Personal Protective
Equipment Use in
Chemotherapy
Administration
Stacy J. Ravert, RN, BSN
Master’s of Nursing Candidate
University of Washington
School of Nursing
What is Personal Protective Equipment
(PPE)?
 Personal protective equipment includes:





Gloves
Gowns
Shoe covers
Face/eye protection
NIOSH approved respirator
Why are PPE important
 1970’s found secondary cancers in patients
who had received chemotherapy agents
 Researchers have reported that nurses who
are exposed to chemotherapy agents have
increased incidence of cancers
 Dermal exposure is thought to be the primary
route of exposure to chemotherapy agents.
 Inhalation may also be a significant source of
exposure.
Skin Exposure to Chemotherapy
Dermal exposure from chemotherapy spill. Scaring is likely to occur.
Photo courtesy of: James Tinguely, TycoHealthcare
I Should Use PPE When:
 Preparing chemotherapy
 Introducing or withdrawing
needles from vials
 Transferring drugs using
needles or syringes
 Opening ampules
 Expelling air from drug
filled syringes
 Administering all
hazardous drugs by any
route
I Should Use PPE When:
 Spiking IV bags and changing any tubing in
the biological safety cabinet

Note: IV tubing should not be spiked at the
point of administration
 Priming IV tubing
 Handling leakage from tubing, syringe, and
connection sites
 Disposing of hazardous drugs and items
contaminated by hazardous drugs
I Should Use PPE When:
 Handling the body fluids of a patient who
received hazardous agents in the past 48
hours (longer if the hazardous agent has a
longer half life)
 Cleaning up of hazardous agent spills
Gowns
 Should be:


Lint free
Made of low permeability fabric





i.e. polyethene-coated material
Have a solid front
Long sleeves
Tight cuffs
Back closure
Photo courtesy of
Tycohealthcare
Gloves
 Are essential
 Must be worn at all times when handling drug
packaging, cartons, drug vials, inventory
control procedures, and when gathering
hazardous drug and supplies.
 Gloves should be powder free.
 Wash hands thoroughly prior to and after
donning gloves.
Photo courtesy of Tycohealthcare
Gloves continued
 Gloves should be worn for no
more than 30 minutes
 Change gloves immediately
if:



They are torn
Punctured
Knowingly contaminated
 Use thick Gloves
 Use gloves long enough to
cover gown cuffs.
Photo courtesy of Tycohealthcare
Gloves Continued
 Gloves worn to handle chemotherapy agents
should be disposed of as hazardous waste
 Gloves must be tested for use with
chemotherapy agents
 Double glove
 Meets ASTM Standard D6319 (as noted on
glove box)
Double gloves and ASTM Standard
 Nurses should double glove even when using
gloves conforming to the ASTM standard to
prevent potential skin contamination in the
following situations:



Gloves become inadvertently torn
When removing contaminated gloves
In the event of a glove puncture
What is ASTM
 ASTM International is an international
voluntary standards organization that
develops and produces technical standards
for materials, products, systems and services.
It was formed in 1898 in the United States as
the American Society for Testing and
Materials by a group of scientists and
engineers.
ASTM Standard D6319
 This test measures the resistance of
protective clothing materials to liquid or
gaseous chemicals under the condition of
continuous contact.
 For chemotherapy gloves the standard is 30
minutes.
Shoe covers
 Use if there is a potential for floor
contamination
 Use if cleaning up a chemotherapy spill
 Remove shoe covers with gloved hand before
leaving area
 Discard shoe covers as hazardous waste
Masks
 Surgical masks DO NOT
provide adequate protection
 Use a NIOSH approved
respirator (N95) that has been
fit-tested

Wear if air contaminated.
 Must comply with OSHA’S
respiratory protection standard
 Use when cleaning up drug
spills
NIOSH Approved mask
Photo courtesy of Tycohealthcare
Use Facial Protection
 If possibility for splashing or uncontrolled
aerosolization will occur
 If goggles or safety glasses will not provide
enough protection
 OSHA recommends to use a NIOSH
approved respirator
Web links to resources
 OSHA: Hazardous Drugs

www.osha.gov/SLTC/hazardousdrugs/recognition.html
 OSHA Technical Manual Section VI, Chapter 2
 http://www.osha.gov/dts/osta/otm/otm_vi/otm_vi_2.html
 ASHP Pre-publication guidelines
 http://www.ashp.org/bestpractices/new/HD-Prepubfinal.pdf
 NIOSH Alert: Preventing Occupational exposures to
antineoplastic and other hazardous drugs in the
health care setting

http://www.cdc.gov/niosh/docs/2004-165/
References
American Society of Health-System Pharmacist. ASHP Guidelines
on Handling Hazardous Drugs. Accessed April 24, 2006, from
http://www.ashp.org/bestpractices/new/HD-Prepub-final.pdf
Centers for Disease Control (2004). NIOSH Alert: Preventing
Occupational exposures to antineoplastic and other hazardous
drugs in the health care setting. Accessed April 24, 2006, from
http://www.cdc.gov/niosh/docs/2004-165/
Occupational Safety Health Administration (last updated March 2,
2004). OSHA Technical Manual: Section VI: Chapter 2.
Retrieved April 23, 2006, from
http://www.osha.gov/dts/osta/otm/otm_vi/otm_vi_2.html
Polovich, M., White, J. M., Kelleher, L.O. (eds.) (2005).
Chemotherapy and biotherapy guidelines and recommendations
for practice. Pittsburgh, PA: Oncology Nursing Society.