Just imagine 8 million people losing their lives in a single accident. Wouldn’t it be a big tragedy? Surely, a whole country, if not the whole world, would be mourning. While the health care industry has never caused a disaster as big as this, it actually exposes about 8 million workers (at least in the United States) to the possibility of getting hurt or killed every single day. This is all because of working with or close to hazardous drugs.

Health care workers exposed to the hazards of drugs include physicians, nursing personnel, veterinary personnel, operating room personnel, maintenance workers, shipping and receiving personnel, laundry workers, and waste handlers. Whether they’re handling containers, touching contaminated areas, cleaning spills, and compounding, administering, or disposing of hazardous drugs, they are at risk of suffering from different health conditions. These conditions can be anything from skin rashes and blindness to cancer and birth defects.

The National Institute for Occupational Safety and Health (NIOSH) recommends that employers protect their workers by providing them with personal protective equipment (PPE) appropriate to their exposure. Every company must also have a safety program that provides workers with proper training, retraining, and periodic testing of their knowledge of the proper use of PPE.

Administrative Controls and Engineering Controls

But before we go into the requirements for each kind of PPE for hazardous drugs, let’s talk about controls first. NIOSH recommends that exposure to hazardous drugs be minimized first through the use of controls. They can be in the form of engineering controls or administrative controls.

Engineering controls include:

• Class II or III biological safety cabinets (BSC)
• Closed system transfer devices
• compounding aseptic containment isolators
• needleless systems

Administrative controls include:

• Management policies
• Implementation of work practices
• Training programs to reduce worker risk

A safety program must also include a medical monitoring program. With it, employers implement a secondary form of prevention that works by determining indicators of exposure or early disease. PPE comes into the picture when it is not feasible to use engineering and/or administrative controls or when other control measures are not practical or available.

PPE

Here are guidelines recommended by NIOSH in the proper selection, use and care of PPE:

• Assess the exposure of your work area to hazardous drugs. Select PPE based on the assessment.
• Make sure that each PPE fits and functions properly. They should also be made of material appropriate for the level of exposure to hazardous drugs.
• Wearing and removal of PPE must follow both local hospital procedures and manufacturer’s instructions.

Respirators

NIOSH-certified N-95

• protection from airborne particles
• insufficient against direct liquid splashes
• no protection against vapors and gases

Surgical N-95 respirator

• Provides a combination of the respiratory protection of an N-95 respirator and the splash protection of a surgical mask

Full-facepiece chemical cartridge-type respirator

• Protection for large spills

Eye and Face Protection

Safety measures for the use of eye and face protection:

• Wear goggles and face shields at the same time to secure a full range of protection against splashes to your eyes and face.
• Safety glasses or eye glasses with side shields do not provide sufficient eye protection.
• One good alternative for eye and face protection is a full-facepiece respirator.

Gowns

General guidelines in the selection and use of gowns:

• Gowns should have long sleeves with tight fitting cuffs.
• They must not have seams or closure where drugs could pass through.
• Compared to non-coated gowns, disposable gowns made of polyethylene-coated polypropylene or other laminate materials offer better protection.
• After each use, dispose of the gowns to minimize risk of hazardous drug exposure.
• Never wear gowns outside compounding or administration areas.

Gloves

Safety tips on selecting and using gloves:

• Follow the test information indicated by the glove manufacturer to make sure your safety gloves have the appropriate permeation resistance.
• Always check gloves for defects before use.
• Change gloves regularly. NIOSH recommends that changes be done from 30-60 minutes.
• Always use powder-free gloves to avoid contamination of work area and absorption of hazardous drugs.
• When administering, compounding, and disposing of hazardous drugs, always use two pairs of gloves. Make sure to wear the inner glove under the gown cuff and the outer glove over the cuff. When using gloves with long cuffs, place them over the cuff of the gown.
• Turn gloves inside-out when removing double gloves.
• Before wearing gloves and after removing them, wash your hands thoroughly with soap and water.
• Carefully remove and dispose of gloves when they are damaged, or if you suspect or know of their contact with a hazardous drug.

Related Links:

PPE and How It Can Save Your Life – Part 1

Top 7 Tips on Using the 2006 Census to Improve Workplace Safety

Proper Management of Hazardous Chemicals: Plan and Training for Workers

MSDS in Your Hazard Communication Program: Your Guard against Hazardous Chemicals

All about Material Safety Data Sheets