Should PPE be worn when administering immunotherapy and biologics?

When determining whether PPE should be used during the administration of antineoplastics, including chemotherapy, immunotherapy and targeted therapies, it is best to first reference the National Institute for Occupational Safety and Health (NIOSH) List of Hazardous Drugs. It is recommended that when the structure and toxicity profiles of new drugs mimic existing drugs determined hazardous, that they too be treated as such (NIOSH, 2023).

Little is known about the long-term effects of many of the newly approved immunotherapy and biologics used in practice. In 2023, NIOSH noted that, moving forward, biological agents will not be included in the drug list, as they follow a different process of testing and approval. Keep in mind, however, that many of these drugs carry a risk of embryofetal toxicity and other reproductive risks, leading to a need for caution.

ONS produced an algorithm to help clinicians determine if PPE is needed during the administration of checkpoint inhibitors and encourages nurses to consider if the administration area could be contaminated with HDs, if the treatment regimen contains known HDs in addition to immunotherapy and biologics, and the properties of the agents being administered.

Each institution should determine if any medications being administered outside of those on the list are considered hazardous. Institutions are encouraged to have their own list in addition to the NIOSH list (USP, 2020).

Consider reviewing the following additional resources:

Toolkit for Safe Handling of Hazardous Drugs for Nurses in Oncology

Safe Handling of Checkpoint Inhibitors

Safe Handling Basics

Safe Handling of Hazardous Drugs (Third Edition)

References:

National Institute for Occupational Safety and Health. (2023a). Procedures for developing the NIOSH list of hazardous drugs in healthcare settings. DHHS (NIOSH) Publication No. 2023-129, https://doi.org/10.26616/NIOSHPUB2023129 

United States Pharmacopeial Convention. (2020). USP General Chapter <800>: Hazardous drugs—Handling in healthcare settings. https://www.uspnf.com/sites/default/files/usp_pdf/EN/USPNF/revisions/gc-800-rb-notice-20200626.pdf