What are the recommendations for wearing PPE when handling hazardous drugs?

ONS guidelines for personal protective equipment (PPE) during hazardous drug (HD) administration are based on the harmonized recommendations of organizations such as National Institute for Occupational Safety and Health (NIOSH), Occupational Safety and Health Administration (OSHA), and USP Chapter 800. 

Gloves: Double gloving with chemotherapy-tested gloves is recommended for all activities involving HDs except for handling intact, unit-dose oral agents, when one pair of chemotherapy-tested gloves is acceptable (NIOSH, 2023). USP General Chapter 800 requires double gloving for HD compounding, administration, and all cleaning and decontamination activities. NIOSH (2023) recommends double gloves for spill control as well as for disposal of HD waste and patient waste. Recommendations are to change gloves every 30 minutes and immediately if contamination occurs. Gloves should be removed immediately if torn, punctured, or knowingly contaminated.

Gowns: Gowns for HD administration must be disposable and nonpermeable (NIOSH, 2023; Polovich & Olsen, 2018). Disposable gowns made of polyethylene-coated polypropylene or other laminate materials offer better protection than those made of uncoated materials. Gowns must close in the back (i.e., no open front), be long sleeved, and have closed cuffs that are elastic or knit. Gowns must not have seams or closures that could allow HDs to pass through. As opposed to gloves, there is no testing process for gowns for them to be called "chemotherapy tested." Gowns believed to provide adequate protection from HDs are made of lint-free, low-permeability fabric. Gowns worn in HD-handling areas must not be worn to other areas to avoid spreading HD contamination and exposing other healthcare workers. Disposable gowns must not be reused. Used gowns should be carefully removed immediately and discarded appropriately after each use.

Eye and Face Protection: A plastic face shield and goggles should be worn in situations where eye, mouth, or nasal splashing is possible. Goggles protect the eyes, but not the face, against spraying. For HD administration, working below eye level greatly reduces the likelihood of eye and facial splashing.

Respiratory Protection: Respiratory protection is necessary when drug aerosols are present, such as when administering aerosolized HDs or cleaning up spills. Surgical masks do not provide respiratory protection from drug exposure and must not be used when respiratory protection from HD exposure is required. A surgical N95 respirator provides the respiratory protection of an N95 respirator and, like a surgical mask, provides a barrier to splashes, droplets, and sprays around the nose and mouth (U.S. Pharmacopeial Convention, 2020).

Consider reviewing the following additional resources:

Toolkit for Safe Handling of Hazardous Drugs for Nurses in Oncology

Safe Handling Basics 

References:

National Institute for Occupational Safety and Health. (2023). Managing hazardous drug exposures: Information for healthcare settings. (DHHS [NIOSH] Publication No. 2023-130). Retrieved from https://doi.org/10.26616/NIOSHPUB2023130.

Polovich, M., & Olsen, M. (2018). Safe handling of hazardous drugs (3rd ed.). Pittsburgh, PA: Oncology Nursing Society. 

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