  • Use a detergent solution for cleaning followed by a water rinse to remove drug residues and a disinfectant to clean all surface counters and equipment.
  • Place drug vial in a sealed bag before it is removed from the biological safety cabinet or hood.
  • Wash hands immediately after removing gloves.

Training for VHUP Clinical Handling

Training must be provided for the safe handling of hazardous drugs.  ChemochekTMChemotherapy Training is a self-administered, hands-on techniques training to safely handle chemotherapy drugs.  Programs such as these can be a valuable tool to practice drug handling techniques which reduce occupational exposure.

VHUP Drug Preparation

  • Avoid all skin contact with hazardous drugs.  Treat all packaging and vials as contaminated.  Handle with gloves.  Inspect shipments for leakage immediately upon receipt.
  • Wear proper PPE during preparation.  Wear chemo gloves, chemo gown, and safety glasses.
  • Prohibit eating, drinking, chewing gum and applying cosmetics within area where these drugs are handled.
  • Use a vented biological safety cabinet for preparation if available or a designated area in the pharmacy or clinic.
  • Use a detergent solution for cleaning followed by a water rinse to remove drug residues and a disinfectant to clean all surface counters and equipment.
  • Dispose of Chemo Dispensing Pins, syringes, small drug vials and PPE in a ‘Cytotoxic’ sharps container.
  • Pre-prime IVs in the biosafety cabinet or prime in-line with nondrug solutions.
  • When drug preparation is complete, seal the product in a plastic bag or other sealed carrier.
  • Wash hands immediately after removing inner gloves.

VHUP Drug Administration

  • Wear proper PPE during administration including doubled nitrile gloves or chemo gloves, chemo gown, safety glasses or face shield and shoe covers as needed.
  • Use syringes and IV sets with Luer-Lok fittings for preparing and administering hazardous drugs.
  • Flush IV systems with nondrug solutions before removal.
  • Dispose of contaminated syringes, vials and PPE in a ‘Cytotoxic’ container or sharps containers labeled as chemically contaminated.

VHUP Waste Cleaning and Disposal

  • Dispose of contaminated syringes, vials and PPE in a ‘Cytotoxic’ container  (VHUP) or sharps containers labeled as chemically contaminated.  Unused drug and drug vials should be collected as hazardous waste.
  • Clean and decontaminate work areas before and after each activity involving hazardous drugs.
  • Remove shoe covers, gown and outer gloves and dispose of in a ‘Cytotoxic’ container before leaving room.
  • Wash hands thoroughly after removing gloves.

Emergency Contacts

General emergency response information can be found at Emergency Info

Spills

General procedures for chemicals spill response can be found in Section X: Chemical Spills in this CHP.

Do not hesitate to call EHRS for assistance with spill cleanup

24 hours: 215-898-4453

Contact Penn Police (511) only if the spill involves a fire, imminent risk of fire, an injury requiring an ambulance, or if there is a hazard that may affect others in the building.

References

"Safe Handling of Hazardous Drugs for Veterinary Healthcare Workers", National Institute for Occupational Safety and Health, June 2010. 

"Hazardous Drug Exposures in Health Care", Centers for Disease Control and Prevention