1. Personal Protective Equipment Use in Chemotherapy Administration
Stacy J. Ravert, RN, BSN
Master’s of Nursing Candidate
University of Washington
School of Nursing
Stacy I don’t see the aerosolization slide. Betty

2. What is Personal Protective Equipment (PPE)?
Personal protective equipment includes:
Gloves
Gowns
Shoe covers
Face/eye protection
NIOSH approved respirator

3. 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.

4. Skin Exposure to Chemotherapy
Dermal exposure from chemotherapy spill. Scaring is likely to occur.
Photo courtesy of: James Tinguely, TycoHealthcare

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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)

12. 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

13. 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.

14. 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.

15. 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

16. 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

17. 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

18. Web links to resources OSHA: Hazardous Drugs
OSHA Technical Manual Section VI, Chapter 2
ASHP Pre-publication guidelines
NIOSH Alert: Preventing Occupational exposures to antineoplastic and other hazardous drugs in the health care setting

19. References
American Society of Health-System Pharmacist. ASHP Guidelines on Handling Hazardous Drugs. Accessed April 24, 2006, from
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
Occupational Safety Health Administration (last updated March 2, 2004). OSHA Technical Manual: Section VI: Chapter 2. Retrieved April 23, 2006, from
Polovich, M., White, J. M., Kelleher, L.O. (eds.) (2005). Chemotherapy and biotherapy guidelines and recommendations for practice. Pittsburgh, PA: Oncology Nursing Society.