You’ll need to take extra care when preparing chemotherapeutic drugs, both for the patient’s safety and for your own. Patients who receive chemotherapeutic drugs risk teratogenic, mutagenic, and carcinogenic effects, but the people who prepare and handle the drugs are at risk as well. According to the Occupational Safety and Health Administration (OSHA), no acceptable levels of exposure have been determined for these drugs. Because of this, the goal is to prevent or minimize workplace exposure.

OSHA, the National Institute for Occupational Safety and Health (NIOSH), the American Society of Health System Pharmacists, and the Oncology Nursing Society have established guidelines for handling and administering chemotherapeutic drugs. These guidelines are strongly recommended; adhering to them will help reduce the risk of contamination to both yourself and your environment.

The use of proper personal protective equipment is essential. Personal protective equipment must include chemotherapy-resistant gowns and gloves, which you should wear when handling, preparing, administering, or disposing of chemotherapeutic agents; priming administration sets; cleaning up spills; and handling excreta.¹ Gowns should be lint-free, have a full front, close in the back, and have elastic or knit cuffs. You should wear a gown once and discard of it appropriately; never hang it up after use. Also, never wear a gown for multiple patients or multiple times for the same patient. Make sure your gloves are chemotherapy-resistant. Double-gloving is recommended, and you should replace your gloves every 30 minutes or when they’re visibly contaminated as well as after each individual patient contact. Wear a face mask and goggles when splashing is likely.² Also wear a face mask and NIOSH-approved respirator when cleaning up chemotherapy spills; surgical masks aren’t effective against aerosolization of chemotherapeutic agents.

All health care workers who handle chemotherapeutic drugs must be properly educated and trained.³ A key element of such training involves learning how to reduce exposure when handling such drugs.⁴ The second requirement states that the drugs should be prepared in a class II biological safety cabinet.⁴ OSHA guidelines further recommend that chemotherapeutic drugs be mixed in a properly enclosed and ventilated work area and that respiratory and skin protection be worn.⁴ Smoking, drinking, applying cosmetics, and eating where these drugs are prepared, stored, or used should be strictly prohibited, and sterile technique should be used while mixing the drugs.

Gloves, gowns, syringes, or vials as well as other materials that have been used in chemotherapeutic preparation and administration present a possible source of exposure or injury to the facility’s staff members, patients, and visitors. Therefore, using properly labeled, sealed, and covered containers, handled only by trained and protected personnel, should be routine practice.⁴ Spills also represent a hazard, and all employees should be familiar with appropriate spill procedures for their own protection.⁴