Editing Chemotherapy (section)

=== Safe handling in health care settings ===
As of 2018, there were no [[occupational exposure limit]]s set for antineoplastic drugs, i.e., OSHA or the [[American Conference of Governmental Industrial Hygienists]] (ACGIH) have not set workplace safety guidelines.<ref name=":2">{{Cite web|url=https://www.cdc.gov/niosh/docs/2004-165/pdfs/2004-165.pdf |archive-url=https://web.archive.org/web/20040913063413/http://www.cdc.gov/niosh/docs/2004-165/pdfs/2004-165.pdf |archive-date=2004-09-13 |url-status=live|title=preventing occupational exposure to antineoplastic and other hazardous drugs in health care settings }}</ref>

==== Preparation ====
NIOSH recommends using a [[Engineering controls|ventilated cabinet]] that is designed to decrease worker exposure. Additionally, it recommends training of all staff, the use of cabinets, implementing an initial evaluation of the technique of the safety program, and wearing protective gloves and gowns when opening drug packaging, handling vials, or labeling. When wearing [[personal protective equipment]], one should inspect gloves for physical defects before use and always wear double gloves and protective gowns. Health care workers are also required to wash their hands with water and soap before and after working with antineoplastic drugs, change gloves every 30 minutes or whenever punctured, and discard them immediately in a chemotherapy waste container.<ref>{{Cite web|url=https://www.lni.wa.gov/Safety/Topics/AtoZ/HazardousDrugs/ProgramGuides.asp|title=Hazardous Drugs Program Guides|website=lni.wa.gov|access-date=2018-11-22|archive-date=27 October 2019|archive-url=https://web.archive.org/web/20191027005510/http://www.lni.wa.gov/Safety/Topics/AtoZ/HazardousDrugs/ProgramGuides.asp|url-status=dead}}</ref>

The gowns used should be disposable gowns made of polyethylene-coated polypropylene. When wearing gowns, individuals should make sure that the gowns are closed and have long sleeves. When preparation is done, the final product should be completely sealed in a plastic bag.<ref>{{Cite journal |last=Kilinc |first=F. Selcen |date=2015 |title=A Review of Isolation Gowns in Healthcare: Fabric and Gown Properties |journal=Journal of Engineered Fibers and Fabrics |volume=10 |issue=3 |pages=180–190 |doi=10.1177/155892501501000313 |issn=1558-9250 |pmc=4791533 |pmid=26989351}}</ref>

The health care worker should also wipe all waste containers inside the ventilated cabinet before removing them from the cabinet. Finally, workers should remove all protective wear and put them in a bag for their disposal inside the ventilated cabinet.<ref name=":1" />

==== Administration ====
Drugs should only be administered using protective medical devices such as needle lists and closed systems and techniques such as priming of IV tubing by pharmacy personnel inside a ventilated cabinet. Workers should always wear personal protective equipment such as double gloves, goggles, and protective gowns when opening the outer bag and assembling the delivery system to deliver the drug to the patient, and when disposing of all material used in the administration of the drugs.<ref name=":2" />

Hospital workers should never remove tubing from an IV bag that contains an antineoplastic drug, and when disconnecting the tubing in the system, they should make sure the tubing has been thoroughly flushed. After removing the IV bag, the workers should place it together with other disposable items directly in the yellow chemotherapy waste container with the lid closed. Protective equipment should be removed and put into a disposable chemotherapy waste container. After this has been done, one should double bag the chemotherapy waste before or after removing one's inner gloves. Moreover, one must always wash one's hands with soap and water before leaving the drug administration site.<ref>{{Cite book|title=Infectious and Medical Waste Management|isbn=9781315894430|last1=Reinhardt|first1=Peter A.|date=29 November 2017|publisher=CRC Press }}{{page needed|date=December 2018}}</ref>

==== Employee training ====
All employees whose jobs in health care facilities expose them to hazardous drugs must receive training. Training should include shipping and receiving personnel, housekeepers, pharmacists, assistants, and all individuals involved in the transportation and storage of antineoplastic drugs. These individuals should receive information and training to inform them of the hazards of the drugs present in their areas of work. They should be informed and trained on operations and procedures in their work areas where they can encounter hazards, different methods used to detect the presence of hazardous drugs and how the hazards are released, and the physical and health hazards of the drugs, including their reproductive and carcinogenic hazard potential. Additionally, they should be informed and trained on the measures they should take to avoid and protect themselves from these hazards. This information ought to be provided when health care workers come into contact with the drugs, that is, perform the initial assignment in a work area with hazardous drugs. Moreover, training should also be provided when new hazards emerge as well as when new drugs, procedures, or equipment are introduced.<ref name=":2" />

==== Housekeeping and waste disposal ====
When performing cleaning and decontaminating the work area where antineoplastic drugs are used, one should make sure that there is sufficient ventilation to prevent the buildup of airborne drug concentrations. When cleaning the work surface, hospital workers should use deactivation and cleaning agents before and after each activity as well as at the end of their shifts. Cleaning should always be done using double protective gloves and disposable gowns. After employees finish up cleaning, they should dispose of the items used in the activity in a yellow chemotherapy waste container while still wearing protective gloves. After removing the gloves, they should thoroughly wash their hands with soap and water. Anything that comes into contact or has a trace of the antineoplastic drugs, such as needles, empty vials, syringes, gowns, and gloves, should be put in the chemotherapy waste container.<ref>{{Cite web|url=http://www.searo.who.int/srilanka/documents/safe_management_of_wastes_from_healthcare_activities.pdf?ua=1|title=Safe management of wastes from health-care activities |website=WHO}}</ref>

==== Spill control ====
A written policy needs to be in place in case of a spill of antineoplastic products. The policy should address the possibility of various sizes of spills as well as the procedure and personal protective equipment required for each size. A trained worker should handle a large spill and always dispose of all cleanup materials in the chemical waste container according to EPA regulations, not in a yellow chemotherapy waste container.<ref>{{cite journal | vauthors = DeJoy DM, Smith TD, Woldu H, Dyal MA, Steege AL, Boiano JM | title = Effects of organizational safety practices and perceived safety climate on PPE usage, engineering controls, and adverse events involving liquid antineoplastic drugs among nurses | journal = Journal of Occupational and Environmental Hygiene | volume = 14 | issue = 7 | pages = 485–493 | date = July 2017 | pmid = 28326998 | doi = 10.1080/15459624.2017.1285496 | bibcode = 2017JOEH...14..485D | s2cid = 3879822 }}</ref>