Antineoplastic medications: Non-antineoplastic medications: Proper Management of Bodily Fluids by Clinicians for Patients Receiving Chemotherapy By: Christopher Lang University of New Hampshire Senior Nursing Student 2019 PICO Question Does wearing the proper personal protective equipment (PPE) when managing the bodily fluids of patients receiving and 48 hours post chemotherapy administration effectively reduce the risk of clinician exposure? Evidence Based Implications Protecting clinicians from health hazards associated with hazardous drugs. (Guidelines for cytotoxic (antineoplastic) drugs, 1986). Limiting clinician exposure to as low as reasonably achievable (ALARA). (Guidelines for cytotoxic (antineoplastic) drugs, 1986). Minimizing subsequent negative health effects to clinicians who experience unintentional exposure to hazardous drugs. (Guidelines for cytotoxic (antineoplastic) drugs, 1986). Problem Absence of a policy explaining the PPE required for clinicians when managing the bodily fluids of patients receiving and 48 hours post chemotherapy administration to minimize their exposure risk. Current Evidence OSHA Recommendations (Polovich, 2011; Polovich, Olsen & Lefebvre, 2014). When caring for patients receiving cytotoxic (antineoplastic) drugs (CDs): Personnel dealing with blood, urine, feces, emesis or excreta from patients who have received CDs in the last 48 hours should wear surgical latex gloves and disposable gowns. Personnel dealing with linen contaminated with blood, urine, feces, emesis or excreta from patients who have received CDs in the last 48 hours should wear surgical latex gloves and disposable gowns when handling stated materials. Eye and face protection must be worn when splashing is possible. Hand washing should be performed after the removal of PPE. Goal Reduce the risk of clinician exposure to bodily fluids containing chemotherapy drugs. Clinical Practice Recommendations Develop a policy for the proper management of bodily fluids by clinicians for patients receiving chemotherapy to reduce clinician risk of exposure. Intervention Develop a policy that explains the PPE required for clinicians when managing the bodily fluids of patients receiving and 48 hours post chemotherapy administration. Research findings suggest that the following PPE should be worn when managing the bodily fluids of patients receiving and 48 hours post chemotherapy administration: Antineoplastic medications: Double Gloves Or Chemotherapy Safe Gloves Wear Gown Wear Goggles (if splash risk) Non-antineoplastic medications: Single Gloves Wear Gown (if exposure risk) Wear Goggles (if splash risk) Clinical Implications 8 million US healthcare workers are exposed to hazardous drugs annually. (Infection prevention – chemo, 2018). 17% of nurses experienced unintentional skin and eye exposure to chemotherapy agents. (Infection prevention – chemo, 2018). Since the 1990s, more than 50 studies have documented the presence of hazardous drugs in the urine of healthcare workers, indicating actual exposure. (Infection prevention – chemo, 2018). Exposure to chemotherapeutic agents increases your risk for chromosomal damage, cancer development and adverse reproductive outcomes, such as 2-3.5 times the risk for miscarriages. (Infection prevention – chemo, 2018). Gloves: D6978 or its successor USP 800 Guidelines (USP general chapter <800>, 2017). Potential Opportunity of Exposure: Handling bodily fluids (e.g., urine, feces, sweat, or vomit) or contaminated clothing, dressings, linens and other materials. Activity: Personal-care activities. Gowns: polyethylene-coated polypropylene Eye Protection: Goggles provide full range of protection against splashes Guideline: The facility’s standard operating procedure should describe the appropriate PPE to be used based on the risk of exposure from the performed activity. *Hand washing must be performed following the removal of PPE*

Guidelines for cytotoxic (antineoplastic) drugs. (1986) Guidelines for cytotoxic (antineoplastic) drugs. (1986). United States Department of Labor, Office of Occupational Medicine. Retrieved from https://www.osha.gov/enforcement/directives/std-01-23-001 Infection prevention – chemo (2018). O&M Halyard. Retrieved from https://www.halyardhealth.com/solutions/infection- prevention/chemo.aspx?gclid=CjwKCAjwy7vlBRACEiwAZvdx9j4wvFHcmWCUem8V3JmxpiMMRGjJ- W4w9i2XPe9GWk7hL4KR58CnMhoC_ogQAvD_BwE&gclsrc=aw.ds Polovich, M. (2011). Safe handling of hazardous drugs. 2nd ed. Pittsburgh, PA, Oncology Nursing Society. Polovich M., Olsen, M. & LeFebvre, K. B. (2014). Chemotherapy and biotherapy guidelines and recommendations for practice. Pittsburgh, PA, Oncology Nursing Society. USP general chapter <800> hazardous drugs – handling in healthcare settings. (2017). The United States Pharmacopeial Convention. Retrieved from http://www.usp.org/sites/default/files/usp/document/our-work/healthcare-quality-safety/general-chapter- 800.pdf