Study Points

Safe Handling of Hazardous Medications

Course #91380 - $15 -

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  • Participation Instructions
    • Review the course material online or in print.
    • Complete the course evaluation.
    • Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.
  1. What does United States Pharmacopeia (USP) Chapter <800> focus on?

    INTRODUCTION

    U.S. Pharmacopeia (USP) Chapter <800> was created to provide better guidance on how to safely handle hazardous medications in all settings, including both inpatient (e.g., hospitals, nursing homes) and outpatient (e.g., pharmacies, physician offices) sites. It includes safe handling of hazardous medications for all employees, such as those receiving the product, compounding the medication, or transporting it to the patient and those who clean areas where these products are administered. In addition, USP Chapter <800> focuses on minimizing the risk of contamination not only to the patient but also to healthcare professionals and the environment [1].

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  2. What is important to include when training a new employee on personal protective equipment used while compounding hazardous medications?

    REVIEW OF EQUIPMENT

    When chemotherapy gloves are required for handling hazardous medications, they must meet the American Society for Testing and Materials (ASTM) standard D6978 (or its successor) [1,7]. When using chemotherapy gloves with hazardous medications [1]:

    • Make sure they are powder-free, because powder can absorb hazardous material and particulates from the powder can contaminate the sterile compounding area.

    • Inspect for defects prior to use and dispose if any are identified.

    • Keep in mind the outer layer of chemotherapy gloves used during sterile compounding must be sterile.

    • Change chemotherapy gloves at least every 30 minutes unless the manufacturer recommends an alternative duration. Gloves should also be changed if any kind of tear or puncture occurs.

    • Wash hands with soap and water after removing gloves.

    Gowns for handling hazardous medications must be long-sleeved with elastic or knit cuffs at the end. They must be able to resist permeability by hazardous drugs. Gowns cannot have openings in the front and must close in the back and must not have seams or closures that could allow hazardous medications to pass through [1]. When using gowns with hazardous medications [1]:

    • Change gowns according to the manufacturer's instructions. If no information is available from the manufacturer, then gowns must be changed every two to three hours and immediately after a spill.

    • Do not use gowns worn in hazardous areas in other areas.

    When handling other items accidentally exposed to hazardous substances, such as a lab coat or scrubs [1]:

    • Remove the item immediately to prevent exposure to your skin.

    • Do not take these items home to clean.

    • Wash them according to the facility's policy.

    Head, hair, shoe, and sleeve covers provide protection from contact with hazardous residues [1]. Shoe covers worn in hazardous medication areas must be removed before walking into other areas to prevent hazardous contamination.

    If there is a risk of a spill or splash from a hazardous medication or its waste, expect to be required to use appropriate eye and face protection (e.g., face shield and goggles) [1].

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  3. Which of the following situations could result in exposure to hazardous materials?

    HANDLING HAZARDOUS MEDICATIONS

    Situations that could expose employees to hazardous materials include [1]:

    • Accidentally crushing a hazardous medication tablet during repackaging

    • Handling a container holding hazardous medications that has residue on the outside

    • Handling a hazardous medication spill incorrectly

    • Incorrectly collecting hazardous waste

    • Incorrectly handling the container used to transport hazardous medications

    • Opening a hazardous medication capsule to place down a patient's feeding tube or to compound into a liquid

    • Priming a hazardous IV infusion on a patient care unit of a hospital

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  4. According to USP Chapter <800>, at a minimum, how often should a facility review and update hazardous medication policy and proce­dures?

    HANDLING HAZARDOUS MEDICATIONS

    Hazardous medication policy and procedures must be reviewed at least every 12 months. Any changes made must be communicated to all personnel who handle hazardous medications, and evidence of these communications must be documented and maintained for the length of time as required by the facility's state regulations [1].

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  5. According to USP Chapter <800>, which personal protective equipment should a nurse wear when administering oral chemotherapy ready-to-use tablets?

    HANDLING HAZARDOUS MEDICATIONS

    EXAMPLES OF ACTIVITIES INVOLVING HAZARDOUS MEDICATIONS AND GUIDANCE FOR SAFE HANDLING

    Example ActivityPersonal Protective EquipmentEngineering Control
    Receiving, unpacking, and storing medications determined to be potentially hazardous during these procedures
    • Single chemotherapy gloves, unless spill occurs, then double glove

    • Special circumstances may require additional items, such as if spills occur (see handling spill example below)

    Not required
    Administering ready-to-use intact hazardous medication tablets or capsules
    • Single chemotherapy gloves

    Not required
    Administration of compounded hazardous medication
    • Double chemotherapy gloves

    • Gown (impermeable to hazardous drugs)

    • Eye/face protection if liquid could splash

    Closed-system drug-transfer devices must be used if the dosage form allows.
    Handling waste of hazardous medications
    • Double chemotherapy gloves

    • Gown (impermeable to hazardous drugs)

    • Eye/face protection if liquid could splash

    • Respiratory protection if vapor or other inhalational exposure

    N/A
    Handling spills
    • Double chemotherapy gloves

    • Gown (impermeable to hazardous drugs)

    • Certain larger spills may require eye/face protection and/or respiratory protection (should be described in policy)

    N/A
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  6. In order to contain any potential exposure, hazardous medications should be received

    HANDLING HAZARDOUS MEDICATIONS

    Hazardous medications on NIOSH's list should be reviewed for their potential risk of exposure upon receipt. For example, the antineoplastic agent cisplatin is available as a liquid in a vial. If the vial breaks upon delivery to the facility, then it could lead to hazardous exposure to employees who receive the order. It is recommended to contain any potential exposure by receiving medications like this in a neutral or negative-pressure area. In addition, a spill kit must be available in this area and employees should be trained to use necessary PPE, such as chemotherapy gloves [1].

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  7. What is the safest way to administer IV antineoplastics?

    HANDLING HAZARDOUS MEDICATIONS

    All employees who may administer any hazardous medication should be educated on safe handling. For those hazardous medications that will require special handling, such as compounded IV antineoplastics, nurses should be educated on administration procedures, such as appropriate PPE and the use of closed-system drug-transfer devices. Spiking an IV set into a hazardous solution at the patient bedside should be avoided. It is a best practice for the pharmacist to attach and prime the IV set to the final container in the hood prior to adding the hazardous medication. This prevents all personnel from being exposed to spiking a hazardous medication [1,7].

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  8. Which of the following work controls and practices is recommended when administering hazardous medications?

    HANDLING HAZARDOUS MEDICATIONS

    Other work controls and practices that are recommended during the administration of hazardous medication include [12]:

    • Require the use of disposable gloves and gowns. Wear the gloves and gown cuffs in a manner that produces a tight fit (e.g., loose glove tucked under gown cuff; tight glove fitted over gown cuff).

    • Discard gloves after each use and immediately if contaminated.

    • Discard gowns on leaving the patient room and immediately if contaminated.

    • Do not use intravenous containers designed with venting tubes.

    • Use plastic-backed absorbent liners under IV tubing during administration of hazardous drugs to absorb any leakage and prevent the solution from spilling onto the patient's skin (a source of exposure to workers).

    • Work at waist level, if possible; avoid working above the head or reaching up for connections or ports.

    • Avoid contact with these drugs if pregnant or breastfeeding.

    • Wash hands thoroughly after hazardous drugs are handled.

    • Use disposable linen or protective pads for patients who are incontinent or vomiting.

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  9. Which definition is matched to the correct term used to describe a step for handling areas contaminated with hazardous medication residue?

    DEACTIVATING, DECONTAMINATING, CLEANING, AND DISINFECTING

    All areas, equipment, and devices handling hazardous medications must be deactivated, decontaminated, and cleaned. In addition, if it is used for sterile compounding, it must also be disinfected [1]. Deactivation makes the compound inactive. Decontamination removes hazardous residue from non-disposable surfaces and transfers it to an absorbent, disposable material, such as a wipe or towel. Cleaning removes contaminants, such as soil, from objects and surfaces. Disinfecting inhibits or destroys micro-organisms. All surfaces must be cleaned before they can effectively be disinfected.

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  10. Which of the following statements regarding medical surveillance programs is FALSE?

    MEDICAL SURVEILLANCE PROGRAM

    All healthcare personnel who are involved with handling hazardous medications on a regular basis should be enrolled in a medical surveillance program. This program will review the employee's baseline status and then follow-up with periodic evaluations. The goal is to minimize any adverse effects to employees potentially exposed to hazardous medications. Following procedures designed to ensure safe handling of hazardous medications is the most important step. Consider the medical surveillance program as a back-up—if unintentional exposure is occurring, a surveillance program may be able to provide early detection if a health problem is developing [1].

    The facility should [1]:

    • Define which employees will be enrolled in the program.

    • Develop a process for these employees to have a baseline exam and then regular follow-up monitoring. Initial baseline exam should include:

      • Which hazardous medications the employee has been exposed to during the time since the last visit and the frequency of exposure, such as number of hazardous medications handled and estimated time per week handling them.

      • Physical assessment and lab work directed toward identifying common toxicities of the hazardous medication handled by the employee, such as monitoring a complete blood count with technicians who frequently compound IV antineoplastics.

    • Create education for employees on self-monitoring for symptoms of exposure to the hazardous medications being handled and to help identify a pattern of increased absences that may be caused by exposure.

    If workers exhibit signs of toxicity, the facility must investigate the cause of the exposure. Examples of steps the facility should take to follow up on a possible exposure-related incident include [1]:

    • Identify cause of the exposure by verifying:

      • All engineering controls are working properly.

      • The employee received required training and is compliant with safe handling procedures.

      • Equipment is accessible (e.g., availability of PPE).

      • Policies and procedures are clear and easy to understand.

    • Develop and document a plan to prevent future exposures.

    • Notify any other employee who may have been exposed.

    • Provide ongoing medical surveillance of all workers at risk for exposure to determine whether the plan is effective.

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  • Back to Course Home
  • Participation Instructions
    • Review the course material online or in print.
    • Complete the course evaluation.
    • Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.